Choices at the time of the climate emergency

B. Jochum

F. Delfosse

M. Guevara

L. L. Tremblay

C. Devine

Bruno Jochum, François Delfosse, Maria Guevara, Léo L.Tremblay, Carol Devine • Médecins Sans Frontières

Knowing about the discussions in progress at Médecins Sans Frontières, as well as the actions it intends to implement to adapt to climate change, provides precious insight. Though they speak in their own names, the five authors – from the Swiss and Canadian sections – say a lot about the ongoing debates within the movement, about the actions taken and about the possibilities for procrastination. Lessons that apply to the entire humanitarian community.

The scientific diagnosis is unequivocal: we have entered an emergency climate phase, where the consequences for humanity and the environment are worsening every day. Massive atmospheric pollution linked to human activity is disrupting the climate, increasing temperatures and directly causing health crises. Since it includes colder ocean surface temperatures, the reference to predicted average global temperatures tends to obscure the scale of the real phenomena on land and very pronounced regional variations(1)Nicholas Watts, Markus Amann, Sonja Ayeb-Karlsson et al., “The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health”, The Lancet, 391/10120, 30 October 2017.. Alongside the intensification of extreme events, unsustainable pollution levels are developing in major urban areas, whilst other regions are becoming uninhabitable due to disrupted hydrological cycles(2)Jacob Schewe, Jens Heinke, Dieter Gerten et al., “Multimodel assessment of water scarcity under climate change”, Proceedings of the National Academy of Sciences of the United States of America, 2014. Nicholas Watts, Markus Amann, Nigel Arnell, et al., “The 2018 Report of The Lancet Countdown on Health and Climate Change”, The Lancet, 2018.. Continuing current practices with the resulting greenhouse gas emissions would lead to a rise in average global temperatures of over 4°C by the end of the century(3)Climate Action Tracker, 11 December 2018, https://climateactiontracker.org/global/temperatures. And even if existing mitigation policies were translated by States into action, they would not prevent to exceed 3°C, and thus reaching an unprecedented existential risk to the stability of human societies(4)The scenarios described by the Intergovernmental Panel on Climate Change (IPCC) do not take into account a number of “tipping points” which, once a certain temperature has been reached, will set off feedbacks and a possible loss of control of the climate system, leading to a “Hothouse Earth” in the 21stcentury. Will Steffen, Johan Rockström, Katherine Richardson et al., “Trajectories of the Earth System in the Anthropocene”, Proceedings of the National Academy of Sciences of the United States of America, 2018. https://www.pnas.org/content/115/33/8252. In any event, in the shorter term – in the next twenty years –, an increase of 1,5°C to 2°C is inevitable regardless of what measures are taken. Those areas most vulnerable to climate disasters have been clearly identified as the tropics in general, and Sahelian Africa and the Indian subcontinent in particular.

Beyond this diagnosis, it is important to highlight the existence of another consensus which exists around the roadmap to be implemented in order to comply with the Paris Climate Agreement and stabilise temperatures at a level “well below 2°C”(5)Report of the Conference of the Parties on its twenty-first session, held in Paris from 30 November to 13 December 2015. Addendum Part two: Action taken by the Conference of the Parties at its twenty-first session. https://unfccc.int/resource/docs/2015/cop21/fre/10a01f.pdf. This includes achieving worldwide carbon neutrality before 2050(6)IPCC press release, 8 October 2018. https://archive.ipcc.ch/pdf/session48/pr_181008_P48_spm_fr.pdf. A number of publications recommend a “carbon law”(7)Johan Rockström, Owen Gaffney, Joeri Rogelj et al., “A roadmap for rapid decarbonization”, Science, 355/6331, 24 March 2017, p.1269-1271, https://science.sciencemag.org/content/355/6331/1269, which would consist in reducing carbon emissions by half every decade. Whilst this has the advantage of being easy to understand and apply to all States, communities, businesses, organisations and individuals, the implementation of such a law would require a radical change in practices and crucially, compliance with a timetable for action over two or three decades.

Climate change, and the collapse of biodiversity(8)Press release: « Le dangereux déclin de la nature : un taux d’extinction des espèces “sans précédent” et qui s’accélère », Plateforme intergouvernementale sur la biodiversité et les services écosystémiques, 6 mai 2019. that accompanies it, represents an exceptional challenge for humanitarian organisations and the way in which they conceive their responsibilities. It affects three main levels. Firstly, the challenge forces them to confront their own polluting practices, especially in the context of emergency deployments. Secondly, it requires humanitarian organisations, which are traditionally present in the most exposed areas, to anticipate the development and typology of humanitarian needs, think about the relevance of their programmes and adapt their operational response capacities. Finally, in a context where the political measures taken in the coming years will largely determine the collective capacity to limit global warming to 1,5°C or 2°C, this emergency requires humanitarians to take a stand on this historic ecological crisis and publicly denounce the sacrifice of ever more vulnerable populations.

Awareness of these issues is developing within organisations such as Médecins Sans Frontières (MSF) and the International Committee of the Red Cross, and new approaches are emerging. However, in this time of choices, legitimate questions and dilemmas arise. This article aims to explore them and examine humanitarian responsibilities in light of the decisions to be made.

“Do no harm” and set the right objectives to reduce the carbon footprint

In terms of their operational models, humanitarian organisations are faced with the same problem as any public authority or business; how can they drastically reduce their carbon footprint, in a limited time, without compromising their social mission? While humanitarian workers are at the forefront of alleviating the suffering caused by polluting practices locally or globally, can they still tolerate their own pollution, when alternatives do exist? For too long, the humanitarian sector in general – and MSF in particular – has been able to consider that the imperative of its social mission, that of saving lives here and now, exempted it from controlling its practices with high environmental impact and their future consequences. In order to avoid a situation of aggravated “cognitive dissonance(9)Cognitive dissonance refers to a situation involving contradictory attitudes, beliefs or behaviours. The term was invented by Leon Festinger in his book A Theory of Cognitive Dissonance (1957). https://www.simplypsychology.org/cognitive-dissonance.html”, it is time for humanitarian organisations to set themselves measurable reduction goals, without compromising the effectiveness of their aid.

With this in mind, by the very fact of its social responsibility, MSF must firstly analyse and monitor its operating mode(10)Locally polluting operational practices and overall net contribution to CO2emissions. and minimise its environmental impact, something which is potentially at odds with the priority to do no harm. MSF has not yet evaluated its energy and water consumption, or its waste management practices or CO2emissions, which is a complex yet essential task for its international network.

However, it has already committed(11)Thus, the following binding motion, was voted by the International General Assembly of MSF on June 30, 2019: “Recognizing the current climate emergency, and in line with our mission and our social responsibility, MSF should urgently commit to addressing the growing humanitarian consequences of environmental degradation, and in particular climate change, on vulnerable populations, by integrating this commitment into the strategy and medico-operational policies at the scale of the MSF’s movement. This should translate into an environmental policy and dedicated resources to mitigate our own footprint; a strategic operational engagement related to the climate crisis; and an associated strategy of public positioning and advocacy to mitigate the negative impacts on the environment and the health of populations at risk.” to identify practices that have a negative impact on the environment. Tools for the evaluation and systematic monitoring of energy and water consumption are being set up through partnerships. In 2018, a project was launched by MSF, as part of a transformational investment, to measure MSF’s ecological footprint and create a tool to reduce it. Following the pilot phase in Honduras and Kenya, as well as in the Mexican, Canadian and Swiss offices, the tool will be deployed in all MSF entities, headquarters and field offices. This must naturally be done holistically, based on an environmentally friendly way of working which include the principles of sustainability and efficiency from the very design to the implementation of the social mission. Excessive air travel, the choice of training sites, supply chains, the use of plastics, medical waste and fossil fuels for vehicles and buildings must all be examined. As an employer, MSF must also encourage change by providing its teams with the means and frameworks to accelerate the implementation of good practices.

This also means taking into account a critical risk factor linked to our operating methods, which are currently utterly dependent on the industrial, globalised practices that arise from the use of fossil fuels. A prospective analysis(12)In their article, “Humanitarianism in the Anthropocene”, Sverre Molland and Darryl Stellmach describe “humanitarian action [as] an industrialised response to suffering. The same tools and techniques that power global capitalism also enable humanitarian action: transnational supply chains, administration, media and communications mobilise personnel and materials to faraway places”, 13 August 2016, http://somatosphere.net/2016/08/humanitarianism-in-the-anthropocene.html shows that humanitarian organisations will themselves be affected by the consequences of this climate crisis, which ought to lead them to consolidate their own resilience(13)Aptitude of an organisation to resist shocks, adapt or bounce back. Gilles Teneau, La Résilience des organisations, Les fondamentaux, L’Harmattan, 2017.. The potential impacts of restrictive (and necessary) environmental policies, which will make access to fossil fuels more costly and regulated, carbon-intensive products more expensive and plastics increasingly forbidden, must be anticipated. The long-term risk analysis must therefore result in a review of the sustainability of operational models and accelerate the necessary transition towards non-fossil energies.

Such an ambition would entail an environmental policy which fully implicated the organisation in a tangible response. The transition towards more environmentally-friendly practices has to be made gradually, by optimising and seeking synergies between existing activities in a quest for efficiency. It must remain focused on medical needs and never be at the expense of the efficiency required to accomplish the social mission. Real dilemmas will arise, but a significant margin of reduction can be achieved through innovation and technical simplification. Similarly, changes to the organisation’s management and conduct would make it easier to implement a voluntary simplicity, rather than one imposed by society over the coming years.

As we have noted, the “carbon law”(14)Johan Rockström, Owen Gaffney, Joeri Rogelj et al., “A roadmap…”, art.cit. sets forth a clear and measurable objective. And, for reasons which have also been mentioned above, its implementation should be the priority target for any credible environmental policy. This can be achieved through different strategies focusing on the emergency humanitarian organisations’ largest sources of emissions, including transport of people, procurement and energy for buildings. And, for emissions that cannot be reduced, agreeing to pay the economic price by means of an offset programme that complies with recognised standards(15)Nations unies-Plateforme de compensation carbone, Certification ONU des réductions d’émissions de gaz à effet de serre, https://offset.climateneutralnow.org/uncertification, or by paying a carbon tax(16)World Bank and Ecofys, State and Trends of Carbon Pricing 2018, World Bank, Washington, DC, 2018; 2018 World Bank report on initiatives intended to put a price on carbon, https://openknowledge.worldbank.org/bitstream/handle/10986/29687/9781464812927.pdf?sequence=5&isAllowed=y. Such a position must be combined with a more general commitment to reduce the impact on the other “planetary boundaries”(17)The concept of “planetary boundaries” refers to the limits that must not be exceeded if humanity wants to evolve in a safe global ecosystem. See Johan Rockström, Will Steffen, Kevin J. Noone, et al., “A safe operating space for humanity”, Nature, no.461, 23 September 2009, p.472-475. https://www.nature.com/articles/461472a According to the researchers behind the concept, four of the nine identified boundaries are exceeded or close to being: climate change, biodiversity erosion, the nitrogen cycle erosion, and that of phosphorus. See Will Steffen, Katherine Richardson, Johan Rockström, et al.,“ Planetary boundaries: Guiding human development on a changing planet”, Science, Vol. 347, 13 February 2015, https://science.sciencemag.org/content/347/6223/1259855.abstract, related to land, water and ecosystem degradation and caused by the production of plastic, chemical and organic waste in the context of humanitarian programmes. Most of the measures would involve a more efficient use of the organisations’ human and financial resources. The necessary investments for the transition can be partially offset by the significant budget savings on transport, fossil fuels and carbon taxes which, in future, will be factored into the cost of many products. Such choices will also involve accelerating the localisation of human, technical and material capacities to the closest societies affected by the crises. The benefits of a reduced carbon footprint are numerous, and there would be great value in having an inventory of the solutions that are adapted to the humanitarian fields, and their impact and costs, in order to support the transition to action.

Being equipped to provide a better response to the humanitarian consequences of the ecological crisis

There is a substantial body of literature(18)For example, non-exhaustively, Dina Bélanger, Pierre Gosselin, Ray Bustina et al. Changement climatique et santé, Prévenir, soigner et s’adapter,Editions Hermann, Presses de l’Université Laval, 2019; George Luber, Jay Lemery, Global climate change and Human health, Editions Jossey-Bass, 2015; Johan Schaar, The Relationship between Climate Change and Violent Conflict. Edited by Sida, the Swedish Development Agency and International Cooperation, 2018, https://www.sida.se/contentassets/c571800e01e448ac9dce2d097ba125a1/working-paper—climate-change-and-conflict.pdf; Collective, 4 Degrees and Beyond: Implications of a global climate change of 4+ degrees for people, ecosystems and the earth system, Oxford University, 2009. The International Climate Conference, which was held in Oxford in 2009, brought together 35 speakers whose contributions are available here: https://web.archive.org/web/20100110053951/http://www.eci.ox.ac.uk/4degrees/programme.php  that describes the expected impacts of climate change over the next few decades. All aspects of human security will be affected. It is not our purpose to discuss these here, but rather to take stock of the significant change in needs which is expected, in volume, type and location(19)Bruno Jochum, Carol Devine, Dr Philippe Calain, Dr Maria Guevara et al.“Climate Change and Health: an urgent new frontier for humanitarianism”, The Lancet Countdown, November 2018, www.lancetcountdown.org/media/1422/2018-lancet-countdown-policy-brief-msf.pdf. Fully recognising the ecological crisis as a catalyst or exacerbator of humanitarian needs is a prerequisite for creating and adapting programmes in the most exposed areas and the deployment of specific expertise and partnerships. But to what extent does the climate emergency, and the accompanying industrial pollution, involve the mastery of new programmatic and technical knowledge, or does it merely confirm existing knowledge which will be used on a wider scale? It is essential to anticipate extreme events, chronic diseases linked to air, water and soil pollution, the isolation of large, forcibly-displaced populations, often without status and therefore deprived of services, the explosion of health requirements on the peripheries of megacities and atypical epidemiological situations. It is now critical to tackle new domains and give ourselves the tools to provide a better response and the lessons learned from field experience will be indispensable.

On 4 October 2016, the eye of hurricane Matthew struck the small community of Les Anglais on the Tiburon Peninsula in south-west Haiti. The hurricane left the country hours later, leaving behind 500 dead, hundreds of wounded and a completely devastated peninsula. For the residents of coastal towns, emergency humanitarian relief arrived about a week later, whilst populations in the peninsula’s mountainous inland regions had to wait several weeks before receiving the same aid(20)United Nations Office for the Coordination of Humanitarian Affairs, Haiti: Hurricane Matthew – Situation Report No.11 (15 October 2016). https://reliefweb.int/report/haiti/haiti-hurricane-matthew-situation-report-no-11-15-october-2016. The region, which has over 100,000 inhabitants, will take years to recover, leaving a highly vulnerable population to the mercy of future hazards. Given that meteorological models had anticipated the intensification of tropical storm Matthew and its trajectory over this part of the Caribbean more than four days in advance(21)National Hurricane Center Miami, Hurricane Matthew Discussion no. 12, 30 September 2016. https://www.nhc.noaa.gov/archive/2016/al14/al142016.discus.012.shtml?, could humanitarian organisations, in support of the Haitian government, not have helped with evacuations, thereby reducing the number of deaths?

This example illustrates the fact that humanitarian organisations would benefit from strengthening their anticipation capacities by investing in predictive and preparatory tools. Meteorological and environmental indicators which are often ignored would then be better integrated, in order to mitigate the impacts on populations and avoid “missing” certain crises. In the case of Haiti, active partnerships with specialised atmospheric science institutions would have enabled organisations to preposition teams, participate with the community in logistical protection actions, and speed up the response by several days.

The “dry corridors” of Central America are a known climate “hot spot”, a tropical region where the population is increasingly vulnerable to rising temperatures, drought and rainfall(22)World Food Programm, Erratic weather patterns in the Central American Dry Corridor leave 1.4 million people in urgent need of food assistance, 25 April 2019, https://www1.wfp.org/news/erratic-weather-patterns-central-american-dry-corridor-leave-14-million-people-urgent-need. MSF provides humanitarian medical care throughout this subregion, in Mexico, Guatemala, Honduras and El Salvador. The organisation is also studying the complex and sometimes combined, circumstances which are contributing to people’s decision to flee, including an analysis of needs specifically related to climate change. Migrants who attempt to reach northern Mexico and the United States are subject to extreme violence, from their home countries and throughout their journey(23)Médecins Sans Frontières, Forced To Flee Central America’s Northern Triangle: A Neglected Humanitarian Crisis, May 2017, https://www.msf.org/sites/msf.org/files/msf_forced-to-flee-central-americas-northern-triangle_e.pdf. Testimonies mention the lack of water in their region of origin, except for tourists, bankrupt farms, unemployment and the fact that life has become “impossible”. In northern Honduras, MSF is responding to a major dengue epidemic. It is essential to explore the potential effects of climate change on the transmission of this endemic disease in order to reduce its spread and prevent and treat the epidemic outbreaks that may occur(24)Kristie L. Ebi, Joshua Nealon, “Dengue in a changing climate”, Environmental Research, vol.151, November 2016, p.115-123. https://www.sciencedirect.com/science/article/pii/S0013935116303127. With its frontline experience, a humanitarian medical organisation can therefore contribute to a better understanding of the epidemiological evolution of certain chronic and infectious diseases.

Similarly, the capacities for humanitarian assistance in terms of access to drinking water are currently often inadequate in unstable or inaccessible areas, because of the lack of operational actors in the field and delays in deployment. Consequently, two questions deserve to be asked. Firstly, in anticipating climatic disturbances which lead to periods of drought and population growth in the most vulnerable areas (sub-Saharan Africa, the Indian subcontinent), should we not invest in more robust and sustainable interventions in terms of the regional capacities for water and sanitation that would provide for larger populations? Secondly, should we not incorporate engineering expertise in water and sanitation systems in order to respond to the crises that will occur in urban and peri-urban environments, especially in neglected slums rapidly growing around megacities in Africa, the Middle East and Asia? We know that climate refugees will primarily be internally displaced people following a slow and continuous route to these resource cities(25)See Humanitarian Alternatives, special issue “The urban bomb: which impact for humanitarian workers?”, no.10, March 2019, http://alternatives-humanitaires.org/en/tenth-issue-march-2019(editor’s note)..

The issues are often cross-cutting, suggesting the importance of interdisciplinary work. Building real operational capacity for interventions requires innovation and skills-development in domains such as environmental epidemiology, morbidity and associated mortality, water stress, food insecurity, climatology and meteorology. It would be strategic to build alliances and develop strong partnerships with different institutions. Finally, MSF and other humanitarian organisations could usefully collaborate with these institutions by sharing some of their own health data and analyses in order to contribute to a better understanding of the impacts of the ecological crisis.

The limits of humanitarianism and the need to radically accelerate mitigation efforts 

Although humanitarian organisations are used to speaking out to give evidence, raise the alarm or make a stand, the climate crisis presents them with new dilemmas. As a medical organisation, MSF is particularly well-placed to communicate the humanitarian consequences of climate emergencies on the most vulnerable populations, and to give a vital human face to these impacts. But the credibility of this communication depends on the ability of the field personnel to establish a direct causal link between their observations and the regional or global scale of climate change. The “observable fact” for humanitarian workers would therefore require an adaptation of analytical frameworks in order to gather relevant information from vulnerable communities and local actors. It would also require the ability to integrate and relate their programme data to recognised scientific analyses, while fully accepting the synergy and working partnerships.

For example, the development of maternal and infant morbidity and mortality in the Sahel could be cross-referenced with access to agricultural commodities and climate pressure. A number of institutions are studying the link between climate, environment, economy, health and society, and could be partners in operational research projects with humanitarian organisations. The use of elements from their work would enable a refining of the reading of certain crises by humanitarian workers and would enrich the narrative built around the sources of the needs which they identify. Niger, the Lake Chad region, Nigeria (especially Borno State), Darfur in Sudan, Bangladesh, the Philippines, Mozambique and Central America would all be suitable settings for such partnerships.

For its part, the new scientific field of climate change attribution(26)Quirin Schiermeier, “Droughts, heatwaves and floods: How to tell when climate change is to blame”, Nature, no.560, 30 July 2018, p.20-22. https://www.nature.com/articles/d41586-018-05849-9 aims to evaluate whether a given environmental change can be attributed to climate change. Its results, together with testimony from humanitarian workers, could provide additional validation for establishing a causal link between climate change and observed disasters. By contributing both accounts and data to the public narrative, medical personnel in particular can play a role in raising awareness and encouraging a societal response in terms of mitigation and adaptation. They can conclusively demonstrate that climate change is also a public health issue. They can lobby for policies that focus on the people most affected by the direct and indirect consequences of climate change. In contrast, choosing to ignore or not to investigate the link between certain situations encountered in the field and the environmental factors at play at this critical moment of climate emergency would be a decision with very serious consequences.

Beyond bearing witness, lobbying and contributing to the public narrative, humanitarian organisations play an essential role in raising the alarm amongst political leaders, by exposing the inevitable limits of their actual capacities to provide assistance and prevent risks. With a prediction of 200 million forcibly displaced people by 2050, compared to 65 million today(27)International Organization for Migration, Migration and Climate Change, 2 November 2018. https://www.iom.int/migration-and-climate-change-0, and a decrease in regional agricultural production leading to a rise in malnutrition(28)Nicholas Watts, Markus Amann, Sonja Ayeb-Karlsson et al., “The 2018 Report of The Lancet Countdown…”, art. cit.; Intergovernmental Panel on Climate Change. Global Warming of 1.5ºC, Summary for Policymakers, 8 October 2018., expectations of the humanitarian system are disproportionate in relation to even the most conservative climate scenarios. The limits have already been exceeded and significant delays in the responses in current contexts (Sudan, the Central African Republic, Nigeria, Yemen, Syria, Lebanon) mean that it is very unlikely that public and private humanitarian actors will be able to prevent a considerable rise in the number of victims. It is perfectly legitimate to focus on adapting to a world that is 2°C warmer and the ways of preparing for this in order to reduce risks(29)Åsa Persson, Adis Dzebo, “Exploring global and transnational governance of climate change adaptation”, International Environmental Agreements: Politics, Law and Economics, Springer, 2019. https://link.springer.com/article/10.1007/s10784-019-09440-z; Russell Wise, Ioan Fazey, Mark Stafford Smith, et al., “Reconceptualising adaptation to climate change as part of pathways of change and response”, Global Environmental Change, vol.28, September 2014, p.325-336. https://www.sciencedirect.com/science/article/pii/S095937801300232X, but this can sometimes lead to complacency, clearly overestimating the ability to respond to future humanitarian crises. It underestimates the importance of political obstacles to solidarity and the fact that neither the discourse of resilience, nor that relating to “localisation”, will prevent the new situation. It also dangerously exonerates political actors, foremost in the major emitting countries, from their primary responsibility to avoid the most serious scenarios linked to global warming by immediately applying the “carbon law” to reduce their greenhouse gas emissions.

With regard to positioning, to what extent and in what situations should humanitarian actors look into the causes of crises rather than concentrating on organising aid and alleviating suffering? This classic question, stemming from contexts of war or violence against populations, needs to be reviewed in the light of the ongoing ecological crisis. The traditional argument, according to which a humanitarian organisation should abstain from attributing responsibility for a particular crisis to a specific cause or set of actors actually has two origins: on the one hand, the respect for neutrality and a political independence needed gain access to conflict areas, and on the other hand, the lack of vocation and/or skill to establish often complex causal links. In the case of the ecological crisis, the facts and causes are established by a very large scientific community whose authority is now fortunately undisputed. Unlike human violence, which is, by nature, difficult to control, the agro-energy production and consumption systems which are responsible for greenhouse gases can be managed. Responsibilities are not proportionally equivalent but they ultimately concern all countries and are present at all levels of society.

Consequently, there is no fundamental reason for humanitarian organisations to steer clear of the diagnosis which has been established by science, or to refrain from stating the cause when it is established, the overall responsibilities it implies, or the objectives of reducing emissions which need to be attained in order to stabilise the climate and avoid the worst human consequences. On the contrary, it is becoming imperative in the current environment to go beyond the role of simply being technical adaptation agencies contributing to the preparation and mitigation of the consequences, whilst being aware that the resources will not be enough. Is it ethical to prepare technically for the worst-case scenario without taking a public interest in the causes of the crisis? In highlighting their capacity limits, do humanitarian workers not have a duty to remind people that the best prevention is still to avoid the current trajectory in order to restore a stable climate? Finally, the spirit of moral revolt in the face of the predicted disaster must lead them to denounce political inaction and call for the rapid implementation of appropriate mitigation strategies. 

Questioning humanitarian responsibility

Faced with the ecological crisis, no institution can escape its own responsibilities. Humanitarian organisations are similar, in this way, to all other actors, but they also have a particular vantage point given their unequalled presence amongst the first affected populations, their in-depth knowledge of the medical and human impacts, their ability to demonstrate the links between conceptual forecasts and current realities, and their social mission devoid of private interest. They have a unique and specific role to play with regard to the issue of climate change, but also, more broadly the issue of environmental degradation.

Following the emergency call launched by the scientific community in 2017(30)William J. Ripple, Christopher Wolf and 15,364 scientist signatories from 184 countries, “World Scientists’ Warning to Humanity, A Second Notice”, BioScience, Volume 67, Issue 12, December 2017, Pages 1026-1028, https://doi.org/10.1093/biosci/bix125, taking responsibility means becoming unequivocally involved in the managerial and operational choices of a roadmap to achieve carbon neutrality within 20 or 30 years, with measurable and credible interim targets, including halving emissions by 2030. It also means fully recognising the ecological crisis as a catalyst and/or exacerbator of humanitarian crises, in the same way as conflicts, epidemics or endemic diseases, exclusion, social violence and “natural disasters” (a somewhat old-fashioned expression). This could help implement or strengthen the capacities for analysis and expertise and the technical investments necessary to improve the operational response. Finally, health humanitarian organisations in particular, would also fulfil a strategic role in line with their social vocation: to be the critical witnesses in the field of the medical impacts of the disruption caused by our development model. Emboldened by their own choices to reduce their polluting practices, and by the field assistance they provide to the most vulnerable, they will be justified in calling for the avoidance of the most dramatic scenarios through an acceleration of mitigation policies strong enough to meet the challenge.

Climate change has become a dominant political and social issue within societies which, although divided, are concerned with finding alternatives to the social and economic model which has led to the state of existential crisis we are experiencing. As the pressure from external events grows, this upheaval may well divert societies and the allocation of their resources away from international solidarity towards the radical transformation effort required at home, whilst encouraging the emergence of conflicting global ideological frameworks not all of which will be humanist in nature. It is therefore no longer a given that the “without borders” movement, which emerged almost fifty years ago in a very different context, will continue to make sense for its social base, especially for younger generations, if it does not integrate the ecological crisis more centrally within its social mission and public positioning. On the other hand, choosing to confront it directly will not only lead to an imperative for action in favour of populations otherwise doomed to focus on profits and losses, but will also enable us to find a new legitimacy for the humanitarian project in the new historical era that is beginning. 

This article commits only its authors and in no way the organisation to which they belong.

The authors express their thanks to the team of the Research unit on humanitarian issues and practices (UREPH), the MSF think tank in Geneva: Françoise Duroch, Philippe Calain, Amy Mavor and Duncan McLean. 

Translated from the French by Juliet Powys

  

Biographies

Bruno Jochum • Bruno, who is currently a fellow in residence at the Geneva Centre for Security Policy (GCSP), is the former Director General and Operational Director at MSF’s operational centre in Geneva. Bruno joined MSF in 2001 as Head of Mission. He is a graduate of the Institute of Political Studies in Strasbourg, and has a Master’s in International Relations and a Master’s in International Public Law.

François Delfosse • François is responsible for the development of the environmental roadmap at MSF’s operational centre in Geneva, within the Research Unit on Humanitarian Issues and Practices. He has a Master’s degree in Geopolitics and a diploma of logistics applied to humanitarian aid. François joined MSF in 1997.

Maria Guevara • Maria is a doctor, Senior Operational Positioning and Advocacy Advisor in public health, and Head of the working group on global health at MSF’s operational centre in Geneva. She has acquired extensive field experience with MSF since 2004. She has had specialised training in pulmonary medicine and intensive care, and has a diploma in tropical medicine and hygiene and a Master’s in public health policy.

Léo Lysandre Tremblay • Léo is a specialised consultant for water and atmospherics, a meteorologist and a former Head of water and sanitation in emergency operations for MSF. He has a diploma in atmospheric and oceanic science and a Masters in hydrogeology.

Carol Devine • Carol is the Humanitarian Advisor for MSF Canada and former head of MSF’s Campaign for Access to Essential Medicines. She works on the climate, the environment and health for MSF. She has a Master’s in Sciences from the University of London and is a member of the Society of Women Geographers, Social Science Expert Group of Scientific Committee on Antarctic Research.

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1. Nicholas Watts, Markus Amann, Sonja Ayeb-Karlsson et al., “The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health”, The Lancet, 391/10120, 30 October 2017.
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3. Climate Action Tracker, 11 December 2018, https://climateactiontracker.org/global/temperatures
4. The scenarios described by the Intergovernmental Panel on Climate Change (IPCC) do not take into account a number of “tipping points” which, once a certain temperature has been reached, will set off feedbacks and a possible loss of control of the climate system, leading to a “Hothouse Earth” in the 21stcentury. Will Steffen, Johan Rockström, Katherine Richardson et al., “Trajectories of the Earth System in the Anthropocene”, Proceedings of the National Academy of Sciences of the United States of America, 2018. https://www.pnas.org/content/115/33/8252
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6. IPCC press release, 8 October 2018. https://archive.ipcc.ch/pdf/session48/pr_181008_P48_spm_fr.pdf
7. Johan Rockström, Owen Gaffney, Joeri Rogelj et al., “A roadmap for rapid decarbonization”, Science, 355/6331, 24 March 2017, p.1269-1271, https://science.sciencemag.org/content/355/6331/1269
8. Press release: « Le dangereux déclin de la nature : un taux d’extinction des espèces “sans précédent” et qui s’accélère », Plateforme intergouvernementale sur la biodiversité et les services écosystémiques, 6 mai 2019.
9. Cognitive dissonance refers to a situation involving contradictory attitudes, beliefs or behaviours. The term was invented by Leon Festinger in his book A Theory of Cognitive Dissonance (1957). https://www.simplypsychology.org/cognitive-dissonance.html
10. Locally polluting operational practices and overall net contribution to CO2emissions.
11. Thus, the following binding motion, was voted by the International General Assembly of MSF on June 30, 2019: “Recognizing the current climate emergency, and in line with our mission and our social responsibility, MSF should urgently commit to addressing the growing humanitarian consequences of environmental degradation, and in particular climate change, on vulnerable populations, by integrating this commitment into the strategy and medico-operational policies at the scale of the MSF’s movement. This should translate into an environmental policy and dedicated resources to mitigate our own footprint; a strategic operational engagement related to the climate crisis; and an associated strategy of public positioning and advocacy to mitigate the negative impacts on the environment and the health of populations at risk.”
12. In their article, “Humanitarianism in the Anthropocene”, Sverre Molland and Darryl Stellmach describe “humanitarian action [as] an industrialised response to suffering. The same tools and techniques that power global capitalism also enable humanitarian action: transnational supply chains, administration, media and communications mobilise personnel and materials to faraway places”, 13 August 2016, http://somatosphere.net/2016/08/humanitarianism-in-the-anthropocene.html
13. Aptitude of an organisation to resist shocks, adapt or bounce back. Gilles Teneau, La Résilience des organisations, Les fondamentaux, L’Harmattan, 2017.
14. Johan Rockström, Owen Gaffney, Joeri Rogelj et al., “A roadmap…”, art.cit.
15. Nations unies-Plateforme de compensation carbone, Certification ONU des réductions d’émissions de gaz à effet de serre, https://offset.climateneutralnow.org/uncertification
16. World Bank and Ecofys, State and Trends of Carbon Pricing 2018, World Bank, Washington, DC, 2018; 2018 World Bank report on initiatives intended to put a price on carbon, https://openknowledge.worldbank.org/bitstream/handle/10986/29687/9781464812927.pdf?sequence=5&isAllowed=y
17. The concept of “planetary boundaries” refers to the limits that must not be exceeded if humanity wants to evolve in a safe global ecosystem. See Johan Rockström, Will Steffen, Kevin J. Noone, et al., “A safe operating space for humanity”, Nature, no.461, 23 September 2009, p.472-475. https://www.nature.com/articles/461472a According to the researchers behind the concept, four of the nine identified boundaries are exceeded or close to being: climate change, biodiversity erosion, the nitrogen cycle erosion, and that of phosphorus. See Will Steffen, Katherine Richardson, Johan Rockström, et al.,“ Planetary boundaries: Guiding human development on a changing planet”, Science, Vol. 347, 13 February 2015, https://science.sciencemag.org/content/347/6223/1259855.abstract
18. For example, non-exhaustively, Dina Bélanger, Pierre Gosselin, Ray Bustina et al. Changement climatique et santé, Prévenir, soigner et s’adapter,Editions Hermann, Presses de l’Université Laval, 2019; George Luber, Jay Lemery, Global climate change and Human health, Editions Jossey-Bass, 2015; Johan Schaar, The Relationship between Climate Change and Violent Conflict. Edited by Sida, the Swedish Development Agency and International Cooperation, 2018, https://www.sida.se/contentassets/c571800e01e448ac9dce2d097ba125a1/working-paper—climate-change-and-conflict.pdf; Collective, 4 Degrees and Beyond: Implications of a global climate change of 4+ degrees for people, ecosystems and the earth system, Oxford University, 2009. The International Climate Conference, which was held in Oxford in 2009, brought together 35 speakers whose contributions are available here: https://web.archive.org/web/20100110053951/http://www.eci.ox.ac.uk/4degrees/programme.php 
19. Bruno Jochum, Carol Devine, Dr Philippe Calain, Dr Maria Guevara et al.“Climate Change and Health: an urgent new frontier for humanitarianism”, The Lancet Countdown, November 2018, www.lancetcountdown.org/media/1422/2018-lancet-countdown-policy-brief-msf.pdf
20. United Nations Office for the Coordination of Humanitarian Affairs, Haiti: Hurricane Matthew – Situation Report No.11 (15 October 2016). https://reliefweb.int/report/haiti/haiti-hurricane-matthew-situation-report-no-11-15-october-2016
21. National Hurricane Center Miami, Hurricane Matthew Discussion no. 12, 30 September 2016. https://www.nhc.noaa.gov/archive/2016/al14/al142016.discus.012.shtml?
22. World Food Programm, Erratic weather patterns in the Central American Dry Corridor leave 1.4 million people in urgent need of food assistance, 25 April 2019, https://www1.wfp.org/news/erratic-weather-patterns-central-american-dry-corridor-leave-14-million-people-urgent-need
23. Médecins Sans Frontières, Forced To Flee Central America’s Northern Triangle: A Neglected Humanitarian Crisis, May 2017, https://www.msf.org/sites/msf.org/files/msf_forced-to-flee-central-americas-northern-triangle_e.pdf
24. Kristie L. Ebi, Joshua Nealon, “Dengue in a changing climate”, Environmental Research, vol.151, November 2016, p.115-123. https://www.sciencedirect.com/science/article/pii/S0013935116303127
25. See Humanitarian Alternatives, special issue “The urban bomb: which impact for humanitarian workers?”, no.10, March 2019, http://alternatives-humanitaires.org/en/tenth-issue-march-2019(editor’s note).
26. Quirin Schiermeier, “Droughts, heatwaves and floods: How to tell when climate change is to blame”, Nature, no.560, 30 July 2018, p.20-22. https://www.nature.com/articles/d41586-018-05849-9
27. International Organization for Migration, Migration and Climate Change, 2 November 2018. https://www.iom.int/migration-and-climate-change-0
28. Nicholas Watts, Markus Amann, Sonja Ayeb-Karlsson et al., “The 2018 Report of The Lancet Countdown…”, art. cit.; Intergovernmental Panel on Climate Change. Global Warming of 1.5ºC, Summary for Policymakers, 8 October 2018.
29. Åsa Persson, Adis Dzebo, “Exploring global and transnational governance of climate change adaptation”, International Environmental Agreements: Politics, Law and Economics, Springer, 2019. https://link.springer.com/article/10.1007/s10784-019-09440-z; Russell Wise, Ioan Fazey, Mark Stafford Smith, et al., “Reconceptualising adaptation to climate change as part of pathways of change and response”, Global Environmental Change, vol.28, September 2014, p.325-336. https://www.sciencedirect.com/science/article/pii/S095937801300232X
30. William J. Ripple, Christopher Wolf and 15,364 scientist signatories from 184 countries, “World Scientists’ Warning to Humanity, A Second Notice”, BioScience, Volume 67, Issue 12, December 2017, Pages 1026-1028, https://doi.org/10.1093/biosci/bix125