In November, Dr. Saia Ma’u Piukala stood outside the main hospital in Honiara, Solomon Islands, and watched seawater lapping at the outer walls of the facility. A surgeon and the World Health Organization’s regional director for the western Pacific, Dr. Piukala described the scene as a warning: the hospital is now under threat, and plans are underway to relocate it to higher ground.
The relocation is a massive and costly undertaking, one that Dr. Piukala believes should never have been necessary. His experience highlights a critical and escalating global crisis: the health impacts of sea-level rise. Although often discussed as a matter of geography or economics, the rising tide is creating a profound medical emergency for coastal populations, threatening the very infrastructure designed to save lives.
In 14 Pacific island countries, 62% of health infrastructure lies within 500 metres of the coast, according to Dr. Piukala. This vulnerability is not limited to the Pacific. At a 2024 UN general assembly meeting on sea-level rise, representatives from small island developing states and low-lying countries warned that this crisis threatens approximately 1 billion people worldwide.
The scale of the injustice is a central theme for those on the front lines. Afioga Fiamē Naomi Mataʻafa, then prime minister of Samoa, told the UN meeting that her country contributed almost nothing to the global emissions driving this scourge, yet We see their land being consumed by the sea.
The systemic medical risks of saltwater intrusion
As a physician, I notice the clinical implications of sea-level rise as a cascade of failures. It begins with the most fundamental human necessitate: fresh water. When saltwater seeps into underground freshwater sources, it doesn’t just craft the water undrinkable; it alters the chemistry of the local environment in ways that directly impact human physiology.
Increased salt intake from contaminated drinking water is linked to hypertension, which can cause long-term damage to the heart, brain, kidneys, and blood vessels. Beyond cardiovascular risks, Prof. Kathryn Bowen, a co-chair of the Lancet Commission on sea-level rise health and justice, notes that this salinity is linked to worse renal and pregnancy-related health outcomes. The combination of seawater intrusion and certain agricultural practices has been linked to the presence of heavy metals in groundwater.
The risks extend to infectious diseases. Flooding often overwhelms sanitation systems, pushing raw sewage and pollutants into the water supply. This increases the prevalence of waterborne diseases such as cholera and leptospirosis. When combined with the forced migration and displacement of populations, the resulting overcrowding in temporary settlements further fuels the spread of infectious disease.
Nutritional security is similarly at stake. When saltwater destroys crops and renders farmland unviable, populations face chronic malnourishment. This creates a vicious cycle where people are more susceptible to disease while their primary healthcare facilities are being physically eroded by the sea.
Gender inequality and the burden of survival
The health impacts of sea-level rise are not distributed equally. Women and girls often bear a disproportionate burden due to existing social and domestic roles. In many affected regions, women are primarily responsible for collecting water for cooking and sanitation. As local supplies become polluted, they are forced to travel longer distances, increasing their exposure to exploitation, waterborne disease, and sexual violence.
The danger intensifies during extreme weather events. Storm surges and flooding now reach further inland, forcing families into emergency shelters. These crowded environments can expose women and girls to poor sanitation and sexual violence, leading some to avoid shelters entirely and remain in dangerous, flooded areas.
Sunita Narain, director general of India’s Centre for Science and Environment, observes that as livelihoods are pressured, men are often the first to migrate in search of perform. This leaves women to manage the survival of the household and the care of children and the elderly in increasingly precarious environments.
The psychological and cultural cost of relocation
When the land is gone, the only option is relocation. However, moving a community is not merely a logistical challenge; it is a psychological trauma. In the Pacific, where health is deeply intertwined with identity, the loss of ancestral land erodes culture, traditions, and a sense of belonging.
In low-lying atoll nations such as Kiribati, Nauru, the Marshall Islands, and Tuvalu, routine flooding and erosion are pushing families off their land. This displacement disrupts food systems and social cohesion. Dr. Piukala emphasizes that protecting health requires more than just building latest clinics on higher ground; it requires safeguarding the deep connections to place that sustain mental wellbeing.
Who is responsible for the cost?
One of the most contentious questions facing the international community is the financial responsibility for this adaptation. The Lancet Commission on sea-level rise health and justice, co-chaired by climate negotiator Christiana Figueres and Prof. Bowen, is currently grappling with the ethics of payment.
| Priority Area | Primary Health Threat | Objective |
|---|---|---|
| Sanitation Systems | Waterborne/Vector-borne diseases | Prevent sewage overflow into drinking water |
| Health Infrastructure | Loss of critical care facilities | Relocate and protect clinics from coastal erosion |
| Water Security | Hypertension and Renal failure | Mitigate saltwater intrusion in aquifers |
| Social Justice | Displacement and Mental health | Establish accountability for polluting nations/firms |
The commission is examining whether the most polluting corporations and countries should be held responsible for the costs of rebuilding critical infrastructure in cities like Honiara. The overarching argument is that the health impacts of sea-level rise are a political choice, and the failure to reduce emissions is a failure of public health policy.
Next steps and the path forward
The Lancet Commission is expected to present a comprehensive set of recommendations by the end of 2027. These findings will be designed for adoption by governments, international institutions, and civil society to create a framework for health justice.
Prof. Bowen warns that while solutions exist, adaptation alone is insufficient. The core of the crisis remains the continued emission of greenhouse gases. “People can’t adapt our way out of this,” she says, stressing that urgent emission reductions are the only way to prevent the most dire health outcomes.
The next major checkpoint for these findings will be their integration into the seventh report of the Intergovernmental Panel on Climate Change (IPCC), where sea-level rise is expected to be a core component of the health chapter.
Disclaimer: This article is for informational purposes only and does not constitute professional medical advice. Please consult a healthcare provider for personal health concerns.
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