Should rich countries pay for climate-related health crises in Global South countries? Humanitarian organizations say yes – but it’s complicated

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In a scathing speech early at COP27, Barbados Prime Minister Mia Mottley paraded the biggest geopolitical climate elephant in the room for all the world to see.

The whole planet is well on track to surpass 3 C above current temperatures by 2100. However, many poor Global South countries are suffering the most from climate catastrophes caused by the immense economies of the United States, China, Canada, and other wealthy states. Ironically, those Global South countries largely created the industrial backbone of the world’s largest polluters.  

“We were the ones whose blood, sweat, and tears financed the Industrial Revolution,” Mottley told dignitaries, according to The Guardian. “Are we now to face double jeopardy by having to pay the cost as a result of these greenhouse gasses from the Industrial Revolution?”

Shaban Mwinji, a community scout ranger, in Ukunda, Kenya. Standing in a restored Mangrove Forest by Mikoko Pamoja. Mikoko Pamoja is a community-led mangrove conservation and restoration project based in southern Kenya. Photo: Anthony Ochieng / Climate Visuals Countdown

The answer, in her view, was ‘loss and damage’ – an international financial agreement to compensate poor nations for climate-related damages caused by the emissions of rich nations. First proposed by the Alliance of Small Island States in 1991 to compensate island nations vulnerable to rising sea levels, ‘loss and damage’ became the defining issue of COP27, and will form the basis of international climate diplomacy for years to come.

Dozens of Global South countries see a future loss and damage fund as an essential source of funds to rebuild after climate change-fuelled storms, floods, or heatwaves – including climate triggered health crises.  

Unfortunately, the sheer scale and complexity of a loss and damage facility – as well as the political backlash from rich polluter nations – has turned the fight for a loss and damage fund into a grueling siege. International climate finance agreements already exist, but many are in the form of loans, rather than a grant-based system without any interest charged by lending countries. 

Humanitarian and climate justice organizations will need to understand the concept of loss and damage in order to follow what is perhaps the largest fight for climate justice on the planet. According to a report by the 55 most climate vulnerable countries on Earth, climate change alone has resulted in roughly $525 billion U.S. in damage over the last 20 years.

And healthcare is a significant portion of that total. By 2030, the World Health Organization expects direct healthcare costs – in other words, paying for medical staff to treat illnesses, staff hospitals, and respond to climate disasters – will balloon to anywhere between $2 billion and $4 billion U.S. a year. This figure, the World Health Organization says, doesn’t include costs related to agricultural or sanitation failures as a result of climate change. 

Future of Good spoke to humanitarian organizations and climate experts to break down why loss and damage matters so much, what it could look like in the future, and the future challenges loss and damage supporters will have in pursuing reparations:

Why do Global South countries want a loss and damage fund?

Most Global South nations bear a miniscule responsibility for the greenhouse gasses currently driving climate change. On a per capita basis, Pakistan contributed only 0.9 metric tons of CO2 per person in 2019, according to the World Bank. That same year, Canada contributed 15.4 metric tons of CO2 per person to the atmosphere.

But while global warming today is largely fuelled by emissions from rich countries like Canada, the United States, and China, the harm done by climate change is not distributed equally. Canada is warming twice as fast as the rest of the world, but its relatively temperate climate and vast territory means climate disasters have not been as severe as in the Horn of Africa, Southeast Asia, or island nations in the Pacific.

This is not the case in a Global South country like Pakistan. On top of ongoing political instability and stark economic inequality driven, in part, by the lingering effects of British colonialism, Pakistan suffered an unprecedented monsoon season in 2022 – exacerbated by climate change. The South Asian country went from very dry conditions to massive floods that killed nearly 2,000 people and displaced or otherwise affected roughly 15 per cent of the national population. At one point, roughly 30 per cent of Pakistan’s landmass was underwater. 

Pakistan simply doesn’t have the financial means to address a myriad of problems related to the 2022 monsoon season – from rebuilding homes, to preventing the spread of waterborne diseases like cholera, to addressing domestic violence in refugee camps. In October 2022, a month before COP27 began in Egypt, the Pakistani government made an $816 million appeal for aid from the international community. It remains unfunded.

Pakistan, along with other Global South nations like Antigua and Barbuda, Jamaica, Fiji, Senegal and Tuvalu – and, notably, China – spearheaded an international push for a loss and damage fund in the lead-up to Cop27. While the details of how such a fund would work is still unclear, these countries, along with humanitarian agencies working with the Global South, believe all sorts of damages should be covered.

“We want a loss and damage facility, one that responds to the needs and aspirations of climate vulnerable nations that don’t have the support to recover at this moment,” says Eddy Perez, international climate diplomacy director at Climate Action Network Canada.  

Would a loss and damage fund cover health-related costs?

At COP27, a grueling 36-hour bargaining session between the richest and poorest countries ended on Nov. 19 with an agreement to launch a loss and damage facility. Unfortunately, when it comes to international climate finance, the devil is in the details – and at the moment, there simply aren’t any on what a loss and damage facility would support.

Generally speaking, discussions about loss and damage funds have referred to two types of losses. The first are so-called ‘economic losses’, or calculable financial damages for homes, businesses, and infrastructure. But there are plenty of other damages inflicted by climate change on vulnerable countries, not the least of which are health-related, called ‘non-economic losses’, that are difficult to quantify on a balance sheet.

“Quite often, non-economic losses can refer to loss of life – it’s very difficult to put a monetary value on human life,” says Daniel Willis, policy and campaigns manager at Global Justice Now, a UK based organization. “We know that after all kinds of extreme weather events, there is a potential for disease to spread very quickly throughout a country.”

Perez points to another example. Workers who toil outdoors in hot climates, but even in relatively temperate ones like Canada’s, are increasingly suffering cardiovascular episodes due to heat waves. In countries like the United Arab Emirates and Jordan, heat waves have gone from unbearable to lethal for anyone without air conditioning.

Climate justice organizations like CAN-A, as well as humanitarian agencies like CARE, see health crises as an essential part of any loss and damage facility agreed to by COP members. “Loss and damage covers economic and non-economic damage,” Perez says. “Of course, it includes health.”

Whether Global North funders agree to this interpretation of loss and damage is very much up in the air. Simon Donner, a professor of climate science at the University of British Columbia, doesn’t believe that the loss and damage facility will start calculating health losses by climate-vulnerable countries. “The point of it is to provide money to help,” he said of the fund. “Think of it as disaster relief.”

What are the complications to setting up a loss and damage fund?

Rich polluting countries, particularly the United States, have resisted the idea of a loss and damage facility for decades. The EU, until the final few days of COP27, also held off on support for such a fund. Both superpowers claimed existing climate finance arrangements, as well as international humanitarian aid by NGOs and governments, was sufficient to meet the needs of climate vulnerable countries.

Estimates of annual climate change damage suggest it far exceeds the most ambitious climate finance program agreed to by COP attendees, a $100 billion-a-year agreement by 2020. One estimate suggests it could reach from $290 billion to $580 billion U.S. every year by the year 2030, and potentially hit $1 trillion a year by 2050. The death toll will be catastrophic. In both the Global North and South, climate change is expected to kill 250,000 people a year between 2030 and 2050. 

Perez – and many Global South heads of state – say rich polluting countries have other reasons to stay away from loss and damage. “They don’t want to be under a framework that makes them liable to losses and damages,” Perez says. “I think that’s a red line for them.” By the time COP27 ended, both the EU and the US had agreed to the fund after tremendous pressure from Global South countries.

There are also complications around which countries would actually qualify for the fund. When the United Nations Framework Convention on Climate Change was signed in 1992, some of today’s biggest polluters – most notably China – were still considered to be ‘developing countries’. Today, China is the largest greenhouse gas emitter in the world. “Within a few years, China will pass the U.S. in its historical responsibility for the problem,” Donner says.

Meanwhile, the World Health Organization says, Global South countries will be among the most vulnerable to the healthcare impacts of climate change, everything from faster-spreading zoological diseases to heat stroke deaths caused by extreme heat. “Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond,” the WHO says. 

Perhaps the least obvious complication of a loss and damage facility involves how it would determine fault for climate impacts. Donner fully supports the idea of a loss and damage fund, but worries it’ll be difficult to determine which countries are liable for a disaster in a Global South country.  “It comes to these questions of what fraction of the event was caused by climate change?” Donner says. “What fraction of the emissions came from their country? There’s never going to be one solid answer.”

How are Global South countries coping until a loss and damage facility launches?

Delegates at COP27 may have hammered out the bare bones of a loss and damage fund, but the details of how it’ll allocate money won’t come out until COP28 in the United Arab Emirates next year. Until then, climate vulnerable nations will need to depend on existing climate finance agreements, humanitarian and international aid, or the newly launched Global Shield – a plan that provides prearranged insurance and disaster protection funding for dozens of climate-vulnerable countries.

Meanwhile, humanitarian and climate justice organizations will continue to support millions of people affected by the health effects of climate change across the Global South – from gender-based violence against climate refugees in Pakistan to heat-related deaths in the Horn of Africa.

As Climate Action Network International executive director Tasneem Essop said in a statement after COP27, national governments aren’t the only actors bringing international attention to loss and damage. Through “the collective struggle of developing countries, civil society and movements”, a concept devised by island nations threatened with total destruction is now the cornerstone for climate diplomacy.   

“This decision, taken on African soil brings hope for vulnerable impacted peoples and communities,” Essop’s statement said, “not just in the continent, but for the entire Global South.”

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