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3.10  Forced migration and conflict The total number of people vulnerable to migration will increase substantially by the end of the century without significant further action on climate change. Among areas likely to be worst affected is the Sahel (Defrance et al. 2017), and the EU is likely to continue to be a major receiving area for climate refugees. Climate-changeinduced migration can occur through a variety of different social and political pathways, including population displacement by heat, sea level rise, extreme weather events and exacerbation of food and water security issues. There is some evidence, for example from Syria, that a reduction of national capacity to deliver food and nutrition security in consequence of drought was a factor leading to civil unrest, conflict and forced migration, both internally and to other countries. However, there are scientific and methodological challenges in evaluating the links between climate change and conflict. Recently, such claims have become more controversial because of the suggestion that there is sampling bias in the evidence base: research had focused on regions of violent conflict (Anon. 2018d; Adams et al. 2018). Nonetheless, although it is important not to overstate an association, it is reasonable to describe climate as a contributing factor to some conflicts (Whitmee et al. 2015; EEA 2017c; WHO Europe 2017a,b; Gleick et al. 2018). In understanding the evidence base, there is need to attend to the context in which droughts and other climactic extremes may increase the risk of forced mobilisation. For example, for agriculturally dependent groups in very poor countries, drought during the growing season has been associated with the increased likelihood of sustained conflict (von Uexkull et al. 2016). Other evidence supports the association between climate change and migration. An analysis of weather variations in 103 countries for the period 2000–2014 (Missirian and Schlenker 2017) found that when temperatures deviated from the moderate optimum, asylum applications to the EU increased in a nonlinear fashion. This observation implies an accelerated increase under continued future warming: if everything else is held constant, asylum applications by the end of the century are predicted to increase on average by 28% per year at RCP 4.5 and by 188% under RCP 8.5. The issues relating to climate change and migration are discussed further in the European Commission’s JRC publication (Migali et al. 2018) and in the latest Lancet Countdown assessment (Watts et al. 2018b). However, the impacts on health are less easily quantified. One significant factor is the living conditions

that are allowed for migrants, particularly if there has been declining immunisation coverage in the countries of origin of migrants (Berkley 2017). For example, previous EASAC work on tuberculosis (EASAC 2009), noted that migrants may only be infected after arrival in their host country in consequence of their impoverished socio-economic status. In the past 3 years, the EU has experienced the most significant influx of migrants and refugees since the Second World War. The institutional response, including the health services, has been suboptimal, failing to address specific vulnerabilities (Puchner et al. 2018). For example, in Greece the asylum-seekers crisis has led to unmet health needs both for locals and for refugees (see Kotsiou et al. 2018)30. These growing challenges have to be countered by a sustainable and comprehensive approach to screening and vaccination of migrants (ECDC 2018b) and by integrating all into strengthened national health systems, which must be climate-resilient and migrant-inclusive (Schwerdtle et al. 2018). 3.11  Mental health effects Mental health effects can arise from all of the various impacts described in the preceding sections and are considered here as a cross-cutting issue. From detailed review of the literature worldwide (Hayes et al. 2018) it is clear that the specific attribution of mental health outcomes to climate change remains challenging, but the risks of effects are accelerating, disproportionately affecting those who are most marginalised. Policy interventions on climate and mental health need to be coordinated, for example with the SDGs and the Sendai Framework on disaster risk reduction. Effects on mental health, as on physical health, can derive directly from impacts of floods, storms, wildfires and heatwaves. Other effects are more indirect, for example in response to changing temperature and rising sea levels that cause forced migration (Clayton et al. 2017; and see footnote 31). Acute mental health effects include post-traumatic stress disorder, anxiety, substance abuse and depression. Chronic effects include higher rates of aggression, violence and hopelessness. One recent study of long-term data (in the USA and Mexico) has shown an association between higher temperatures and increased suicide rates (Burke et al. 2018). Factors that may increase vulnerability to mental health effects include ageing (Bei et al. 2013), pregnancy (Xiong et al. 2010), geographical location, pre-existing medical conditions (including mental disorders, Page et al. 2012) and socio-economic inequalities. Stress from climate extremes can cause children to experience changes in behaviour, development, memory, executive

30  See also the publication from the International Rescue Committee (www.rescue-uk.org) ‘Unprotected, unsupported, uncertain’ documenting mental strain that includes suicide attempts, suicidal ideation, anxiety, depression and post-traumatic stress disorder (section 3.11).

EASAC

Climate change and health  |  June 2019  |  27

The imperative of climate action to protect human health in Europe  

Opportunities for adaptation to reduce the impacts and for mitigation to capitalise on the benefits of decarbonisation. The pace and extent...

The imperative of climate action to protect human health in Europe  

Opportunities for adaptation to reduce the impacts and for mitigation to capitalise on the benefits of decarbonisation. The pace and extent...

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