There can be no health justice without climate justice

South Asia is already seeing the devastating health impacts of climate change. In 2024, the average Indian could experience about 20 heatwave days, of which 6.5 days were directly attributable to climate change. In 2024, an estimated 247 billion potential labor hours are lost due to extreme heat, primarily in the agricultural and construction sectors. This resulted in economic losses of approximately $194 billion, underscoring the severe impact of climate change on both lives and livelihoods. Between 2000–2019, approximately 489,000 heat-related deaths occurred each year, of which 45% occurred in Asia and 36% in Europe.

Changes in monsoon patterns and saltwater intrusion into coastal areas impact crop cycles and traditional farming practices, impacting food security in a region already burdened with malnutrition and poverty. Air pollution from industrial and vehicle emissions, construction, road dust and fossil fuel burning is not only choking the lungs of millions of people, but also worsening forced migration, conflict, gender and caste-based violence, economic inequalities and much more. However, these impacts are not felt equally across all communities. Disadvantaged communities such as the urban poor, Dalits and tribal communities, who contribute the least to the climate crisis, are suffering the most. First, their homes are flooded, they continue to travel long distances to drought-stricken areas in search of water, their children fall ill from extreme heat and polluted air, their livelihoods are lost as crops fail and more often than we know, they are forced out of their homes to extract the minerals that fuel our industries and boost the country’s economy.

As Doctors Without Borders, or Medecins Sans Frontiers (MSF), we see this firsthand in the communities we work with. For example, the tremendous health impacts of floods can be seen even six months after the devastating floods that hit Pakistan in 2022. Despite the onset of winter, malaria cases were increasing; Malnutrition cases were worsening due to inadequate access to food and safe drinking water. And to add to this suffering, displaced communities in the worst affected areas still need to prepare for winter while living in temporary shelters. These first-hand experiences that we see drive our climate action and response.

Health equity means ensuring that everyone has a fair opportunity to be healthy, regardless of their socio-economic status, race, gender or geography. But how can we achieve this when the climate crisis is testing the resilience of our health systems every day? Health care facilities in disaster-stricken areas struggle to remain operational during stressful events and lack emergency preparedness plans. Often, health care providers lack the resources and training to deal with climate-induced adversities. Indigenous communities, who have relied on their traditional knowledge of forests for generations, are increasingly being displaced from their lands and homes. This displacement threatens not only their homes but also their deep understanding of traditional farming, climate adaptation and cultural practices linked to nature. This is a sudden loss of the wealth of knowledge passed down through generations.

Some initiatives like the Heat Action Plan (HAP), training of community-based first responders on rapid cooling mechanisms in India, emergency preparedness training in Sri Lanka are important steps in the right direction, but they alone cannot be successful. National action plans on climate change in many countries now include a health mission, but implementation remains uneven due to top-down approaches, limited community consultation, and limited convergence between different agencies working on climate-related issues. Without addressing the root causes of climate vulnerability and relevant interventions, these efforts will remain mere band-aids on a deep wound.

Indigenous communities have long known how to live in harmony with nature. From mangrove restoration in the Sundarbans to traditional farming techniques that conserve water and soil, their knowledge provides scalable, sustainable solutions to climate challenges. Centralizing community knowledge is key to building democratic climate resilient systems.

In the Yaku Mama Flotilla, led by indigenous women, communities from Ecuador, Peru, Colombia and Brazil have united to undertake a 3,000 kilometer journey by river to COP 30. Their demand is simple ‘COP 30 cannot take decisions about us without us.’ They demand indigenous-led climate solutions. While this is inspiring, a pertinent question is why something that is long overdue still needs a central demand at an event where global leaders meet to take decisions that impact these communities most. Why is their voice missing from what has historically been the most influential and decisive climate sector? We hope that the spirit of popular participation seen in Belém will not only continue but can be further strengthened in any future climate negotiations.

Indigenous knowledge is not just cultural heritage. It can complement scientific resources. Studies show that integrating traditional ecological knowledge into climate adaptation planning can increase resilience, protect biodiversity and improve food security. Policymakers should prioritize investments in climate-resilient infrastructure, sustainable agriculture, and community-based adaptation initiatives that center indigenous voices and leadership.

The intersection of climate and health demands an integrated response: health must be a climate priority.

National policies on health and climate adaptation should clearly link health outcomes to climate resilience, ensuring that vulnerable communities are not only protected but also treated as equal partners in decision-making. Recognizing this urgent need, MSF is organizing regional climate scenario workshops to integrate climate and health action. These workshops aim to map the impacts of this twin crisis and prepare for the future, helping humanitarian organizations like ours understand what lies ahead and how best to respond to this growing challenge.

We need to demand direct climate financing for indigenous and local initiatives such as community health worker programs, community-based emergency preparedness plans, and community-led restoration and conservation initiatives.

Government bodies, international agencies, community-based organizations and minority protection bodies should collaborate to scale up climate action and enable inter-regional policies that address climate, health and social justice issues. To achieve this, MSF is hosting a Regional Working Group of South Asia Climate Experts, which has brought together approximately 40 organizations from the South Asia region to identify and define pathways for collaborative climate action in the region. The working group has representation from academics, government bodies, international agencies, local CBOs, health care and environmental activists, youth members and journalists.

Media, academia and civil society must highlight the stories and solutions of the most affected people, not just as victims, but as thought leaders and implementers of indigenous low-cost innovative mechanisms for adaptation.

South Asia has a unique opportunity to lead the world in climate-equitable health policies. This requires political will, public pressure and a commitment to equality. As we participate in the negotiations at COP30 and approach the deadline of the 2030 Sustainable Development Goals, the message must be clear ‘Health justice cannot be achieved without climate justice.’ Both must be addressed together, in collaboration with the communities most affected.

The question now is not whether we have the resources to act, the question is whether we have the resources not to act.

This article is written by Dr. Sewanti Ghosh, Head of Strategic Medicine, Médecins Sans Frontieres, South Asia.