Intended for healthcare professionals


Flooding and climate denialism are harming millions of people in southern Brazil

BMJ 2024; 386 doi: (Published 10 July 2024) Cite this as: BMJ 2024;386:q1519
  1. Raquel Canuto, nutritionist and epidemiologist
  1. Faculty of Medicine, Federal University of Rio Grande do Sul State, Brazil

The damage caused by flooding in southern Brazil was exacerbated by climate change denial and a lack of prevention measures by the government, says Raquel Canuto

Brazil has experienced several environmental disasters over the past decade, and in May it experienced one of its most severe disasters to date.1 Rio Grande do Sul, the country’s southernmost state, saw 95% of its municipalities affected by the largest and most destructive floods in its history. Around two million people were affected, over half a million were displaced, 800 were injured, and 178 deaths have been confirmed. The floods damaged infrastructure, with hundreds of obstructions to roads and bridges leaving entire cities isolated and complicating the supply of food, water, medicine, and rescue services.2

The government in Brazil, with support from other governments and multilateral organisations, needs to commit to improve its preparation, prevention, and response regarding the climate emergency, to protect the health and safety of citizens in future disasters.

Climate change and government inaction

The recent extreme flooding is a direct consequence of ocean overheating that has altered rainfall patterns, increasing the frequency of storms and the volume of precipitation.34 But these devastating consequences are also the result of climate denialism among government officials. While scientists warned about the increased flood risk in Rio Grande do Sul, investment in flood prevention hasn’t kept pace. The state invests less in civil defence than the national average, leading to understaffing and a lack of resources at municipal civil defence agencies.5 In an interview on 19 May the state governor, Eduardo Leite, stated, “Studies warned, but the government also has other agendas.”6

The state’s capital of Porto Alegre was one of the cities most affected. The city is bordered by Lake Guaíba and is highly susceptible to flooding. Porto Alegre constructed its current water drainage and sewage system in the 1970s, and the flooding overwhelmed a system that hasn’t been updated or received adequate maintenance. The state and the municipality have no warning or evacuation plans in place for such events.7

These failings demonstrate the state’s lack of commitment to prepare for and mitigate the harms of the climate emergency. The governor and the mayor of Porto Alegre were elected on neoliberal agendas, implementing policies that have led to reduced public services and the relaxation of environmental regulations, mainly in agriculture—the state’s principal economic activity—and of urban planning within cities.8 These actions undermine efforts to tackle climate emergencies, while hindering the state’s capacity to manage their impact.

Power of organised civil society

In Porto Alegre, amid the denialism and ineptitude of public authorities, I saw the critical role of organised civil society in providing essential support during the emergency. The flooding affected the water collection system, main access routes, and public facilities, including health services, schools, and government buildings. We lacked clean water, electricity, food, and medicines, but the greatest challenge was rescuing people and animals from the flooded areas. With no coordinated response from public management, civilians were heavily involved in rescue efforts, organising shelters for displaced people, preparing meals, and donating essentials.

My university opened its doors to the community, setting up shelters and offering services and resources, including food, healthcare, and legal assistance, with the support of faculty, students, volunteers, and public employees. Health professionals, organised in their professional associations, also provided voluntary health assistance. Solidarity kitchens are collective spaces for the production and free distribution of food in situations of social vulnerability: led by the Homeless Workers’ Movement (MTST), they have already produced over 100 000 meals in Porto Alegre alone since the beginning of the crisis.9 Social movements have demonstrated the ability to respond quickly and reach the most vulnerable populations in emergencies.

Reconstruction and future directions

We face a long period of reconstruction, with many health, economic, and social challenges. In the health sector around 3000 establishments in the state were affected and now face additional operational difficulties, impeding the treatment of chronic conditions and medical emergencies.11 We need a robust public health strategy that can meet immediate needs during disasters while also enhancing the resilience of health infrastructure against future events. This includes strengthening universal primary healthcare to comprehensively respond to the needs of the populations affected, as well as creating a permanent emergency operations centre for quicker responses.

Food access is also a significant problem. Losses in food production have disrupted fresh food supplies and driven up prices. Public food security policies and stronger social movements focused on food production and distribution are crucial to ensuring access to healthy food, especially for the most vulnerable populations.

Brazil’s president, Luiz Inácio Lula da Silva, has responded by establishing the Ministry of Reconstruction of Rio Grande do Sul, which aims to improve cooperation between federal, state, and local governments and to maintain dialogue with civil society.10 This coordinated effort is crucial for effective reconstruction and long term resilience against future disasters.

With Brazil hosting the COP30 UN Climate Change Conference in 2025, as well as holding the G20 presidency in 2024 with a sustainability agenda, there’s a significant opportunity for new agreements related to the climate emergency. Our future depends on more effective global responses to climate change.


  • Competing interests: None.

  • Provenance: Commissioned, not externally peer reviewed.