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Extreme weather, environmental degradation, and climate-driven displacement are placing new pressures on health systems worldwide, especially in settings of existing vulnerabilities. Medical humanitarian organisations are saying these pressures are no longer episodic, but constant. On this episode of #ConsiderThis Melisa Idris speaks with Dr Maria Guevara, International Medical, Secretary of Médecins Sans Frontières (MSF), also known as Doctors Without Borders.
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00:00Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show
00:15where we want you to consider and then reconsider what you know of the news of the day. Extreme
00:19weather, environmental degradation and climate-driven displacement are placing new pressures on
00:26health systems worldwide, especially in settings of existing vulnerabilities. Medical humanitarian
00:31organisations are now saying these pressures are no longer episodic but constant instead.
00:39And joining me on the show to discuss this more and the cost, the human cost of climate emergencies,
00:45I have with me Dr Maria Guevara who is the International Medical Secretary of Medicines
00:51on Frontier, better known as Doctors Without Borders or MSF for short. Dr Mary, thank you
00:57so much. Maria, thank you so much for being on the show with me today. I really appreciate you
01:01joining us while you're in town giving a workshop to MSF field staff. Talk to me a little bit about
01:09how this impacts your people who are on the field, in the field. So MSF works in crisis zones long
01:18before governments declare them emergencies even. And I'm curious to know what you're seeing in terms
01:26of how climate stresses affect or impact field operations. So you've rightly said that MSF is
01:36usually in the conflict settings. And if we really look at the work of MSF through the years and
01:42especially in the last few years, we are more and more again in conflict situations. But that's been
01:48compounded. So what we're seeing as medical humanitarian actors and those who are working
01:54in humanitarian settings is this triple crisis. And many have said this before, it's a triple C
02:00of climate, conflict and contagion. Because those are actually interact and intersect with each other
02:06and compounds each other. It's partly because of the actual impacts, direct impacts of each, but then
02:13it's also the race for the resources. And then by, you know, part of what's at the heart of climate change
02:21is also this environmental degradation impact of broken human systems that are not in equilibrium
02:29in natural systems. And that then creates also more disease processes. So how does connect is creating
02:38this kind of emergencies that are out of scale of what we're used to, right? It's scales that are much larger
02:46than we have ever seen, storms that are much more severe, much more frequent, and scales of food and water
02:55insecurity that are compounding on top of each other. And so we're stretching our limits to try to answer
03:03to all these emergencies. And it's, and then also going back to what you said before you even know it,
03:11because what's at the heart of climate change are already the impacts that are of losses and damage
03:15being felt today by those who are exposed to more of most vulnerable situations. And that are the,
03:22that those are the humanitarian hotspots. And so what we see are the hotspots of humanitarians,
03:28humanitarian hotspots are also climate hotspots. Unfortunately, as we see climate change
03:35record highs of warming, 1.5 degrees Celsius is supposed to be the ceiling of the Paris Agreement. We
03:43are recording them more and more in many cases. We're already past the safe operating zone. So we're having
03:51to deal with people who are having to live with in uninhabitable areas. And that's growing. So
04:00what I'm bracing for and what we're bracing for is that expansion of localities. So is the future of
04:07humanitarian hotspots not just where it is today, but global spots. Wow. Can you give me an example of
04:16the type of how it's manifesting today? How climate stresses are being seen today?
04:27And I think if you, one of the jobs that I do as international medical secretary is looking at our
04:31mutual accountability. What did our operations look like over the year? So 2025, we're collecting the
04:38data. So I'll give you the 20 to four numbers. And just in this last cycle of review, in the last five,
04:47six years, in 2024, that meant 16 million outpatient consultations, which is a 60% rise over the five
04:55years, and including on top 2 million emergency consultations, the same number, similar numbers of
05:03in-patient admissions. But more scarily, malnutrition cases have tripled in this period of time.
05:12So we have now, if you combine moderate and severe acute malnutrition, we're seeing 800,000,
05:21but only in the areas we are in. So that's not to mention all the other hotspots.
05:26Dr. Marie, did you say 60% rise in the last five years?
05:31In our consultations in the last five years, tripling of numbers of malnutrition cases.
05:36Did that shock you?
05:37Yes, of course. Well, as true MSF form, we just adjust and address the responses. So
05:46because we are fortunate to have 7 million donors globally, private, supporting us, enabling us to
05:53respond within the 72 hours critical period of response. We're able to go where most people don't
05:59go, and therefore we're able to reach them. So we just keep responding as the needs keep growing.
06:08But that support enables us to grow that much. So we went from the same period, from 1.3 billion to 2.3
06:17billion budget, because that growth was that much needed. But that means the same growth, a doubling
06:27of our staff globally. So just headcounts is 67,000. Protecting that headcount and keeping a safe and
06:38secure work environment is a challenge. When the number of armed conflict situations are becoming even
06:44more deadly, which is the fifth deadliest year, 2024 was recorded by experts analysis. The most,
06:53the fourth most violent, with more attacks on healthcare. So these are impossible situations
07:00that we're seeing and having to grow and respond to an ever warming world.
07:06Yeah. Okay. So, so talk to me about the component of the climate crisis, because we have, as you said,
07:12you've got conflicts already, you're exacerbating, conflicts exacerbating existing vulnerabilities,
07:20then you have climate, which you have extreme weather. And often I think, especially when I talk to
07:25people, when we talk about the climate crisis, or even if calling it a climate emergency, everyone
07:31thinks it's a future problem. It's something we'll have to worry about in the future. Future generations
07:36will have to deal with the repercussions. But we're seeing it, you are seeing it today. MSF is eyewitness to it today.
07:43But let me just go back a decade ago. Oh. In Asia Pacific. Here, where we're sitting today,
07:51Typhoon Haiyan. Oh, I recall. So Philippines, as a Filipino by background, we're used to typhoons. But at that time,
08:02that was the most severe that we've ever seen, category five. Ten years later, it's become the norm.
08:11Right? You see such extreme categories. You see black categories of typhoon hitting Hong Kong. You see this,
08:20and you see typhoon just hitting in numbers and numbers, on top of which are other kind of
08:26natural disasters, as we sit in the Pacific Ring of Fire. It's this compounding effect. In
08:35a megalopolis Asian city, where billions of people live. That means more people are exposed,
08:43and more people are having to fall victim to such. So without preparedness, you're going to lose lives.
08:52And so in these settings, you also have the heat waves and everything that that implies. And the
09:00other impact of getting hit with trauma, the mental health and the eco-anxiety compounding on each other.
09:08When your cities are not built to absorb that much rainfall, you have wonderful standing pools of water,
09:18beautiful for mosquitoes to breed, and love to transmit dengue and other infectious diseases.
09:25So these are all compounding in one setting. You're going to have to be challenged. So back to the climate
09:33scenario workshop that we're putting together is, how do you prepare for that in a two degree world,
09:39in a three degree world, in a geopolitical changing landscape, with economic changing landscape, with
09:47technology changing landscape. So these are all things that we try to create compounded scenarios
09:58to be better prepared to what we invest in today. I just want to add one last thing. And one of the
10:03reasons we wanted to do this in Asia-Pacific, not only because we have operations in the region, but
10:09because the amount of capacity, brain capacity and research and technology in the region is where we
10:18need to find the partners to identify where the expertise are. And this is also part of why we're here.
10:24Hence the Sunway Center for Planetary Health is one of the co-hosts
10:28of this workshop is how do we build this framing and work together. And also Malaysia has also used
10:37the framing of Planetary Health and we want to make sure that we learn from this system and how to
10:43actually help formulate our responses accordingly. I love that Planetary Health is now becoming more
10:51and more understood by people. I think after the pandemic, we realized that no system stands alone.
11:00Everything is interlinked. How do you see Planetary Health, particularly from a
11:06humanitarian medical perspective? So I personally believe very much around Planetary Health because
11:12it is this ecosystem of interconnectedness. As a humanitarian actor, we are addressing the impacts
11:19of inequalities that is brought on by the structural violence of our human systems. And at the heart
11:25of Planetary Health is that the human systems are not compatible with natural systems anymore. So we're
11:32changing this equilibrium of balance. And by doing that, we're creating this kind of crazy cascade of
11:40emergencies and ever-arising inequality. So when you're hitting all these planetary boundaries and you don't
11:49have the proper framing because your governance is not correct, you have not invested in your knowledge
11:57and capacity to implement that at the core of Planetary Health, then you're missing the point and you're
12:02not prepared for not only today, tomorrow or the future. Your job is doubly hard because you're going to have to
12:10prepare MSF globally for this. Talk to me about preparedness. How would an organization, an international
12:24organization like MSF, think about how to prepare for climate emergencies in the future?
12:32So one of the best things, one of the things that you need, you know, in climate speak, you have the mitigation pillar.
12:40So at MSF, that's one of the pillars. We have a three-pillared approach. One is mitigation.
12:45We look at how do we do more sustainable practices so we do not contribute. We do no harm in the workspace that we do.
12:54We do our work to reduce the carbon, but not only managing also more alternative, sustainable electric supplies, for example, energy supplies.
13:05So you think about how much you're contributing in terms of emissions as well?
13:08First and foremost. And then, well, before I go to the second pillar, which is adaptation, just a word on that.
13:16Because the fact that we have started to do hybrid hospitals and facilities where you have many solar panels and battery that is fed,
13:27as well as, you know, the usual generators, because sometimes you just, when there's nothing else.
13:34When you are in a sometimes conflict situation and you are barred to come in with supplies,
13:39you cannot bring in the fuel to run those generators, how do you run a hospital?
13:47Because we have solar panels, we are not, we have been able to save lives because we can continue oxygen.
13:55So that is part of why mitigation is also so key and especially in frugal areas and low resource areas.
14:04The second is, how do we do anticipation? And this is the preparedness.
14:10Early warning systems, for sure, this is something that is well established in the region as a region of disaster,
14:19prone to disasters, but not only. And how do you translate that at the health facility level?
14:24So we've been trying to do more anticipatory kind of tools where you take facility data,
14:31layer that using machine learning with, you know, meteorological data, then you can predict where
14:39maybe a malaria outbreak might be and you go do more seasonal chemo prevention. So very targeted,
14:45climate smarter prevention. And that's what we try to do. And then because we, we, one of our parts of our
14:54principles is witnessing, we listen to the patients and our staff who are living the day-to-day
15:01reality of climate impacts and give voice to that. So, um, because in, you know, in the,
15:07in the larger scheme of things, there is, um, a dearth of information and data coming from, um,
15:14developing countries. And we need to empower that voice, provide evidence-based experience,
15:21that it goes into big policies, um, or collection points like the IPCC,
15:27the Intergovernmental Panel of Climate Change, they, in their assessment reports is important
15:32because those define policies. So we add our voice to that. So one of the things that we've been doing
15:39has been to contribute to the Lancet Countdown that's tracking the climate change and health.
15:43Right. Um, and is really showing where, where the, the climate change induced by humans,
15:53is really contributing to the changes. And, you know, in their last report, 2025, 84% of the heat
16:01wave days face today, they can attribute in the last five years, can be attributed to human induced change.
16:08And that has led to 60% increase over a decade of collection of deaths. So,
16:15and then we match that with the reality of what we see. And so we give voice to the of the human,
16:21from the humanitarian perspective. And because of that, we also go, um, to the, to the conferences
16:27of parties, the COP. And the COP30 this year, um, I had participated, which was, uh, very emotionally,
16:36um, interesting. Oh, in what way? Uh, well, because, you know, I've been to the other COPs,
16:42and those were the COPs of oil, like they say, because it was in Dubai in Egypt. And this was
16:48supposed to be COP of the people and truth. In Brazil with Balaam. Yeah, Balaam, yeah, that's right.
16:53At the gateway of the Amazon. So you saw the Amazonian tribes living in that, in their, in the Amazon
17:02river basin from Peru and all over South America, traveling for days and weeks on a boat, buses,
17:10boats, et cetera, and 200 ship flotilla of 200 tribes marching together, calling to save their home.
17:17But they're standing outside the gates of the conference of parties. So all the negotiations,
17:25the people affected. You couldn't see it more starkly and that, but the power of the community
17:33to say save our Amazon, because actually the Amazon is one of the biggest carbon sinks of the world.
17:40And it's dying back. It's no longer a carbon sink. It's starting to be a carbon emitter
17:45because all the degradation of the area. And this is the tipping point. And that was one of the
17:53important voices I heard. The second was the scientist who's flagging our earth health planet
18:01health is sick. And we are close to tipping points that once you tip over will create irreversible
18:11cascades. And I came out going, oh, wow, I've been calling climate crisis as a health crisis,
18:18as a humanitarian crisis, and it is today, but it is a matter of survival for all of us.
18:24And it had mobilized me to push harder on what we need to do to inform all of us to do better.
18:32So when you're observing all of this, you're experiencing it, you're there in the moment,
18:38and you see how climate change disproportionately affects the people who have contributed the least
18:45to it. How do you make sense of that when they're the ones being impacted? Where are the ones being
18:50impacted the most? And this is why we, our voice is to speak to that truth, the reality that we're seeing,
18:57and the weight that MSF has in that sense of our globality, and that we collect a part of that larger
19:06community affected by sheer proximity and sheer work together. We hope that our voice can create,
19:15can contribute to the platform and give the platform for the indigenous tribes. And I think,
19:21again, this is part of why the advocacy pillar is key in our climate action, is giving voice to that.
19:28Right. So in speaking on behalf of or highlighting the voices of the people who are
19:35experiencing climate, the climate change as a reality, and you talk to governments at the highest
19:43level, I'm curious to know how they respond. What are you telling governments? How are they receiving
19:49this information? And are you seeing them act? So it's very interesting having watched the negotiations
19:58these last few years. And they have their groupings, right? You have the small island states, you have
20:06obviously the global north, you have the G77 plus China, and the negotiations between mitigation, which
20:13is at the heart of the conference of parties, and the link to adaptation, which is really what the
20:21developing countries, because they're not the big emitters, right? So where do you put that money,
20:27and who is responsible for what? And you can see that play. So our tactic is add our voice to the reality,
20:35and highlight that common but differentiated responsibilities, and the impacts of that. But we also
20:42speak to the governments to say, we're partners with you, especially in these areas. How do we help you
20:48in responding? How do we help you in adaptation? And this is what we do for mitigation, and sharing our
20:57experiences, and how do we contribute to build evidence that you need. Can I just ask you in this
21:02region specifically, say, looking at Southeast Asia specifically, which is very climate exposed,
21:08we have highly exposed to climate risks. What is it that you're hoping governments here, policy makers here,
21:15start prioritizing, or stop doing even, stop ignoring even? What would you, if you could distill it into
21:23a key message for them? Well, the first thing that needs to happen is the fossil fuel face down.
21:30But the way the ASEAN and the weight of the ASEAN together to create a voice for the people and the impact of the people,
21:44that should be a consistent voice together. And what's really, again, I'll go back, what's really
21:51interesting from the Malaysian government is this planetary health frame. So finding that common
21:56language that you can speak together and being exemplary to the different models of sustainable
22:03practices can really amplify, and that's the beauty of this, of multilateral platform like the ASEAN,
22:09you can amplify that and enable different neighbors to address the inequities, right? Because it's not just
22:17inequality. You're right. It's enabling, giving a ladder for the ones who have less. And this is sort of,
22:24that spirit has to be there. And so it's a win, it's a learning, learning. And how do we learn together
22:31and do together? And one of the things that we're trying to create in Malaysia is our, is a hub to
22:39really start to look at this. Because it's in real practice for us, when we look at our sustainable
22:46practices, for example. So we have a hub for here that we're trying to establish to look at
22:53access to quality medicine. But quality medicine and products, when you're looking at climate, could be
23:02better single, moving away from single use plastics, like IV infusion sets, which has PVC in it and it
23:11leaks plastic in your system. What can be the innovation to use alternative packaging? Because that's
23:18healthier for the system and for the environment, for humans as much as. So these kinds of technology
23:25is really interesting also to do together. There's so many, and that's platforms, how do you do sustainable
23:32supply chains? That's one aspect of why we're here to create that kind of bridge and support that we're looking at
23:41as we establish our footprint here.
23:43I'm fascinated by this. You've brought up a lot of aspects that I hadn't even considered as part of
23:53the way you can change the way you work and the way you help people and also help the planet.
23:58Dr. Marie, do you have a quick message that you'd like to convey to our audience about
24:03the work that you're doing and why it's important that we care about how the climate crisis impacts us all?
24:12So what's really interesting is that we opened our ceremony and we had a beautiful guest speaker,
24:20Professor Abbey and Dr. Amir and also Ms. Sally Edwards from WHO Regional and the title of that opening
24:27ceremony was Everything Everywhere All At Once.
24:32Oh, I love that.
24:34So everything everywhere is all at once, but it affects
24:39differently everybody. But we each and every one of us has a role and responsibility
24:45and the answer to everything here is actually how do we stay in solidarity as a larger community of
24:53humanity and each in the individual role responsibility to increase our awareness and knowledge about
24:59climate change, but also how can we be solutions collectively. Thank you so much for coming on the
25:07show, sharing what you have witnessed. Thank you for having me. You're most welcome. That's all the time we
25:12have for you on this episode of Consider This. I'm Melissa Idris signing off for the evening.
25:16Thank you so much for watching and good night.
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