Africa is increasingly recognising that climate change is far more than an environmental challenge. It is a direct and growing threat to public health, food security and the resilience of communities. This shift in perspective is becoming increasingly visible at global climate negotiations, where the African Group of Negotiators is pushing for health priorities to be integrated into climate finance, adaptation planning and loss-and-damage frameworks.
Africa contributes less than 4% of global greenhouse gas emissions, yet it faces some of the most severe health consequences of a changing climate. The continent is warming at 1.5 times the global average, according to the World Meteorological Organisation (WMO, 2024). This imbalance is at the heart of Africa’s increasingly assertive position in climate negotiations. For countries that have contributed least to the crisis, securing greater support for adaptation, particularly for vulnerable health systems, is not simply a question of assistance. It is a question of accountability.
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One of the clearest manifestations of this challenge is the changing pattern of infectious diseases. Climate change is creating conditions that allow malaria to spread into areas where transmission was previously limited. In the East African highlands, the number of climate-suitable days for malaria transmission has increased by 30% since 2015. Across Africa, a 15% rise in malaria cases in 2022 was equivalent to roughly 30 million additional infections, placing further pressure on already stretched health systems. Without effective intervention, as many as 600 million additional people globally could be exposed to malaria by 2050. Vector control, therefore, needs to be treated as a central component of climate adaptation alongside emissions reduction.
Extreme weather events are creating another layer of pressure. Cyclone Freddy, for example, displaced approximately 800,000 people in Mozambique and was followed by a 50% increase in cholera cases, with weekly infections rising from 1,200 to more than 1,800 within three weeks. Such events demonstrate how climate disasters can trigger cascading health emergencies, from infectious diseases and malnutrition to disrupted access to essential healthcare. With climate-related disasters in Africa increasing by 35% over the past decade, building resilient health systems must become an integral part of disaster preparedness rather than an afterthought.
Cholera illustrates the scale of the problem. Africa accounts for 60% of global cholera cases, with flooding and inadequate water and sanitation infrastructure contributing to outbreaks. In 2024, 15 African countries reported active cholera outbreaks, the highest number in a decade. The economic burden of waterborne diseases is estimated at $50 billion annually across Africa, highlighting the enormous cost of failing to invest in safe water, sanitation and climate-resilient infrastructure.
The climate-health crisis also extends beyond infectious disease. In the Horn of Africa, drought has affected more than 20 million people, while acute malnutrition rates have reached three times the World Health Organization’s emergency threshold. The consequences can extend across generations, particularly among children. With drought frequency projected to rise from roughly once a decade to once every three years by 2040, Africa faces the urgent task of re-engineering its agricultural and health systems to withstand a more volatile climate.
Yet many health facilities remain ill-equipped to withstand the shocks they are expected to manage. Only 12% of health facilities in sub-Saharan Africa have climate-resilient designs, while 40% lack reliable electricity. When cyclones, floods or other disasters damage healthcare infrastructure, interruptions to routine services can produce more deaths than the immediate impact of the disaster itself. Retrofitting facilities at an estimated cost of $8 billion could prevent approximately $30 billion in losses, making climate-resilient healthcare infrastructure a potentially high-return adaptation investment.
Reliable energy is equally critical. Power outages are estimated to cause $350 million in annual vaccine spoilage across sub-Saharan Africa, while 70% of health facilities lack adequate backup power. Decentralised solar systems offer a practical alternative. At an estimated cost of $5,000 and with a lifespan of around 15 years, such systems could provide reliable power at a fraction of the cost associated with losing vaccines during major outages.
These realities strengthen the case for placing health at the centre of climate negotiations. Doing so would move climate discussions beyond abstract targets and towards measurable human outcomes. The Green Climate Fund’s allocation of only 8% of its financing to health highlights the gap that remains. With the health benefits of climate action in Africa estimated to exceed the costs by as much as 50 times, health-focused climate finance presents a compelling case for greater investment in adaptation.
Africa is also pushing for a broader understanding of loss and damage. Conventional economic assessments often struggle to capture the consequences of climate-related health crises, trauma and other non-economic losses. These costs, which are estimated at more than $100 billion annually for Africa, can have lasting effects on individuals, families and communities. Recognising them within loss-and-damage frameworks would strengthen the case for the substantial financing required to help African countries adapt, rather than limiting assessments to easily quantifiable physical and economic damage.
Africa’s decision to frame climate change as a public health emergency is therefore more than a rhetorical shift. It is a strategic response to a crisis that is already affecting lives, livelihoods and health systems across the continent. With projections pointing to an additional 250,000 climate-related deaths annually by 2050, the demand for health-centred climate policies and measurable health outcomes is ultimately a demand for survival.
For Africa, the climate negotiations are no longer only about emissions targets or environmental commitments. They are about whether communities can access healthcare during disasters, whether vaccines can remain viable during power outages, whether children can be protected from malnutrition and whether health systems can withstand a changing climate.
Redirecting climate finance towards stronger, more resilient African health systems offers an opportunity to turn global climate commitments into tangible improvements in people’s lives. Failing to make that connection risks allowing a climate crisis to become an even deeper and more enduring public health catastrophe.
