As COP30 comes to an end and government representatives lay out their positions and commitments, as a doctor and humanitarian aid worker I am keenly anticipating the acknowledgement of an undeniable truth: There is no health justice without climate justice. These two are inextricably linked, and ignoring this connection will only deepen our suffering, particularly those who endure the most of both climate change and systemic neglect in forms of structural violence and health care access issues.
South Asia is already witnessing the devastating health impacts of climate change. In 2024, the average Indian experienced nearly 20 heatwave days, with 6.5 of those days directly attributable to climate change. In 2024, extreme heat exposure led to the loss of an estimated 247 billion potential labour hours, primarily in the agriculture and construction sectors. This translated into 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, with 45% of these in Asia and 36% in Europe.
Changes in monsoon patterns and salt-water intrusion in coastal regions impact cropping cycles and traditional methods of farming further impacting food security in a region which is already struggling under the burden of malnutrition and poverty. Air pollution from industrial and vehicular emissions, construction, road dust, and burning of fossil fuels is not only choking the lungs of millions, but is also worsening forced migration, conflict, gender and caste-based violence, economic inequalities and more. However, these impacts are not felt equally across all communities. Underserved communities like the urban poor, Dalit and Adivasi communities, who contribute the least to the climate crisis, suffer the most. Their homes flood first, they continue to walk longer distances in drought prone regions in search of water, their children fall ill from extreme heat and polluted air, their livelihoods vanish as crops fail and more often than we know they are forced out of their homes to extract minerals that fuel our industries and boost the country’s economy.
As Doctors Without Borders or Medecins Sans Frontieres (MSF), we witness this firsthand in the communities that we work with. For instance, during the devastating Pakistan floods in 2022, even after six months the overwhelming health effects of the floods could be seen. Malaria cases were rising despite the approaching winter; malnutrition cases were worsening due to inadequate access to food and safe drinking water. And to add to this suffering, the displaced communities in the worst affected regions needed to prepare for winter while still living in makeshift shelters. These first-hand experiences that we witness drive our climate action and response.
{{/usCountry}}As Doctors Without Borders or Medecins Sans Frontieres (MSF), we witness this firsthand in the communities that we work with. For instance, during the devastating Pakistan floods in 2022, even after six months the overwhelming health effects of the floods could be seen. Malaria cases were rising despite the approaching winter; malnutrition cases were worsening due to inadequate access to food and safe drinking water. And to add to this suffering, the displaced communities in the worst affected regions needed to prepare for winter while still living in makeshift shelters. These first-hand experiences that we witness drive our climate action and response.
{{/usCountry}}Health equity means ensuring that everyone has a fair opportunity to be healthy, regardless of their socioeconomic status, caste, 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 prone areas struggle to stay operational during stressful events and lack emergency preparedness plans. Often, health care providers lack the resources and training to handle climate-driven adversities. Indigenous communities, who have relied on their traditional knowledge of the forests for generations, are increasingly being displaced from their lands and homes. This displacement threatens not only their homes but also their deep-rooted understanding of traditional farming, climate adaptation, and cultural practices tied to nature. It is an abrupt loss of a wealth of knowledge that has been passed down through generations.
Some initiatives like the Heat Action Plan (HAP), trainings on rapid cooling mechanisms in India to community-based first responders, emergency preparedness trainings in Sri Lanka are significant steps in the right direction, but they cannot succeed in isolation. 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 consultations and limited convergence between different agencies that work on climate related issues. Without addressing the root causes of climate vulnerability and contextualised interventions, these efforts will remain band-aid solutions on a gaping 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 offers scalable, sustainable solutions to climate challenges. Centering community knowledge is key to building democratic climate resilient systems.
In the Yaku Mama Flotilla led by indigenous women, communities across Ecuador, Peru, Colombia and Brazil have united to journey 3,000 kms by river to COP 30. Their demand is simple ‘COP 30 cannot decide about us without us’. They demand for indigenous led climate solutions. While this is inspiring, a pertinent question to ask is why something that is long overdue still needs to be the central demand in an event where global leaders meet to make decisions that affect these communities the most. Why has their voice historically been missing from the most influential and decisive climate space? We hope that the spirit of popular participation that was seen in Belém not only remains but can become stronger in any future climate negotiations.
Indigenous knowledge is not just cultural heritage. It can complement scientific resource. Studies show that integrating traditional ecological knowledge into climate adaptation planning can enhance resilience, protect biodiversity, and improve food security. Policymakers must prioritise 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 a unified response: Health must be a climate priority.
National policies on health and climate adaptation must explicitly link health outcomes to climate resilience, ensuring that vulnerable communities are not only protected but also treated as equal partners in decision-making. Recognising this urgent need, MSF is organising regional climate scenario workshops to integrate climate and health action. These workshops aim to map the impacts of this dual crisis and prepare for the future, helping humanitarian organisations like ours understand what lies ahead and how best to adapt to this growing challenge.
We need to demand direct climate financing toward indigenous and local initiatives, such as community health worker programmes, community-based emergency preparedness plans and community-led restoration and preservation initiatives.
Government bodies, international agencies, community-based organisations and minority protection bodies must collaborate to amplify climate action and enable inter-sectoral policies that address climate, health and issues of social justice. To achieve this MSF South Asia is hosting a regional working group of climate experts, which has brought almost 40 organisations from the South Asia region to come together and define pathways for collaborative climate action in the region. The working group has representation from academia, governmental bodies, international agencies, local CBOs, health care and environment activists, youth members and journalists.
Media, academia, and civil society must highlight the stories and solutions of those most affected, not just as victims, but as thought leaders and implementers of indigenous low-cost innovative mechanism to adapt.
South Asia has a unique opportunity to lead the world in climate-just health policies. This requires political will, public pressure, and a commitment to equity. As we participate in the conversations at COP30 and approach the 2030 Sustainable Development Goals deadline, the message needs to be clear ‘Health justice cannot be achieved without climate justice’. The two must be addressed together, in collaboration with the most impacted communities.
The question is no longer whether we have the resources to act—it’s whether we have the resources to not act.
This article is authored by Dr Sevantee Ghosh, strategic medical lead, Médecins Sans Frontières, South Asia.