Intended for healthcare professionals

Rapid response to:


Record flooding in Pakistan poses major health risks

BMJ 2022; 378 doi: (Published 05 September 2022) Cite this as: BMJ 2022;378:o2148

Rapid Response:

Re: Record flooding in Pakistan poses major health risks

Dear Editor

Asia-Pacific is one of the most vulnerable regions to climate change, and impacts are projected to intensify in the future. It also accounts for nearly half of global greenhouse gas emissions. Developing countries are particularly vulnerable to the effects of climate change because of their high dependence on natural resources and their limited capacity to cope with these impacts.

We are Health Equity advocates based in four countries in Asia that are experiencing the devastation of climate change; India and Pakistan with extreme heat waves, Malaysia with flooding and the Philippines with typhoons. We are concerned about the future of our fellow citizens, particularly the vulnerable populations we work with.

Climate change and environmental pollution impact every single person; however, the effects are tough on the vulnerable communities who are least prepared for it. Women and children, migrants, socioeconomically deprived, disabled and indigenous people – were already disproportionately disadvantaged before the pandemic. Now, they have to face the health impacts of climate change.

The climate crisis is not "gender-neutral". Women and children first may be an often-used mantra, but they are actually often known to be at the end of the line in disaster situations. In countries such as India and Pakistan, where many of these gaps are amplified, women and children are particularly vulnerable during food insecurity, drought or flooding due to insecure livelihoods and income poverty. It is worse for pregnant women and lactating mothers who face high food insecurity levels and malnourishment during heat stress and drought events.

Earlier this year, severe floods forced more than 100,000 residents across seven states to evacuate in Malaysia, encroaching on the indigenous heartland. In the neighbouring Philippines, powerful typhoons and earthquakes have repeatedly left a trail of destruction and displaced communities. When floods engulf road access to health facilities, indigenous communities and people with disabilities are the most affected. We need preparedness and planning in the event of a disaster for these vulnerable communities, or we are only exacerbating their vulnerability, leading to poor health.

Asian countries can mitigate the challenges caused by climate change by adopting the following recommendations:
1. To ensure adequate and sustainable funding to support climate action that accommodates everyone, including disadvantaged groups.
2. To scale up and streamline climate action in national and local government systems, structures, and processes, before and in between pandemics.
3. Countries must integrate a gendered perspective and strengthen gender-responsive mechanisms into existing climate policy frameworks. Women need to be empowered and included in the decision-making process.
4. To incorporate vulnerable populations for community participation and representation in planning activities to ensure equitable access to care across all communities.
5. To encourage local evidence-based practices to allow for nuanced climate action. This evidence should inform the design of climate change action policies, programs, activities, and projects to improve their effectiveness.

Pandemic preparedness and climate change planning should not be mutually exclusive. Future pandemic preparedness plans must integrate details about how the responses could address the needs of different vulnerable groups.

While Asia re-prioritises, it must consider those who have been at the end of the line and realign priorities, action and policy. Asia needs a renaissance in climate change efforts to ensure a more equitable, inclusive, sustainable, evidence-based approach to climate action.

Robust climate action plans, health systems and global health security must be rooted in principles of equality and dignity.

Competing interests: No competing interests

06 September 2022
Peter Gan Kim Soon
Public Health Physician
Shubha Nagesh (Dehradun, India), Lindsley Jeremiah Villarante (Manila, Philippines) and Bilal Asim (Lahore, Pakistan)
Atlantic Fellow for Health Equity
Kuala Lumpur, Malaysia