Under the weather: Stories from communities on the front lines of climate and health adaptation

The health impacts of climate change are happening now. This report tells the stories of communities in three countries across Africa. Burkina Faso, Malawi and Somalia were chosen because they are among the African countries most vulnerable to climate change (NDGAIN, 2024). All three countries have recently experienced climate-health events, including heatwaves, cholera outbreaks and tropical cyclones. All three also have climate adaptation plans: Burkina Faso has a National Adaptation Plan while Malawi and Somalia have National Adaptation Programmes of Action (NAP Global Network, 2024). Malawi has also completed a health Vulnerability and Adaptation assessment. The case stories describe the experiences of health workers, villagers and families struggling with dehydration, displacement and death as temperatures soar and water becomes scarcer. They speak of local resilience, of successful interventions and of the choices we make in the face of adversity.

The climate crisis is a health crisis. Climate change poses a significant threat to global health, exacerbating existing health challenges and creating new public health emergencies. Climate change is increasing the frequency and intensity of extreme weather events, such as floods, droughts and heatwaves, which have direct impacts on health including injury, complications with existing conditions and death. Indirectly, climate change exacerbates food and water insecurity and increases the prevalence of both communicable and non-communicable diseases. For instance, undernutrition, malaria, diarrhoea and heat stress are projected to contribute to at least 250,000 additional deaths annually between 2030 and 2050 (WHO, 2023). Therefore, any discussion of adaptation to the impacts of climate change is incomplete unless it includes health (IPCC, 2021).

The impacts fall disproportionately on vulnerable communities. According to the most recent IPCC report, between 3.3 billion and 3.6 billion people live in contexts that are highly vulnerable to climate change, with the vast majority living in Africa, Asia, Central and South America, the least developed countries, small islands and the Arctic (IPCC Summary, 2022). Indigenous peoples, small-scale farmers and low-income households remain the most vulnerable communities globally (IPCC, 2021). The impacts of climate change are also particularly intense for vulnerable fragile communities and those affected by protracted crises and conflict. In these settings, hazards like cyclones are magnified by already compromised systems, governance and infrastructure. Worse, climate shocks and stressors can strain already overstretched systems – creating a vicious cycle. Vulnerable populations face increased climate-driven health risks due to heightened exposure, precarious living conditions and limited access to healthcare. As a result, climate change is aggravating existing health inequities while also creating new health challenges (Romanello et al., 2022; IPCC, 2021).

These communities are the least responsible for climate change. Regionally, Africa accounts for around 3 per cent of global greenhouse gas emissions, yet Africans experience disproportionate impacts from climate change (IPCC, 2021). African countries are projected to face the highest number of additional annual deaths attributable to climate change in 2030 and 2050 (IPCC, 2021). Yet African countries often lack the financial resources and infrastructure to implement effective climate adaptation from national budgets. This leaves them reliant on international financing. As a result, climate-health impacts in Africa are both more severely felt and more difficult to manage (Alcayna, 2020; WMO, 2023).

The international community is increasingly aware of the health impacts of climate change. In the past decade, we have seen an improvement in the international recognition of climate change’s health impacts. This is in large part due to key international players and the advocacy efforts of thousands of health professionals. In 2023, we saw several major advances (see Box 1 in the PDF). The UAE [United Arab Emirates] Framework for Global Climate Resilience has set a target specifically on health as a key sector. The UAE Declaration on Climate and Health (from the 28th meeting of the Conference of the Parties to the UNFCCC, COP 28) was endorsed by more than 120 countries. The declaration included a commitment to transform health systems to be climate-resilient, low-carbon, sustainable and equitable. These agreements built on previous global initiatives, such as the establishment of the Alliance for Transformative Action on Climate and Health in 2022. Yet this recognition of climate change’s health impacts has not been fully translated into action (Romanello et al., 2022).

Adaptation funding remains wholly inadequate. Adaptation costs for low- and middle-income countries will range from 194 billion to 366 billion US dollars annually this decade (UNEP, 2023). Yet adaptation finance is underfunded: more than 10–18 times the current flow of international public finance to underdeveloped countries is needed (GCA, 2023). This adaptation gap significantly affects vulnerable people’s health and capacity to cope (UNEP, 2023). On average, African countries are losing up to 5 per cent of their annual gross domestic product due to climate change. Many are forced to divert nearly 10 per cent of their budgets into unplanned expenditure to respond to worsening climate extremes (WMO, 2024). Yet in 2019–2020, international commitments on adaptation financing for Africa stood at just 11.4 billion US dollars. More than half of that was financed through loans to already debt-strapped countries (GCA, 2023).

Even less adaptation funding goes to the health sector. Between 2009 and 2019, only 4.9 per cent of global adaptation commitments focused on health sector adaptation. This is hindering efforts to address climate change’s health impacts and eroding decades of global health gains (Alcayna et al., 2023). Multilateral funding for health adaptation is less than 0.5 per cent of total multilateral funding for adaptation. Worse, it often does not meet local needs (Alcayna et al., 2023). Only 10–17 per cent of international adaptation funding addresses programmes at the local level (Soanes et al., 2017; Browne, 2024).

Community resilience is possible. The case stories in this report show that, while progress has been made, it is not enough. Adaptation can lead to transformative action if there is intentional, equitable and efficient investment in implementation and local engagement, and diversification of financing options. By centring people and prioritizing community leadership, we can collectively contribute to a more healthy and resilient future.

The IFRC network is working to address these five climate-health sensitive areas:

1. Epidemic and pandemic diseases – vector-borne, water-borne and zoonotic
2. Nutrition and food security
3. Environment and displacement
4. Extreme-heat resilience and disaster preparedness and response
5. Mental health