4. Environmentally displaced people

Climate migrants

Climate change has displaced an average of 26.4 million people around the world every year since 2008. The 2020 World Migration Report issued by the International Organization for Migration details that climate related disasters are responsible for the displacement of more people than war and conflict related events.[1] By 2050, the United Nations estimates that there will be as many as 1 billion climate migrants. [2]

Climate Migrants are unwillingly forced from their homes by the climate emergency, are fleeing situations in which their health is put at risk, but subsequently find their health threatened by the vagaries of an international system that is struggling to keep pace with the many harmful aspects of the climate crisis. [3]

Postmigration

Postmigration factors, such as access to housing, employment and a sustainable income, language skills and social support, as well as experiencing discrimination and social isolation, must also be considered to understand the psychological effects of the refugee experience. The asylum system, however, is unpredictable and is characterized by a lack of transparency as well as individual control. Someone else, usually a refugee programme administrator or service provider, tells you where to live and how to fill your days. Another person decides your fate, on grounds that are often arbitrary and hard to understand. Most asylees find it difficult to seek help and use services because of the aforementioned heightened sense of distrust and insecurity. Moreover, the operational difficulties such as language barrier and lack of secure and safe relationships, make it more difficult to connect again to others in the new host country. [14]

Understanding the intersection between global migration & health

Selected examples based on information presented in the UCL-Lancet Commission on Migration & Health [14]

displacement in context: Syrian civil war

In 2007, Syria experienced a major drought that lasted several years and resulted in the mass migration of internally displaced people towards urban city centers. [4] Precipitation, temperature and sea-level pressure data collected over a century in the area confirmed that the probability of this kind of relentless drought was increased by a factor of 3 due to climate change. [5]       

The influx of 1.5 million people from rural farming areas toward urban centers destabilized the fragile social, economic and political fabric of Syria. The urban peripheries of major cities in Syria were inundated by displaced people and characterized  “by illegal settlements, overcrowding, poor infrastructure, unemployment, and crime”. [6] These settlements were “neglected by the Assad government and became the heart of developing unrest” that galvanized the onset of the Syrian civil conflict in 2011 and eventually led millions of people to flee the country. Ultimately, the confluence of climate change, water mismanagement, a decline in crop yield and of livestock herds, unstable farming practices and a repressive government regime were largely responsible for driving people from their homes and destroying their livelihoods. [7]

The United Nations Refugee Agency attributes the increase in forcibly displaced people from 43.3 million in 2009 to 70.8 million in 2018 primarily to the Syrian conflict. [11] In 2018, Canada admitted the largest number of resettled Syrian refugees (28,100 out of the documented 92,400 refugees). [12]

Arrival to Canada - or any other country of asylum - does not necessarily imply an easy fix to the number of health concerns described by the International Organization for Migration. The profound stress and uncertainty inherent in fleeing one’s home - compounded with the difficulties of navigating language and cultural barriers and coping with stigma in their country of asylum - shapes future health outcomes in refugees. [13]

Learn about the Syrian Civil War & Its Climate Context:

displacement in context: Canadian wildfires

In 2017, an overwhelming 12,000 square kilometers was burned in British Columbia during the wildfire season. While the dryer weather in the summer months naturally results in forest fire activity, climate change has increased the area burned by a factor of 7-11. [15] The destruction of land resulted in the displacement of 65,000 people.[16] The forest fire season of 2018 burned 13,000 square kilometers of land, surpassing the record-breaking devastation caused by the year earlier and caused the provincial government of British Columbia to declare a state of emergency. [17]

Some of the Health Effects of Wildfires:

1.     Direct Injury and death from contact with fire. 

2.     Exacerbation of chronic respiratory and cardiac conditions.

Wildfire smoke can increase pollutant levels up to 10-fold and contains particulate matter, which has damaging cardiopulmonary effects. [18,19] Smoke inhalation has been shown to increase respiratory morbidity and mortality, in addition to an increased risk of cardiovascular incidents, such as cardiac arrest. [20,21]

3.     Stress of Displacement

Evacuees and communities on the periphery of wildfires in evacuation limbo experience prolonged stress associated with increasing rates of depression, anxiety and post-traumatic stress disorder. [22] Ensuring that mental health professionals play a role in wildfire response and are readily available for patients in affected areas, contributes to positive health outcomes in these individuals. [23] Patients at a higher risk of mental health illnesses following wildfire (such as those with pre-existing mental health conditions) benefit from early intervention and support. [24]

Learn about the 2014 wildfire season in the Northwest Territories, Canada:

What can we do as medical students?

Research, ask questions, and continue learning. As underscored by the UN Commission on Migration and Health: education on climate change and migrant health is of paramount importance.

The current gaps in knowledge about how climate change events catalyze mass migration movements, and the subsequent health challenges these migrants face, present a barrier for supporting these individuals in their transition. 

Examples of areas that require further research:

• The health implications of laws governing environmentally displaced people and Canadian policy on climate change related asylum claims. 

• As of January 2020, the United Nations Human Rights Committee has ruled that governments cannot return people to countries where their lives might be threatened by climate change. [26]

• Perspectives and perceptions of displaced people to understand how and to what extent environmental changes in their countries of origin contributed to their decision to leave their homeland. [27]

• The implications of acknowledging climate change with refugees in the clinical setting – what are possible harms or benefits to patients?