What does a Health Day at COP28 mean for the Middle East?

For years, the World Health Organization (WHO) and civil society have been calling for the inclusion of health on the global climate agenda, but calls have fallen on deaf ears. The WHO has consistently reiterated that climate change is "the biggest global health threat facing the world in the 21st century”. Now, at the 28th annual United Nations Climate Change Conference, global health and environment ministers gather for the first time at the same table. COP28, held this year in the UAE, has designated December 3, 2023, the first-ever COP Health Day.

“It is time to end any silly confusion on whether the climate crisis is a health crisis… health is the human face of climate change,” said UAE Minister of State for International Cooperation Reem Al-Hashimy on Saturday.

The WHO has consistently urged that climate change is the biggest global health threat facing the world in the 21st century. Now, at the 28th annual UN Climate Change Conference, global health and environment ministers gather for the first time at the same table

On Saturday, the COP28 Presidency unveiled the ‘COP28 UAE Declaration on Climate and Health’, in addition to announcing $1 billion in financing for climate and health. Endorsed by 123 countries, the Declaration marked a world first in acknowledging the need for governments to protect communities and prepare healthcare systems to cope with climate-related health impacts.

Signatories have committed to incorporate health targets into their national climate plans, and improve international collaboration to address the health risks of climate change, including at future COPs.

In the Middle East, a ‘hotspot’ for the climate crisis, human health is directly affected by extreme weather events, water shortages, food insecurity, and air pollution. Climate change in the region has also influenced the epidemiology of vector-borne diseases (VBDs) and health consequences of population displacement.

The declaration “brings an overdue recognition to health in the climate space”, environmental health expert and Director of Greenish foundation Mohamed Kamal told Raseef22.

Kamal explained that the declaration highlights a number of key elements that are rarely discussed or referenced in negotiations, such as climate sensitive disease and health risks, mental and psychological health impacts due to climate, and “addressing environmental determinants of health”.

“The declaration would provide a reference point for future discussions, commitments, pledges and programs,” he said.

Finance and accessibility

Among the newly announced financial pledges targeting climate and health is a 300 million USD commitment by the Global Fund to prepare health systems, 100 million USD by the Rockefeller Foundation to scale up climate and health solutions, and up to 54 million GBP by the UK Government.

But according to Kamal, the declaration only “diplomatically and vaguely” covers how the promised funds would go to countries in need.

“Terms such as ‘climate resilient health systems’ imply that there exist adequate health systems that need to be made more resilient. The truth is however, that those most vulnerable to climate impacts also lack basic access to healthcare. Thus, the question becomes, what would fit under climate and health finance? Is it even appropriate?” he said.

Complicating the issue further are countries that have high levels of pollution and highly strained public health systems. “Are they eligible for climate ‘health’ funds?,” Kamal pointed out.

At the moment, discussions are targeted towards allocating funds and aid to areas where public health is affected by heat stress, disease outbreak, or loss of medicinal knowledge and supply proven to be caused by climate change. Kamal points out that this emphasizes the issue of having to “prove” a need for funds.

Founder and Director of the Palestine Institute for Biodiversity and Sustainability (PIBS) Professor Mazin Qumsiyeh said that the majority of funding goes towards studies and workshops that deal with the “symptoms” of the climate and subsequent health crisis, rather than solving the underlying causes.

According to Qumsiyeh, “The money supports NGOs and governments that have historically done little to reverse negative trends– it is little in terms of return on investment. Superficial work will not help, nor will it tackle the underlying causes.”

Water scarcity is another major climate and health issue. The Middle East is among the world’s regions with the least water availability and a lack of clean and accessible freshwater, with 60% of the population living under high or very high water stress conditions

The Middle East’s health and climate crisis

Among the greatest concerns in the Middle East are rising temperatures, which are already well above the global average, with extreme heat waves becoming more frequent. In 2021, temperatures reached over 50 degrees Celsius in the UAE, Saudi Arabia, Kuwait, and Oman. One study found that up to two in three deaths from heat are attributable to human-made global warming.

Water scarcity is another major climate and health issue. The health of human populations is heavily dependent on the availability of clean, safe and accessible freshwater. The Middle East is among the world’s regions with the least water availability, with 60% of the population living under high or very high water stress conditions, according to The European Academies’ Science Advisory Council (EASAC). Nine out of fifteen countries in the Middle East experience absolute water scarcity, with one country, Kuwait, possessing no internal natural renewable water resources.

Exposure to contaminated water is the leading cause of diarrhoeal diseases, and multiple countries in the region have substantial death rates caused by diarrhea in young children. Syria is at the top of the list, with approximately 15% of its infant mortality attributable to this reason.

An insufficient water supply can also indirectly impact the well-being of a region's inhabitants by diminishing local food production, thus hindering individuals' capacity to access a wholesome and nourishing diet from nearby sources. By 2050, according to World Bank estimates, the entire Gulf region could face a 50% reduction in water availability per capita.

Rising temperatures in the Middle East are well above the global average. In 2021, temperatures reached over 50 degrees Celsius in the UAE, Saudi Arabia, Kuwait, and Oman. 2/3 of deaths from heat are attributable to human-made global warming.

Air pollution is the cause of up to 9 million excess deaths per year on a global scale, and it is of serious concern in the Middle East. Pollution from urbanization, fossil fuel, dust storms from the Sahara and Arabian Peninsula, and smoke from regional forest fires, such as those in Lebanon, cause serious health problems including allergies, respiratory and circulatory disorders, the carriage of pathogens and chemical contaminants, cerebrovascular and cardiovascular diseases, and lung cancer. Moreover, premature mortality is increasing, with Egypt possessing the highest numbers.

In addition to the consequences of climate change, is the growing threat of locally transmitted VBDs including the West Nile, Dengue, Chikungunya, and Zika viruses. Elevated temperatures could also contribute to greater genetic diversity, potentially resulting in the emergence of novel viral variants. Malaria was once prevalent in this area, and instances of locally transmitted cases have been documented in Saudi Arabia, EASAC notes.

Conflict, health, and the climate

In their addresses ahead of COP Health Day, COP28 President Sultan Al-Jaber, Minister Al-Hashimy, and WHO Director-General Dr. Tedros Ghebreyesus did not discuss the impact of current wars, such as that on Gaza, and ongoing conflicts like in Yemen and other countries, on the health-climate nexus.

Rising sea levels, droughts, flooding, and other extreme climate events, along with war and conflict, are causing population displacement and subsequent severe health risks among the displaced.

Greenish Institute Director Mohamed Kamal tells Raseef22, “if we want developing countries to be more resilient in the face of health impacts caused by climate, we need to improve health systems in said countries and improve access to basic healthcare for all”

Yemen has seen an influx of ‘illegal’ immigrants from the horn of Africa, where desertification and other climate problems are occuring, Yemeni Health Minister Dr. Qassem Bahaibah told Raseef22. According to him, in 2023 alone, more than 90,000 illegal immigrants have sought refuge in Yemen, a country already suffering from war and economic collapse. This influx has put additional strain on an already severely-damaged health system.

Healthcare for displaced populations is faced with several challenges. Firstly, there are direct consequences of displacement, such as injury, trauma, malnutrition, and increased vulnerability to further climate-related events. Secondly, these populations are sometimes exposed to infectious diseases, further complicated by their lack of immunity to new infections, and the heightened risk of disease transmission in subpar living conditions.

Furthermore, non-communicable diseases, exacerbated by limited access to medication, poses a threat. Host countries are also subjected to a substantial burden on their public health infrastructure. There are also sexual nd reproductive health risks, including sexual violence, sexually transmitted diseases, and a heightened risks of pregnancy-related complications. Lastly, mental health issues are prevalent, aad affect 15-50% of displaced populations. Access to psychological support services is limited, children are particularly vulnerable, and the repercussions can be enduring, even extending to subsequent generations.

When asked whether the Declaration on Climate and Health would practically help the Middle East, Qumsiyeh stated that its impact would be marginal.

“The Declaration is cosmetic… It is maybe useful in PR, to have the attendee government officials go back and say that [they did] something useful about human health”.

Kamal agrees. “The truth is, if we want developing countries to be more resilient in the face of health impacts caused by climate, we simply need to improve health systems in said countries and improve access to basic healthcare for all people.”

Fossil fuels: The elephant in every room

Centering the conversation back to the driving force behind climate change, Kamal said that the Declaration “still fails to address the elephant in the room, the root cause of the problem, which is fossil fuels”. Fossil fuels are not only the primary driver of climate change, he pointed out, they are also the primary catalyst for the Triple Planetary Crisis, the three intersecting global environmental crises of pollution, climate crisis, biodiversity loss and/or ecological crises.

Saudi Arabia, among the world’s top CO2-emitting petrostates, did not sign the Health Declaration.

When announcing the Declaration, WHO Director Ghebreyesus pointed out that the global addiction to oil, gas, and coal is “health sabotage”. In his address to delegates last Saturday, Ghebreyesus asked to prioritize three actions: delivering on the Paris Agreement and phasing out fossil fuels, transitioning to climate resilient, low carbon systems, and delivering on climate finance systems.

“The Declaration focuses on symptomatic relief like putting a bandage on a severed artery that needs surgery. It is, as Greta Thunberg would say, ‘more bla bla bla’. What needs to be done is challenge unfettered capitalism, consumerism, and militarism,” Qumsiyeh concluded.