I read with great interest the report by Mutch et al. in your journal, which illustrated the utility of a comprehensive multidisciplinary paediatric clinic tailored specifically to refugee health needs. The paper also describes the wide range of medical, psychological and social issues observed in the first 1026 children seen at this clinic.
The need for similarly integrated refugee/migrant health services will only increase in future decades with the predicted rise in global population dislocation. Forced migration is usually triggered by natural or manmade threats that severely compromise human security and livelihood. According to the United Nations High Commissioner for Refugees António Guterres, human-induced climate change will become the biggest driver of population displacement in this century, prompting an estimated 150–200 million people to move by 2050.[3, 4]
The impacts of climate change on human health are far-reaching. Climate change will instigate major regional variations in temperature and rainfall, leading to more frequent and severe weather events (droughts, floods, heatwaves, tropical cyclones), rising sea levels (coastal flooding, salinisation), changing patterns of infectious diseases (malaria, dengue, diarrhoeal illness), significant decreases in agricultural productivity and water availability, and worsening air pollution (Fig. 1).[2-4] Climate change is expected to increase the number of undernourished people worldwide by 40–170 million, of which at least 25 million will be children. Flow-on effects include a significantly increased risk of civil/political conflict over diminishing resources, and mental health issues arising from trauma, displacement and conflict.[2, 3]
The World Health Organization estimates that climate change already accounts for 150 000 deaths and 5.5 million disability-adjusted life years annually. Not all people will be affected equally; it will grossly amplify already existing wealth disparities, both within and between countries, leaving those least able to adapt most vulnerable. The brunt of these consequences will be felt unequivocally by developing countries.
As ‘climate refugee’ arrival numbers increase, we as paediatric health specialists must be prepared to care for the unique physical, mental and psychosocial issues that accompany children that have been displaced. As elaborated by Mutch, et al., a familiarity with tropical diseases, micronutrient deficiencies, growth retardation, dental and skin disorders, and psychological conditions such as post-traumatic stress disorder must become part of our standard repertoire. Clinics that offer integrated, culturally sensitive, situationally aware services are essential to this adaptation process.
As importantly, we must also act personally and professionally to halt the progression of climate change, with a view to further prevent these considerable human health impacts.