MSF director on climate: 'We are at a crucial moment in the history of mankind'

Several warnings to humanity have been published by scientists on the unprecedented risks triggered by the climate emergency. With less than 20 years left before we cross the Paris agreement threshold of 2°C warming, they urge society to now radically transform its ways. Its anticipated consequences will heavily impact the most vulnerable with humanitarian needs likely to grow several folds.

Geneva Solutions: As the new director of Médecins sans Frontières in Geneva, how do you factor in the climate crisis in your priorities and in the delivery of emergency medical assistance ?

Stephen Cornish: MSF’s ambition, which from Geneva prioritises planetary health, improved emergency response and patient and community centred health, is what attracted me to the role. My aim is to prepare the organisation and its operations to better meet the challenges of tomorrow.

Also watch: MSF video “Planetary health: how human health depends on the wellbeing of the planet”

It's very clear that the climate crisis, along with other planetary overreaches, such as overfishing, draining aquifers, ocean acidification and extinction of species, affects the very survival of millions of people and thus of life as we know it today. When taken together, these represent the greatest humanitarian emergency ever faced by mankind. It's therefore no longer a question of whether this impacts us or not, it's about how we respond to the scale of the challenges ahead.

‘The classic model whereby medical humanitarian organisations independently sends staff and goods around the world from a centralised repository will no longer be fit for purpose.’

The current COVID epidemic gives us a snapshot and the urgency of the case for change as well as a glimpse into what a climate crisis future looks like. One filled with concurrent emergencies the world over, interrupted global supply chains, closed borders, heightened costs of doing business, of obtaining and distributing goods, of acquiring authorisations and permissions and hindrances to moving personnel around our once globally connected planet.

The classic model whereby medical humanitarian organisations independently sends staff and goods around the world from a centralised repository will no longer be fit for purpose.

We need to learn by doing and progressively change our culture and methodology of response. We need to make it less singular-focused, more community and partnership minded and more resilience-building, in an effort to respond to the many things we won't be prepared for.

Agility, reactivity and resilience will become key parts of emergency response. Local and regional actors increasingly need to work together to respond to humanitarian emergencies as international attention is being diluted and traditional donor countries are increasingly concentrating on their own domestic challenges, more so than on the most affected communities.

As a medical humanitarian organisation, we must ensure we are relevant, but also adapt our response capacity to be able to assist those most in need with the climate chaos future on the horizon.

Also read: MSF Policy Brief in Lancet Countdown 2020

GS: What impacts do you observe already and how does this influence your activities?

SC: We've already trialled different approaches to community centred care, where we build resilience into systems in conflict zones so that patient groups can be the agents of their own treatment once they're on the move again, for example with TB or HIV drugs. We're looking at better responses to avoid the peaks of epidemics for instance in malaria, where we do a blanket treatment ahead of time, or with the introduction of a cholera vaccine. Through anticipation and free capacity to concentrate on other needs, it is our hope that systems and populations can be more resilient in the face of natural disasters and climatic events.

We see stresses on centralised systems and on the post-World War aid and political apparatus that are no longer fit for purpose. The COVID-19 pandemic has clearly shown that solidarity has limits, especially in situations of global concern. At the same time, there's no point in pretending to be a superhuman organisation that's going to meet all needs. However, we can change our ways of working.

We've been fortunate in MSF to start investing in future medical technology, mechanisms and medicines to prepare for tomorrow's needs, as have other organisations. We have been trialling solar generators, thermodynamic tents, mini labs… Resilient and more decentralised technologies can be more effective in times when systems and services may be cut off.

‘We have lessons to learn from others and we are taking it very seriously.’

I would imagine an increased partnership with the Red Cross family, joining forces with an organisation which has a long history of on-the-ground capacity building in disaster preparedness response. There is an opportunity to harness each partner’s own capability and bring them to cooperate together whilst also strengthening the resilience of communities themselves, as development actors have done for many years.

We have lessons to learn from others - like from the Global Green and Healthy Hospitals initiative - and we are taking it very seriously. We want to be environmentally responsible and as a medical humanitarian organisation reduce our own footprint - the portion we contribute to this global problem.

Those changes might be a little harder to implement in a classic emergency mode. There are still many neglected situations and humanitarian deserts today. But we certainly can work on improving partnerships right from the start and involve communities more in their own recovery process.

The classic emergency responses can also lend resilience in front of future catastrophes, through the types of shelters built and the types of installations we leave behind. These can better meet and withstand some of the climate impacts to come and give communities a greater role in their own mitigation and recovery from future shocks.

GS: Does MSF have a role in advocating on the climate emergency?

SC: Advocacy is key, and we have both an internal and external communication role to play. We need to show that the effects of climate chaos are not just something far off in the future - they already exist.

We need to start linking the co-causality of climate with the aggravation and augmentation of suffering we see. As a humanitarian organisation, to truly become environmentally responsible, we will need to change our own culture, inform our donors, and use our advocacy to bring this issue to the attention of governments, companies and others.

Some of the latter are well on their own climate journeys, but we know that there are many powerful actors who are still pulling in the opposite direction. We have the moral responsibility to paint a better tableau of the effects that are already occurring to our patients.

I personally met migrants in Central America who were making their way from Nicaragua up through Mexico towards the US border. In our communication, we were describing them as fleeing gang violence towards a better life in the U.S., which is absolutely true.

But having talked with many of those migrants myself, I would ask them: how long had the violence been going on and how were they able to live before? To my surprise, many of them told me it was only weeks or months. They said they had only just got to the city after multiple years of not being able to grow crops because of high winds, flooding or recurring droughts in the summer.

With all these changing climate patterns, they could no longer make out when to plant and when to harvest. And they simply couldn't make life work anymore in their villages. So they were forced to migrate to the city, and that's when they met violence. The reason they were on the road was not climate change alone, but it was a co-causal element. MSF has the responsibility to expose the full lived reality of our beneficiaries so people know what it is.

I have more doubts about the role that advocacy by medical humanitarian actors can play in the future, as attention tends to squarely focus on our own societies at the expense of the other. When hurricanes are striking the Caribbean today, the media is covering Florida's preparations. After the storm is gone, it's again Florida's recovery. Wildfires hit Latin America, but we only look at the wildfires across California. When heat waves were experienced across the Sahel, we saw the heat waves in Europe.

I am therefore very concerned if we believe that in the future, when there will be less resources, greater climatic events, that advocacy will be the key to unblock the type of assistance, mitigation or other measures needed. Now is really the moment when we have a very important role to play, not later.

GS: Many in society have endorsed a net zero pathway to avoid the worst impacts of climate change. Some aid organisations are moving in this direction, with very clear targets. Is MSF today considering the same course of action, with footprint reduction targets ?

SC: As a global movement, MSF recently signed up to its own Environmental Pact, with measures linked to its footprint, not only in terms of carbon but also on medical and plastic waste that affects the environment in which we work. That moral engagement of the organisation is being implemented and taken on board by the different entities of MSF.

A number of them, including the MSF Operational Centre in Geneva, are seriously considering signing up to the Paris agreement targets [reduction by 50 per cent by 2030], because we question our ability to make the changes needed by an incremental approach only.

Some companies, municipalities and other actors already took the courageous move of signing up to targets that were truly very ambitious, not knowing how they would get there. That brought a cultural change and a shift that allowed those organisations, their staff and partners to become part of the solution. They were able to bring in new elements, onboard new technologies and find new ways and ideas that no one would have thought of without this initial cultural appropriation and ownership.

My sense is that it won't be very long down the road before MSF in Geneva signs up.

GS: Do you see a role for medical organisations like MSF to put their weight in accelerating the action that's needed to stabilise temperature increase? And play the role of an amplifier to help reach the social tipping points needed to avoid a climate breakdown?

We're all in this together and it's going to take a planetary answer to a planetary crisis. And I personally believe that as a humanitarian actor, conscious of the effect that these issues will have on our beneficiaries and patients, we do have a moral role to play whether or not we reach a tipping point.

I have led an environmental organisation for three years [the David Suzuki Foundation] and saw many battles be overturned, as companies, think tanks and others get ahead of advocacy campaigns and roll them back. Many battles were won or made a lot of progress, and then, like in a game of snakes and ladders, progress pushed back.

“We have a moral responsibility to participate to adaptation and contribute to reaching the tipping points needed to avoid greater suffering. There is no other choice in my mind.”

Sooner or later, this fight will be won. The problem, of course, is that we already have so many negative consequences coming into play that we know that it's too late to simply mitigate. We need to work on adaptation in order to better prepare communities for the changes that are coming. For example, we know that with greater tree cover in some slum areas you can reduce temperatures by 10C! From a quality of life standpoint and health standpoint, that would be enormous.

We have a moral responsibility to participate in adapting and contributing to reaching the tipping points needed to avoid greater suffering. I don’t know when or how those forces come together, but shall we try? Absolutely. There is no other choice in my mind.

GS: Could you share your vision for the transformation to happen?

SC: We need to take our individual, our societal and our organisational responsibilities. Moe importantly, we need to act on all three. From my past life, I've seen a number of studies that show that if people are involved in one of those three areas, they often allow the other two to be under-serviced. We all need a cultural shift to understand what this means.

It's hard for us humanitarians because we're not good at warning nor at crisis avoidance. And it's very hard to understand what tens of millions of people suffering means.

We are at a crucial time in the history of mankind that not many people have lived in. We are facing a crisis of a proportion that our brains can't even fully understand. We owe it to our children and grandchildren and we owe it to ourselves, to do everything we can on all three of those levels so that it truly becomes part of the lens through which we see everything we do.

It can be achieved and we shouldn't let our brains be the blocker of the how.