Earth Day 2020 - Health, humanity, and the climate emergency

Avril Benoît: 

Hello, and welcome to our Earth Day 2020 Discussion: Health, Humanity and the Climate Emergency. I'm Avril Benoît. I'm the Executive Director of Doctors Without Borders/Médecins Sans Frontières in the United States, and I'm really delighted to be with you today. Of course, Médecins Sans Frontièresis also what we often call MSF. So, when you hear that acronym, it's just deriving from our international name, and you'll hear us using it quite often, it means Doctors Without Borders. 

So many of us imagined that this Earth Day would really be an opportunity to talk about climate change, to talk about environmental degradation, and all the issues that have been preoccupying us as international humanitarian responders, when we look at how climate change and all the effects of this are exacerbating the suffering and the health burden in the places where we work. Of course now with a pandemic, it's even worse. So we will touch on COVID-19 and how it intersects with the complexity of this. But certainly, we want to focus on Earth Day and all the issues that that we've been following with our experts. So this discussion will last around one hour. 

Wherever you're joining us today, you can add your questions. They will be fed to me and then I'll ask them of the panelists. If you're watching on Zoom, you've got the Q&A option that you'll see there on the screen. If you're joining on Facebook Live or Twitch, you can send the questions through the comments section. I'd like to just start now by introducing our panelists today. So joining us from Toronto is Carol Devine. So Carol is a Humanitarian Affairs advisor for MSF Canada, a research fellow at the Dahdaleh Institute for Global Health Research at York University. She co-leads a project on climate environment and health for MSF, and she's worked for us in many, many countries around the world. I'm really happy to have you here with us, Carol. How about describing where you are and what kind of unexpected noises we can expect to interrupt this panel today? 

Carole Devine: 

Hi, I'm in Toronto. Hello everyone. I have sent my teens and my rescue Husky dog to the backyard. Thank you. 

Avril Benoît: 

Fantastic. Also joining us today from Geneva, we have Dr. Maria Guevara. She's a Senior Operational Positioning and Advocacy Advisor on Global Health for MSF. She focuses on MSF's Emergency Response and Planetary health. She began working with us in 2004. She has worked among other roles in many countries around the world as our regional representative in Asia. Hey, Maria, how are you doing there in Geneva? 

Dr. Maria Guevara: 

Well, I'm doing well, it's evening for me. Good evening, everyone. I guess that's good afternoon to you all. Thank you for having me here. 

Avril Benoît: 

Good to have you as always, Maria. Finally joining us from Toronto is Dr. Edward Xie. He's Assistant Professor at the University of Toronto and an emergency physician. His work focuses on health equity and structural determinants of health. These are key areas of interest for him, which also involve issues of addictions, global health, planetary health, all these things we're going to talk about today. Dr. Xie is a member of the board of directors of the Canadian Association for Physicians for the Environment, and also the Toronto Environmental Alliance. He's worked with MSF on climate change, health and humanitarian issues. He's also a fellow for the Center for Sustainable Health and Systems at the University of Toronto. Hey Edward, tell us about where you are and how you're holding up with this pandemic. 

Dr. Edward Xie:  

Yeah, I'm also in Toronto, like Carol. Things are going not too bad right now. Things are settling down. With the transferable skills I got from MSF was how to cut my own hair. So that's helped me engage a lot. 

Avril Benoît: 

All right, good it looks all right. You're camera-worthy. I'm a little conscious now that my eyeglasses give a bit of glare on the screen. But let's just talk about the main issue that seems to be on everyone's mind. Even though we've got Earth Day and we're trying to focus on climate change, this pandemic is a major complication for the kind of work that MSF does. Carol, maybe you could just start us off by reflecting on, on how you see our preoccupation with the pandemic with the arrival of COVID-19 in the countries where we work, with this added layer of climate change and its impact on health. 

Carole Devine: 

Yeah, certainly. Thanks, Avril. Well, COVID is rightly preoccupying us globally, in Canada as well. It doesn't mean we're not thinking about climate change. But there's a lot of suffering and a lot of work going on right now. As MSF is working in so many countries, there's the ongoing crises. So you have this cascade of events. Now climate change, we haven't stopped thinking about it. In fact, there's interrelationships that we're going to talk a little bit about. But certainly what COVID is magnifying, that climate change is telling us is about vulnerable groups, and the strength of health systems, but also with political will and collaboration, and how we're rapidly adapting as well. Thank you. 

Avril Benoît: 

Yeah. For Edward, you're somebody who's following the the science of all of this, how do you see this pandemic also making it so much more complex when we think of the health burden on people? 

Dr. Edward Xie:  

Yeah, that's a great question. For the last two months, like most of us have barely had time to think about anything besides COVID-19, I think as the science comes out, we're starting to see that COVID-19 shows us that it's a result of humans and animals and environments rubbing up against each other in dangerous ways. That's quite similar to what's happening with climate change as well. So I think this is the right time to have a discussion. So that we can learn from our responses at pandemic, and also figure out how to build a healthier future afterwards. 

Avril Benoît: 

Maria, you've been really thinking a lot of zoonotic disease. Can you explain what that means? Obviously, this is very much our thinking when we think of the risk of this pandemic and how the presence of human beings is disrupting ecosystems, fragile ecosystems, and actually, is all connected with your concerns around planetary health. 

Dr. Maria Guevara: 

Yeah, well, so zoonotic sounds like a scary disease, but it's just meaning that it's an infectious disease that's caused by an infectious agent, like bacteria or virus, in this case of COVID, that's jumped actually from animals to humans. So zoo coming from animals to humans. It can happen in five probably general. So you can get it by direct contact, whether that's you're coming into contact through body fluids of animals because you're petting them or they bite you or they scratch you or it could be indirect just from exposure to the living environment because those germs are sitting in surfaces as we know for COVID. 

Then there's vector-borne so it can be transmitted through ticks or fleas or mosquitoes or foodborne because of contaminated food that we eat, and also waterborne because of contaminated water that we drink. It can be endemic, which means it's regular. It happens all the time, or epidemic, sporadic as we've seen in many others, but there are those, it's what's most concerning is the emerging infectious diseases and the re-emerging infectious diseases, which is what we've already seen as COVID being termed as an emerging infectious disease, which is coming anew, which we've never seen before. It's not been in the population. 

The thing is, if you actually look at 30 years of the last decade, the 30 new human pathogens, 75% of them are zoonotic. Part of that is, as already been mentioned by Ed is that is because of that interface between human, animals and the environment, we're getting closer. There's much more contact, but part of that is also because of the changing, our impact on the environment like climate change, warmer temperatures, more soil moisture because of increased precipitation. So the habitats of vectors for example, changes in their feeding behavior changes, land use changes, deforestation, dams, etc. Then you have biodiversity loss. 

So you take Darwin's Theory of Evolution, where the survival of the fittest, as the humans drive out species, we actually filter out the most fittest, right? Who can maybe transmit diseases better. And then I won't even go into melting glaciers and falling from the prospect yet, we'll leave that for another time. 

Avril Benoît: 

Well, we might get to it later. We have an hour. Hey, so Carol, you were recently in Bangladesh. That's come up a number of times in recent months now, as people have been talking about some of the worst places for a pandemic to hit would, for example, be in Cox's Bazar in Bangladesh, where you've got a million Rohingya refugees having crossed over from Myanmar. You were there actually looking at the vulnerability of people in Bangladesh related to this climate change with the flooding and all the adverse weather events. What did you find there? What's on your mind as you think of this intersection that we've got? 

Carole Devine: 

Yes, I went with my colleague, Nora. We were asked by MSF colleagues to come to Bangladesh as a known climate hotspot, meaning a really highly-impacted country to help put on this climate lens that MSF is committed to. So I started, just to situate you in Bangladesh, it's a river delta where three rivers meet. It's a low-lying country, it means two thirds of the countries only five meters above sea level. So there's salinity intrusion, which means water's coming up and affecting crops that saline, you have flooding. We're going to come back to this, you have migration within Bangladesh, but also to Bangladesh, as you mentioned. So I think what's important to say is Bangladesh has been dealing with this for centuries and cyclones, and is highly resilient.  

Despite all the resilience, it's just more frequent and more intense. So in that light in Bangladesh, first I started in Dhaka, and my colleagues Dr. Cyfle It started off with his whiteboard that that had dengue, Kamrangirchar, and Cox's Bazar. So dengue, every meeting that we had applying this climate change lens, all of our colleagues in MSF, and in other organizations that we met in Dhaka just raised dengue, we're going to hear more about that too, but it's a climate-sensitive disease, big preoccupation with that. Then we went to this MSF's two projects in Bangladesh. One is in Kamrangirchar, which is an urban slum. 

There's so many people coming to Bangladesh a year, half a million people almost. For us, the MSF Urban Health Project in this really poor area with a lot of informal sector workers, it's a gender-based violence project, it's healthcare for workers, it's also where people are excluded from healthcare. Now add on top of it, climate change is not causing problems, but it's a threat multiplier. So what's happening with these people in closed quarters, like also in Cox's Bazar, with COVID, but also the rivers were flowing with plastic. There is a lot of the garment industry. So MSF is doing occupational health, but we're applying this climate lens to say, "How do we prepare? How is this a window for MSF in terms of Urban Health projects?" 

Then Cox's Bazar where Nora went, now, what was what was interesting at the time and what we're seeing now with COVID is these concurrent crises. We have to carry on the ongoing work for the most vulnerable people that MSF aims to assist. So she went to Cox's Bazar to talk about climate change and just to speak to MSF population into some of the Bangladeshi and Rohingya refugees where there's a million people in a precarious place where there's mudslides, and a million highly vulnerable people trying to get by day to day, and then Cyclone Bulbul is coming and everyone's freaking out. Now I mentioned that Bangladesh has cyclone shelters and is preparing. But there's none nearby. 

So what happens is if that Cyclone had hit Cox's Bazar, you would have the double whammy. So what MSF is trying to do, fortunately diverted, but this is the question of the hour, we can't go back. The emergencies have been posed. So what MSF is trying to do is to say, "How are we going to better prepare? How are we going to better adapt? How are we going to talk about what we see not as climate scientists, but people who believe in science and see exacerbations? Then finally, how do we want to mitigate our own footprint?" Bangladesh only contributes 0.3% to carbon emissions, but they do want to mitigate and so does MSF. Thanks. 

Avril Benoît: 

Edward, just to continue on with the scientific analysis. You've been thinking a lot about the global perspective on this issue. Some people have wondered, and certainly this is, it's less now, but in the initial discussions that we were having, even I remember having them 10 years ago, people would say, "Well, why would MSF is a medical humanitarian organization have anything to say about climate change?" What gives us the expertise to even talk about this topic? What is it that you've been uncovering as you as you've been really thinking through what our role is on this dossier? 

Dr. Edward Xie:  

Thanks for that question, Avril. It really goes back to what a lot of things that Carol was mentioning, so I was trying to avoid slides, but I think sometimes it's just easier to tell a story with- 

Avril Benoît: 

Sure. 

Dr. Edward Xie:  

With pictures. So I'm just going to share a few from the work that I've been doing, a small, small role in Carol's project. So this is a world map. Can everyone see this?  

Avril Benoît: 

Yes. It looks good. 

Dr. Edward Xie:  

Okay, great. So it shows different levels of risk that countries face from climate change, and so the darker the red shade, the higher the risk. It takes into account many different factors such as economic status, health services, food systems, and extreme weather. I'd like everyone to try to keep this map in mind as I switch over to the next one, which is the places in the world where MSF works. You can see that there's quite a bit of overlap. MSF already works in those regions where climate change will hit the hardest. It includes Bangladesh, which Carol had just talked about, it includes Mexico and Central America where I've been assigned to look into climate change and humanitarian issues.    

It's not only that MSF is working these high-risk places, but also that it witnesses the widespread and diverse effects that climate change has on marginalized people, including those who are affected by war, poverty and persecution. I'll give you two of those examples. I'm sure we're going to hear more of that from Carol and Maria as well. So part of my assignment, I would hear anecdotes from people, including this one from someone in Guatemala quite recently. The science is backing up what they're saying, what people are feeling, that temperatures are rising and will continue to. So one of the major consequences of this is drought. The reason why it's so concerning is that prolonged drought is one of the most dangerous things that can happen, it can lead to many different health conditions, such as malnutrition, such as stunting, such as wasting. In young children, this could eventually also lead to death. I can promise you that it's heartbreaking to watch families enduring this. 

That's why it's so concerning, that as many as one in three people in Guatemala, Honduras and Nicaragua depend on rain for their farming, depend on rain for their livelihood. So when I was traveling through some indigenous communities in Mexico and southern Mexico, in one of the farming villages, the people there told me that there used to be eight streams feeding their fields a generation ago, and now they're only half as many. I'm not sure whether climate change was directly responsible for that, but we know that higher temperatures and lower rainfall in that region will contribute water scarcity. It's the rural people, it's the people living with poverty, it's the people with limited access to health services who are going to be worst affected. 

Our world is so connected, as we've already talked about that it's not just a problem for rural farmers in Central America. This map actually shows the the sources, the top five sources of food imports in the United States. Number one is Canada, and number two is Mexico. So you can see that if crops fail, people will fall into poverty, people will suffer from malnutrition. But the global community also will suffer from that because we rely on each other. The second example, that I'll give from Mexico and Central America is the risk posed from posed from dengue. So dengue is a disease caused by a virus that's spread by mosquitoes. It causes fever, it causes pain all over the body, and sometimes it can even kill. So the problem is that warmer temperatures make dengue more likely to spread. In Central America, it's estimated that over the next generation, 20 to 36 million more people will be at risk from dengue. That's almost the entire population of California. It's almost the entire population of Canada. 

What's MSF experience with this? Well, last year, MSF helped to manage a large outbreak in Honduras where about 5,000 patients were cared for. We're used to thinking about dengue as a tropical disease. For the US, it's something that's already common, in Puerto Rico, in the Virgin Islands, in American Samoa. But there's also been outbreaks in Hawaii, Florida and Texas. As temperatures rise, the dengue mosquito can spread to new areas. So it's important for us to see that some regions will be more affected. But essentially, we're all in this together. So MSF is talking about climate change because it works in over 70 countries, and as staff and volunteers from the US and all over the world, who are experts at responding to the health and humanitarian effects of climate change, but who were also potentially at risk themselves. 

Avril Benoît: 

Thanks very much for that, Edward. As I think of some of the strategies that we've put in place, and how we're looking at it, and then taking the map, we have the locust infestation in East Africa of course right now, Somalia, Somaliland, Kenya, this is going to trigger much more food insecurity, as we call it, as the crops fail because of the locusts. A lot of concern about what should MSF do, they're expecting, perhaps that the pandemic COVID-19 will coincide as the worst of the locust season comes in maybe in two months, it will already happen at a time after which Kenya will potentially have faced the worst of the pandemic burden. Maria, can you reflect on what you're hearing about this? 

Dr. Maria Guevara: 

Well, I mean, yeah, how to reflect on those overlying multiple factors of complex emergencies. I mean, I guess what, maybe we just step back on how we're framing it within MSF. But first, I want to just say, it's wonderful to be talking around our Earth Day. As mentioned, it's 50 years anniversary, but it's, we're also it's MSF approaching our 50 years next year. But in 1998, we actually did speak around the environmental tragedies that's imposing on the populations that we manage. So in 1998, which was the World Earth Day International Year of the Oceans, we actually put out a press release and launched a website campaign to speak and raise awareness about the Aral Sea regressing and that we were saying stop the regression and that that's actually impacting large populations. 

So roll that to today, and I think for MSF, we've started to really look at this in the last few years and putting on the climate lens and understanding what our role should be. There are many ways to skin that cat, right? We've looked at environmental health, for example, and looking at pollution and disease, and also through the One Health frame of animal health with human health and environment, but really looking at that more practically from the antimicrobial resistance. We know Edward had just well-presented climate change in health science. But I think within MSF or at least a Swiss-based operational center, we're looking at it through a larger frame of planetary health. I know it sounds very cosmic out there, but it is because of the different planetary boundaries that we're starting to encroach as humans. Right? 

As a humanitarian actor, we're sitting right in the middle of that responsibility of actually causing it, reacting to the threat, but we're part of that equation of being the cost, but also possibly the solution. I think within the planetary health train, which encompasses climate change, land use, changes, biodiversity loss, just to name a few. So we're looking at that and seeing what our human impact is. So within MSF, we're framing it around the operations footprint and advocacy, as already been said by Carol. So looking at two sides of the same coin, adaptation and mitigation, so looking at our operation and how we're actually framing, connecting what we're already doing, and how do we reframe that and actually add evidence to what we're seeing and witness what we're seeing. 

But also projecting, right? Modeling, early warning systems, just predicting where bigger outbreaks are. Just to give an example, the cholera outbreak in Haiti, we were partnering with an institution here in Switzerland, where we were able to predict where the next breakouts would be. So that's where we then targeted those locations to do a vaccination campaign. So I think MSF is already doing it. So it's just a matter of reframing it and taking that climate hotspots and interposing it on the map of the humanitarian hotspots. What we see is, they're the same. I think we just need to address that smarter. We need to do it more efficiently and we need to plan for it. They're unpredictable, unfortunately, and I think we need to do that. The other thing is do no harm. 

I think that's where our footprint and really looking at our own contribution is very, very key that we don't also create negative impacts to the population that we're trying to serve. So just to finally answer your question on food security with COVID, that's exactly the problem, right? You have East Africa that's just being inundated, engulfed by the worst locust plague ever. Already with food insecurity at the base of it, and then you put on top all the different outbreaks that's hitting that area today, it's going to be a disaster. It's a huge catastrophe. I think we're all bracing as humanitarian workers on how we actually manage all this with all the measures that's been put in place, travels, quarantine, etc, and with supplies that are being also held up and in shortages. It's going to be a tragic situation, but we're bracing and we're preparing for it in the best way we can. 

Avril Benoît: 

Yeah. Definitely we've got teams all over the world that are that are preparing, positioning, staffing, getting everyone ready for it and are already starting to treat, of course, patients with COVID-19. Hey, we've got some great questions coming in from those who are tuning in and watching this special Earth Day broadcast from Doctors Without Borders MSF or Médecins Sans Frontières. So first, I'd like to start this one for you, Carol. It's about our partnerships and education. I'm kind of merging two questions. One from Janet, "What's MSF doing to educate people around climate change?" Educating both in the places where we raise funds and wealthier nations where we don't normally have operations, but also in the places where we work. Then also, how are we doing so with partners, what kind of big, high level partnerships do we have on this? Are we working with environmental groups or UN agencies on this work, Carol? 

Carole Devine: 

Great question. So this is this is quite nascent, this applying the climate lens, though as Maria has shared, it's something we've been thinking about for a very long time with the Aral Sea drying up and other examples. But when it comes to education and partnerships, our number one work is this independent needs based medical care for those who most need it. But the second part of our mandate of this humanitarian assistance, is speaking out or is witnessing. Not as many people know that MSF was also founded by doctors and journalists. I think around climate and health, because we're not climate experts, I think what we're experts in and the majority of our workforce live in these countries where Edward showed the map, we should just continue speaking about what we see. I think that's really valuable, and where we can, I think something we're really committed to is to have more partnerships, work with the experts in meteorological surveillance or disease surveillance. 

Some colleagues that, Epicentre have done, which is our epidemiological research center, have worked with John Hopkins University, have worked in Yemen with colleagues in Yemen, looking at cholera precipitation there plus the conflict. Then I think we realized too, we're going to keep sharing what we see. We want to amplify people's stories, and what we're witnessing ourselves because we're in some very remote places where people's voices should be heard and amplified. But we also were trying to do some with Maria and Edward and other colleagues in Canada around the world, this early kind of sharing with the Lancet Countdown that tracks progress on health and climate change. 

We've done a couple papers, humbly so just saying, "Here's initially our reflections as humanitarians." Then also there's groups in Canada who also wants to reduce their environmental footprint. So not like we have to speak humbly about what we're doing. But they say, "Hey, we heard you made an environmental toolkit to do a high level diagnosis of your carbon and your waste. What does your toolkit look like?" Well, we share it because ICRC shared their toolkit with us. So I think partnerships and really, with local populations, so, so important. 

COVID is showing us that. Partnerships not only for sharing what we see, helping to push for policies that work and push against policies that don't, and then lastly, I mentioned that or you mentioned that I work at this research institute, Dahdaleh Research Institute in Toronto. My colleague, Lynn and I, with Edward, we're also working with the teams in Mexico and saying, "How is climate change exacerbating health and warming temperatures and pushing migration, but how do policies also play a part?" So we work with partners to do advocacy to support patients, better policies for people-centered care. 

Avril Benoît: 

Edward, a question for you from Dawn. The environment, it's improving for viruses and bacteria, but not for us. Is that how you see it? 

Dr. Edward Xie:  

That's a very interesting question. I should start off by saying that I'm not an expert in viruses and infectious diseases. So I may not be the right person to answer this. But I would say that, so I think we talked about this a little bit before where we're talking about human encroachment on fragile ecosystems. So one of the points I'd like to make about that is that ecosystems didn't start off fragile. In fact, they were quite resilient. The same way as people are like people are, people are not inherently fragile or vulnerable. There's something that's pushed them to be that way. 

As the ways that we are using land or extracting from the land encroaches on habitats of animals, on vegetation, we're creating environments where there's a lot more exchange of pathogens, of germs. That creates a lot more exchange of things that humans aren't used to, that we're not immune to already, that we haven't been exposed to in the past. So as I think Maria had said, we're going to be coming upon lots of new diseases because we are rubbing up against nature so much. 

Avril Benoît: 

Here's another one for you. It's about sea level rise from Stuart, "What is MSF doing to anticipate that rise and where it would happen?" Maybe start with you, Edward, and then we'll go to Maria for that one. 

Dr. Edward Xie:  

Yeah, sure. I'm not sure what MSF is doing. But there is a lot of science around the world where there is modeling of where sea level is expected to increase. Also very importantly, how that's going to impact coasts, because and I'm sure Carol can weigh on that, there are certain areas where sea level rise will have a much bigger impact than others. 

Avril Benoît: 

Maria? 

Dr. Maria Guevara: 

Yeah. Gosh, it's a complicated issue on the sea level rise. It's sort of the expansion of the sea level with the glaciers. But I think what's really interesting in where MSF is, in operations, but also as offices are in the cities that are actually probably at risk as well today. They're not the usual humanitarian hotspots that we work at. I mean, it's like being based in Jakarta or being based in even in the coastline of New York. I mean, those are at risk. I think within MSF, when we're looking at adapting our operations and responding, we think around e-prep planning, scenario thinking. One of the things that we're trying to project is, what are the different scenarios that we might expect, knowing that these are unexpected, how complex those are? What do we need to have in place to be able to respond better and smarter to those, and more efficiently without ourselves becoming victims? 

But I think this is where just tapping on the question of partnership, and why planetary health is also interesting because it's such an umbrella term, where encourages networking and partnering, so we cannot answer to this alone. We are like the little bandages of the emergencies, except that emergencies are so much more complicated today that we need everybody to do that. One of the things we're looking at is how do we partner with others who are experts on science, who are experts on innovation and then actually do scenario planning together. So those things are something we need to look at. We must do. We must partner. 

Just an interesting thing sitting in Geneva, being in the middle of all the humanitarian activity and discussions, one of the big weeks that happens annually that's held by UN OSHA, the coordination agency of UN, they hold this humanitarian network partnership week. There, they have different streams of different venues, and modules, and discussions where climate is center. It's very interesting to hear some discussion of science like NASA people and the nature-based organizations sitting there saying, "Okay, now we need to reach out to the human organizations." Really seeing that not only from the humanitarian perspective, but also from the other sector saying, "We need to come together because we need to find a solution together." COVID is reminding us, we have to collectively work it's about humanity. It's about solidarity. I think we're just reminded now on a daily basis and we need to work on this. 

Avril Benoît: 

Well, that's one of the things that I've been thinking of for so many years around climate change is that if you look at the projections, the scientific projections that are coming out, it will overwhelm the capacity of humanitarian aid organizations, let alone all the emergency responders in the world. It will overwhelm our capacity at some point, you talk about a triggering, then it sort of goes so quickly and becomes exponential, like a snowball rolling down a mountain. Then we also are saying this about this pandemic is that it is overwhelming our capacity even when you have every nurse every doctor rolling up their sleeves and trying to fight this off. 

We can't end it without a whole society approach. Even on this question of the sea level rise, I know Carol you have a particular passion for the polar zones, right? You've been obviously following this for so long. Do you ever start to feel overwhelmed by the scale of the impact of climate change? Yeah, I mean, how do you how do you sort of move through the action points that you've set for yourself without being overwhelmed? 

Carole Devine: 

Sure. Yeah. I mean, I think it's okay to recognize that COVID and climate change, these dual crises are really serious and worrying. But I think acting helps. About sea level rise, we should know that out there are these amazing scientists with NASA and glaciologists, who are studying actually what's happening to threatened glaciers, to help us understand when is that going to happen. When is the dam going to break for some countries where people are not going to be able to live? So I think we know too that action helps us feel better. But most importantly, it means we're going to address this as we can in our own capacities. 

In Bangladesh, what I love, a country that I mentioned, was highly threatened by sea level rise. It's this reality check that people are going to be on the move. One of the organizations we met with sees this big devastating reality for people who are moving who are vulnerable people, but what I loved about what they're doing is this project called Climate Resilient and Migrant-Friendly Cities. It's saying people have to move. I mean, I'm buoyed by local and large organizations who are acting in the way that they can. I also think that there's co-benefits for all of us of fixing these broken systems, health benefits and equity benefits. 

Avril Benoît: 

What about that notion of preparing MSF, knowing that sea level rises will push people to move? Already I think of a city like Lagos, Nigeria, one of those mega cities of the developing world with a lot of people living out on this kind of like mud flats, on the water, informal settlements all over. Where are all those people going to go and how will we manage that? Not that we as MSF, but I mean we as a community. Carol, any thoughts on that? 

Carole Devine: 

Well, I think that's a million-dollar question. But I think what's really important about what you asked is, it's going to happen. As much mitigation as possible is incredibly important. We can all play our part again and in the ways that we can, but that is going to happen. So there's groups who are right now having to move in the South Pacific. How do you do it with dignity? How do you do with planning? I think a concern is we're Sans Frontières, Without Borders. Borders don't stop people from moving. 

So I think I think we do as much as we can to fight back the effects. But I think then we have to really say that people are equal, they're going to be on the move. So how do we plan? Like the Bangladesh example of saying, "Our city is migrant friendly." Cities are doing some great things. MSF is going to connect more to these cities through a project we have on urban populations. But cities, that's where people are going to be. So let's figure out ways to welcome people because as COVID taught us, if we exclude people, and we marginalize people, everyone suffers. 

Avril Benoît: 

Edward, how can we improve as humanitarians our ability to make the most of the forecasting that's available, the modeling that the experts are doing all the time? 

Dr. Edward Xie:  

Yeah. So I think as Maria And Carol had mentioned earlier, MSF, we're not the scientists ourselves. We take the evidence, we use it. Then more importantly, we're able to partner with other organizations. I think that's really one of the strengths of Doctors Without Borders, that we are working in so many different places in the world, that we are so in tune with what's happening all over the world, that we can take the knowledge that scientists are producing, that we can make use of some of these models. It's also a partnership two ways. So we can make use of it to benefit the people who are most affected by climate change. But also, MSF has a wealth of knowledge to offer that can contextualize the science, that can show the scientist what it actually means on the ground, that can potentially help to detect where things are changing rapidly. So there's a lot of different ways. 

Avril Benoît: 

If you're watching us live, we're streaming this discussion for Earth Day with colleagues from Doctors Without Borders/Médecins Sans Frontières. We have Dr. Edward Xie, who's an emergency physician but also an assistant professor in Toronto focusing on health equity and structural determinants of health. We also have Maria Guevara, a doctor who's worked with MSF, many years. She's our operational positioning and advocacy advisor based at our operational center in Geneva. Carol Devine, a Humanitarian Affairs Advisor for MSF, she's based in Toronto. We have a question here from Anna, "In terms of climate change, impact on health, what more can MSF, Médecins Sans Frontières, do to influence policymakers in prevention versus preparation?” Where do we see the political angle on that? Maria? 

Dr. Maria Guevara: 

Right, give it to me. Well, actually, that's what's interesting about planetary health because it's actually addressing the ecosystem, right? So, it's our natural ecosystem's health is important for our human health. But it also highlights the failures of the society to address that. So it already looks at the imagination challenges with regards to are we being creative enough in the solutions. Are we doing enough research and development? Are we actually have the addressing the governance failures that's linked to why we have encroached on our system in such a manner? 

So, inherent in there is already these policy issues. I think for MSF, we try to not be so politically implicated. But we know that this is affecting us from an individual standpoint as much as it is an institutional, as much as global society and community. I think we cannot separate necessarily from that. Our influence is really by the fact that we're on the ground and we're highlighting that. I think Carol already mentioned the importance of one of our principle action is bearing witness in addressing the inequities or highlighting the inequities that climate and justice brings up, right. 

So we already know that vulnerability, even if you look at COVID, people don't want to look at it as an equalizing factor. It's a totalizing because it actually relates some of what the most vulnerable populations are experiencing on a daily basis. We're now for the larger community from developed countries are finally realizing what it means to lose a loved one and not be able to say goodbye to that, to what it needs to be stuck in not being able to go and find your food, etc. Just those challenges that is a day to day thing in humanitarian work. So by experiencing that, we're able to mobilize this. 

One of our ways to actually bring the policy to, well to influence policy is to actually show what the reality is, and show that policy isn't working. Maybe we need to work differently. So yeah, how do we put our experience on the ground based through operational research even? Make it more evidence based, scientifically sound, connect with the science that exist, and bring it to the table to highlight what is the reality. Climate change is a human health issue. I think we have a voice to say about that. 

Avril Benoît: 

Well, there are many of us around the world working with MSF who agree and who really are passionate about this, even if right now we're completely focused on stopping this pandemic. We still have in the back of our minds that this is such an extra complication. Nora Dettmer is one of our allies in this space. This is a question from her, she's joining us, watching the webcast, "How can we keep the focus on climate change with COVID getting all of our attention?" Who wants to take that? Maria, Go ahead. 

Dr. Maria Guevara: 

Well, I think COVID is actually the litmus test to humanity and what we're doing. It's really testing us to our limits and saying, "You cannot go back to business as usual." You cannot. It's forced us to ground ourselves. Mother Nature is saying, "You don't want to listen, I'm going to force you." I think we need to take this as an opportunity. If you take, I'm not a mandarin expert, when they when they highlight what crisis is in Chinese, they always say, it's off and probably not well quoted, that it's about danger and opportunity. 

But actually, it's about a critical juncture, where actually it's the best, it's the perfect storm. It's the perfect poster child of what we need to do to change to make climate change something we can handle and manage. So we have an opportunity now to actually collectively work together and push ourselves forward and find that silver lining to make it better. It starts individually. But as an organization, as an institution as part of the community, we need to take this and not lose sight of what we need to do for the future to be more sustainable, to be smarter, to be more humane to each other and respectful. 

Avril Benoît: 

Carol, anything to add? 

Carole Devine: 

Yeah, thanks. Hello, Nora. Nora, is the one I worked on the Bangladesh report with so it's a great question because clearly, we have a global pandemic to focus on plus all the existing humanitarian work that MSF and others are working on. But in the background, those of us who are able, we like Maria and this transformational investment capacity project we're working on which is an MSF fund to work on sustainability and efficiency issues, and there's other projects. In the background, those of us working on innovation and who are not right on the front lines treating in Canada or elsewhere, what can we learn from the challenges that COVID have brought us? Massive challenges, but also how have we adapted quickly? 

I think colleagues from DRC, just gave the example with borders shut and flights shut and supply chains disrupted, we are innovating quickly. That's the quick innovation that we have to do with climate change that we can't sit on any longer. I'm speaking beyond MSF here. But how are we going to be a sustainable future? How are we going to work on our health systems? Also, what clean energy do we want to use and scale up like solar air conditioning? But back to the DRC example, our two colleagues just returned from there and are extremely worried about COVID and the lack of ventilators and the tensions that are rising, but they also were talking about how MSF and others are adapting locally to the extreme challenges, making masks quickly there, local procurement, quick thinking, and quick validating for quality. So, let's capture those lessons from COVID, when the real acuity passes, we're focusing on the next crisis. 

Avril Benoît: 

For sure our infection prevention and control in different health structures is going to be a lot better. It was already pretty good, but this has really tightened up the procedures. That's a big part of the job. Edward, one of the questions that we've got from AFRA is really related to the health implications of climate change. You had mentioned some of the diseases that we could expect, vector-borne diseases and things like that. How could preventive measures really help? What preventive measures could we put in place? Right now, with COVID-19, I mean, the infection prevention and control, really gets cranked up, you're maybe distributing masks in the community, obviously, personal protective equipment per staff and this, and hand washing, distributing soap, these are all the things that Doctors Without Borders, that MSF is doing right now in response to the pandemic. What kind of preventive things could we do for the various health burdens of climate change, Edward? 

Dr. Edward Xie:  

Yeah, thanks. That is such a big question. So I'm going to tackle small parts of it and a really important one. Because we know as we're learning from COVID-19 pandemic, that prevention is much, much less costly than trying to find a cure after a crisis has happened. So it's important for us to learn from the pandemic, to find some lessons about how to flatten both of those curves, COVID-19 and also climate change. Starting from the beginning, one of the best ways of prevention is actually looking way upstream and trying to mitigate climate change in the first place, so trying to reduce pollution. Partly that's because the pollution that we produce directly harms health through things like air pollution, but also it fuels climate change, it throws fuel onto the fire. 

So, finding ways internally within Doctors Without Borders, to reduce our impact, trying to look at our own actions and do carbon footprinting to figure out how we can reduce our individual impact. Also, from a governance perspective, pushing international governments frameworks, like the United Nations to make strong commitments on reducing carbon emissions, on finding mechanisms to finance, that to actually fund that, especially to help countries that are currently disadvantaged and will be more disadvantaged by climate change, to be able to respond to foster more resilience globally. 

Because again, as we're learning with COVID-19, we all depend on each other. This is not something that we can achieve by ourselves. Looking at a more micro level, for example, in the field, we're already seeing tools popping up in terms of disease surveillance. So using monitoring stations and using different information tools to figure out where the next dengue outbreak is going to be, forecasting where the local swarms will go, looking at weather conditions to see where the next forest fires might break out. Then trying to put policies and processes and procedures in place to help prevent those things. 

One of the other places where MSF works are in areas in Africa where they are severely affected by droughts. So being able to anticipate a drought will help to develop water systems, so that sanitation can be maintained and so that actually enough water is available to supply people to supply livelihoods that are going on there. 

Avril Benoît: 

One of the things that we tend to really focus on in terms of our efforts as medical humanitarians is in conflict zones, also countries that are just in crisis breakdown, societal breakdown, places that are insecure. Maria, in your research, have you found that there's real evidence that climate change is driving conflict in places where we work? This is a question from Peter. 

Dr. Maria Guevara: 

Wow, okay. Well, it's very interesting, because when I was reading through there's a lot of talk that Syria was driven by climate change and changes of that, but there's a really interesting paper, I can't cite it now exactly from where. I know it's somewhere. It's a collaborative work from different universities, some of them are coming from the US, is actually how they, they've seen different trends, there is a reality of the natural trend of weather patterns and climate changes, right? So, climate change occurs more natural than usual, but it's because the human impact has been so great in the recent years and what they call the Anthropocene Epoch now, because we are changing the landscape of our ecosystem. That there is a significant component that is human induced. 

But taking the normal patterns, and then modeling for 16 different models, they've actually seen the interposition that that actually has probably driven the changes and probably instigated or multiplied or made it worse, exacerbated what was already a social issue, a policy issue, the way they were extracting water from the land. I mean, those were existing already, and this just aggravated it. So it's a compilation of different factors that have driven that going on for decades really. We're just seeing the tip of the iceberg. So that is just from the research, that's not necessarily an MSF work. But what we can highlight definitely are the impacts of that. 

When you're talking about whether it's Syria or Yemen, where cholera was just breaking out massively, the constant historic or decades of use of the groundwater and just taking away that water resource, then you hit it with a conflict, you just break down the immunity. Then you have a cholera outbreak, and you don't actually have the source for good water and clean water. Then you want to address this? Then you throw another outbreak on top of that. I mean, you just crippled the whole nation or the areas, at least the populations that are affected by it. So yeah, I mean, I think we all have our added value, our voice within that, and it's cobbling it together to understand what the situation is. We can't, like I said already, we are not here to create the science. Science is out there. We're just trying to link what we're seeing to that. 

Avril Benoît: 

Okay, we have time for one last question. This one's going to you, Carol. How is MSF reducing its carbon footprint so that we are trying to limit our own impact on climate change? 

Carole Devine: 

All right, nice one. I said before that I think MSF has to have certain humility around this because we have a long way to go. But we have from decades worked on it. Why? Because of the medical ethics of do no harm. Why? Because of this duty of care issue to our colleagues and in our communities. Anyway, what we've been doing are these, we've had solar for decades, we have a clean energy project, in Kenema Hospital in Sierra Leone. We have some amazing examples. Looking at sea freight over air freight, great examples of really looking at data and improving our sea freight, so it has a lower footprint. Then we have I mentioned solar air conditioners, we have one in Haiti, and now we have 60. 

How do we get to 1000? How do we do that leap that we need to do? I mentioned this toolkit that we're working on with Maria and other great colleagues in and outside MSF. What that is about is, where we have data. Let's use the data that MSF has, because what we've measured, we will mitigate. Let's get this high level diagnosis. So we looked in Canada, Geneva, Mexico, Kenya and Honduras. Now that's not representative of all of MSF. But what we understood was air freight, air personnel. Now we're going to have to take a look with COVID. 

But the US, thank you, use the toolkit, so did Germany. So the point is that we learned this. We looked at what's out there, we adapted what's out there. The healthcare industry has an enormous footprint. So what do we learn from organizations like Healthcare Without Harm? So my answer is that we're working on it, we have a long way to go. But let's learn from COVID. Let's learn from that scaling of the solar aircon, let's learn from clean energy projects. Let's go for it. We must. 

Avril Benoît: 

I agree. Thank you so much to all of you for joining us today for this special webcast. It's really great to see you all and to be able to talk about something that's a real combined passion of ours. Look, it's been a really difficult time for everyone. The fact that we can even think about something like climate change, it's hard at this time to see our way through this very dark period that we're in with the pandemic. But thank you so much, Carol Devine, Dr. Edward Xia, and Dr. Maria Guevara for joining us. 

Dr. Maria Guevara: 

Thank you. 

Carole Devine: 

Happy Earth Day! 

Avril Benoît: 

Yes. That too. Thanks to everyone who asked to your questions through the various Q&A and comment section. Sorry if we didn't get to your question, but you can always go to our website DoctorsWithoutBorders.org for all kinds of information about upcoming events. To stay informed about MSF's work, well you can find us just about everywhere. We've got the Facebook page in different languages especially MSF.English, that's the English one. Twitter is @MSF_USA. On Instagram, we're @doctorswithoutborders. We have a YouTube channel. We're just so happy if you can support our work. You can make a donation on our websites, every little bit counts. We're trying to put it to good use. We report very transparently back to you on how we're using your funds to support the medical humanitarian work we do worldwide, including our work on climate change. So thanks again. I'm Avril Benoît. 

Dr. Maria Guevara: 

Thank you. 

Avril Benoît: 

Executive Director signing off from New York. Take good care and be safe.