1
Submission by the World Health Organization
in collaboration with
the International Organization for Migration (IOM), World Vision (WV), the United
Nations High Commissioner for Refugees (UNHCR) and the International Federation of
Red Cross and Red Crescent Societies (IFRC)
Protecting the health of vulnerable people from the humanitarian consequences of
climate change and climate related disasters
6th session of the Ad Hoc Working Group on Long-Term Cooperative Action
under the Convention (AWG-LCA 6). Bonn, June 1-12, 2009
EXECUTIVE SUMMARY
The health and humanitarian dimensions of climate change are among the ultimate justifications for
taking action on climate change and these are closely interlinked. Humanitarian assistance provides a
strong health imperative to save lives and alleviate the suffering of crisis affected populations. Climate
change mitigation and adaptation, in particular, are important for the protection of health of vulnerable
populations from both sudden and slow onset climate-related emergencies.
The aim of the paper is twofold: first, it documents the range of risks that climate change poses to
human health associated with humanitarian emergencies, and secondly, it proposes policy directions to
manage the health humanitarian impact of climate change for consideration by the 15th Conference of
the Parties (COP) to the UNFCCC, the health sector and by the humanitarian community.
Comprehensive long-term cooperative actions are needed to formulate clear responses in order to protect
and enhance human health and well-being from the risks of climate change, including humanitarian
emergencies. Relevant actions are specified under the headings of climate strategies outlined in the Bali
Action Plan, including shared vision, mitigation, adaptation, finance and technology. The most
immediate actions for minimizing health humanitarian impacts from climate change are in the field of
adaptation, and include 1) strengthening of public health systems, 2) enhancing capacity to address
public health emergencies, 3) strengthening surveillance and control of infectious disease, 4) improving
the use of early warning systems by the health sector, and 5) enhancing local public health interventions
to enhance community resilience to climate-change and climate-related disasters.
This paper has been developed within the framework of the Inter-Agency Standing Committee (IASC)
a
Task Force on Climate Change by the World Health Organization (WHO), in collaboration with
IOM/WV/UNHCR/IFRC
b
and in consultation with the United Nations International Strategy for
Disaster Reduction system.
1. Introduction to Climate Change, Disasters and Health
The health of millions of people is impacted each year by the acute and long-term effects of climate,
including humanitarian emergencies. Climate change is happening now and it inevitably affects the
a
The Inter-Agency Standing Committee (IASC) is the primary mechanism for inter-agency coordination of humanitarian
assistance. It is a unique forum involving the key UN and non-UN humanitarian partners
b
IOM: International Organization for Migration; WV: World Vision; UNHCR: United Nations High Commissioner for
Refugees; IFRC: International Federation of Red Cross and Red Crescent Societies.
2
basic requirements for health: clean air and water, sufficient food and adequate shelter. Each year, about
800 000 people die from causes attributable to urban air pollution, 2.2 million from diarrhoea, (largely
resulting from lack of access to clean water supply sanitation and poor hygiene), 3.5 million from
malnutrition and approximately 60 000 in climate-related disasters
1-4
, mostly in low resource settings
and highly prevalent in humanitarian settings. Climate change will lead to higher levels of some air
pollutants, increased outbreaks and transmission of diseases through unclean water and through
contaminated food, threaten agricultural production in some of the poorest countries, and an increasing
number of extreme weather events.
Climate change also brings new challenges to the control of infectious diseases. Many of the major
killers are highly climate-sensitive to temperature and rainfall, including cholera and the diarrhoeal
diseases, as well as vector borne diseases including malaria, dengue and schistosomiasis.
Diminished resources, such as food and water, also has the potential to increase competition leading to
conflict and ultimately to humanitarian crises. Such stresses may also lead to forced migration,
increasing risks of transmission of communicable diseases and burdens on health systems, and further
aggravating tensions between communities
5
. In sum, climate change threatens to reverse the progress
that the global public health community has been making against many diseases, and increase the
challenges for the humanitarian community to respond to natural, biological and social emergencies. It
also presents an opportunity to health and humanitarian sectors to galvanize a common understanding
and approach for countermeasures which reduce the impact of emergencies on the health of affected
communities.
2. Health impact of climate-related disasters
Globally, the number of reported weather-related natural disasters is increasing. Reports of natural
catastrophes have more than tripled since the 1960s. In 2007, 14 out of 15 appeals for emergency
humanitarian assistance were for floods, droughts and storms – five times higher than in any previous
year.
6
2.1 Acute stresses
More numerous reports of climate disasters are partly due to population growth in high-risk areas, but it
is likely that climate change is also a contributing factor. The last few decades have seen rapid growth in
populations living in flood plains and coastal areas, particularly in developing country cities, placing
more people in the path of weather-related disasters. At the same time, climate change has driven
extreme high temperatures and has probably contributed to more frequent and extreme precipitation
events and more intense tropical cyclone activity.
7
Together, these trends will increase weather-related
hazards to human health.
Extreme heat. Studies have shown that daily temperatures above a locally specific threshold result in
higher mortality rates. The hot summer of 2003 in Europe produced sustained record high temperatures
which resulted in markedly higher death rates, particularly among the elderly population. In total, it has
been estimated that 70 000 more deaths occurred in western Europe during that extreme summer than
expected.
8
Continuing global warming and possible increases in temperature variability
9
will make such
events more frequent and more severe. It is projected that European summer temperatures as high as
those experienced in 2003 may be the norm by the middle of the century.
10
Floods and droughts. Even small changes in average precipitation can have a very large effect on the
extremes of rainfall events that cause either flooding or drought, already the most frequent and deadly
forms of disasters. For example, studies have shown that human influence on the global climate is likely
to make what would currently be considered a “very wet winter” in the United Kingdom, or a “very wet
summer” in the South Asian monsoon region, about five times more frequent by the second half of this
3
century.
11
Floods cause drowning and physical injuries; heighten the risk of diseases transmitted through
water, insect vectors and rodents; damage homes; and disrupt the supply of essential medical and health
services. The number of floods reported globally is rising rapidly – much more rapidly than disasters
unrelated to climate.
Globally, climate change is likely to widen the area affected by drought, with particularly severe impacts
in areas that are already water-stressed. These trends will impact on lives and on health. Droughts
increase the risk of water and food shortages and malnutrition, and diminished health among vulnerable
population. They also increase the risk of diseases spread by contaminated food and water. The
combination of extreme heat and drought are also important risk factors for causing wildfires, resulting
in direct health and economic losses, and increased risk of respiratory illness due to smoke pollution.
Tropical storms. Extreme winds, particularly in the tropical regions, bring death, illness, injury,
psychosocial impacts, and destruction of health facilities and health services. There is evidence of a
marked increase in the numbers of the most extreme cyclones in recent decades, and this trend is likely
to continue. Studies suggest that a doubling of the level of carbon dioxide in the atmosphere would
result in an increase of only about 6% in average cyclone windspeed but of 300% in the frequency of the
largest (category 5) storms.
12
Changing patterns of infection. Infections caused by pathogens that are transmitted by insect vectors
are strongly affected by climatic conditions such as temperature, rainfall and humidity. These diseases
include some of the most important current killers: malaria, dengue and other infections carried by insect
vectors, and diarrhoea, transmitted mainly through contaminated water. Populations in crisis situations,
in particular, face heightened risk of these illnesses.
Malaria transmission is strongly affected by climate. Transmitted by Anopheles mosquitoes, malaria is
the most important vector-borne cause of mortality globally. It kills almost 1 million people each year,
mainly poor children in Africa.
13
Malaria is strongly influenced by climatic conditions; it is not
transmitted in the cooler temperatures associated with high altitudes and latitudes, and the number of
mosquito vectors depends on the availability of freshwater breeding sites. Warmer temperatures, higher
humidity and more places where water can collect generally favour malaria transmission. There is
evidence that in some sites in the highlands of East Africa, a warming trend over the last 30 years has
improved conditions for mosquitoes, increasing the probability of malaria transmission and highland
epidemics.
14
Dengue prevalence is increasing rapidly. Transmitted by Aedes mosquitoes, dengue is a fast growing
challenge, particularly in tropical cities in developing countries. Cases have risen dramatically in the last
40 years, as unplanned urbanization with standing water in waste and other receptacles have created
mosquito breeding sites, and movement of people and goods has spread both mosquito vectors and
infections. Climate trends may also have played a role, since the distribution of dengue is also highly
dependent on climate.
2
Diarrhoea remains one of the biggest killers of children. Viruses and bacteria transmitted through water
and contaminated food can cause severe diarrhoea in children, often locking them into a vicious cycle of
undernourishment, susceptibility to other infectious diseases, and eventually death. Higher temperatures
and too much or too little water can each facilitate transmission of this disease. In countries with
inadequate water and sanitation services, diarrhoea is much more common when temperatures are high.
For example, rates of diarrhoeal disease in Lima, Peru, are 3–4 times higher in the summer than in the
winter, increasing by 8% for every 1 °C increase in temperature.
15
Both flooding and unusually low
levels of water can also lead to water contamination and bring higher rates of illness and death from
diarrhoea.
16
Warming and greater variability in precipitation threaten to increase the burden of this
disease.
4
Many other diseases will also be affected. Any disease caused, transmitted or harboured by insects,
snails and other cold-blooded animals can be affected by a changing climate. New and unfamiliar
infections strain health services and economies. When infectious diseases appear in new locations,
where people do not have immunity and health services may not have experience in controlling or
treating infections, the effects can be dramatic. In severe or unusual outbreaks, the cooperation of
community, national and international epidemic and emergency response systems will be required to
control the spread of disease, provide emergency health services to the affected population and help
manage the widespread societal and economic aspects through coordinated multi-sectoral action..
2.2 Chronic stresses: water shortages, malnutrition, psychosocial stress, displacement, migration and
conflict
In the long run, the greatest health impacts may not be from acute shocks such as disasters or epidemics,
but from the gradual increases in pressure on the natural, economic and social systems that sustain health
which are already under stress. These gradual stresses include reductions and seasonal changes in the
availability of fresh water, regional drops in food production, and rising sea levels. The effects of
climate change on ongoing conflicts (such as the Darfur crises) is also a critical concern of the health
humanitarian community.
Each of these changes has the potential to cause, prolong and exacerbate chronic emergencies, including
major population displacement, and increase the risks of civil conflict.
Mounting water stress fosters a range of long-term public health challenges. Lack of access to clean
water supply and sanitation, along with poor hygiene, is already the main contributor to the burden of
diarrhoeal disease.
17
Climate change is projected to bring changing rainfall patterns, increased
temperatures and evaporation, and salinization of water sources through rising sea levels. In addition,
over the course of the century, water supplies stored in glaciers and snow covers are projected to decline.
This will reduce water availability to populations supplied by melt-water from major mountain ranges,
more than one sixth of the global population. The Himalayas glaciers, whose melt waters serve 1.3
billion people, are showing a rate of recession greater than anywhere else in the world.
i
In many regions,
the effects of climate change come on top of pre-existing water stress and mounting pressures of
population growth, as well as extraction for irrigation and contamination from agriculture and industry.
18
Pressures on agriculture threaten to increase the burden of malnutrition. Undernutrition and related
disease is currently the greatest contributor to the global burden of disease, killing over 3.5 million
people per year, mostly children in developing countries.
4
It is projected that climate change will boost
agricultural production in the high latitudes of developed countries, but cause decreases in many tropical
developing regions. There is particular concern for sub-Saharan Africa, where people are most reliant on
subsistence and rain-fed agriculture and have least money to buy imported food. Some studies agree that
higher temperatures and longer growing seasons could result in increased pest populations in temperate
regions of Asia
19
. Increased frequency of El Niño events and future changes to the ocean ecology have
the potential to substantially alter fish breeding habitats and food supply for fish, and ultimately the
abundance of fish populations. Tens of millions more people are projected to become at risk of food
insecurity and the health consequences of malnutrition.
18
Population displacement compromises health and damages lives. By destroying ecological and
agricultural systems and by flooding communities, climate change can eventually force people to
abandon where they live in order to seek new homes and livelihoods. Forced displacement is associated
with a range of health issues, including social isolation and mental disorders and, in many cases, reduced
socioeconomic status and associated health problems. When migration crosses ethnic and/or national
boundaries, such as forced migration from low-lying, small island states, the social transition is more
difficult and the associated health effects are likely to be more severe. Refugee or displaced persons
camps are often sited on marginal lands which may provide breeding sites for disease vectors (Malaria,
5
Dengue). Population movement may take refugees and displaced through or to areas of higher malaria
endemicity than their place of origin.
Environmental pressures exacerbate pre-existing problems and accentuate underlying social fault lines.
Economically and socially marginalized groups within society will be worst affected. Migrants can also
experience increased vulnerability post-disaster due to compromised access to services in the affected
areas as well as potential language and cultural barriers. For irregular migrants and migrants who have
lost their documents as a result of the disaster access to assistance might be particularly difficult.
20,21
Competition over dwindling or degraded natural resources can increase the risks of conflict and war.
Although most conflicts are not directly related to natural resources, stresses on natural ecosystem
services can lead to competition between population groups over, for example, freshwater supplies or
fertile agricultural land. Combined with factors such as poor governance and ethnic rivalries, such
competition can inflame tensions into conflict.
22
3.2 Vulnerable regions: exposed populations
All regions of the world will be affected by a changing climate, but the resulting health risks to human
populations vary greatly, depending on where and how people live. People living in small island
developing states and other coastal regions, megacities and mountainous and polar regions are all
particularly vulnerable in different ways.
18
Small island developing states and other low-lying regions are in the front line. Populations in these
countries are vulnerable to death and injury and destruction of their public health infrastructure from
increasingly severe tropical storms, as well as salinization of water resources and agricultural land from
sea level rise.
23
Many of these nations struggle to supply adequate fresh water for basic sanitation and
hygiene, particularly to outlying islands and other isolated areas where populations suffer elevated rates
of diarrhoea and nutritional deficiencies during droughts, floods and high temperatures
16
. Displacement
of populations from small island development states is expected to increase due to these climate-related
impacts on basic resources.
Urban populations, particularly those of tropical megacities, are exposed to a combination of health risks
such as heatwaves, floods, infectious diseases and air pollution. Rising global temperatures combine
with the urban heat island effect, and can raise temperatures by 5–12
o
C, heightening hazards from
heatwaves.
24,25
Extensive coverage with impervious surfaces, along with inadequate drainage and
precarious housing, increase the risks and the health impacts of flash floods. High population densities,
inadequate coverage of clean water, sanitation and waste disposal services raise vulnerability to climate-
sensitive infectious diseases such as diarrhoea and dengue. Many cities also have high levels of air
pollution, almost all of which results from burning of fossil fuels.
26
These factors accentuate the risk of
emergencies requiring local and national response, and increased prospect of international assistance.
Mountain populations are vulnerable, due to high exposure to hazards, remoteness, poor infrastructure
and marginalization. at increased risk of water insecurity, floods and landslides, and infectious disease.
Climate change at high altitudes can cause a range of health challenges.
27
The widespread retreat of
glaciers threatens to deprive mountain and downstream populations of reliable summer fresh water for
household use and for agriculture, from China to Peru. Swelling of the lakes that form at the bottom of
glaciers increases the risks of glacier lake outburst floods, which occur suddenly and can cause injury,
death and destruction in downstream communities. Furthermore, higher temperatures are intensifying
the risks of transmission of vector-borne diseases, such as malaria, among high-altitude populations that
lack immunity against such diseases.
14
While trying to cope, nomad populations may need to become
sedentary - already occurring with some groups in the Northern Himalayas - and traditional ethnic
groups may thus face social tensions and eventual loss of their identity. The psychosocial stress may
result in depression, leading to misuse of alcohol, domestic violence and other dramatic and negative
behavioural changes.
6
The health of indigenous people in polar regions may be particularly affected by changes in temperature,
food sources and livelihoods. Rising winter temperatures in Arctic regions are expected to reduce excess
winter mortality and cold-related injuries.
28
However, the traditional diet of circumpolar residents is
likely to be impacted by melting snow and ice, affecting animal distributions and accessibility for
hunting. Wildlife and waterborne and vector-borne diseases are expected to have a wider seasonal and
geographical distribution.
29
Perhaps most importantly, changes in the physical environment will make
traditional ways of life impossible, forcing changes of behaviour and means of supporting livelihoods,
with associated effects on mental health and community cohesion, and displacement of populations.
Women and children in developing countries are particularly vulnerable to death and illness following
disasters. In the 1991 cyclone disasters that killed 140 000 people in Bangladesh, death rates among
women were almost four times greater than those among men: rates among children under 10 years of
age were more than six times greater than those of adult men.
30
Disasters can also result in increased
suffering from domestic violence and post-traumatic stress disorders in women,
20,21
who are also often
called upon to play a leading role in disaster recovery and in rebuilding shattered communities.
3. Solutions: health governance, humanitarian assistance and the climate change
agenda
Climate change will affect the health and well-being of all populations, with impacts escalating into the
foreseeable future in many different ways. Human health and wellbeing are central to humanitarian,
environment and development policy.
We have outlined the range of risks that climate change poses to human health, with a focus on those
risks that can cause emergencies and displacement.. The extent to which these risks translate into
increased numbers of deaths and burdens of injury and disease will depend on the effectiveness of
mitigation and adaptation policies. Strengthening public health systems and health emergency
management systems is necessary, particularly to safeguard the health of the most vulnerable population
groups and respond effectively to emergencies when they arise. This principle has been outlined in
frameworks for action developed by individual countries and in regions during the past two years, for
example in the Asia Pacific Region where over 3 billion people live
31
.
3.1 Actions to improve our health and protect our climate
The global public health community has a wealth of experience in protecting people from climate-
sensitive hazards. Many of the necessary preventive actions to deal with the additional risks of climate
change are already clear. Widening the coverage of proven, effective health interventions will be critical
to the global effort to adapt to climate change.
Strengthening of public health systems is necessary with or without climate change; climate change
makes this need even more critical and urgent. Today's shortfalls in providing basic public health
services leave much of the global population exposed to climate-related health risks. There is a need for
additional investment to strengthen key health functions and for forward planning to address the new
challenges posed by climate change. This should include increase capacity of the health system to
extend services and continuity of care to mobile, hard-to-reach populations and newly established
communities after displacement, bridging emergency relief and long-term sustainability. To this effect,
coherent partnership needs to be strengthened between humanitarian actors, NGOs, private sector, and
national health systems through emergency preparedness measures in advance of any emergency, and be
maintained from the very on-set of the emergency and throughout the community recovery and
stabilization phase
32
.
7
Enhanced capacity to address public health emergencies saves lives and protects communities. Acute
shocks such as extreme weather events and disease epidemics can overload the capacities of health
systems in even the most developed nations. Complex emergencies, resulting in humanitarian crises,
result in enormous health burdens for the affected population, and often require wide-scale international
assistance. As far as natural hazards are concerned, the number of disasters reported and the numbers of
people affected have risen in recent decades, thus creating additional demands on health systems.
Conversely, the number of people killed has fallen, as societies and individuals have become more able
to protect themselves. Further reinforcing health vulnerability and risk assessment, multi-sectoral
disaster risk reduction, health emergency preparedness, early warning, and health action in emergencies
can help to ensure that people are better protected from the increasing hazards of extreme weather and
help communities recover faster following a disaster
3
.
Strengthened surveillance and control of infectious disease can protect health from local to global scales.
Effective disease surveillance and control become even more important under conditions of rapid
environmental change and movement of people, disease vectors and infections. Rapid and accurate
disease notification, in compliance with the International Health Regulations,
33
is the essential basis for
planning disease control. Approaches such as Integrated Vector Management, which make the best use
of proven interventions, such as bed nets, insecticide spraying and environmental management, to
control malaria, dengue and other vector-borne tropical diseases, are relevant to humanitarian situations
and protect against the effects of climate change.
34
Improving access to primary health care in
humanitarian settings ensures faster treatment for patients, alleviating suffering and containing the risks
of disease spread.
Extreme weather forecast and early warning. There is great potential for using meteorological
information to enhance early warning and effective response over a range of time scales, from hours or
days (for example for flood or heatwave warnings), to weeks (for seasonal epidemics of vector-borne
disease), to months (seasonal forecasts of precipitation anomalies allowing planning for flooding or
drought) or years (for drought and associated food insecurity). While not useful for operational decision
making, climate change projections on a decadal time-scale can give indications of how hazards may
change and enable longer term planning for changing risks, such as the selection of safe sites for the
development of health infrastructure. However, there is a need for improved institutional arrangements
to ensure that the roles of meteorological, humanitarian, health and other agencies are well-defined, that
climate information products are demand driven, user friendly and relevant for operational decision
making in health and other sectors, and that there is sufficient capacity for operational response.
Efficiency can be improved by sharing of data sources, protocols and information across warning
systems for different hazards.
Local public health interventions to build community resilience. Action on environmental and social
determinants of health is critical to protecting populations from climate change in both emergency and
non-emergency situations. For example, scaling up water and sanitation services and disinfection at the
household level would immediately reduce diarrhoea and, at the same time, lessen the health impacts of
decreasing and more variable water supplies before and during emergencies. Implementing participatory
approaches such as the FAO’s
c
concept of Farmer Field Schools to empower local communities to
manage disease vectors in an integrated manner and thus increase their capacity to protect their health
will increase climate resilience.
35
The benefits of such interventions are already several times greater
than the costs, and the threat of climate change makes these preventive health measures as part of the
humanitarian response an even wiser investment. Improving social welfare in emergency situations,
particularly educating and empowering women in developing countries, is a fundamental requirement
for improving health. It is also essential to strengthening community resilience to disasters and to
climate change. Such strategies need to be flexible enough to take into account the diverse composition
of modern communities, and include migrants and people from different ethnic and cultural groups, and
with different health-seeking behaviour.
c
Food and Agriculture Organization
8
4. Protecting the health of vulnerable people from the humanitarian consequences of
climate change and climate related disasters: proposals to COP 15 negotiators for
the roadmap of action
Action on climate change is necessary to avoid adverse impacts on human health and wellbeing,
alongside damage to the environment and economic development. A greater appreciation of the human
and humanitarian dimensions of climate change is necessary for both the development of effective
policy and the mobilization of public engagement regarding the impacts of climate change.
Mainstreaming of climate change is essential to development of health systems and planning for
humanitarian emergencies.
Shared Vision
Climate change, and climate policies, will profoundly affect some of the most fundamental determinants
of health (especially food and water security) which increase the risks of humanitarian emergencies and
decrease the effectiveness of humanitarian response. Comprehensive long-term cooperative actions are
needed to formulate clear responses in order to protect and enhance human health and well-being from
the effects of climate change, including those giving rise to humanitarian emergencies. Climate
strategies, including, adaptation, mitigation, finance and technology, should therefore properly address
the health consequences of climate change, including death, injury, disease, disability, mental illness and
displacement arising from extreme weather events, sea-level rise and conflict arising from diminished
food and water security. These disaster risk reduction strategies should be combined with good
governance and institutional strengthening, health risk identification, knowledge management and
education, and preparedness for effective response and recovery – the five priority actions of the Hyogo
Framework for Action of the UN International Strategy for Disaster Reduction (UN ISDR)
36
.
Adaptation
Adaptation policies and forward planning will be required to assess and cope with the threats posed by
climate change and enhance capacity to deal with public health emergencies. This approach will need to
strengthen the health coordination with the humanitarian sector, health emergency management systems,
early warning systems related to the health consequences of climate change, and interventions to control
neglected tropical diseases. The investment in hospitals, health facilities and other infrastructure should
be protected from the long-term effects of climate change. Renewed emphasis should be placed on
primary health care, and improving the environmental and social determinants of health, from provision
of clean water and sanitation, to enhancing the welfare of women, especially in emergency situations.
All adaptation measures are designed to build the resilience of nations and communities to disasters and
negative health impacts attributable to climate change through awareness raising, capacity building on
interventions and relevant research.
Adaptation and mitigation policies outside the health sector will also have major health implications. A
common theme must be ensuring health equity and giving priority to protecting the health security of
particularly vulnerable groups. Increased investment in health systems is already necessary in order to
meet the health-related Millennium Development Goals, whose achievement will be further
compromised by the impact of climate-related events.
Mitigation
Mitigation is essential to prevent continuing rises in the frequency and severity of extreme weather
events. Parties are encouraged to continue to specify the avoidance of health and humanitarian disasters
as a primary motivation for mitigating climate change.
9
Finance & Technology
Financial mechanisms and technological innovation to support action to strengthen health systems and
health emergency management systems to reduce the impact of climate change should be accessible by
the health and humanitarian sectors, both to support actions that provide opportunities for improving
health and support programmes that help protect public health from the humanitarian consequences of
climate change. The effects of climate change on health, the long-term risks stemming from drought and
sea-level rise that could affect water and food security and safety, competition for resources, and
displacement of populations with humanitarian needs, should all be integrated into early warning
systems with appropriate evaluation schemes.
10
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