In early December, I was one of the nearly 100,000 delegates at COP28, the biggest climate conference ever held. As a senior health professional and campaigner for gender equity in health, I was pleased to see the adoption of the first ever COP health declaration.

Who among us can still deny that climate change is a direct threat to human health? Ours is an age when humanitarian disasters as a result of wildfires, flooding, heatwaves and hurricanes have become the norm. The WHO tells us that 3.6 billion people already live in areas highly susceptible to climate change. That’s nearly half of us humans. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from undernutrition, malaria, diarrhoea and heat stress alone. We know that women and children are 14 times more likely to die as a result of a disaster than men and that women and girls are more likely to be malnourished than men and boys, so it is clear that climate risks are not equally shared.

Women and girls among the hardest hit by dual climate and health crisis

Women and girls are part of the vulnerable populations hardest hit by the dual climate – health crisis. Together they represent 20 million of the 26 million people estimated to have been displaced already by climate change. Because of poverty, detrimental social and cultural norms and other such factors, they often come last in accessing vital health services. The numbers are so stark, it seems almost redundant to highlight that this is a deeply gendered injustice.

The tight link between climate, health and gender doesn’t stop here, however. The overwhelming majority of people dealing with the impacts of climate disasters within health services everywhere are – you guessed it – women.

Women make up 70% of the health workforce and 90% of frontline health workers during crisis situations, such as natural disasters or the COVID-19 pandemic. They are the ones who tend to bear the brunt of huge disruption, keeping health systems afloat – and saving lives. As we have seen in the pandemic, they work the extra shifts, put their own health at risk and do what’s needed to keep everyone safe in times of high risk  and hardship.

This alone is nothing if not commendable. But that’s not all.

Women also on frontlines of healthcare crisis

In keeping all of us safe, women health workers themselves are forced to accept unsafe working conditions. Often, they don’t have basic personal protective equipment (PPE). Our own Women in Global Health research during the pandemic, documented stories of women nurses or doctors having to fashion themselves aprons out of garbage bags, or to reuse PPE because of insufficient supplies. To make matters worse, when PPE is provided, it often doesn’t fit women – and therefore doesn’t protect them, because it was made to fit a male body, which is used as the standard.

And to make their jobs and lives even more stressful, women health workers routinely experience abuse, sexual violence and harassment from male colleagues, patients and community members. This only gets worse in times of crisis. During the pandemic, for instance, women frontline workers were targeted with abuse in some contexts, wrongly accused of spreading infection and later by anti-vaccination campaigners.

This might all be different if women health workers were equally included in health systems’ decision-making. Although they represent the large majority of the health workforce, women occupy only 25% of leadership positions. In January 2020, just five women were invited to join the 21-member WHO Emergency Committee. A 2020 Women in Global Health Study found 85% of 115 national COVID-19 task forces had majority male membership. It’s high time we recognise this is not only unfair and obscenely disproportionate – but it has a cost as described in our new report ‘The Great Resignation’, which details the growing global trend of women health workers leaving, or planning to leave, the profession. And we cannot be surprised that women are leaving the health sector in alarming numbers.

Gender equity is not just a ‘nice-to-have’

When it comes to the humanitarian impacts of the climate crisis, all of this matters. Women are the first to respond during a climate-induced natural disaster, from the health frontline, but also as carers of their families and their communities. Climate change is amplifying and multiplying health emergencies.  Gender equity is not just a ‘nice-to-have’ in the face of such unpredictability, it is fundamental to all our survival. When we depend on women to keep us safe and minimise the human toll of climate unpredictability, we can’t afford to let them down.

This is why, as glad as I am – as a health professional – to see a first-ever health declaration adopted at COP28, and knowing – as a former government official of Pakistan – what painstaking negotiation is needed for any international agreement, I know we need to go much further, much faster, for the predominantly female health workforce upon whom we depend in climate unpredictability. The health declaration mentions health workers as well as women and girls only once, when they must be central to our thinking and our interventions around the climate-health intersection. Anything short of a new social contract for women in health, equity in leadership and gender transformative approaches across our health system means we risk not being able to withstand the challenges that unpredictable climate events are throwing at us. Anything less than genuine commitment and action is, frankly, hot air that we cannot afford.

Dr. Shabnum Sarfraz is the Global Director for Gender and Health and Deputy Executive Director of Women in Global Health.  Before joining Women in Global Health, Dr. Sarfraz previously served at the Federal Planning Commission, Government of Pakistan, including leading Pakistan’s national COVID19 response efforts and served as the national focal person for SDGs. 

Image Credits: Roberto Barcellona, Shutterstock, UNICEF, Women in Global Health .