Merging Two Paths: Climate Migration and Health System Preparedness

I came to Columbia fairly certain that I was interested in building on the work I had done as an undergraduate in Bulgaria with Syrian refugees through a program at Oxford. I wasn’t sure how it would manifest, but choosing Public Health and Humanitarian Action (PHHA) as my certificate seemed like a natural place to start. But the Core had a way of surprising me and I found that I was unexpectedly drawn to Health Systems and Determinants of Health through an environmental module. Concurrently, the New York Times broke the story of the Intergovernmental Panel On Climate Change's special report, which predicted extreme and rapidly approaching consequences if Earth’s temperatures surpassed an additional .5^oC past pre-industrial levels. The threats of the climate crisis had loomed large for a long time, but it wasn’t until I listened to the report’s dire predictions that I felt truly sickened.

I avoided anything related to the report until a month later when I was listening to the hosts of Pod Save America talking about reframing discussions on the climate crisis by making it sound solvable as a way to encourage innovation. The climate crisis became a driving force of my second semester, which culminated in the final project for my Program Planning class, where my team and I created a hypothetical FEMA intervention that provided an array of resources and connections for climate migrants in the southeast region of the United States. While it seemed natural for me to pursue PHHA in the fall because of my passion for complex emergencies and refugee health, the PHHA certificate gave me the background to explore other facets of this field during my practicum.

Through researching climate change and migration, I discovered that there was a lack of scholarship on the health implications of climate migration. There is a lot of research on the health consequences of climate change: from fortifying communities to extreme heat waves like the one France endured in 2003, to handling the aftermath of severe storm systems like 2017's Hurricane Maria in Puerto Rico. Historically, climate migration has been a natural response to untenable climate conditions like the 1930’s Dust Bowl, which pushed approximately 400,000 Americans mostly to California. Yet the health implications for climate migration have largely not been puzzled through. The World Bank Group predicts that within Sub-Saharan Africa, Southeast Asia, and South America, internal migrants will total about 143 million people by 2050. Strengthening health systems will be essential to ensuring that climate migration is planned and adaptive rather than forced and chaotic. 

In the search for a practicum with an organization that could bring forced migration and climate change together, I found a 2008 Forced Migration Review article by Dr. Manuel Carballo who was the executive director of the International Centre for Migration Health and Development (ICMHD), a World Health Organization (WHO) collaborating center, and an instrumental figure in creating the Forced Migration program at Columbia Mailman. The review was over 10 years old, but I e-mailed the address listed at the end of the article and then formerly applied to an internship at ICMHD. My acceptance into their summer program followed shortly thereafter and by the end of my second semester, I was preparing for a summer in Geneva, a city where public health and humanitarian action are two of the main industries.

Fast forward to my practicum and I’m sitting in a quaint two-story house that serves as ICMHD’s headquarters in Vernier, a neighborhood on the edge of Geneva. I'm researching the intersection of climate migration and health system preparedness in the United States. Dr. Carballo, my direct supervisor, is interested in focusing on migration and health topics that are under-researched, including climate migration. Prior to this opportunity, I had fieldwork experience, so I wanted a more academic, policy centered practicum, and I have not been disappointed. Each week, we discuss the health and policy implications of climate migration, and talk through the different aspects of what should be emphasized and analyzed in our research. My first year at Mailman has been fantastic preparation for such a free-form, self-motivated research endeavor that includes creating causal loop diagrams to better visualize complex problems and conducting a needs and resources assessment to guide research. Having intensive academic and professional mentorship has shaped my research, my overall understanding of the topic within public health, and where it fits into the history of migration. At lunch and on the field trips we’ve taken to the Jura mountains of Switzerland, Dr. Carballo regales the team of fellow interns with stories of his time leading the Global Program on AIDS for the WHO and working as a public health advisor for Bosnia and Herzegovina during the Bosnian War. He extracts the details from his harrowing experiences that are most salient to our research and weaves together a narrative of migration ranging from Lucy and her ancestors to the Central American migrants pouring over the Mexican border today. It’s invigorating to be constantly challenged and engaged in a way that makes think of new connections for my research, my degree, or my own life.

Each day as I commute home from Geneva to a small French town called Ambilly (there is a housing crisis in Geneva), I am struck by the need for preparedness, especially when considering the scale expected from our climate crisis. Ambilly is home to countless African and Middle Eastern migrants and refugees who are relatively disconnected from both economic opportunities and other resources that would make their transitions easier. All around the city there are posters tacked to decaying bus stations and abandoned shops calling for Frexit, similar to Brexit, and decrying Emmanuel Macron in favor of more right-wing candidates. There is no more important moment than this one to be studying forced migration. As we gear up for far greater numbers of migrants than perhaps anyone is expecting, we need health-focused policies even as we push for mitigation efforts from the federal government and global community.

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Nika Sabasteanski, a Huo Family Foundation Scholar, is a second-year MPH student in the Heilbrun Department of Population and Family Health. Her writing has also appeared in Scientific American. She received her BA from Barnard College in 2017.