COP27 Climate Change Conference: Urgent Action Needed for Africa and the World

Authors: Lukoye Atwoli, Editor-in-Chief, East African Medical Journal; Gregory E Erhabor, Editor-in-Chief, West African Journal of Medicine; Aiah A Gbakima, Editor-in-Chief, Sierra Leone Journal of Biomedical Research; Abraham Haileamlak, Editor-in-Chief, Ethiopian Journal of Health Sciences; Jean­Marie Kayembe Ntumba, Chief Editor, Annales Africaines de Medecine; James Kigera, Editor-in-Chief, Annals of African Surgery; Laurie Laybourn­Langton, University of Exeter; Bob Mash, Editor-in-Chief, African Journal of Primary Health Care & Family Medicine; Joy Muhia, London School of Medicine and Tropical Hygiene; Fhumulani Mavis Mulaudzi, Editor-in-Chief, Curationis; David Ofori­Adjei, Editor-in-Chief, Ghana Medical Journal; Friday Okonofua, Editor-in-Chief, African Journal of Reproductive Health; Arash Rashidian, Executive Editor, Eastern Mediterranean Health Journal; Maha El­Adawy, Director of Health Promotion, Eastern Mediterranean Health Journal; Siaka Sidibé, Director of Publication, Mali Médical; Abdelmadjid Snouber, Managing Editor, Journal de la Faculté de Médecine d’Oran; James Tumwine, Editor-in-Chief, African Health Sciences; Mohammad Sahar Yassien, Editor-in-Chief, Evidence-Based Nursing Research; Paul Yonga, Managing Editor, East African Medical Journal; Lilia Zakhama, Editor-in-Chief, La Tunisie Médicale; Chris Zielinski (corresponding author — chris.zielinski@ukhealthalliance.org), University of Winchester.


AFRICA HAS SUFFERED DISPROPORTIONATELY ALTHOUGH IT HAS DONE LITTLE TO CAUSE THE CRISIS
The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects (Kaddu et al., 2020).Impacts on health can result directly from environmental shocks and indirectly through socially mediated effects.(WHO, 2016).Climate change-related risks in Africa include flooding, drought, heatwaves, reduced food production, and reduced labour productivity (Trisos et al., 2022).
Droughts in sub-Saharan Africa have tripled between 1970-1979and 2010-2019(World Bank, 2021).In 2018, devastating cyclones impacted 2.2 million people in Malawi, Mozambique, and Zimbabwe (World Bank, 2021).In west and central Africa, severe flooding resulted in mortality and forced migration from loss of shelter, cultivated land, and livestock (Opoku et al., 2021).Changes in vector ecology brought about by floods and damage to environmental hygiene have led to increases in diseases across sub-Saharan Africa, with rises in malaria, dengue fever, Lassa fever, Rift Valley fever, Lyme disease, Ebola virus, West Nile virus, and other infections (Evans and Munslow, 2021;Stawicki et al., 2021).Rising sea levels reduce water quality, leading to water-borne diseases, including diarrhoeal diseases, a leading cause of mortality in Africa (Evans and Munslow, 2021).Extreme weather damages water and food supply, increasing food insecurity and malnutrition, which causes 1.7 million deaths annually in Africa (Climate change and health in Africa: Issues and options, 2013).According to the Food and Agriculture Organization of the United Nations, malnutrition has increased by almost 50% since 2012, owing to the central role agriculture plays in African economies (Climate change is an increasing threat to Africa, 2020).Environmental shocks and their knockon effects also cause severe harm to mental health (Atwoli et al., 2022).In all, it is estimated that the climate crisis has destroyed a fifth of the gross domestic product (GDP) of the countries most vulnerable to climate shocks (Vulnerable Twenty Group, 2020).
The damage to Africa should be of supreme concern to all nations.This is partly for moral reasons.It is highly unjust that the most impacted nations have contributed the least to global cumulative emissions, which are driving the climate crisis and its increasingly severe effects.North America and Europe have contributed 62% of carbon dioxide emissions since the Industrial Revolution, whereas Africa has contributed only 3% (Ritchie, 2019).

THE FIGHT AGAINST THE CLIMATE CRISIS NEEDS ALL HANDS ON DECK
Yet it is not just for moral reasons that all nations should be concerned for Africa.The acute and chronic impacts of the climate crisis create problems like poverty, infectious disease, forced migration, and conflict that spread through globalised systems (World Bank, 2021;Bilotta and Botti, 2022).These knock-on impacts affect all nations.COVID-19 served as a wake-up call to these global dynamics and it is no coincidence that health professionals have been active in identifying and responding to the consequences of growing systemic risks to health.But the lessons of the COVID-19 pandemic should not be limited to pandemic risk (WHO, 2021;Al-Mandhari et al., 2022).Instead, it is imperative that the suffering of frontline nations, including those in Africa, be the core consideration at COP27: in an interconnected world, leaving countries to the mercy of environmental shocks creates instability that has severe consequences for all nations.
The primary focus of climate summits remains to rapidly reduce emissions so that global temperature rises are kept to below 1.5 • C.This will limit the harm.But, for Africa and other vulnerable regions, this harm is already severe.Achieving the promised target of providing $100bn of climate finance a year is now globally critical if we are to forestall the systemic risks of leaving societies in crisis.This can be done by ensuring these resources focus on increasing resilience to the existing and inevitable future impacts of the climate crisis, as well as on supporting vulnerable nations to reduce their greenhouse gas emissions: a parity of esteem between adaptation and mitigation.These resources should come through grants not loans, and be urgently scaled up before the current review period of 2025.They must put health system resilience at the forefront, as the compounding crises caused by the climate crisis often manifest in acute health problems.Financing adaptation will be more cost effective than relying on disaster relief.
Some progress has been made on adaptation in Africa and around the world, including early warning systems and infrastructure to defend against extremes.But frontline nations are not compensated for impacts from a crisis they did not cause.This is not only unfair, but also drives the spiral of global destabilisation, as nations pour money into responding to disasters, but can no longer afford to pay for greater resilience or to reduce the root problem through emissions reductions.A financing facility for loss and damage must now be introduced, providing additional resources beyond those given for mitigation and adaptation.This must go beyond the failures of COP26 where the suggestion of such a facility was downgraded to 'a dialogue' (Evans et al., 2021).
The climate crisis is a product of global inaction and comes at great cost, not only to disproportionately impacted African countries, but to the whole world.Africa is united with other frontline regions in urging wealthy nations to finally step up, if for no other reason than that the crises in Africa will sooner rather than later spread and engulf all corners of the globe, by which time it may be too late to effectively respond.If so far, they have failed to be persuaded by moral arguments, then hopefully their self-interest will now prevail.
Provenance and peer review: Commissioned; not externally peer reviewed.

Conflict of interest:
In the interest of transparency the authors wish to declare the following roles and relationships: James Kigera is the Ex-Officio, President and Secretary of the Kenya Orthopedic Association; Paul Yonga been paid to speak or participate at events by Novartis, bioMerieux and Pfizer; Chris Zielinski is a paid consultant for the UK Health Alliance on Climate Change; Joy Muhia is an unpaid board member of the International Working Group for Health systems strengthening; David Ofori-Adjei has a relationship with GLICO Healthcare Ltd.The authors declare no further conflicts of interest beyond those inherent in the editorial roles listed.