Kiribati: Clean water for community health

In the middle of the Pacific Ocean, Kiribati’s 33 low-lying atolls span more than 3.5 million square kilometres and are home to more than 130,000 people. This is one of MSF’s most remote projects – and one on the front lines of the climate crisis. Rising sea levels, saltwater intrusion and frequent droughts make access to clean water in Kiribati’s communities a daily challenge. And the impacts of climate change increase children’s and adults’ susceptibility to non-communicable diseases, such as diabetes and high blood pressure.

MSF is developing a community integrated climate-health model of care in partnership with the Kiribati Ministry of Health and Medical Services (MHMS).

The goal is to better understand how environmental change is affecting people’s health and to support communities as they adapt to these realities. The approach depends on strong local collaboration, drawing on the insights, knowledge and leadership of national healthcare teams and community volunteers.

The I-Kiribati, the people of these islands, have been addressing the impacts of climate change and advocating for action for decades. One local expert is Mila Tirikai, who joined MSF just over a year ago as a water, sanitation and hygiene (WASH) supervisor. Born and raised in Kiribati’s capital, Tarawa, with family roots in the islands of Abaiang and Beru, his connection to his community runs deep. For him, water and sanitation are not just a job, but his passion.

“Being a WASH supervisor gives me a deep sense of purpose and fulfillment, because I know that the work I do directly improves the wellbeing of my community,” Mila said. “It reminds me that even small actions, like supervising water treatment or ensuring latrines are maintained, have a big impact on people’s daily lives.”

Mila has witnessed the effects of climate change firsthand in his own community.

“From a young age, I was taught that climate change is one of the natural enemies of Kiribati – not only because it affects our daily life, but because we lack the resources to fight it,” he said. “The sea level has risen, flooding homes and washing away our coastline. Our wells have turned salty, and traditional crops like bwabwai [giant swamp taro] are dying. The weather has become unpredictable, with stronger winds, longer droughts and sudden heavy rains.”

Mila works with a small team to investigate changes in water quality in Abaiang, one of Kiribati’s remote islands. By testing well water for salinity and coliform bacteria, they can identify which areas are at highest risk of contamination. Using geographic information system (GIS) technology, the team maps identified wells, recording their location, type and test results to create a geo-referenced profile of water sources. This collaborative project helps both MSF and MHMS identify communities most in need of improved water access. In Kiribati, high water salinity levels can also correlate with hypertensive disorders of pregnancy and gestational diabetes.

In Abaiang, several freshwater wells were recently found to be contaminated, indicating just how susceptible the groundwater is when not protected or replenished through natural cycles. In response, the WASH team and community members will work together to rehabilitate wells located near schools and clinics, cover open water sources, improve drainage and establish hygiene committees to protect these vital resources. Plans are also underway to improve existing rainwater harvesting systems in remote primary health centres and strengthen capacity building so that communities can install, operate and maintain these systems.

“Climate change is not a distant threat, it is here, reshaping lives,” Mila said. “In Tebunginako village, the rising tides forced a community to abandon their church and move inland, leaving behind not just buildings, but generations of memories.

“However, I am also optimistic because I see the strength and resilience of our people. Communities are working together to plant mangroves, build seawalls and protect freshwater sources. The government and partners are planning adaptation projects and raising our voice in global climate discussions.”

MSF is also leading efforts to strengthen healthcare waste management on Kirabati – an often overlooked but critical part of protecting people and the environment. Mila has supported waste reduction efforts that prevent harmful materials from entering groundwater or the sea. The team also trains local healthcare workers on safe waste disposal and infection prevention, reinforcing clean, sustainable practices at the community level.

For Mila, this work is more than technical. “Our actions – testing water, covering wells, managing waste – save lives. They prevent disease, promote dignity and bring communities together around health,” he said.

This is what a community response to a climate crisis looks like in practice: recognising that health systems, human behaviour and environmental factors are deeply interwoven.

“I believe that if the world takes stronger action to reduce emissions and if we continue to adapt locally, Kiribati can survive and preserve its culture, land, and identity,” he says. “So, while the future will not be easy, I remain hopeful that with unity and determination, our nation will endure.”

You can follow the work of Mila and MSF Kiribati team on their Facebook page.