Climate crisis
Climate and environmental changes directly affect human health
The impact of human-induced climate change and environmental degradation on health is evident in many places where MSF provides medical care around the world.
Climate change has been described as the biggest global health threat of the 21st century, while the response to climate change provides the greatest opportunity to protect health. The scientific evidence for climate change is unequivocal, and the magnitude of the consequences can no longer be ignored. The evidence clearly shows that we will be seeing further rising temperatures and sea levels, and more frequent and intense extreme weather events such as heavy rains, heat waves, cyclones, droughts, and floods.
The medical impacts of the climate emergency
MSF works in some of the most climate-vulnerable settings in the world where people already lack access to basic healthcare. These people are also the least responsible for the emissions that generate the climate crisis – and yet they are bearing the brunt of its effects.
In many MSF project locations, our medical humanitarian teams are responding to situations that are linked to the changing environment. This includes increasing numbers of people with infectious diseases such as malaria, dengue fever and cholera, as a result of changing rainfall and temperature patterns. There are also increasing cases of zoonotic diseases (transmitted from animals to humans) due to rising pressure on the environment; and more frequent extreme weather events, such as cyclones, hurricanes and droughts, which can contribute to malnutrition. In many places where we work today, our teams see people with multiple health needs resulting from frequent epidemics, food insecurity, conflict and displacement, which are all exacerbated by the climate emergency.
Drought and water insecurity
Drought poses multiple risks for health, threatening drinking water supplies, sanitation, and crop and livestock productivity, and enhancing the risk of wildfires. Consequently, droughts increase food insecurity and malnutrition, which can lead to stunting, wasting and death in children. Current models predict that climate change will severely exacerbate water scarcity throughout the world. In 2021 The United Nations announced that Madagascar was on the brink of experiencing the world’s first climate change famine. Three consecutive years of drought severely affected harvests and access to food in the southern, desert regions of Madagascar. It also exacerbated the annual ‘lean season’ resulting in an acute food and nutritional crisis. In response, MSF launched a medico-nutritional program to screen and treat communities for acute malnutrition.
Climate-related extreme weather events
According to the Lancet Countdown on Climate and Health 2020, climate change had a role to play in 76 floods, droughts, storms, and temperature spikes between 2015 and 2020. In 2019 MSF launched a massive emergency operation in Mozambique following the devastating floods caused by Cyclone Idai. A few weeks later, with people still reeling from the disaster, a second cyclone struck the country. It was the first time in recorded history that two cyclones hit Mozambique in a single season. The scale of the damage caused by these back-to-back disasters was a wake-up call to prepare for more high-impact tropical cyclones, coastal flooding, and intense rainfall linked to climate change, according to the World Meteorological Organization, a UN agency.
Climate sensitive infectious disease
Warmer temperatures, such as those associated with climate change, have been shown to increase the incidence of water and food-borne diseases such as hepatitis, viral gastroenteritis and cholera. Climate change has also been linked to the spread of infectious disease vectors including mosquitoes and ticks, leading to likely increases in malaria, dengue fever, and Lyme disease. In 2018, Honduras, considered a climate change hotspot, battled its worst outbreak of dengue fever in 50 years following a prolonged rainy season.
MSF treated more than 5,000 patients, mainly children under the age of 15 living in poor urban areas, during the dengue epidemic. Severe dengue affects most Latin American and Asian countries and is a leading cause of hospitalisation and death in these regions. The incidence of dengue has grown dramatically in recent decades partly due to warming temperatures and the associated spread of the mosquito species that carry and spread the disease. The WHO estimates about half of the world’s population is now at risk, with an estimated 100-400 million infections each year.
Our teams have observed spikes in malaria cases in several sub-Saharan countries compared to long-term averages and the evidence suggests that the incidence and prevalence of malaria will increase, particularly in Africa. MSF is very concerned that we are now seeing malaria cases in regions where mosquitoes were previously not present, such as the Ethiopian highlands.
Climate migration and population displacement
Climate change is increasingly influencing human mobility as more places become uninhabitable. Millions of people are currently on the move and the conditions that create such displacement will likely be exacerbated by climate change. Most climate-related migration is expected to occur within national borders and towards urban areas, where people may face the challenge of living in overcrowded, unsanitary, urban slums. Two and a half billion people are expected to be added to urban environments by 2050, with 90 percent of this increase occurring in Asia and Africa. Regions experiencing strong climate shocks are often home to densely populated, impoverished communities. These ‘hotspots’ include large river deltas in South Asia, semi-arid regions in Africa and the Middle East, glacier and river basins in Central Asia, low-lying islands and coastal regions vulnerable to sea level rise, and areas increasingly affected by extreme weather events including Central America, the Caribbean, and the Pacific. MSF has large-scale operations in several such climate ‘hotspots’ and continuously responds to population displacement caused by storms, floods, and droughts, including in Haiti, Bangladesh, Nigeria, Somalia, and Yemen.
Health and Humanitarian consequences of the climate emergency
The climate crisis is a health and humanitarian crisis. Climate change is negatively affecting communities in many parts of the world and the impacts will become more severe over time unless urgent action is taken to reduce greenhouse gas emissions.
As health workers, we are witnessing the climate crisis. We are treating patients experiencing the health impacts of the climate emergency first-hand. It is very clear: this crisis is disproportionately hitting the most vulnerable people. We work in some of the most climate-vulnerable settings in the world where people already lack access to or are excluded from basic healthcare. These people are disproportionately affected by the climate crisis, yet they are the least responsible for the emissions that generate the climate crisis.
As a humanitarian medical organisation, we are concerned that the climate emergency will worsen existing vulnerabilities among the communities we serve. The humanitarian and medical consequences are projected to grow as the climate emergency worsens. We are seeing worrying trends in many places where we provide assistance.
The effect on humanitarian response
In multiple countries where MSF works, our medical humanitarian teams are responding to situations that are linked to or aggravated by climate and environmental change. These include infectious diseases transmitted by insects - such as malaria, or in water - such as diarrhea, which is affected by changing temperature and rainfall patterns. They also include malnutrition, for example, due to prolonged droughts, and other extreme weather events such as cyclones and floods which are becoming more frequent and severe. These situations are occurring in a world of 1.2 degrees warming, and additional warming will have catastrophic consequences for many people across the globe.
We are reviewing our operational strategies to strengthen emergency preparedness. Adapting our activities to the realities of climate change will enable us to continue to provide the best care for our patients and deliver assistance where it is most needed. As the needs change, so will our medical action.
How climate change is affecting communities
Mozambique
Mozambique is one of the countries most at risk of the effects of climate change in Africa. Its geographical location and long coastline make it prone to extreme weather events. In recent years, the country has faced climate-related hazards such as droughts, floods and cyclones, with the latter increasing in intensity and frequency. Poverty, high dependence on agriculture, fragile institutional development, and lack of health infrastructure make it particularly sensitive to climate shocks.
In 2019, cyclones Idai and Kenneth hit Mozambique a mere 6 weeks apart, the first time in history that two strong tropical cyclones were recorded in the same season. The cyclones left 2.5 million people in need of humanitarian assistance. At the time, MSF responded to a cholera outbreak that was declared in the weeks after the disaster. We supported the Ministry of Health to vaccinate 900,000 people against the disease and in total, we conducted nearly 11,900 outpatient consultations, primarily for malnutrition and malaria, in 25 locations. In total, the catastrophic impact of two cyclones in such a short space of time was compounded by months of drought later in the year. Several cyclones have hit the country on a yearly basis since then, with Tropical Storm Ana and Cyclone Gombe both causing widespread destruction in 2022. Together they exacerbated the already serious food insecurity and malnutrition situation in the country.
Recognising Mozambique’s vulnerability to the effects of climate change and the high burden of climate-sensitive diseases, such as the ones transmitted by insects like malaria and dengue, we decided to start a new project in Nampula province. We have started working with local health responders to build up the capacity to provide the care most suited to the needs of the local population. MSF teams are working side by side with Mozambican ministry of health staff to diagnose and treat NTDs across 8 health rural centres and we have established a blood bank to provide lifesaving transfusions for people suffering from severe malaria. We started the medical activities four months ago and are working with the health authorities and local communities to build up our collective understanding of the climate-sensitive health needs in the area and to ensure the best response is provided.
Somalia
Somalia and the wider Horn of Africa are facing one of the worst droughts in 40 years after four back-to-back poor rainy seasons and a currently failing fifth rainy season. Many parts of the region are affected, and communities are being uprooted - amidst a ravaging drought and ongoing conflict, an inadequate humanitarian response, and rising food prices, forcing hundreds of thousands to flee their homes seeking food, water, pasture for their livestock and access to humanitarian assistance and healthcare.
The drought is intensifying an already dire health situation. People have been forced to leave their homes in rural areas for larger cities to access food, water, and healthcare. However, crowded living conditions and poor water and sanitation bring outbreaks of diseases like measles and cholera, overwhelming the already strained healthcare system. In turn, these disease outbreaks lead to an increased risk of malnutrition, especially for the most vulnerable people, such as young children. Somalis find themselves in a vicious cycle and a downward spiral that cannot be broken without an acute humanitarian response. People have not yet overcome the drought of 2017, and now find themselves facing an even more severe drought situation.
As this is happening, outbreaks of measles and cholera pose additional health threats - all this is taking a heavy toll on people who barely have time to recover from one crisis before another climate shock hits. In response, MSF is providing nutritional support and treatment for disease outbreaks including cholera and measles in several areas of Somalia and Somaliland.
Cameroon
Cameroon is facing multiple and overlapping crises, including recurrent epidemics, malnutrition due to food insecurity, displacement, and conflict. Climate change is exacerbating the existing humanitarian and health needs and is adding additional woes for local communities in the Far North region of the country. Changing, shorter and unpredictable rainy seasons are negatively impacting the local food production capacity. Communities in this region are mostly made up of farmers who can no longer find enough food for their families and livestock. This has led to increased prices of foodstuffs on the market due to the high demand and this, in turn, is causing additional vulnerability, including increased malnutrition.
The longer dry seasons push communities to search for cultivable or exploitable land, which can become a source of conflict, as already observed in the Logone- and-Chari region, which is plagued by inter-ethnic conflict between herders and fishermen and farmers. Local communities are struggling to anticipate and adapt to the changing seasons and extreme weather conditions. Climatic variations have resulted in a longer annual hunger gap and have impacted the planning for responding to malaria and conducting measles and meningitis vaccination campaigns.
In response, we are increasing our medical activities and support to communities in the Far North. On top of our regular health activities, we are working to improve access to basic health services by supporting health centres during the seasonal malaria peak. We have trained community health workers to screen and treat children suffering from mild cases of malaria and diarrhea directly in the communities where access to health care is limited due to insecurity. Children requiring more medical attention are referred to health centers for specialised care. From 2019 to 2021, 142 community health workers in the Far North region treated over 49,000 children aged 0-15, among which 27 265 were suffering from malaria.
South Sudan
South Sudan is experiencing its fourth year of consecutive severe flooding. Approximately two-thirds of the country is underwater – with 29 counties impacted by floods. Over 900,000 people have been affected across the whole country.
Seasonal flooding of the rivers and tributaries is nothing new in South Sudan, but the flooding in the past few years is unprecedented. The severity of the floods has increased in geographic scale, water levels, and the impact on the population. The water levels have been so high and the soil so waterlogged that the waters have not fully receded in the intervening dry seasons; resulting in more severe flooding situations year after year. Climate experts warn there will be more heavy rains in the future as the world continues to heat up.
The majority of South Sudanese are pastoralists and agriculturalists; relying on subsistence farming for survival. People in camps and villages are telling us the rainfall patterns have changed over the past decade and as a result, they don’t know when to plant their seeds anymore. This impacts the capacity of growing crops, contributing to existing food security concerns in the region. The floods have also killed hundreds of thousands of livestock, with animals either drowning or dying of hunger because the grass they feed on is covered by water. About 6.83 million people – 55% of the population – face high acute food insecurity, of which 2.37 million people faced emergency conditions. MSF is witnessing concerning increases in rates of moderate and severe acute malnutrition. Between January to September we treated 4,204 cases of malnutrition across our projects in South Sudan.
Entire villages have been destroyed by the floods; leading to the displacement of hundreds of thousands of people. The lack of shelter, safe drinking water, and sanitation facilities in makeshift IDP camps, are resulting in a high risk of outbreaks of infectious and waterborne diseases. For example, in Bentiu, where there is the largest IDP camp in South Sudan, the floods resulted in about an extra 50,000 newly displaced arrivals last year, putting additional strain on facilities. A recent assessment conducted by MSF showed an average user ratio of 1 latrine for 166 people. The flooding exacerbated already dire WASH conditions, as water filled up latrines and contaminated other sources of water, thereby increasing rates of cholera, hepatitis E and AWD. This September alone, MSF received 491 cases of acute watery diarrhea and 247 patients with hepatitis E just in Bentiu.
Chad
Chad has been facing has been a worrying rise in the water level of the Chari and Logone rivers, reaching their highest level of 8.14m in the capital, N’Djamena, which was caused by unusual heavy rainfall that led to these rivers overflowing their banks. This has resulted in major floods in several areas in the south and centre of the country, notably in Ndjamena, driving hundred thousands of people out of their homes to seek temporary shelter on higher dry lands, and exacerbating already dire humanitarian conditions.
On 19 October, the head of the Chad government, Mahamat Deby, declared a state of emergency in the country in response to the flooding in 636 localities across 18 of Chad’s 23 regions. As of October 31, more than 1 million people (200,000 households) in 18 of 23 regions have been effectively affected by floods – a number that includes people who have been impacted by floods that hit the country since mid-August this year. As of 15 November, over 155,000 people have been displaced, according to UNOCHA, and are now living in a camp setting in more than 12 sites of Ndjamena, excluding those who managed to be hosted by their own family or relatives.
The floods have submerged vital country infrastructures; including healthcare facilities, and have severely impacted the livelihoods of a population dependent on farming, with over 465,000 hectares of crops damaged and 19,000 heads of livestock destroyed – raising concerns over agricultural production and food insecurity. A leading cause of death among young children, malaria is endemic in large parts of the country and spreads even faster during the rainy season which normally runs from June to November. With prolonged floods, this major health threat is now likely to continue to surge.
In coordination with local health authorities and different aid actors, MSF launched an emergency response to the flooding of the capital – mobilizing resources to address unmet medical and humanitarian needs to ensure meaningful access to basic healthcare services for displaced people. MSF teams are running several mobile clinics that provide primary healthcare and referral services for patients requiring hospital treatment as well as water and sanitation services, and access to routine vaccination against preventable and treatable diseases, such as measles. However, humanitarian response is significantly insufficient considering the massive needs of the population.
What climate-related actions is MSF taking?
We recognise that as a large, international organisation we have an important role to play in reducing our impact on the climate. We are progressively adapting the way we work to ensure we are environmentally responsible and that our activities don’t cause harm to the people we are trying to assist. We have developed a toolkit to measure and mitigate our environmental footprint, including carbon emissions, other greenhouse gases and other elements that contribute to environmental degradation so that we can change our practices.
- Reducing our carbon footprint: MSF’s operational centre in Geneva, Switzerland has pledged to reduce emissions by at least 50 per cent compared to 2019 levels by 2030; with this target the organisation aims to chart a firm trajectory towards decarbonisation. At MSF Australia, we are committed to reducing our carbon footprint by 15% by 2023 (from our 2019 levels), with the target to be carbon neutral by 2030.
- Avoiding and reducing waste: We are working to ensure an efficient and socially responsible supply chain, in order to reduce, reuse and recycle medical materials and equipment, such as mosquito nets, transport containers or personal protective equipment. MSF has launched a sustainable supply project and set up ‘green teams’ of volunteers in more than 15 countries, who are conducting mitigation campaigns at the local level, to raise awareness and reduce plastic pollution. One example is in Uganda where we have launched a project to replace the millions of plastic bags we use each year to distribute medicines, with ecologically sustainable bags using local resources made by local communities. We are reducing medical waste in our hospitals and clinics, including exploring options to move away from single-use disposable masks and gloves towards reusable products where appropriate.
- Embracing solar power: We are developing new energy solutions, such as using solar panels to power some of our medical activities, as well as innovative approaches that respond to the environments we work in.
- Reducing non-essential air travel: We are reducing our international travel, for example attending meetings or workshops virtually rather than in person and sourcing medical supplies closer to the places where we work. These changes have also accelerated because of the impact of the COVID-19 pandemic on international freight and personnel travel.
“MSF teams are medical humanitarians, not climate scientists —but after years of witnessing how climate change has likely exacerbated health and humanitarian crises in multiple contexts where we work, we are compelled to speak out about what we see."
MSF Australia is grateful to Pangolin Associates for their pro-bono support in conducting our annual audits and advising us on ways to reduce our carbon emissions footprint.
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As an independent, impartial medical humanitarian organisation, Médecins Sans Frontières can respond rapidly to emergency situations and deliver urgent medical treatment to people in need – no matter who they are.
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*The Lancet Countdown: Tracking Progress on Health and Climate Change is a collaboration of over 120 leading experts bringing together climate scientists, engineers, energy specialists, economists, political scientists, public health professionals and doctors. Each year its findings are published in the Lancet ahead of the UN climate change negotiations. MSF has been contributing a policy brief to the Lancet Countdown for a number of years. In the 2021 brief MSF’s teams around the world and across multiple disciplines share their experiences with how climate change has likely exacerbated health and humanitarian crises and how they have adapted or plan to adapt their response.
While MSF is not an environmental organisation, we increasingly recognise that the health of our patients is intricately linked to the health of their environment. Now is the time to act—collectively. This emergency cannot wait.
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Stories From Patients & Staff
