As the Glasgow climate conference winds to a delayed close, the latest draft COP26 declaration appears destined to contain watered-down language on fossil fuel phase-out, and no clear way forward for the $100 billion annual finance promised to low-income countries. Against that landscape, Dr Maria Guevara of Médecins Sans Frontières explains why health is the elephant in the room – and needs to be more central to future climate debates.
As climate negotiations in Glasgow in Scotland moved towards a close with a weakened text on fossil fuel phase-out likely, and no clear commitment from rich countries for a promised $100 billion annually to finance the green transition in developing countries – the health aspects of the climate crisis are another one of the issues on the cutting floor. Although the “devastating impacts of the coronavirus disease 2019 pandemic” and the “right to health” are mentioned in passing in the preamble of the draft COP26 decision, health has not been a driver of COP26 debates or decisions. The health impacts of climate change are not quantified nor are the potential health benefits of mitigation.
This is despite the fact that tens of millions of people in rich and poor countries alike are already suffering from the health impacts of extreme weather and other climate-related events, as reflected in recent reports by WHO and a Lancet Countdown series. Nowhere is this more evident than in fragile states and conflict zones of the developing world, where the climate crisis has placed an additional burden on fragile health systems. As a result, leading humanitarian groups from Médecins Sans Frontières to the International Committee of the Red Cross (ICRC) increasingly see climate as critical to their future crisis response.
Dr Maria Guevara, International Medical Secretary for MSF (or Doctors Without Borders), was representing the organization this year at COP – and officially participating in the conference for the first time ever. She sat down with Health Policy Watch to explain why she felt MSF’s presence at climate talks is increasingly important:
“Health and humanitarian emergencies have always been at the heart of what we do,” Guevara said, speaking at the action hub area of the COP venue, where a giant rotating globe is suspended from the ceiling, reminding the delegates what they are here to save.
Latest reports from the UN suggest that if countries meet all their current climate pledges, the global temperature will still rise by 2.2°C to 2.4°C by the end of this century. That is a virtual death sentence for large parts of the world already hit by rising sea levels, heatwaves and toxic air.
“But what’s going to be different is [the climate crisis] is more intense, more uncertain, more unpredictable. And the vulnerable will be even more vulnerable, which we’re seeing already today.” says Guevara.
Climate emergencies have compounded impacts of conflict and disasters
MSF’s mandate is emergency response – often in conflict situations. But in recent years, climate emergencies have compounded the overwhelming global health and humanitarian situation, she notes.
With temperatures rising, droughts or flooding are becoming ever more frequent in the Middle East, the Horn of Africa, and other places where chronic conflicts are already raging. Against this landscape, climate change adds to food insecurity and hunger and increases the transmission of infectious diseases – which are central to the mission of groups like MSF.
Guevara cited, as an example, a maternal and child facility that MSF is running in the Balochistan region of Pakistan, where rising temperatures are raising a whole new set of challenges.
“When it’s 50°C outside, and women are giving birth and having to be in a facility, we still have to maintain a core temperature to maintain the [stability of] newborns, including premature babies,” explained Guevara.
Premature babies that lack adequate physiological mechanisms to adequately control their body temperatures are typically kept in incubators in their first days or weeks of life. But when ambient air temperatures rise too high, incubators fail to operate properly – in the absence of reliable air conditioning.
And air conditioning is extremely difficult to maintain in low-resourced settings with unreliable electricity – as well as contributing to even more climate change.
Need to rethink health systems globally
That is just one of the multiple dilemmas faced by relief groups, attempting to respond to immediate crises while also reducing their carbon footprint.
“We’ve been really looking at how we run our facilities in a changing climate,” concludes Guevara, explaining that there are no easy answers.
On the one hand, high-end health facilities in high income countries are huge carbon emitters – guzzling enormous amounts of electricity for heating and cooling, as well as water and disposable plastic products. A 2019 estimate by Healthcare Without Harm found that if the global healthcare system was a country, it would be the fifth largest global carbon emitter.
Recognizing that, around 50 countries pledged to decarbonize their health systems at this year’s COP. But at the same time, health facilities in low-income settings often lack access to reliable electricity for even basic services.
Despite those dilemmas, MSF is making attempts to reduce its own carbon footprint where it can, for instance by replacing plastics with more sustainable materials.
It is also looking at greener health facility designs that would incorporate the use of solar-powered electricity alongside air conditioning, “sustainable setups that would allow us to continue to run our maternal child health hospitals where it needs to.”
Still no convergence of health and core climate conversations
However, health needs to play a much larger role in climate debates, says Guevara, insofar as health is so heavily impacted by climate change in multiple domains.
At this year’s COP, the topic received marginally more attention than in the past – with a full-fledged Health Pavilion in the official COP “Blue Zone” conference space.
There also was a day-long Health and Climate Conference on the margins of COP26, organized by WHO, civil society groups and a consortium of UK universities, as well as health-focused events in the Blue Zone Health Pavilion, which touched upon climate in relation to children’s health, air pollution, sustainable cities, and more.
But what remains missing is the convergence of the core topics of climate negotiations with key global health priorities – and this needs to change, says Guevara.
“I think it should be the compass of the decisions of any policy,” she said. “We should be going for our collective well-being and health. And it is because of that, it [health conversations] should be front and center.”
As a starting point, health impacts of climate change, as well as health benefits of effective climate mitigation and adaptation should be clearly referenced in the negotiated text of climate decisions, Guevara added.
“I think it is a work in progress for us to start to put all our actions through the climate lens. But it’s getting there and we hope that we can add our voice to the table and our experiences because what we’ve been able to do in low-resource settings will be part of the solutions as well to whatever our future climate is.”
This story was originally published in Health Policy Watch on November 12, 2021. It was produced as part of the 2021 Climate Change Media Partnership, a journalism fellowship organized by Internews’ Earth Journalism Network and the Stanley Center for Peace and Security.
Banner image: Action zone at the COP26 venue in Glasgow, Scotland where this rotating globe reminds delegates of what they are trying to save / Credit: Disha Shetty.