26th October 2022

In October 2022 HCN with think tank E3G hosted a webinar with four international experts on climate risk, loss and damage, disaster response and health. What it offered was a master class in the complex but urgent need for action and resourcing loss and damage, with stark examples of current devastating impacts climate and health loss and damage, an unpacking of climate risk, and practical ways that the health sector can engage.

You can watch the full webinar at the link here

Below are some highlights of the presentations to give just a taste of the urgency and complexity of the issue.

Dr Maria Guevara,  International Medical Secretary at Doctors Without Borders/Médecins Sans Frontières (MSF), explained that health impacts should have been on the UNFCCC agenda since day zero, and that the Intergovernmental Panel on Climate Change (IPCC) recent assessment report shows there is an ‘unequivocal link between health and the climate crisis’.

While there is no clear definition for what climate change loss and damage is, the working definition is: the destructive impact of climate change that cannot be avoided by mitigation or adaptation. However, for MSF loss and damage ‘simply means emergency’.

Loss and damage impacts can be sudden (including hurricane or flood). Maria gave examples of the MSF response to the recent sudden impact floods in Pakistan, where 33 million people were affected. Medical teams there saw  ‘a lot of skin diseases, diarrhoea, malarial infections and much more problems with water and sanitation and food insecurity’. This required rapid response but also ongoing treatment and recovery, as well as preparedness for future climate impacts in the country.

But loss and damage also includes slow-onset impacts (such as drought or sea level rise). MSF have long worked in countries around Lake Chad, where the lake has shrunk 90% in the last 50 years. This loss of water resources has contributed to community conflicts by compounded climate-related food and water insecurity. The people of the Lake Chad basin have seen their ‘normal coping mechanisms are fading away’. One woman is quoted saying: “If the rain abandons us again we do not know what we will do.” In the region MSF responds to the malnutrition challenge which used to be seasonal, but now it is continual. The MSF acute malnutrition programme ensures co-design of  programmes with the local community so they can own the work and ensure its sustainability.

Taylor Dimsdale, Director of E3G’s Risk and Resilience Program, is very clear that climate risk is complex and systemic, impacting across society, and requiring a ‘whole of society approach’. Climate risk arises when adaptation measures fall short. Adaptation is often fragmented, for example when interventions are exclusively focussed on individual projects or sectors, and when resourcing is insufficient for  the scale of impact. Some loss and damage impacts are unavoidable with the worst impacts concentrated in the poorest and vulnerable communities.

Taylor explained the two categories of loss and damage. ‘Economic losses and damage’, including direct disaster related direct costs such as loss of infrastructure and cost of recovery. For example, the Mozambique cyclones in 2019 pushed government debt to 125% of GDP. 

Meanwhile, ‘non-economic loss and damage’, includes impacts on health, mortality, biodiversity, species loss, culture, human dignity, and displacement. While these impacts have financial implications, they cannot be fully accounted for in cost terms. One example in 2020 there were 30 million people displaced by weather related disasters, mainly in Asia, Africa and central America.

There are potential proposed solutions for non-economic loss and damage, such as innovative funding, social protections such as cash transfers, early warning systems and legal protection for refugees. But there is a ‘big gap between what resources are needed and what is available’. 

Colin McQuistan is Head of Climate and Resilience, Practical Action, a development organisation which has seen the irreversible impacts of climate change eroding many of the development gains they have delivered over the past 50 year.

Colin explained that though it has only been officially acknowledged by the UNFCCC sinceCOP19 in Warsaw ( 2013), small island states realised that loss and damage was an existential threat to their survival in the 1990s. Of course, more recently we have seen that loss and damage is no longer just an issue affecting remote communities, but it is seen with wildfires in Australia, floods in Europe and an extreme heat event followed by extreme floods in Pakistan. 

There is a cascade of degradation of health which includes ‘loss of water, loss of soil quality, loss of housing and infrastructure, and disruption of the medical supply chains’. So we have the direct impacts on health, but also the indirect consequences that further undermine health outcomes.

At COP19 the Warsaw International Mechanism (WIM) for loss and damage was established, creating a space for the UNFCCC to think about loss and damage.  However,  in the past decade it has struggled to deliver any significant progress. Loss and damage was included in the Paris Agreement at COP21 in 2015, which said it would aim to ‘avert (mitigation), minimise (adaptation) and address loss and damage’. But the urgency to ‘address’ loss and damage has been the missing piece of the puzzle in the negotiations, and where we need to focus in the future. At COP26 there were calls from developing countries for a Glasgow loss and damage finance facility.  

Health is an interesting area for the WIM which aims to engage relevant experts’ groups to progress its work. Additionally, health expertise will be needed in the Santiago Network, which aims to give technical advice to countries on responding to loss and damage. This advice needs to be informed by and targeted towards front line responses in communities where impacts are occurring. 

But delivering responses to loss and damage needs resourcing. If only the Santiago Network gains funding then it would be ‘like having your house destroyed, and paying for the architect but having no resourcing to rebuild your house’.  

Elizabeth Willettsconsultant with the World Health Organisation (WHO), said that WHO will be providing formal submissions to COP27 on L&D. The submissions are in the context of the strategic priorities of the WHO ‘Triple billion targets’ which are aimed at 1 billion more people receiving ‘universal health coverage’, 1 billion more ‘protected from emergencies’ and 1 billion more ‘enjoying better health and wellbeing’. Strategies to address loss and damage impact the achievement of all three of these targets.  Additionally, the SDG indicators under WHO custodianship – including malnutrition, malaria, tropical diseases, non-communicable disease such as heart and respiratory diseases, and access to clean water and sanitation – the IPCC AR6 shows that all are negatively impacted by climate change, undermining the WHO efforts to make progress on them.

Tools are needed to analysing health as a non-economic loss and damage, and these need to be developed at the same time underlying decisions are made for the health sector. Metrics on health outcomes such as disease, mortality, and morbidity are being developed (not just on input costs to provide health services).  Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) recently released a study on means and challenges for understanding non-economic value, which is often culture based. Non-economic loss and damages are often more costly and harder to recover from than economic losses.

All this analysis is still in the early stages, at the same time vulnerability mapping for sub-populations is also needed. In particular, loss and damage events can have a big impact on children and their ability to thrive. There is a significant need for more understanding on slow-onset conditions in the context of loss and damage events, for example the decline in food systems can lead to health conditions such as child stunting, reduced brain development, and susceptibility to non-communicable diseases.

Health engagement with the Warsaw International Mechanism on Loss and Damage should focus on entry points with the Santiago Network on technical assistance to developing countries and in the Expert Group on Non-Economic Losses, including a potential nexus study on health and biodiversity. At COP27 the Santiago network needs to be developed and funded, with a priority on producing a loss and damage needs and gaps assessment, and for a combined assessment of economic and non-economic impacts to determine true vulnerability. Finally, the health sector needs to invest in climate resilience and preparedness for both emergency and slow-onset impacts.