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“The Earth is critically ill”: A call for action from emergency physicians

Hospital emergency departments are at the forefront of dealing with the impacts of the increasing number of floods, heatwaves, bushfires and other natural disasters that are being driven by climate change.

In the article below, Sydney-based emergency physician Dr Lai Heng Foong, chair of the Australasian College for Emergency Medicine’s Public Health and Disaster Committee, outlines the rapidly escalating risks, in Australia and globally.

She calls on her ED colleagues and the broader community to “address this emergency – the climate emergency – with all the armamentarium that emergency physicians possess”.

This article is an extract from ACEM’s upcoming issue of Your ED magazine, due to be published in September.

Croakey is pleased to publish it as part of the global Covering Climate Now initiative, an international media collaboration that is putting the spotlight on the climate crisis in the leadup to the Climate Action Summit at the United Nations General Assembly in New York on 23 September.


Lai Heng Foong writes:

In years past, the ice that drifted south from Greenland’s north-east was thick. It had built to a thickness of several metres over the course of many years, inviting people to hunt seals from it and children to play on it.

This year the ice that drifts in is new and slight; the large sheets are thin, fragile and break easily.

“We don’t hunt from it, we are too scared to fall into freezing waters,” my friend Kelly says. He’s a resident of Ammassivik, a settlement on Greenland’s southern coast.

Without that opportunity to hunt, families have no chance to store seal meat and its blubber. Historically, seal meat is an important cultural delicacy in Greenland, but it is also a vital food supplement through freezing winters.

The melting ice caps are a symptom of something far more sinister. We have a climate emergency on our hands.

Climate change has been officially documented for at least 30 years. In 1990, the United Nations Intergovernmental Panel on Climate Change (IPCC) warned of catastrophic changes in weather patterns, extinction of species and severe impacts on global health due to climate change.

Dr Lai Heng Foong

“We see it firsthand”

As emergency physicians, we see firsthand those catastrophic effects of climate change. We see how it impacts the health of our population. We see it in increased rates of heat-related illnesses in vulnerable populations. We see it in the increasing number of victims of flood and forest fires presenting to EDs.

Globally, 157 million more people were exposed to heatwave events in 2017, compared to the year 2000. It is estimated that 153 billion hours of labour were lost due to heat-related illness or inactivity in that year.

Meanwhile, a 2016 World Health Organization report found more than 90 per cent of the world’s population breathe air that is not compliant with its air quality guidelines and that about three million people a year are killed by the effects of ambient air pollution.

A 2018 report released by the IPCC warns again of the severe impacts of climate change and global warming, including: greater rates of human death and illness; extreme weather volatility; substantial degradation of natural systems (species loss); and malnutrition, particularly where such conditions are already prevalent (Africa, South-East Asia, South America). Weather events disproportionately affect poorer and less developed nations.

More frequency, more severity, more casualties

The Australasian College for Emergency Medicine (ACEM) has started to take action against the effects of climate change by divesting from all fossil fuel-related investments and advocating for more action by governments.

In 2018, the College was a signatory to a letter by the Climate and Health Alliance to Australian politicians, urging them to progress climate actions and policies (in the lead-up to the 2019 Australian federal election).

ACEM’s Public Health and Disaster Committee is working on a Sustainability Action Plan to find actions the College, its members and trainees can commit to in order to reduce our carbon footprint and impact on the environment.

We are also seeing more severe tropical storms, floods and vector-borne diseases, such as dengue, malaria and vibrio cholerae. These disease cause large disruptions in infrastructure and food supply chains, and overwhelm resources in EDs and hospitals.

Dengue and malaria are not endemic in Australia, but we have already seen dengue outbreaks in Queensland and malaria from travellers visiting or returning to Australia.

When I worked on a Médecins Sans Frontières (MSF) project in Angola in 2001, I was stationed in Kuito, the rebel stronghold. Kuito is situated at an elevation of 1,695m. There is usually less risk of malaria at this altitude (above 1,500m), but I was already treating severe malaria in children at that time.

We were already seeing the effects of global warming and adaptation of vectors. We see natural disasters often in the news cycle. These are not one-off extreme weather events. They are events that have occurred with more frequency, more severity and with more casualties due to the effects of climate change.

In February 2016, there was an alarming global temperature warming spike of more than 1.5°C, just months after the Paris Climate Accord set an aim of not exceeding that limit. Scientists report that Arctic air temperatures are currently rising at twice the global average rate.

We are seeing unprecedented melting of ice caps in the Arctic, which will raise the sea water level. The IPCC has predicted the oceans could rise by as much as 98cm by the end of the century, which would be high enough to swamp major cities across the world, including Hong Kong, Miami, Osaka, Rio de Janeiro and Shanghai.

Physicians on the frontline

In the age of technology, we are inundated with information from so many sources about everything. How do we sift through all the information out there and focus on important issues that we can do something about?

There has been inaction from world leaders, ranging from denying climate change actually exists, to muted complacency. Again, our youth have shown the way in demanding change from our politicians.

The recent School Strike 4 Climate Action, which I attended in Sydney with another FACEM, was an inspiring gathering of young people and others who cared enough about the environment to demonstrate the urgency for action.

We need to change how we pitch this problem and galvanise more people to take on the challenge of ensuring we have a viable planet for future generations.

The remarkable Swedish 16-year-old Greta Thunberg, who initiated the worldwide school strike actions, has said, “You don’t listen to the science because you are only interested in solutions that will enable you to carry on like before”.

“We have to address this emergency”

As physicians at the frontline of treating climate change trauma, we cannot afford to carry on like before. We are experts at disaster preparedness and response.

We can build a community in our workplace and our neighbourhood that actively advocates for ways to mitigate climate change, and we can train communities to be more resilient and respond to natural disasters.

We can cooperate with other agencies to have a more robust and prepared emergency response system. We can also show, by example, how to work and live in a more sustainable way. We have to address this emergency – the climate emergency – with all the armamentarium that emergency physicians possess.

The Earth is critically ill. We must manage the risks and do so speedily. I want us to start today for #ClimateAction.

Further reading

2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come

Annotated Bibliography – Climate Change, Migration and Health. Global Health Education and Learning Incubator, Harvard University.

These days, it’s not about the polar bears, New York Times.

• Dr Foong is an emergency physician currently based in Sydney. She is the current Chair of the Australasian College for Emergency Medicine’s Public Health and Disaster Committee and is passionate about climate action, Indigenous health, international emergency medicine and wellness culture in medicine

Our feature image and these below show the shrinking ice cap in Greenland, viewed from Qalerallit Imaat, just north of international airport Narsarsuaq. They were taken by Christian Lynge Hard, a skipper on tour boats. He reports that the water they are sailing on used to be covered by hundreds of meters of ice just a few years ago.

See also: The tiny algae at ground zero of Greenland’s melting glaciers. The Guardian


• This article is published as part of the Covering Climate Now initiative, an unprecedented collaboration involving more than 300 media outlets around the world that is putting the spotlight on the climate crisis in the leadup to a Climate Action Summit at the United Nations General Assembly in New York on 23 September. It is co-founded by The Nation and the Columbia Journalism Review (CJR), in partnership with The Guardian. Croakey invites our readers, contributors and social media followers to engage with these critical discussions, using the hashtag #CoveringClimateNow. See Croakey’s archive of climate and health coverage.If you value our coverage of climate and health, please consider supporting our Patreon fundraising campaign, so we can provide regular, in-depth coverage of the health impacts of the climate crisis, taking a local, national and global approach. All funds raised will go to a dedicated fund to pay writers and editors to put a sustained focus on the health impacts of climate change. Please help us to produce stories that will inform the health sector, policy makers, communities, families and others about how best to respond to this public health crisis.

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