Wealthy nations must step up support for Africa and vulnerable countries in addressing
past, present and future impacts of climate change
The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture
of the future of life on earth, characterised by ecosystem collapse, species extinction
and climate hazards such as heatwaves and floods.1 These are all linked to physical
and mental health problems, with direct and indirect consequences of increased morbidity
and mortality. To avoid these catastrophic health effects across all regions of the
globe, there is broad agreement—as 231 health journals argued together in 2021—that
the rise in global temperature must be limited to <1.5°C compared with pre-industrial
levels.
While the Paris Agreement of 2015 outlines a global action framework that incorporates
providing climate finance to low-income and middle-income countries, this support
has yet to materialise.2 COP27 is the fifth Conference of the Parties (COP) to be
organised in Africa since its inception in 1995. Ahead of this meeting, we—as health
journal editors from across the continent—call for urgent action to ensure it is the
COP that finally delivers climate justice for Africa and vulnerable countries. This
is essential for the health of those countries, and for the health of the whole world.
Africa has suffered disproportionately, although it has done little to cause the crisis
The climate crisis has had an impact on the environmental and social determinants
of health across Africa, leading to devastating health effects.3 Impacts on health
can result directly from environmental shocks and indirectly through socially mediated
effects.4 Climate change-related risks in Africa include flooding, drought, heatwaves,
reduced food production and reduced labour productivity.5
Droughts in sub-Saharan Africa have tripled between 1970–1979 and 2010–2019.6 In 2018,
devastating cyclones impacted 2.2 million people in Malawi, Mozambique and Zimbabwe.6
In west and central Africa, severe flooding resulted in mortality and forced migration
from loss of shelter, cultivated land and livestock.7 Changes in vector ecology brought
about by floods and damage to environmental hygiene has led to increases in diseases
across sub-Saharan Africa, with rises in malaria, dengue fever, Lassa fever, Rift
Valley fever, Lyme disease, Ebola virus, West Nile virus and other infections.8 9
Rising sea levels reduce water quality, leading to waterborne diseases, including
diarrhoeal diseases, a leading cause of mortality in Africa.8 Extreme weather damages
water and food supply, increasing food insecurity and malnutrition, which causes 1.7
million deaths annually in Africa.10 According to the Food and Agriculture Organization
of the United Nations, malnutrition has increased by almost 50% since 2012, owing
to the central role agriculture plays in African economies.11 Environmental shocks
and their knock-on effects also cause severe harm to mental health.12 In all, it is
estimated that the climate crisis has destroyed a fifth of the gross domestic product
of the countries most vulnerable to climate shocks.13
The damage to Africa should be of supreme concern to all nations. This is partly for
moral reasons. It is highly unjust that the most impacted nations have contributed
the least to global cumulative emissions, which are driving the climate crisis and
its increasingly severe effects. North America and Europe have contributed 62% of
carbon dioxide emissions since the Industrial Revolution, whereas Africa has contributed
only 3%.14
The fight against the climate crisis needs all hands on deck
Yet it is not just for moral reasons that all nations should be concerned for Africa.
The acute and chronic impacts of the climate crisis create problems like poverty,
infectious disease, forced migration and conflict that spread through globalised systems.6
15 These knock-on impacts affect all nations. COVID-19 served as a wake-up call to
these global dynamics and it is no coincidence that health professionals have been
active in identifying and responding to the consequences of growing systemic risks
to health. But the lessons of the COVID-19 pandemic should not be limited to pandemic
risk.16 17 Instead, it is imperative that the suffering of frontline nations, including
those in Africa, be the core consideration at COP27: in an interconnected world, leaving
countries to the mercy of environmental shocks creates instability that has severe
consequences for all nations.
The primary focus of climate summits remains to rapidly reduce emissions so that global
temperature rises are kept to below 1.5°C. This will limit the harm. But, for Africa
and other vulnerable regions, this harm is already severe. Achieving the promised
target of providing US$100 billion of climate finance a year is now globally critical
if we are to forestall the systemic risks of leaving societies in crisis. This can
be done by ensuring these resources focus on increasing resilience to the existing
and inevitable future impacts of the climate crisis, as well as on supporting vulnerable
nations to reduce their greenhouse gas emissions: a parity of esteem between adaptation
and mitigation. These resources should come through grants not loans, and be urgently
scaled up before the current review period of 2025. They must put health system resilience
at the forefront, as the compounding crises caused by the climate crisis often manifest
in acute health problems. Financing adaptation will be more cost-effective than relying
on disaster relief.
Some progress has been made on adaptation in Africa and around the world, including
early warning systems and infrastructure to defend against extremes. But frontline
nations are not compensated for impacts from a crisis they did not cause. This is
unfair, and drives the spiral of global destabilisation, as nations pour money into
responding to disasters, but can no longer afford to pay for greater resilience or
to reduce the root problem through emissions reduction. A financing facility for loss
and damage must now be introduced, providing additional resources beyond those given
for mitigation and adaptation. This must go beyond the failures of COP26, where the
suggestion of such a facility was downgraded to ‘a dialogue’.18
The climate crisis is a product of global inaction, and comes at great cost to disproportionately
impacted African countries, and to the whole world. Africa is united with other frontline
regions in urging wealthy nations to finally step up, if for no other reason than
that the crises in Africa will sooner rather than later spread and engulf all corners
of the globe, by which time it may be too late to effectively respond. If so far they
have failed to be persuaded by moral arguments, then hopefully their self-interest
will now prevail.
List of Authors
Lukoye Atwoli, Editor-in-Chief, East African Medical Journal; Gregory E. Erhabor,
Editor-in-Chief, West African Journal of Medicine; Aiah A. Gbakima, Editor-in-Chief,
Sierra Leone Journal of Biomedical Research; Abraham Haileamlak, Editor-in-Chief,
Ethiopian Journal of Health Sciences; Jean-Marie Kayembe Ntumba, Chief Editor, Annales
Africaines de Medecine; James Kigera, Editor-in-Chief, Annals of African Surgery;
Laurie Laybourn-Langton, University of Exeter; Bob Mash, Editor-in-Chief, African
Journal of Primary Health Care & Family Medicine; Joy Muhia, London School of Medicine
and Tropical Hygiene; Fhumulani Mavis Mulaudzi, Editor-in-Chief, Curationis; David
Ofori-Adjei, Editor-in-Chief, Ghana Medical Journal; Friday Okonofua, Editor-in-Chief,
African Journal of Reproductive Health; Arash Rashidian, Executive Editor, and Maha
El-Adawy, Director of Health Promotion, Eastern Mediterranean Health Journal; Siaka
Sidibé, Director of Publication, Mali Médical; Abdelmadjid Snouber, Managing Editor,
Journal de la Faculté de Médecine d’Oran; James Tumwine, Editor-in-Chief, African
Health Sciences; Mohammad Sahar Yassien, Editor-in-Chief, Evidence-Based Nursing Research;
Paul Yonga, Managing Editor, East African Medical Journal; Lilia Zakhama, Editor-in-Chief,
La Tunisie Médicale; Chris Zielinski, University of Winchester.
This comment is being published simultaneously in multiple journals. For the full
list of journals, see: https://www.bmj.com/content/full-list-authors-and-signatories-climate-emergency-editorial-october-2022