Technical Report > Policy Brief
Smiley S, McIver L, Schwerdtle PN, Lugli M, Claire A, et al.
2021 October 21
This brief details MSF’s experiences providing humanitarian assistance in contexts heavily affected by climate change; adapting our operations to climate-related threats; and working to reduce our environmental impact. Much like the process of ‘greening’ this vast, global movement, this brief is incomplete, imperfect: it tells an infinitely complex story from a limited range of perspectives, and poses more questions than it answers as we grapple with emergent facts. Given the imminent existential threat presented by current levels of environmental degradation, these limitations can probably be forgiven. But as we witness the human toll and deep injustice of the climate crisis, silence is, once again, not an option.
Technical Report > Policy Brief
Baxter LM, Cowan K, Devine C, Guevara M, Kalub D, et al.
2022 October 27
As an independent international medical humanitarian organisation responding to health crises in more than 70 countries, Médecins Sans Frontières/Doctors Without Borders (MSF) is seeing first-hand the suffering caused or exacerbated by climate change and environmental degradation, most often experienced by the most vulnerable people. We are witnessing how climate change directly threatens health – for example, through death and injury due to extreme weather – and how climate change impacts health indirectly, through food insecurity and shifting patterns of climate-sensitive infectious diseases.
Recognising the role of the climate crisis in amplifying humanitarian needs, MSF is adapting its operations to be more responsive to the populations it serves while also facing up to the challenges of measuring and reducing its own environmental footprint.
Recognising the role of the climate crisis in amplifying humanitarian needs, MSF is adapting its operations to be more responsive to the populations it serves while also facing up to the challenges of measuring and reducing its own environmental footprint.
Conference Material > Video
McIver L
MSF Paediatric Days 2022. 2022 December 1
Technical Report > Policy Brief
Blume C, Dallatomasinas S, Devine C, Goikolea I, Guevara M, et al.
2023 November 15
Most of the over 70 countries Médecins Sans Frontières /Doctors Without Borders (MSF) works in are in lower-income regions. They are facing not only humanitarian crises but also the most severe impacts of the climate emergency. In 2023, MSF continued to witness and respond to the consequences of extreme weather events around the world, including unprecedented flooding in South Sudan, severe cyclones in Myanmar and Madagascar, and the relentless heat and extended droughts that have driven millions to the edge of starvation throughout the Horn of Africa. This year, the organisation has also responded to epidemics of climate-sensitive diseases, including multiple concurrent cholera outbreaks and the rise of dengue and malaria in several areas, including in conflict-affected settings.
In a time of polycrisis, a simultaneous occurrence of multiple catastrophic events, MSF and other aid organisations are already struggling to meet the rising health and humanitarian needs. If human activities contributing to climate change and environmental degradation go unabated and unaddressed, including the continued dependence on fossil fuels, these needs will only escalate. With each fraction of a degree of global temperature rise, there will be further limitations on adaptation, and reckless losses and damages to lives, livelihoods, and general well-being.
Drawing on evidence from indicators in the 2023 Report of the Lancet Countdown on Health and Climate Change, MSF builds on previous experiences and messages with a focus on three key areas: MSF’s ongoing efforts to reduce its environmental impact; the challenges of adapting emergency humanitarian operations in a rapidly warming world; and the consequences of climate change when the capacities of communities to adapt are surpassed
In a time of polycrisis, a simultaneous occurrence of multiple catastrophic events, MSF and other aid organisations are already struggling to meet the rising health and humanitarian needs. If human activities contributing to climate change and environmental degradation go unabated and unaddressed, including the continued dependence on fossil fuels, these needs will only escalate. With each fraction of a degree of global temperature rise, there will be further limitations on adaptation, and reckless losses and damages to lives, livelihoods, and general well-being.
Drawing on evidence from indicators in the 2023 Report of the Lancet Countdown on Health and Climate Change, MSF builds on previous experiences and messages with a focus on three key areas: MSF’s ongoing efforts to reduce its environmental impact; the challenges of adapting emergency humanitarian operations in a rapidly warming world; and the consequences of climate change when the capacities of communities to adapt are surpassed
Journal Article > ReviewFull Text
Antibiotics. 2019 March 19; Volume 8 (Issue 1); 29.; DOI:10.3390/antibiotics8010029
Foxlee ND, Townell N, McIver L, Lau CL
Antibiotics. 2019 March 19; Volume 8 (Issue 1); 29.; DOI:10.3390/antibiotics8010029
Several studies have investigated antimicrobial resistance in low- and middle-income countries, but to date little attention has been paid to the Pacific Islands Countries and Territories (PICTs). This study aims to review the literature on antibiotic resistance (ABR) in healthcare settings in PICTs to inform further research and future policy development for the region. Following the PRISMA-ScR checklist health databases and grey literature sources were searched. Three reviewers independently screened the literature for inclusion, data was extracted using a charting tool and the results were described and synthesised. Sixty-five studies about ABR in PICTs were identified and these are primarily about New Caledonia, Fiji and Papua New Guinea. Ten PICTs contributed the remaining 21 studies and nine PICTs were not represented. The predominant gram-positive pathogen reported was community-acquired methicillin resistant S. aureus and the rates of resistance ranged widely (>50% to <20%). Resistance reported in gram-negative pathogens was mainly associated with healthcare-associated infections (HCAIs). Extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolates were reported in New Caledonia (3.4%) and Fiji (22%) and carbapenem resistant A. baumannii (CR-ab) isolates in the French Territories (24.8%). ABR is a problem in the PICTs, but the epidemiology requires further characterisation. Action on strengthening surveillance in PICTs needs to be prioritised so strategies to contain ABR can be fully realised.
Journal Article > CommentaryFull Text
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 40-42.; DOI:10.7227/JHA.073
McIver L, Guevara M, Alcoba G
Journal of Humanitarian Affairs. 2021 December 22; Volume 3 (Issue 3); 40-42.; DOI:10.7227/JHA.073
The COVID-19 pandemic has exposed multiple fault lines in the performances of health services at every level – from community to national to global – in ensuring universal, equitable access to preventive and curative care. Tragically, this has been to the detriment of those who have suffered and died not only from COVID-19, but also from the myriad other ailments affecting people around the world. Of those, we wish to highlight here some key categories of diseases that have caused a greater burden of illness and deaths as a consequence of the policies and political decisions made in relation to the COVID-19 pandemic. In our view, these should be considered epidemics or, more accurately, syndemics – the clustering and interactions of two or more diseases or health conditions and socio-environmental factors – of neglect.
Journal Article > ResearchFull Text
PLOS Clim. 2024 March 6; Volume 3 (Issue 3); e0000243.; DOI:10.1371/journal.pclm.0000243
McIver L, Beavon E, Malm A, Awad A, Uyen A, et al.
PLOS Clim. 2024 March 6; Volume 3 (Issue 3); e0000243.; DOI:10.1371/journal.pclm.0000243
This mixed-methods study focuses on the evidence of the health impacts of climate change on populations affected by humanitarian crises, presented from the perspective of Médecins Sans Frontières (MSF)–the world’s largest emergency humanitarian medical organisation. The Sixth Assessment Report from the Intergovernmental Panel on Climate Change (IPCC) was used as the basis of a narrative review, with evidence gaps highlighted and additional literature identified relevant to climate-sensitive diseases and health problems under-reported in–or absent from–the latest IPCC report. An internal survey of MSF headquarters staff was also undertaken to evaluate the perceived frequency and severity of such problems in settings where MSF works. The findings of the survey demonstrate some discrepancies between the health problems that appear most prominently in the IPCC Sixth Assessment Report and those that are most relevant to humanitarian settings. These findings should be used to guide the direction of future research, evidence-based adaptations and mitigation efforts to avoid the worst impacts of climate change on the health of the world’s most vulnerable populations.
Journal Article > ReviewFull Text
PLoS Negl Trop Dis. 2019 June 24; Volume 13; DOI:10.1371/journal.pntd.0007551
Potet J, Smith JS, McIver L
PLoS Negl Trop Dis. 2019 June 24; Volume 13; DOI:10.1371/journal.pntd.0007551
BACKGROUND:
Snakebite envenoming kills more than more than 20,000 people in Sub-Saharan Africa every year. Poorly regulated markets have been inundated with low-price, low-quality antivenoms. This review aimed to systematically collect and analyse the clinical data on all antivenom products now available in markets of sub-Saharan Africa.
METHODOLOGY/PRINCIPAL FINDINGS:
Our market analysis identified 12 polyspecific and 4 monospecific antivenom products in African markets. Our search strategy was first based on a systematic search of publication databases, followed by manual searches and discussions with experts. All types of data, including programmatic data, were eligible. All types of publications were eligible, including grey literature. Cohorts of less than 10 patients were excluded. 26 publications met the inclusion criteria. Many publications had to be excluded because clinical outcomes were not clearly linked to a specific product. Our narrative summaries present product-specific clinical data in terms of safety and effectiveness against the different species and envenoming syndromes. Three products (EchiTabPlus, EchiTabG, SAIMR-Echis-monovalent) were found to have been tested in robust clinical studies and found effective against envenoming caused by the West African carpet viper (Echis ocellatus). Four products (Inoserp-Panafricain, Fav-Afrique, SAIMR-Polyvalent, Antivipmyn-Africa) were found to have been evaluated only in observational single-arm studies, with varying results. For nine other products, there are either no data in the public domain, or only negative data suggesting a lack of effectiveness.
CONCLUSIONS/SIGNIFICANCE:
Clinical data vary among the different antivenom products currently in African markets. Some products are available commercially although they have been found to lack effectiveness. The World Health Organization should strengthen its capacity to assess antivenom products, support antivenom manufacturers, and assist African countries and international aid organizations in selecting appropriate quality antivenoms.
Snakebite envenoming kills more than more than 20,000 people in Sub-Saharan Africa every year. Poorly regulated markets have been inundated with low-price, low-quality antivenoms. This review aimed to systematically collect and analyse the clinical data on all antivenom products now available in markets of sub-Saharan Africa.
METHODOLOGY/PRINCIPAL FINDINGS:
Our market analysis identified 12 polyspecific and 4 monospecific antivenom products in African markets. Our search strategy was first based on a systematic search of publication databases, followed by manual searches and discussions with experts. All types of data, including programmatic data, were eligible. All types of publications were eligible, including grey literature. Cohorts of less than 10 patients were excluded. 26 publications met the inclusion criteria. Many publications had to be excluded because clinical outcomes were not clearly linked to a specific product. Our narrative summaries present product-specific clinical data in terms of safety and effectiveness against the different species and envenoming syndromes. Three products (EchiTabPlus, EchiTabG, SAIMR-Echis-monovalent) were found to have been tested in robust clinical studies and found effective against envenoming caused by the West African carpet viper (Echis ocellatus). Four products (Inoserp-Panafricain, Fav-Afrique, SAIMR-Polyvalent, Antivipmyn-Africa) were found to have been evaluated only in observational single-arm studies, with varying results. For nine other products, there are either no data in the public domain, or only negative data suggesting a lack of effectiveness.
CONCLUSIONS/SIGNIFICANCE:
Clinical data vary among the different antivenom products currently in African markets. Some products are available commercially although they have been found to lack effectiveness. The World Health Organization should strengthen its capacity to assess antivenom products, support antivenom manufacturers, and assist African countries and international aid organizations in selecting appropriate quality antivenoms.