The issue of climate-forced migration, and its impacts on human health, is a discourse that is often underplayed when it comes to discussions about climate impacts and adaptation.  The ramifications of ignoring it, and consequently failing to put in place appropriate policy frameworks to cope with increased levels of migrants at an international level, will be huge.  The health problems associated with climate-related migration also pose a major challenge for existing healthcare systems and the international humanitarian response. 

According to International Organisation for Migration and United Nations figures, between 200 million and 1 billion people could be forced to leave their homes between 2010 and 2050 as the effects of climate change worsen, potentially inundating current response strategies.

Climate change migration is already happening across the world - right now. 

Some are migrating because of the direct impacts of natural disasters like floods, droughts and acute water shortages.  Whilst indirect impacts such as conflict and increases in food prices can also contribute to people being forced to leave their homes.

There is no doubt that forced migration due to climate change will increase the pressure on existing infrastructure and urban services, especially in sanitation, education and social sectors and also consequently increase the risk of conflict over access to scare resources, even amongst migrants.

A study released on 28 November, entitled ‘where the rain falls: climate change, food and livelihood security, and migration’ reveals a much more nuanced relationship between projected climate variability and migration, which could provide key insights into likely drivers of migration the coming years.  The study, carried out by CARE International and UN University, in 8 countries in Asia, Africa and Latin America, revealed that in nearly all instances in which rains have become too scarce for farming, people have migrated, but mostly within national borders. 

At a side event at COP18 on this issue last week, one of the authors, Dr Koko Warner, remarked that "those resilient households use migration to reduce their exposure to climatic variability… In those households, migrants are in their mid-20s, single, move temporarily and send remittances back home. Those resilient households use migration to invest in even more livelihood diversification, education, health and other activities that put them on a positive path to human development."

However, there are also much starker consequences for more vulnerable households:

1. Households may migrate in an attempt to manage risk but suffer worse outcomes.  They are found in countries with less food security and fewer options to diversify their incomes. They move within their countries seasonally to find work, often as agricultural labourers.

2. The study also described how migration could be an ‘erosive coping strategy’; as a matter of human security, when few other options exist. These households are found in areas where food is even scarcer. They often move during the unpredictable dry season to other rural areas in their regions in search of food or work.

3. Lastly, the study found "households that are trapped and cannot move, and are really at the very margins of existence," according to Warner. These households do not have the capacity to migrate.

Health policy making in the context of migration can either been seen as a human rights issue, putting the needs of the individual first, or as a security issue, in terms of its threats to public health (eg. communicable disease control) and social stability.  The latter approach relies principally on monitoring, surveillance and screening, and could be argues to be the modern-day cousin of centuries-old quarantine measures, without an individual-focused perspective.  The human-rights based approach takes into account nuances and special needs of individuals, as well as the social determinants which may have affected individuals’ health along the migratory pathway.

With respect to the UNFCCC process, the response to environmental migration is an area that is particularly underdeveloped.

The negotiating text elaborated at Tianjin in 2010 invited Parties to enhance adaptation action under the Adaptation Framework through: [‘m]easures to enhance understanding, coordination and cooperation related to national, regional and international climate change induced displacement, migration and planned relocation, where appropriate’.  The Cancun agreement in 2010 took some strides forward and laid out a roadmap for progress with reference to migration, but as yet it hasn’t been implemented, and highlights the need for better and more equitable policy at a global level.

As Jane McAdam observes: “Finally—and perhaps most significantly—there seems to be little political appetite for a new international agreement on protection. As one official in Bangladesh pessimistically observed, ‘this is a globe for a rich man’.

In “Migration and Climate Change,” a recent publication by UNESCO, Stephen Castles, Associate Director of the International Migration Institute at the University of Oxford suggests that we may need to re-think our strategy.  “The doomsday prophesies of environmentalists may have done more to stigmatize refugees and migrants and to support repressive state measures against them, than to raise environmental awareness.”

We should be doing more, much more, to raise awareness of this issue, and we must start preparing to cope effectively with the health issues associated with it.

The UN climate talks were an exhausting, turbulent and yet thrilling time. Reading the lack of coverage in the British press – on the occasions we tried to find out what was happening in the outside world – was always a shock to the complete immersion we experienced in Durban. Everything centred around the negotiations. We read COP17, we talked COP17, we campaigned COP17, we wrote COP17. Christ, we even slept COP17.  Now it’s time to document our journey.

  The Kenyan Youth Climate Caravan (or 6 trucks to be more precise) travelled from Nairobi to Durban over 42 days, carrying 161 climate activists from 18 countries. On the way they performed in local concerts and rallies, engaging and mobilising communities. At their arrival at the Conference of Youth they entered in the room in style to perform to other youth activists from all around the World. It was incredible.

Throughout Durban Medsin worked closely with the International Federation of Medical Student Associations (IFMSA), the World Health Organisation and other international health NGOs, to raise awareness of the massive health impacts of climate change and ensuring that the protection of health is an integral part of adaption measures, where countries prepare for the effects of climate change we know are on the way.

This year saw the inaugural Climate and Health Summit held in Durban. Opened by the South African Secretary of State for Health, followed by a day of plenaries and panel discussions with experts from the World Health Organisation, Health Care Without Harm and more, the Summit concluded with a Durban Declaration on Climate and Health, signed by hundreds of healthcare professionals, government ministers and summit delegates. This declaration was released in a press conference during which Medsin and the IFMSA staged a demonstration where we took the temperature of the Earth.

We felt whilst in South Africa, a country wrought with AIDS, it was of the upmost importance that we highlighted this link. So, to commemorate World AIDS Day, we formed a red human ribbon around the Earth. We gained significant media attention, including coverage on CNN and gave television interviews to broadcasters from around the World.

At the end of each day civil society awards the most obstructive country in the talks a ‘fossil’. Countries hate this public shaming and there’s often an official response from government ministers. Here, Canada is awarded 1st place, early on in the conference, not only for refusing to renew their commitments in the Kyoto Protocol, but also entering the week saying they were here to play hard-ball with developing countries whom they were ‘sick of playing the guilt card’. You couldn’t make this stuff up.

HOWEVER. The Canadian Youth Delegation, embarrassed and outraged by their country’s behaviour, made it clear throughout the conference that their government were acting on behalf of polluters and not the Canadian people. During the opening statement of their environmental minister at the negotiating plenary, 6 Canadian young people stood up and turned their back on Canada, and were subsequently ‘debadged’ and removed from the conference centre. Many official government delegates from other countries broke into applause and the Canadian minister was visibly shaken.

The next day, Abigail Borah, part of the US youth delegation, stood up during the speech of Todd Stern and interrupted the lead US negotiator in an intervention on behalf of the America people:

“They cannot speak on behalf of the United States of America … the obstructionist Congress has shackled a just agreement and delayed ambition for far too long.”

On the scheduled final day Anjali Appadurai, from Earth in Brackets, delivered an impassioned and powerful speech on behalf of the young constiuency. Afterwards she moved away from the podium and shouted ‘mic check’. This prompted 50 young people spread around the plenary room to stand up and repeat ‘mic check’ in unison. After another mic check she shouted the following: (the italics are the human microphone effect in repetition). Yet again, a significant majority of the government ministers in the room stood and this time gave our intervention a standing ovation, sending a clear message for stronger action.

Equity now.  You’ve run out of excuses.  And we’re running out of time.
Get it done.

On the last official day of negotiations civil society took an unprecedented stand in solidarity with Africa and Small Island States, representing some of the people most vulnerable to climate change.  Hundreds of civil society delegates held a massive protest and went into occupation of the conference centre, right outside the plenary room where ministers were negotiating. Government ministers from the Maldives and a number of African countries joined us and we then escorted them into the negotiation session. The momentum generated was incredible – many negotiators told us that this stand allowed them to push for stronger action inside the hall.

Negotiations continued long into the night from the scheduled end on Friday evening, through Saturday and reaching a conclusion around 5am on Sunday. The major issues surrounded the renewal of the Kyoto Protocol and the roadmap to a future climate deal. Previously the big emerging economies of China, Brazil and India had refused to commit to legally binding targets as part of this future treaty. In the early hours of Sunday morning the South Africa chair of the plenary asked the EU and India to form a huddle to reach an agreement on the legal status of a future deal. This picture was taken metres from the action (- note our very own Chris Huhne centre-right). Brazil suddenly came up with the wording ‘Agreed outcome with legal force’ which both India and EU (and other countries) agreed to, at which point the South Africa chair ran off in much relief to adopt the Durban Platform for Enhanced Action. Importantly this means that a future deal, to be agreed by 2015 and implemented in 2020, will be legally binding for all countries. This is good news considering the expectations going into the final days of the conference. However, it’s important to remember there’s still a massive gap in the action required now to safeguard the future survival of millions of people. We’re not done yet.

The conference of youth has already begun in Durban and the actual Conference of the Parties will be kicking off on Monday. I am both very excited and also a little bit concerned. I am excited because I feel that this year the Medsin delegation has put in so much work on framing our message and in understanding the negotiation process and the various audiences we want to target, that even though I won’t be going to join them, I know that they will all do their best to make the health message be heard.

What I am a little bit concerned by is how the media is going to cover the conference- would very little coverage be preferable to coverage of in fighting and walkouts? How much of the content of the negotiations, as opposed to the dramas will be covered? And something perhaps a little bit more philosophical- is it good that climate change has turned from being news-worthy to being something that is more in the features pages...

Most of these worries are a bit excessive, and probably mainly to do with the fact that I won’t be in Durban to throw myself into the work, so instead I will be scouring the media keenly here to keep an eye on how things get translated.  However I have been thinking, and realised that sometimes lack of media coverage can perhaps be a good thing. It is easy to get caught up with the negotiations, but what is really important is the long term work on personal, institutional and wider societal change that really matters.

Durban is a good spring board to encourage action and enthusiasm and offers a time and place to take stock, however what is really important is for us to let people know about the wonderful work that the already being done. And as healthcare professional we have already been doing a lot, and we have the capacity to do a lot more; we just need to incorporate sustainability into our everyday practice and clinical thinking and make use of the partnerships that are available to us.

And as medical students we are in the right place to make these changes, whether through asking climate change and health to be included as part of our curricular, doing projects and SSCs on the subject, and even just asking the consultants who teach us about their own clinical practice, and how they can make it better.  So even if we don’t get the media exposure we wanted from the Durban conference, there’s still a lot of very important work to be getting on with!

Below are just a few links to the work that the UK health community is already doing well:

http://sustainablehealthcare.org.uk/green-nephrology-programme : Spearhead clinical programme that aims to look at how to make renal medicine and dialysis more sustainable
http://www.nottenergy.com :  A local government and NHS trust partnership that aims to address health inequalities, by working on fuel poverty.
http://www.bluegym.org.uk :  Community and university project that aims to look at how our coasts can be used for health benefits