Humanitarian organisations are faced with a dilemma: they have to intensify their interventions to meet growing needs but have to drastically reduce their carbon footprint at the same time. This is the case for Médecins Sans Frontières, the NGO for which the two authors work, since most of its footprint comes from the elements essential to its action – air transport, medical supplies and energy for treatment facilities. How can this dilemma be resolved?
Conflict, inequality, epidemics and natural disasters: drivers of medical and humanitarian needs are expected to accelerate dramatically due to the impact of the “threat multiplier” of climate change. Humanitarian organisations have always responded to – and are expected to continue to respond to – and have, indeed, pledged to respond to these needs without compromising on their core mandates. At the same time, the same humanitarian organisations, including Médecins Sans Frontières (MSF), are expected to act as – and have pledged to act as – a responsible member of civil society and reduce their own contribution to the climate emergency, reducing their carbon footprint while doing so.[1]The Climate and Environnent Charter for Humanitarian Organizations, https://www.climate-charter.org/wp-content/uploads/2022/05/ClimateEnvironmentCharter-EN.pdf “Doing good while doing no harm” appears to be a seamless continuum of established humanitarian practice. However, as a universal threat-multiplier, climate change is likely to cause an increase in the number of people in need of humanitarian aid. So, the pledge to respond to this increased need is also an absolute carbon-emission multiplier if this ambition is to be reached. As such, both commitments are incompatible. At best, both pledges are simply unrealistic in their implementation. At worst, with public pledges to a measurable carbon reduction, they are deceitful.
This challenge to the MSF’s publicly pledged commitment to reduce its own carbon footprint by 50% is just a small part of fierce internal debates about broader implications of climate change for MSF’s identity and responsibilities. For most of these more fundamental questions about MSF’s role beyond immediate human health needs, no public MSF positioning is yet agreed upon. Some at MSF even argue beyond the practicalities of response types, stating that humanitarian organisations have no place in the overall politics of accountability and responsibility of who needs to pay or respond, so there is no place for any “climate-centred” humanitarianism at all. Yet a larger number of people at MSF strongly argue that MSF should not only react to the immediate health needs accelerated by climate change but also take responsibility for climate-proofing the health system as a whole, or even the planet as a whole from an environmental point of view. This dichotomy is exemplified in an ongoing debate over the language adopted in MSF’s “Environmental Pact” and subsequent external communications on the impact of climate change: “Planetary Health”, as this implies MSF will extend its mandate beyond human health to include the whole environment. Those against this terminology argue that it dilutes MSF’s focus, goes beyond MSF’s current self-declared mandate and that, in any case, MSF lacks the legitimacy and expertise in areas such as animal health or eco-systems.
Questioning systemic solutions may seem odd. We many wonder why anyone would object to both responding to immediate needs and building resilience to prevent future needs – teaching a man how to fish and so on. Specifically for MSF as a self-declared single-mandate organisation – which means staying singularly focused on reactive medical humanitarian action only – this question is fundamental. This touches both on humanitarian principles and MSF’s identity. Clearly, MSF does not ignore root causes of need, such as conflict, economic inequality and climate change, as understanding these causes is important for anticipating, analysing and quantifying potential needs in order to prepare and adjust operational responses. But as root causes are, by nature, systemic, not individual, not addressing them directly avoids tension with the principle of humanitarian impartiality: remaining focused on the (medical) need of the patient and never prioritising long-term systemic needs over immediate individual needs. For the same reasons, MSF avoids upholding public positions on the rights or wrongs of conflicts or economic inequality, which often surprises otherwise supportive civil-society partners who question why MSF would not declare itself anti-war or anti-capitalist or uphold positions on international justice. Bilateral and public advocacy is limited to holding policymakers – with established responsibilities and obligations for enabling humanitarian and medical action – to account.
“Even natural disasters are now actionable in holding policymakers to account.”
Climate change has challenged these assumptions and practices because it acts as a threat multiplier, negatively impacting almost all these other root causes of acute humanitarian need – a threat multiplier that acts as an “opinion multiplier” in internal debates. Even natural disasters are now actionable in holding policymakers to account. Before the climate emergency, weather-related disasters were unique insofar as they were generally perceived as “nobody’s fault”, despite decades of climate warnings – an “act of God” exempt from advocacy for policy change or global action. This perceived blamelessness of natural disasters also made such disasters the most useful for charity fundraising, generating donations far above those for conflict-related humanitarian crises, often seen as people bringing misery upon themselves. This has now changed. Earthquakes aside, storms, floods and draughts are now firmly in the category of man-made disasters, but, unlike conflicts, they are man-made disasters to which humanitarian organisations contribute through their carbon emissions.
The dual humanitarian constraint of climate change
So, after fierce internal and unresolved debates, especially on the commitment to build systemic resilience, MSF recognised, for the first time, that it was both the cause of and responder to needs, in The Environmental Pact, published in 2020:[2]Medecins Sans Frontieres, The Environmental Pact, November 2020, https://www.msf.org/msfs-2020-environmental-pact
“Whilst recognizing our limitations, and the potential additional investment, we must also remain relevant to our supporters, employees, and patients in a changing world. We recognize the need for MSF to provide medical humanitarian assistance without creating additional humanitarian needs in the future, nor compromising future humanitarian action.”
Whilst this pact initially kept MSF’s commitment to carbon reduction aspirational without targets and with the caveat that it should not compromise humanitarian action, by March 2022 MSF had joined many other international organisations and signed the Climate and Environment Charter for Humanitarian Organisations.[3]Climate Charter, The Climate and Environnent Charter.., op. cit. This charter firmly applies “the principle of ‘do no harm’” – “we will avoid, minimize and manage the damage we cause” – and it crucially commits its signatories to translating “[their] commitments into time-bound targets and action plans within a year”. For MSF, this commitment was published on 29 March 2022:[4]Medecins Sans Frontieres, MSF commits to reduce carbon emissions to help safeguard the most vulnerable, 22 March 2022, … Continue reading
“Recognizing our own contribution to the global problem of carbon emissions and human-caused environmental disruption, we have pledged to reduce our emissions by at least 50 per cent compared to 2019 levels by 2030.”
As this is a target set against an absolute carbon emission figure, MSF had to firstly analyse what all the contributing factors to this are: in 2019, the MSF movement accounted for 507,589 tons of CO2 emissions. The largest contributors to these emissions were the categories of “Goods & Services” and “Air travel”. The Operational Centres bore responsibility for a significant 86% of global baseline emissions.[5]Excerpt from MSF Climate Smart team internal 2019 baseline database. The category “Goods & Services” (47% of emissions) included medicine, water, sanitation, food and others. Travel and freight represented 30% of emissions and energy represented 13%, mainly from electricity and generators for medical facilities.
“In 2019, the MSF movement accounted for 507,589 tons of CO2 emissions.”
This carbon-footprint breakdown reflects the nature of MSF’s humanitarian operations, which focus on providing medical goods and services across the world. Comparisons with similar organisations (e.g., ALIMA, ACTED) show consistent patterns in emissions distribution: 40-50% from purchases, ~30% from transport and the remainder from energy.
The current environmental roadmap has introduced a plan with the ambition of reducing 90% of emissions over the next seven years by using seven main climate solutions, such as setting environmental criteria for purchases, reducing travel (specifically air travel), reducing air freight, increasing use of renewable energy, reducing energy consumption and improving buildings’ thermal efficiency.
The challenges of carbon reduction in emergency medical action
However, most of these areas targeted for a 90% reduction are key to continuity of our response. A good example is the target to reduce international air travel – which, in our era of localisation of responses, appears to be an easy target. But international air travel for staff required for medical projects remains at a high rate. Although the detailed data for all of MSF is hard to isolate, most air travel is linked to MSF’s staffing of medical facilities. Almost 80%[6]Excerpt from MSF Climate Smart…, op. cit. of international travel emissions are caused by flights requested[7]Paid for by the operational budgets of medical projects. by medical projects. This is mostly due to a lack of local resources, which is especially true for healthcare workers, in particular specialised staff, of which there is a global shortage, and in conflict-affected areas, where international staff remain crucial to shield our national colleagues from the pressures of warring parties, whether states or otherwise.
Another example where foreseen reductions are unrealistic is freight of international supplies, which remain crucial to safeguard minimum medical quality standards. For cost-efficiency reasons, what can be shipped by sea is already done so. Acute emergencies, however, remain dependent on air cargo as intervention speed remains essential in the acute first phases of any type of medical emergency where, typically, the most acute medical needs are at the onset of the crisis. A change to alternative energy sources in protracted and fixed long-term medical projects can certainly be achieved, so some reduction is possible. But in acute emergencies, energy sources such as fossil-fuel-powered generators are still key to maintaining medical services in hospitals in times of extreme disruption, such as conflict or large-scale natural disasters. So a 90% reduction remains unlikely.
“MSF has clearly stated it will continue to prioritise responding to needs, without compromising on medical quality.”
MSF has clearly stated it will continue to prioritise responding to needs, without compromising on medical quality. MSF has also stated an absolute and time-bound target for carbon footprint reduction. As needs and responses are likely to increase, the required carbon reduction, measured against a much smaller operational portfolio in 2019, will represent a reduction of over 50% in relative terms. This means the more MSF responds, the less likely it is to meet the 50% target, resulting in an aspirational commitment, rather than a hard objective. As the public pledge is not communicated with such a caveat, the aspirational nature of the pledge is largely an internal interpretation, rather than a clear and transparent conditional pledge externally. This discrepancy is not highlighted to dismiss the importance and responsibility of MSF in acting and responding to carbon footprint reduction. However, MSF needs to acknowledge and promote an understanding of the nuances and complexities implied when working towards these targets, not only internally, but also transparently to the public it made its pledges to.
Towards transparency on the limits of environmental commitments
In parallel to its own pledge, MSF is also calling for ownership across all of society in acting on climate-change footprint reduction, especially regarding states, and is actively participating in the COP climate summits. Christos Christou, MSF International President, in a speech at COP28 in Dubai in December 2023, said:
“At this Global Stocktake, it’s clear that actions to date are failing to meet today’s needs, let alone the growing challenge ahead. Global political leadership has failed to deliver on commitments to curb emissions and to deliver on promises to support the most affected countries to adapt.”[8]Médecins Sans Frontières, MSF at COP28: speech on champions leading the way on climate and health, 2 December 2023, https://www.msf.org/msf-speech-champions-leading-way-climate-and-health-cop28
From this perspective, it is clear that, compared to emissions from large corporations or state-owned industries, carbon emissions from humanitarian organisations are marginal, making it evident that our carbon reduction is aspirational, not critical. Nevertheless, many reading the pledge may not interpret it as such and expect the 50% reduction in hard figures and on time by 2030. So, if MSF is in doubt about whether it can be delivered, then it should say so.
We argue it is unrealistic to expect humanitarian organisations to pledge lowering emissions by 50% or more whilst simultaneously expanding their response to the acute consequences of the climate crisis. Both cannot be delivered simultaneously and successfully. If carbon reduction targets are maintained, delivery or response to the growing number of people affected by climate-change-induced health crises will be reduced.
Humanitarian organisations are expected to do both more and less: to increase their response without compromise, but to do so with their hands tied behind their back.
Picture Credit : © Yann Tauleigne pour Action contre la Faim
