For years, Doctors Without Borders/Médecins Sans Frontières (MSF) has been observing the impacts of climate change on the people we treat and on our medical humanitarian activities. As we respond to many of the world’s most urgent crises—conflicts, disasters, disease, displacement—we are witnessing the consequences and magnified impacts that climate change and environmental degradation can have on extremely vulnerable people. The people most affected are often the least responsible for the greenhouse gas emissions that have led to the climate crisis.
In a new humanitarian brief for the 2021 Lancet Countdown on Health and Climate Change, MSF staff from around the world and across disciplines share their experiences of how climate change has likely exacerbated health and humanitarian crises.
These recorded observations show how environmental change and climate-induced disasters have contributed to health problems in the places where we work. We are confronting the risk of increased transmission of infectious diseases such as malaria, dengue fever, and cholera, as stagnant water and mosquitoes can fuel the spread of these illnesses. Water scarcity and food insecurity can lead to malnutrition. Heat exposure can cause acute dehydration. And people suffer from the mental health impacts of more frequent and traumatic extreme weather events.
“MSF teams are medical humanitarians, not climate scientists,” said Carol Devine, who heads MSF’s project for humanitarian action on climate and the environment. “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 will share these firsthand examples of how climate and environmental factors impact health during the 2021 United Nations Climate Change Conference (COP26) in November.
Responding to malnutrition in Somalia
Over two decades of conflict, political instability, and extreme weather conditions in Somalia has led to one of the most protracted humanitarian crises in the world. This April, intense and frequent floods, droughts, and desert locust swarms that ruin crops combined to disrupt food supplies and people’s livelihoods. Increased competition for scarce resources has heightened existing tensions and hurt the most marginalized people.
The most significant impact of climate change can be seen in malnutrition among children. If climate change continues as projected, MSF warns that diminished food production and reduced nutritional quality of some cereal crops could increase the risk of undernutrition—with infants likely to be the worst affected.
In response, MSF ran a hunger gap program in southern Somalia, which aimed to prevent and address acute malnutrition during the lean season through active surveillance, screening, and ambulatory treatment. In Gedo and the Lower Juba regions, we had three emergency responses to treat children with severe acute malnutrition and address critical water shortages.
“More people are moving in search of food and water, even as the risk of COVID-19 remains and a measles outbreak continues unabated in Dhobley and Kismayo,” said Mohamed Ahmed, MSF project coordinator in Jubaland in April. “Pastoralist communities are also affected, as they have lost livestock that have reportedly died of thirst due to water shortages.”
Supporting climate-resilient health systems in Honduras
In late 2020, when Hurricanes Eta and Iota hit Central America in quick succession, more than 120 health centers in Honduras were damaged or destroyed—some simply disappearing into the mud. Two million people were left with limited or no access to care.
“We have slept in the fields. We have endured hunger and sleepless nights,” said Kimberly, a Honduran woman who lost her home and possessions in the hurricanes while migrating through Mexico with relatives. “I am afraid of staying on the street because anything can happen to us. I am afraid that my son will be taken from me. I don't sleep because, while my son sleeps, I keep watch.”
Even before the storms, the health system in Honduras was under considerable strain. Hospitals struggled to accommodate COVID-19 patients. A dengue outbreak surged, driven by insecticide-resistant mosquitoes that spread following poorly implemented vector control efforts.
In response, MSF implemented measures to bolster the resilience of local health systems to climate-related threats in Honduras. These include mosquito-control activities and a dengue fever surveillance system to stop outbreaks from spreading.
Powering health care with solar energy in Pakistan
In four districts of Balochistan, Pakistan, MSF supports health facilities that provide care to more than 12,000 expectant mothers and approximately 10,000 children suffering from malnutrition each year. However, frequent power cuts and rising temperatures in the summertime make it difficult to maintain a cool temperature at our facilities for patients and health workers, and for the preservation of medicines that require refrigeration to remain effective. Temperatures can reach 50 degrees Celsius [122 degrees Fahrenheit] in the summer months.
To address this problem, MSF has installed solar panel systems at the facilities it supports in Dera Murad Jamali, Chaman, and Kuchlak. Supplemented by grid or generator electricity, these systems provide uninterrupted power for lighting, air conditioning, fans, and water pumping and cooling—all while cutting more than 50,000 kilograms [110,231 pounds] of carbon emissions per year.
“As medical practitioners, our job is not only to treat people, but to prevent future illness from occurring,” said Dr. Monica Rull, MSF medical director. “We must not create problems for tomorrow while trying to solve the health problems of today.”