MSF Mobile Clinics and Tea Teams in Somali Region

Should Médecins Sans Frontières join the fight against global warming?

Fabrice Weissman

Graduated from the Institut d'Etudes Politiques de Paris, Fabrice Weissman joined MSF in 1995. He spent several years as logistician and head of mission in Sub-Saharian Africa (Sudan, Eritrea, Ethiopia, Liberia, Sierra Leone, Guinea, etc.), Kosovo, Sri Lanka and more recently Syria. He has published several articles and books on humanitarian action, including "In the Shadow of Just Wars. Violence, Politics and Humanitarian Action" (ed., London, Hurst & Co., 2004), "Humanitarian Negotiations Revealed. The MSF Experience" (ed., Oxford University Press, 2011) and "Saving Lives and Staying Alive. Humanitarian Security in the Age of Risk Management" (ed., London, Hurst & Co, 2016).

Article initially published as an opinion piece in the magazine Alternatives Humanitaires on March 18.

Following an article co-written by members of the Swiss and Canadian sections of MSF, Fabrice Weissman presents a critical analysis of the arguments put forward by his colleagues. An analysis that could be useful to the entire movement, and to the humanitarian community as a whole.

As shown in the July 2019 issue of Humanitarian AlternativesFocus “Climate change: understanding, anticipating, adapting”, Humanitarian Alternatives, July 2019,, an increasing number of humanitarian organisations are committed to fighting global warming. Many volunteers and managers at Médecins Sans Frontières(MSF) would also like the association to join the fight. Some have already started to do so. In the lead-up to the United Nations Climate Action Summit held on 23 September 2019, the Executive Director of MSF USA signed an appeal: “…governments and polluting industries must act now to slash greenhouse gas emissions and limit global warming… [because] we witness first-hand how environmental factors can exacerbate humanitarian crises”.“We witness firsthand how environmental factors can worsen humanitarian crises. […] We are facing a climate emergency, with devastating consequences for global health and humanitarian needs. […] While we all have a role to play, governments and polluting industries must act now to slash greenhouse gas emissions and limit global warming. They also have a duty to help those most affected by climate change. It’s clear that the disastrous forecasts ahead far exceed the capacities of an already overstretched humanitarian sector”: Avril Benoît, “Climate emergency: A humanitarian call to action”, MSF, 20  September 2019, is also associated with the work of research group Lancet Countdown: Tracking Progress on Health and Climate Change.See In November 2018, the organisation published the survey Climate Change and Health: An Urgent New Frontier for Humanitarianism, which calls for greenhouse gas emissions to be “urgently brought in line with levels consistent with the Paris Agreement”“… a view to highlighting the dramatic health consequences already unfolding, as well the dangerous levels of humanitarian need likely if greenhouse gas emissions are not urgently brought in line with levels consistent with the Paris Agreement on climate change”: Climate Change and Health: an urgent new frontier for humanitarianism, November 2018, to the “dramatic health consequences” of climate change.

The arguments in favour of this position were developed by several MSF members in one of the articles published by Humanitarian AlternativesBruno Jochum et al., “Choices at the time of the climate emergency”, Humanitarian Alternatives, July 2019, p.44-63, summer. In their conclusion, the authors highlight the threat faced by MSF and the “without borders” movement because of the rise of environmental concerns in the public debate. If MSF wants to maintain its “legitimacy” and “social base”, especially among the “younger generations”, and remain competitive in the market of ideas and solidarity, it must “integrate the ecological crisis more centrally into its social mission and public position”. This shift in focus might be regarded as all the more legitimate given that the humanitarian cause and the ecological cause overlap: environmental degradation leads to a dramatic deterioration in the security and health of the most disadvantaged – “a catalyst or exacerbator of humanitarian needs”. As such, the authors call on MSF to commit to three recommendations: reduce its own carbon footprint; anticipate and prepare for the consequences of global warming on public health; and tackle the causes of the disaster attributed to the non-application of the Paris Agreement’s commitment on reducing greenhouse gas emissions. This position, which is common to many humanitarian NGOs, is largely open to debate.

Why should humanitarian organisations commit to fighting global warming?

Firstly, it is doubtful whether the rise in environmental concerns poses an existential threat to humanitarian organisations. Even if it did, this would not be sufficient reason for them to review their social mission and adapt it to fit the supposed expectations of the “younger generations”: should French NGOs abandon their aid programmes for migrants, on the grounds that they are out of step with the prevailing aspirations of European societies? The question of engagement in the fight for the environment is not an issue of institutional survival, but rather one of political choice, much like the commitment of humanitarian NGOs to other “great causes”, such as human rights, peace, democracy, international justice, humanitarian law and so forth.

The authors of the article justify MSF’s commitment to the environmental cause in the name of the “humanitarian impacts of climate change”: risk of conflict, social exclusion, tension over water management, migration, rapid urbanisation, the development of infectious diseases, extreme climate events (drought, flood, hurricanes, etc.), food insecurity and malnutrition, massive population displacement and migration and so on. These phenomena are all presented as direct consequences of climate change and as predictable as the increase in average temperatures of the Earth’s surface, thereby justifying the implementation of contingency plans.

Is it possible to measure and predict the impact of climate change on health?

While there is no doubt about global warming and its human origins, projecting its consequences comes with a high degree of uncertainty. This is primarily due to the difficulty of predicting how the global warming of the atmosphere is changing – and will change – weather conditions at local level. Only those trends related to the rise in average global temperatures are based on strong, consistent models which, under various scenarios, anticipate an increase of between 1,5°C and 6°C by the end of the century.These are conservative scenarios that do not factor in the possibility of drastic divergences linked to unpredictable interactions that could lead to brutal and uncontrollable disasters. See Claude Kergomard, « Changement climatique : certitudes, incertitudes et controverses, Territoire en mouvement Revue de gégraphie et aménagement[Online], 12 | 2012, 1er janvier 2014, models “accurately simulate only the global changes and developments across major atmospheric circulation systems, explains Claude Kergomard, Director of the Geography Department at theÉcole Normale Supérieure. Ibid. Biophysical models are not robust enough to approximate the effects of global warming on hydrology and extreme events at local or regional levels.“Describing actual climate impacts consequently requires projecting climate change for specific regions and seasons. It also requires projecting not just temperature, but also other characteristics of climate, especially precipitation. And it requires projecting not just changes in annual average values, but also changes in their seasonal cycle, variability, and extremes. These requirements pose substantial challenges to climate modelling and projection. As projections move from the global average toward smaller regions, they benefit less from cancellation of smaller-scale errors, so forecast errors grow larger”, ibid.With regard to precipitation, “changes in the water balance (precipitation, flow, groundwater reserves) involve considerable uncertainty, because of the difficulty of physically representing all their associated processes, such as cloud development and precise exchanges between the atmosphere and the surface of the ocean or continent,” explain Professors Dessler and Parson, authors of a review of the issue:See Andrew E. Dessler and Edward A. Parson, “Human-Induced Climate Change: Present Scientific Knowledge and Uncertainties”, in The Science and Politics of Global Climate ChangeA Guide to the Debate, 3rd Edition, Cambridge University Press, 2019, p.65-112. “It is particularly difficult to forecast precipitation at regional level because of its large variations over short distances. Small changes in the storm path can radically change the spatial and seasonal distribution of precipitation.”

Similarly, the impact of global warming on the frequency and magnitude of extreme phenomena (heatwaves or cold snaps, tropical cyclones and storms, heavy rain, drought) is still difficult to grasp. Modelling these events is still a challenge, largely because their rarity and unique nature are a barrier to the development of meaningful statistics. Researchers (including those from the IPCC) have so far refused to establish a causal link between, for example, the increasing frequency of Atlantic hurricanes since 1970 and global warming over the last one hundred years.The IPCC’s fifth report highlighted the complex nature of the factors that may affect the development and life cycle of tropical cyclones, but was unable to reach a definitive conclusion. See

The second source of uncertainty is the difficulty in assessing how ecosystems and human societies are responding, and will respond, to climate change. Contrary to the predictions of some models and the assumptions of the Stern Report,Wikipedia [translated from the French site]: “The Stern Review on the Economics of Climate Change is an account of the impact of global climate change and global warming on the planet written by the economist Nicholas Stern for the UK government. Published on October 30, 2006, this 700-plus page report is the first government-funded report on climate change to be led by an economist rather han a climatologist.” it has not proved possible to establish any compelling correlation between climate change and geographic change in malaria-prone areas.Peter W. Gething et al., “Climate Change and the Global Malaria Recession”, Nature, 465, May 2010, p.342-345, Some studies suggest that the increase in diurnal and nocturnal temperatures in Africa and Asia will substantially reduce the transmission potential of Plasmodium falciparum by Anopheles gambiae and Anopheles stephensiC. C. Murdock, E. D. Sternberg and M. B. Thomas, “Malaria transmission potential could be reduced with current and future climate change”, Scientific Reports, 6, Article number: 27771, 21 June 2016, in these regions. In fact, IPCC experts believe that “climate change will have mixed consequences, such as growth or decline in the spread and transmission potential of malaria in Africa”.« Contribution du Groupe de travail II au quatrième Rapport d’évaluation du Groupe d’experts intergouvernemental sur l’évolution du climat »,, p. 8. The report continues: “The balance of positive and negative health impacts will vary from one location to another, and will alter over time as temperatures continue to rise.” In their fifth report they state that the negative effects of climate change on the transmission of malaria will be compensated by progress in the fight against the disease.

IPCC experts argue that it is equally difficult to make projections about the health impact of natural disasters. Although they believe that floods will become more frequent and devastating, mainly due to the urbanisation of flood plains, they expect their lethality to decrease:

“For example, approximately 500,000 people died when Cyclone Bhola (category 3 in severity) hit East Pakistan (present day Bangladesh) in 1970 […]. In 1991, a cyclone of similar severity caused about 140,000 deaths. In November 2007, Cyclone Sidr (category 4) resulted in approximately 3,400 deaths. The population had grown by more than 30 million in the intervening period […]. Bangladesh achieved this remarkable reduction in mortality through effective collaborations between governmental and non-governmental organisations and local communities.”Smith, K.R., A. Woodward, D. Campbell-Lendrum, D.D. Chadee, Y. Honda, Q. Liu, J.M. Olwoch, B. Revich, and R. Sauerborn, “Human health: impacts, adaptation, and co-benefits”, Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Field, C.B., V.R. Barros, D.J. Dokken, K.J. Mach, M.D. Mastrandrea, T.E. Bilir, M. Chatterjee, K.L. Ebi, Y.O. Estrada, R.C. Genova, B. Girma, E.S. Kissel, A.N. Levy, S. MacCracken, P.R. Mastrandrea, and L.L. White (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, 2014, p.733.

Frequently cited in support of the most pessimistic forecasts, the Lake Chad region is a prime example of the difficulty of predicting the consequences of climate change on weather patterns, ecosystems and human societies. The surface area of Lake Chad shrank by almost 90 % between the 1960s and 1980s. While this drying up has profoundly transformed the economic and political life of lake communities, “the falling water level and the transition to a small lake configuration has freed up fertile land which has enabled the development of agricultural activity for populations that have learned how to exploit this land,” said geographer Christian Seignobos.Romain Gras, «  Assèchement du lac Tchad : le retour du projet Transaqua fait polémique  », Jeune Afrique, 1er  mars 2018, Since the 1990s, this phenomenon has reversed: the lake’s surface area has increased.Romain Mielcarek, « Pas de preuve de menace du réchauffement climatique pour le lac Tchad », RFI, 4 avril 2014, Weather models for this region are highly inconsistent and unable to predict if climate change will be accompanied by a decrease or an increase in rainfall and the surface area of the lake.According to Géraud Magrin, a researcher at CIRAD: “The models that analyse how climate change will affect rainfall in West and Central Africa are not consistent. There are parts of the world where this type of model is highly consistent, but that is not the case in this part of Africa. So, scientifically, it cannot currently be said whether or not global warming will result in more rainfall in the upstream basin of Lake Chad and thus more water in the lake itself, or in a fall in the lake’s water level. We are unable to say that. There is no certainty”, ibid. As for the influence of rainfall on conflicts in the Lake Chad basin and more generally on the political, social and economic life of local populations, predictions are absolutely impossible. Many researchers point out that there is no direct correlation between the depletion of resources and political violence, and that in any case the agricultural and security policies of Sahel governments (notably the sacrifice of nomadic populations in development projects in recent decades) have had a much greater impact on violence in the Sahel than climate change.See, for example, Tor A. Benjaminsen, « Changements climatiques et conflits au Sahel », in Denis Gautier et al.Environnement, discours et pouvoir, Editions Quæ, 2012, p. 181–200. The impact of the latter on population movements is equally speculative, as pointed out by other researchers who criticise the notion of “climate refugee”.See the column by historian Jean-Baptiste Fressoz: « Pour les spécialistes, la notion de “réfugié climatique” est tout simplement une mauvaise notion », Le Monde, 2 octobre 2019.

In summary, explain political scientists Yann Bérard and Daniel CompagnonYann Bérard et Daniel Compagnon, «  Politiques du changement climatique : des controverses scientifiques à l’action publique  », Critique internationale, n° 62, janvier-mars 2014.: “Despite the acquired certainty about the reality of warming and its predominantly anthropogenic origins, climate science remains uncertain in its projections because it not only depends on the imperfection of its measurement and modelling tools, but also on numerous assumptions about how natural and social systems are likely to face up to this challenge.”

Let’s be clear about this. Even though the local effects of global warming on climate, ecosystems, and human society are difficult to predict, there is no doubt that global warming represents a major threat to human societies. The rise in mean sea levels (26-98 cm along the coast by 2100), ocean acidification, changes in water resource distribution, and rapid ecosystem transformation have, and will have major adverse effects (direct and indirect) on disease distribution and health. These effects, however, are both immeasurable and unpredictable.

This limitation is fully accepted and explained in the IPCC reports. The fifth assessment report for instance emphasises that there are very few epidemiological studies documenting the impact of climate change on health due to the slow pace of this phenomenon and the impossibility of isolating the impact of climate variables among the many other factors affecting health:

“Robust studies require not only extremely long-term data series on climate and disease rates, but also information on other established or potential causative factors, coupled with statistical analysis to apportion changes in health states to the various contributing factors. Wherever risks are identified, health agencies are mandated to intervene immediately, biasing long-term analyses.”AR5 Climate Change 2014: Impacts, Adaptation, and Vulnerability, IPCC’s Fifth Assessment Report (WGII AR5), 2014, p.720.

Similarly, GIEC experts point out that the many uncertainties about how climate change will affect human health are an invitation to focus on current health problems. In response to the question “What is the most important adaptation strategy for reducing the health impacts of climate change?” IPCC experts say:

“The present health status of a population may be the single most important predictor of both the future health impacts of climate change and the costs of adaptation…. In the immediate future, accelerating public health and medical interventions to reduce the present burden of disease, particularly diseases in poor countries related to climatic conditions, is the single most important step that can be taken to reduce the health impacts of climate change.”Ibid., p.742.

What social and political response to climate change should humanitarian organisations encourage?

At odds with the methodological rigour of the IPCC, our colleagues suggest that MSF adopt an activist approach that aims to “communicate the humanitarian consequences of climate emergencies” by “establishing a causal link between climate change and observed disasters.”B. Jochum et al., « La question des choix… », art. cit.This instrumental recourse to epidemiology would enable political and social support to be rallied by presenting the fight against climate change as a public health issue. This is how they explain it in their contribution to Lancet Countdown:

“Given evidence that presenting climate change in a health frame is effective at motivating action, and data showing that health workers are some of the world’s most trusted messengers, humanitarians have the potential to amplify societal response by definitively showing climate change to be a human health issue.”

What societal response should be amplified? The authors believe that there is consensus on how to combat global warming: “… comply with the Paris Climate Agreement and stabilise temperatures at a level ‘well below 2°C’. This includes achieving worldwide carbon neutrality before 2050.” In their opinion, such an ambition “would require a radical change in practices and, crucially, compliance with a timetable for action over two or three decades [which is easy to apply to] all States, communities, businesses, organisations and individuals.”

Our colleagues also say that these measures will probably be useless, since “in the next twenty years – an increase of 1,5°C to 2°C is inevitable regardless of what measures are taken.” They therefore propose to use the weight of MSF’s influence to encourage the full implementation of radical measures aimed at achieving an unattainable goal. This objective is challenged by some of the experts and activists who advocate setting more realistic ambitions (and replacing the abstract indicator of the average temperature of the atmosphere with a more concrete set of measures on the state of the planet’s health).David G. Victor and Charles F. Kennel, “Climate policy: Ditch the 2 °C warming goal”, Nature, 514, 2 October 2014, p.30-31,

Achieving carbon neutrality by 2050 requires rich countries (which account for 60 % of annual emissions) to cut their emissions by 75 % in under 40 years. In the absence of revolutionary technical scientific innovation (harnessing nuclear fusion, for example), achieving this objective requires a radical change in individual and collective behaviour with regard to energy consumption in the fields of transport, habitat, the tertiary and agri-food sectors – and birth control.

According to a 2017 study by Canadian and Swedish scientists, the single and by far the most important means of combating global warming is to encourage the population of industrialised countries to have one less child.Seth Wynes and Kimberly A. Nicholas, “The climate mitigation gap: education and government recommendations miss the most effective individual actions”, Environmental Research Letters, 12, 2017, This recommendation is taken seriously by activist networks in France and the United States in particular, whose members practise a “Green Inclinations, No Kids” policy out of ecological considerations.Marylou Magal, «  Faire moins d’enfants, le geste écolo ultime  », Le Point, 18  septembre 2018, (Should this policy be part of the ethical behaviour standards for humanitarian volunteers?)

More generally, in a column published in Le Monde in October 2018, a group of scientists, intellectuals and demographers«  Climat  : “Freiner la croissance de la population est une nécessité absolue ” », Le Monde, 9 octobre 2018, the fact that population growth is the most notable absentee in the debate about climate change, whilst a “significant reduction in global population growth” is just as vital as energy transition in the fight against global warming (a position also shared by the UNFPA).UNFPA, État de la population mondiale 2009 though it is slowing down, human population growth remains staggering: 2.6 billion human beings in 1950, 7.6 billion today, 9.8 in 2050, and 11.2 by the end of the century according to UN projections. The scientists who signed the column in Le Monde maintain that even though the countries with the highest population growth are currently those with the lowest per-capita carbon footprint, “the combined effects of population growth and per-capita consumption in developing countries” must be considered. They argue:

“To avoid disaster, it will therefore be necessary (especially in developed countries) to reduce our greenhouse gas emissions sharply: this is energy transition. Yet we cannot overlook a significant reduction in global population growth: this is demographic transition, and not achieved in many parts of the world.”About demographics, see our Focus “Demography: Figures and ills”, Humanitarian Alternatives, N°12, November 2019,[Editor’s note].

This means of combating global warming is at odds with our social mission and activities, particularly those geared towards early childhood, which contribute to population growth without any concern for its supposed environmental effects. As Rony Brauman pointed out in a 2014 interview with Bruno Rebelle, former head of Greenpeace, there is tension between the humanitarian action that is part of the present, and the ecological commitment that is concerned by the future:

“By its very nature, environmental action (ecological action if you will) is a long-term issue of anticipation: today’s observations are, to a certain extent, built around the impact they will have in the future. The humanitarian community is interested in the ‘here and now’, in preserving life, in freeing itself from the very real need to appreciate its subsequent consequences. […] This creates tension between humanitarian action and ‘sustainable living’ in general, not to mention environmental concerns. Most humanitarian NGOs, such as Médecins Sans Frontières, have opted for the immediate rescue of people, in the name of a kind of division of tasks: it has its merits – we must be aware of our limits – but also its contradictions because it can generate indifference to the damage to which we are contributing and which is of the utmost seriousness for people who suffer its consequences.”Rony  Brauman et al., «  Le Politique, chaînon manquant entre humanitaires et environnementalistes   ? »,  Humanitaire, 38,  2014, p. 32-43,

What do we mean by “Above all, do no harm (to the climate)”?

Our colleagues’ latest recommendation is to “reduce our carbon footprint”. Two avenues are considered: reduce our CO2 emissions, the main sources of which are the transport of people, supplying our missions and the energy consumption of buildings; and “reduce the impact on the other ‘planetary boundaries’, related to land, water and ecosystem degradation and caused by the production of plastic, chemical and organic waste in the context of humanitarian programmes”. Yet even though our colleagues invite us to show “voluntary simplicity”, they add that these eco-friendly adjustments will have to be made “gradually” and must “never be at the expense of the efficiency required to accomplish the social mission”.

Unlike the other two recommendations which are underpinned by a form of hybris (predicting and anticipating extreme climate events and other consequences of global warming; tackling its “roots causes”) MSF’s commitment to reducing its own carbon footprint is characterised by caution. Of significance is for instance the near absence of any questioning on MSF own growth, which is implicitly regarded as a good thing in itself. The recruitment of new donors by direct mail campaigns – one of the main sources of MSF’s carbon emission along with transport of goods and personel – is not even discussed. The only avenues envisaged to reduce MSF’s carbon footprint stem from the very heart of the neo-liberal and techno-scientific ideology described as the root cause of the disaster: “optimising”, “seeking synergies between existing activities”, “efficiency”, “innovation and technical simplification”. In short, we are a long way off the revolution demanded of the rest of the world in order to achieve carbon neutrality – this revolution would be one of “self-limitation” requiring a break from “the capitalist fantasy of unlimited expansion”, to use the words of Cornelius Castoriadis.«  Grand texte  : Cornelius Castoriadis “L’écologie est essentiellement politique”  », L’Inactuelle, 30  avril 2019, As long as “the efficiency required to accomplish the social mission” means “always more, ever bigger” so as to “meet the needs” (by definition, infinite), our commitment to “voluntary simplicity” will be limited to greenwashing.

This criticism of my colleagues’ opinions does not detract from the merits of their undertaking, which is to invite MSF and humanitarian NGOs to reflect on their approach to a social topic that has become unavoidable: environmental degradation. Be that as it may, I strongly disagree with the two main recommendations they advocate: extending MSF’s social mission to include the fight against global warming because of its impact on the health and security of the most disadvantaged; and to strive to anticipate future crises through science. At the risk of repeating myself, even though science is able to predict temperature changes across the globe and their macro effects (melting sea ice and glaciers, rising sea levels, ocean acidification, etc.), it is unable to predict how ecosystems and human beings will adapt to these changes or what impact they will have on human health. Let’s keep the 10-, 20-, and 50-year scenarios in mind so that we can still respond to crises, whatever their nature, regardless of their connection to global warming! And, when warranted, let’s ask ourselves about the environmental determinants of health without necessarily focusing on the climate issue (as MSF did in Nigeria, for example, with regard to the heavy metal poisoning associated with gold panning, and the search for environmental risk factors that may explain the unusually high incidence of pre-eclampsia in other parts of the country).

It seems to me, however, that MSF must certainly question its role as “polluter” without limiting itself to the issue of global warmingOCP logisticians already offer several solutions relating to waste management and our procurement policies.and without forgoing the key issue of its own growth. The minimum would be to audit the association’s practices in order to assess how they stand against existing environmental standards, at the very least against international incentive standards such as the ISO 14 000 family.See the ISO 14000 family of standards: and the definition of ISO 14001: Given the challenges posed by climate change, MSF and humanitarian NGOs are more part of the problem than the solution.


To cite this content :
Fabrice Weissman, “Should Médecins Sans Frontières join the fight against global warming?”, 9 avril 2020, URL :

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