While the United Nations Framework Convention on Climate Change decided to hold, since 1995 and on a yearly basis, the Conferences of Parties (COPs) to regularly assess progress in dealing with climate change, it was only in 2014 that the World Health Organization (WHO) brought to the public attention the negative impact of climate change on human health: its first Global Conference on Health and Climate Change was “aimed at being a spring-board for action in addressing the impacts of climate change on health, with the potential to improve the lives of millions.”1
The habit of smoking was thought to be harmful to tobacco consumers (and to the people around them) long before science was able to provide solid data to support what is today an undeniable fact. Similarly, scientists have been suspecting for some time that climate change is harmful to human health, but now this is being corroborated by irrefutable, evidence-based data. The WHO is expecting humanity to face, between 2030 and 2050, approximately 250 000 climate change-related deaths per year (from malnutrition, malaria, diarrhea and heat stress alone) and estimates the costs to health as per USD 2-4 billion per year by 2030.2
At the time the idea that a prominent humanitarian medical actor like Médecins sans Frontières (MSF) just had to take a stand towards climate change and its impact on human health was making its way within the Movement, COVID-19 pandemic burst turned the year 2020 into a global annus horribilis; the Parties consequently decided not to hold their COP and focus instead on trying to avoid economy and public healthcare sinking in this perfect storm which, at the time this article was written, is still fierce and no safe haven is yet in sight.
The need to reflect on how to better anticipate climate-related disasters through improved emergency preparedness and environmental/climate lenses in our operations (“adaptation”) started to appear on internal documents, together with the intent to put into place technical solutions and practices to reduce our own environment-related impacts through concrete sustainable technical solutions (“mitigation”). Finally, and bearing in mind that the MSF Movement reserves itself the right to “speak out publicly […] when access to lifesaving medical care is hindered, when medical facilities come under threat, when crises are neglected…”3, the activist side of the MSF Movement also expressed the intent to witness and advocate on humanitarian impacts of climate-related shocks and hazards.
2021 has set a landmark within the MSF Movement in its engagement within the struggle against climate change. In May, MSF’s operational centre in Geneva, Switzerland, has pledged to reduce emissions by at least 50 percent compared to 2019 levels by 2030; with this target, MSF aims to chart a firm trajectory towards decarbonization, aligning the organization with the goals of the Paris Agreement (COP 21) on climate change to limit global warming below two degrees Celsius4. The report "Climate change: an ongoing crisis", published in October, shows how MSF bears witness to climate-exacerbated crises, helps communities build resilience to current or future environmental change and implements innovative and environmentally sustainable solutions in its humanitarian response5. In October/November, MSF participated in the COP 26 held in Glasgow as an observer. Then, by the end of the year, two further important steps have been taken: MSF signed an agreement with Climate Action Accelerator, an organization helping NGOs to reduce their carbon footprint6 and, thanks to a narrow majority of Partner Sections, the MSF Movement as a whole has taken the path towards becoming a signing party of the Climate and Environment Charter for Humanitarian Organizations, promoted by the Red Cross/Red Crescent Movement and “intended to help them play their part and highlight their relevance in responding to the climate and environmental crises”.7
Even though the climate issue has finally taken a prominent place in the MSF movement political agenda, , this does not mean that the Movement holds a homogenous position on the modalities MSF should adapt in its “Climate Action”, being the above-mentioned mitigation effort the only chapter that seems to be unanimously shared within the Movement. During the internal consultation prior to signing the above-mentioned Climate and Environment Charter, we heard several voices highlighting that to “help people adapt to the impacts of the climate and environmental crisis”, as written in the document, is to be placed in the field of development, while the Movement’s raison d’être should instead be found, and preserved, within the field of emergency. Others have pointed out that the objectives to “increase focus on climate change adaptation, disaster risk reduction and anticipatory action” and, moreover, to “reduce risks and address the causes and consequences of the climate and environmental crises” are problematic, as our focus should always be on how to save lives and alleviate suffering caused by crisis, not on how our patients should adapt to/become more resilient to the crisis - nor to tackle its root causes.
Again, this seems to be in contrast with the activities that are considered to be within the development chapter and not the emergency one, as many would like MSF to concentrate on.
MSF Luxembourg believes that climate change, and the need to respond to its threats, especially as far as human health is concerned, is actually further watering down the already grey area between “emergency” and “development” which, after decades of discussion, has never been clearly defined by humanitarian academics. Let’s get beyond and return to our root engagements, namely providing “assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict”8, regardless of wherever we want to place the assistance we provide in the theoretical framework.
MSF Luxembourg, enthusiastic signing party to the Climate and Environment Charter, is currently seeking technical solutions to mitigate its own carbon footprint, like many other Movement’s Offices around the world. Whether in “development” or “emergency”, we believe that a thorough medical assistance should also embrace health preventive measures like preparedness or anticipation, as it is obvious that avoiding exposure to diseases is far better (and cheaper!) than therapeutic interventions, provided that the climate changes would still allow remedial action. When feasible, we should accompany our target population towards the best possible adaptation to an already existing climate change-related impacts on health. Together with building resilience against those existing diseases that are being exacerbated by climate change, or against those that are likely to appear in the near future. We must also develop our capacity to engage in multi-disciplinary studies, to ensure the production and analysis of epidemiological data out of our own interventions. In parallel, we should develop the ability to cross the findings with meteorological/climatological data, in order to be able to develop forecasts and adapt, step by step, our medical interventions to these. After all, we attended the COP26 in order to “understand better how we can adapt our humanitarian and medical response in a rapidly changing reality. Many organisations, institutions and individuals have expertise on climate and environmental issues, and we need to learn from them to make sure our response best fits the needs of tomorrow.”9
Finally, the role of observer, embedded in the culture of MSF when participating in different kinds of fora, should also be revised in light of our “work to raise awareness and create debate about these crises through our policy of témoignage”10, at least when the next COP will take place. Our name, Nobel Peace Prize laureate, prestige and response capacity give us sufficient credit and leverage to engage in advocacy activities, to steer decision-making processes towards clear and achievable objectives in terms of climate change mitigation efforts. If necessary, we could even expose world leaders who fail in their responsibilities towards their citizens’ right to health (and of the rest of humanity) through appropriate media actions.
The importance of the issues related to climate change should lead us towards common awareness raising and advocacy actions with other prominent humanitarian or medical actors, to contribute to the strengthening of the global commitment to save our planet. An analysis by the International Federation of the Red Cross and Red Crescent found that 97.6 million people were affected by climate- and weather-related disasters in 201911. Protecting the lives and health of our present and future patients also depends on our own, prompt action. We cannot afford to lose the momentum: our target population and donors may not tolerate prolonged debates within our Movement; and eventually label our good intentions as mere greenwashing.
is the Planetary Health Support and Documentation Officer at MSF Luxembourg
is MSF Luxembourg General Director