Véronique de Geoffroy & Pierre Brunet

Climate change is also a public health issue (due to its impact on population displacement, air quality, heatwaves, etc.). In the face of such concerns, the medical journal, The Lancet, declared that “Combatting climate change could be the greatest global health opportunity of the 21st century” (2015). How do you understand such a statement?

The main idea behind this statement is that many climate change solutions, or factors that could stabilize the climate in the coming decades also have very significant impacts on the health of populations, and vice versa. The different forms of pollution that come from the production and consumption of energy, and from industrial and agricultural products, have direct health consequences. For example, take the example of air pollution related to greenhouse gas emissions or other particles: by reducing them drastically in the transport sector, we mechanically reduce the harmful effects on people’s health that are currently very significant in big cities. Climate change is principally a form of environmental degradation resulting from atmospheric pollution on a massive scale, even though farming systems and deforestation also play a role. By taking action on fossil fuels to stabilize the climate, we also tackle one of the major causes of respiratory infections or other pathologies related to the main forms of environmental pollution, whether in Paris, New Delhi or Lagos. This is why the Lancet says that it is both the biggest threat and the biggest opportunity in terms of global health. On the one hand, allowing the causes to increase and the situation to get worse would lead to significant impacts for the health of the most exposed populations. On the other hand, stabilizing the climate, by stopping certain forms of atmospheric pollution or by transforming the farming system, would help to resolve certain critical public health issues. And this reasoning can be extended to food issues as there are extremely strong links between diet and a whole series of chronic illnesses that are currently becoming more prevalent around the world, whether it is different forms of cancer, cardio-vascular diseases, obesity, etc. Adopting sustainable diets that are compatible with the stabilization of the climate, with less meat, more vegetables and vegetable protein, is a way of preventing a whole series of chronic diseases. A change of trajectory would therefore be very beneficial. Thirdly, we can mention improved access for women to education and reproductive health, which has a significant impact on the climate due to its effect in stabilizing population growth. We know that population growth along with the emergence of a large middle class at the global level, increases land use and the consumption of natural resources and, as a consequence, greenhouse gas emissions. In this area, contrary to what we sometimes hear, the solution is not birth control, but ambitious policies that promote equal rights, access to education, and access to health. These are levers that are altogether more powerful and respectful of liberties. In the end, there are numerous shared benefits between climate action, health, education, rights and respect for the environment.

In this context of climate change and public health, what role do you see for NGOs?

They have a number of key responsibilities: beyond providing assistance to adapt, the first of these is to bear witness about the impacts of the climate emergency on vulnerable people because, very often, NGOs are on the frontline in the most affected contexts (tropical areas, regions that are repeatedly subject to extreme weather events, are affected by disturbed water cycles or by the increase in temperatures). They can easily act as a relay to describe the human impacts of climate change; the way that the climate issue is perceived needs to evolve by putting the accent more on the serious risk faced by human populations. NGOs therefore have legitimacy and credibility on this issue, perhaps even more than medical NGOs. But establishing links of this kind is not always easy. It is easier in some cases, but this generally implies having partnerships and collaborating with research institutes who are able to describe long-term developments, whereas humanitarian organisations tend to observe short- and medium-term impacts. I feel that, working to increase understanding of impacts, and their visibility, showing that it is a problem now, and not just in thirty years’ time, is an essential role to play.

The second responsibility is to take a political stance by coming back to basic principles. Humanitarian organisations have a legitimate role to play in denouncing blatant and completely cynical negligence with regard to populations whose vulnerability is going to deteriorate significantly in the years ahead, and despite the fact that alternative policies exist. It is definitely not up to humanitarian organisations to recommend such and such a specific solution to stabilize the climate, that is not their area of expertise, but they can advocate in favour of what is called ‘duty of care’ in the medical sector, and denounce the fact that whole populations will be sacrificed. In Bangladesh, for example, scientists are convinced that 10-20% of its territory will be under water by the middle of the century, which means that millions of people will be displaced. In Sub-Saharan Africa, even though regional predictions are not precise in terms of the water cycle, the increase in temperatures will have very harmful consequences. Though there is no shortage of examples, it is important that humanitarian organisations are prudent about scenarios and do not fall into the trap of quantitative forecasts announcing precise numbers of people who will be affected, in millions or hundreds of millions. Though this may be useful for institutions to engage in long-term planning, or to grasp the scale of risks, the methodologies used need to be critically reviewed on a regular basis. This should not detract from the most important issue: there is no doubt that the increase in temperature – which is an established fact, the unknown being how high it will rise – will have massive negative impacts on numerous vulnerable populations.

What alternative policies are you thinking of?

Numerous solutions exist today, and organisations and territories, though marginal in number, have made huge progress. Certain local governments and businesses have reduced their emissions by 50%, and even 80%. Possible ways forward are therefore relatively well known and can be implemented. Continuing with the same energy and farming models will lead to a world that is 3 or 4 degrees warmer than the pre-industrial period. There is also the question of using resources sparingly. There is significant debate about access to resources in the near or distant future and the long-term sustainability of a system based on economic growth. Will the resources be available to establish renewable energy on a very large scale within 20 to 30 years? But this is not where humanitarian organisations’ added value, foundations or legitimacy resides.

To achieve carbon neutrality by 2050, as recommended by numerous institutions, you suggest that we should proceed in stages and establish realistic, shorter-term objectives, such as reducing greenhouse gas emissions by 50% in the next ten years. Can you describe what this would involve concretely for relief NGOs, particularly medical NGOs as we know that they have a number of specific characteristics (such as the crucial role of supplying medicine and equipment)?

First of all, we have to be careful with the term ‘carbon neutral’ because it can be understood to mean different things. For some, this corresponds to emissions minus compensations, which means that we can emit as much as before by buying compensations. But the aim really should be to reduce emissions to as close as possible to zero by the middle of the century. This roadmap is based on the IPCC’s scientific consensus, which is behind the Paris Agreement, and has inspired states to fix objectives to reduce emissions. To stabilize the climate at +1.5 or 2 degrees, there is no other choice but to reduce emissions to almost zero within twenty to thirty years, and achieve negative emissions after 2050. Any additional emissions will contribute to a higher level of warming. More and more states are integrating this roadmap into their legislation, but the problem is that it is not just a final objective. The trajectory is just as crucial. Emissions need to be divided at least by two each decade in order to start an exponential reduction. That is why the countries that are the most advanced on the subject are aiming for reductions of between 40 and 60% by 2030.

In the end, humanitarian organisations are not so different from other kinds of actors. Concretely, a collective roadmap for reducing greenhouse gas emissions needs to be implemented by every organisation in a society. As such, the responsibility of a humanitarian organization is the same as that of a hospital in France, or the fire service or any other public service that is subject to certain constraints. Humanitarians cannot use their social mission as a reason to avoid a responsibility that everyone has to fulfil. How could we justify that humanitarian associations, who are on the frontline in addressing vulnerabilities, could be less ambitious than states on measures to stabilize the climate? The question, rather, is ‘how’? Humanitarian organisations work internationally, with a number of big blocks of emissions: transportation (staff and supplies), which, of course, involves a lot of planes, but not only; food distributed (to staff in cantines and to beneficiaries during distributions); energy for buildings (heating, air-conditioning, building materials), which is an issue where there is a lot of leverage; IT, which is more complex, but which is a crucial area; and, lastly, the whole supply chain which is often specific to different organisations. Certain municipalities – including state capitals – are heading for ‘net zero’ by 2030 despite having to deal with much more complex supply chains than those of humanitarian organisations. I think that it is extremely important for humanitarians to adopt the right long-term objective, but especially to have a demanding intermediate target for in five or ten years, such as reducing emissions by half by 2030, by working on what is known as ‘low-hanging fruit’. Though it is difficult to achieve a 100% reduction, it is relatively simple to reduce emissions by 30 to 40%, then 50%. That is the first lever of action to activate: short- and medium-term victories, while, in parallel, working on more complex areas, that is to say, the operational model that will need to be adopted.

Air travel has increased enormously in the last fifteen years, as it has throughout the world, due to lower prices and the arrival of ‘low cost’ airlines. People now travel non-stop to go to meetings, some expatriates go home four or five times a year… Our relationship with travel is not at all the same as it was fifteen or twenty years ago. Imposing much more restrictive travel policies would not affect operational effectiveness. As for energy and buildings, we could, for example, rapidly end the use of fuel-powered generators in the majority of contexts. By replacing them with better solutions, we will very quickly be able to see the local advantages in terms of sustainability and even sometimes in terms of cost effectiveness. The most complicated area is the supply chain because it requires more technical approaches to identify where potential gains are and to apply environmental purchasing criteria. We have to find a way out of the intellectual impasse according to which it is not worth taking action on the first level of reductions as long as we have not found a systemic solution to completely reduce our carbon emissions. This would be a strategic error: on the contrary, we should tackle the first level very quickly while giving ourselves the time to think about operational models that produce fewer greenhouse gas emissions.

What do you mean by the need to examine humanitarian organisations’ operational model in detail?

Our operational model uses a lot of energy because of long-distance deployments, notably for emergency relief organisations who have very centralized supply chains, and all the more so in the medical field in order to have quality medicines and medical equipment. The question is therefore: how can we change the model while maintaining a high level of quality and reactivity? This requires more decentralised approaches that require less transport, staff training in the field, and the empowerment of national staff (still insufficient). This cannot be done from one day to the next, but over a number of years and in stages, while taking care not to implement ideas that initially seem to be solutions but, in the end, are not. IT solutions, for example, have often been presented as a way to reduce our consumption of resources, but we now know that they sometimes lead to more energy being used. Positive and negative experiences, expertise and support should be shared between humanitarian actors in communities of practice. Humanitarian organisations, like many companies and local governments who do not have a critical mass, do not all have the means to have internal technical teams and sustainability experts. As many countries have not yet created agencies to provide operational support for the transition, it would probably be useful to pool operational support and to establish networks. Inspiration can also be drawn from other fields. In the health sector, there is the very impressive example of the National Health Service (NHS) in England which has just announced a ‘net zero’ roadmap, that is to say, reducing greenhouse gas emissions as completely as possible. There is no reason why humanitarians cannot be similarly ambitious.

What do you mean by lack of expertise within the humanitarian community, and how do you think this can be resolved?

There are two issues here: on the one hand, reducing emissions and good practices in terms of sustainability; on the other, the question of programme expertise, for example, in the medical field, with environmental pollution and the health crises it can cause. I think these are issues where humanitarian medical organisations can reinforce their capacities. Regarding climate change, many consequences are the result of a range of classic activities where the aid sector knows what to do, the issue being volume rather than of a technical nature, such as malnutrition and displacements. But in other fields, such as extreme air pollution in vulnerable countries, these are new operational areas. We need to integrate the environment and the climate into our contextual analysis. Many development NGOs already do this, but it is very rare among relief organisations. Factors related to conflicts, violence, lack of access to food or water are very quickly taken into account in field assessments, but this is rarely the case for more complex environmental issues. Analytical frameworks need to evolve and staff need to be given the right tools – which often already exist – to do their work. They need to appropriate them.

To conclude, I would say that the tragedy of the response to the climate crisis is the failure to take responsibility. People tend to think that it is too huge, too global and too technical, and that, in the end, it should be dealt with at the macro level: government, finance and industry. And it is true that political, normative and financial levers are the most powerful mechanisms. But it will take some time before they are able to meet the challenges at hand and even longer before they have an impact. Given the seriousness of the situation, we are now beyond the stage when we can wait for everything to come from above; we have to take direct action. There is a major risk that the tragedy will accelerate if each of us stays confined to their role, their social mission, and doesn’t adapt despite the systemic crisis unfolding before our eyes. Faced with this situation, every organization in society should be questioning its actions and assessing its own sphere of responsibility, and everything that it controls. And for the areas that it doesn’t control, it should try to influence others through its example, high standards and the domino effect. The spheres that we control are often much larger than we think. We quite simply cannot wait for the macro policies which, of course, will eventually be adopted due to the pressure of events, but we don’t know if this will be in ten or fifteen years. We are all taking the risk of wasting precious time because there is a considerable delay between the moment that the political decision is made, its implementation, its concrete effects and its impact on emissions.


Bruno Jochum, Fellow of the Geneva Centre for Security Policy
Former General Director of Médecins sans Frontières Switzerland’s Operational Centre and is currently

Interview conducted by Véronique de Geoffroy and transcribed by Pierre Brunet


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