 I now know why they call you a rock star. Thank you so much for being able to present a whole bunch of serious issues, a bunch of frightening issues, but with humor and humanity. We are now going to move into a panel discussion. We've got three excellent panelists. They're going to speak for two minutes each, roughly. I want you to please read about who the panelists are from your programs. There's only one person who is missing in terms of their biography in the program, and that is Professor Anthony Costello. So let me briefly introduce him. He used to be my former boss when I worked as an academic at UCL. He's a pediatrician, stunned lots of research on maternal and child health. He kind of coordinated the first and second Lancet UCL commission on climate change and health. And he's recently returned from three years of working in WHO in Geneva. As I said, we've got three excellent panelists. We don't have as much time as we would like or really ideally need, so I'm going to just press ahead and invite Carol as the first panelist and a couple of minutes, Perot. Can I get my slide up? You need a slide? Oh, it's up. Okay. Hi, everyone. Hello. I should interview you instead of just show this map, but I'm Carol Devine. I do humanitarian affairs with MSF Canada, and I want to very quickly say that this map is a result of a project that Sarah Lam in the audience and I did, where we posed a question of what's MSF done, past and present related to climate, environmental degradation and health, so the very local impact that Professor Najam spoke about so that we can discuss what next for MSF. And so we kind of crowd map this. It's ongoing. It's like an MSF wiki of what MSF has done, and the point is we've done it ad hoc, and we want to consider, does MSF want to have policy, do more context analysis? It's all happening, but the question is, that came, what is MSF's position on climate change? And on the map, you've got examples of mitigation, and I'm wondering now, do we still go that route? Is it worth MSF mitigating? Because there's been suggestions. We work on our footprint and we do an analysis so that we get a diagnosis so that then we can make changes. The other really big, we interviewed 33 people, mostly internal people, some in the audience, thank you, and a couple external people saying, what do you know about what MSF has done, past and present, where do you think we should go? And some of the adaptation, there's an example of an app that's been made with Radcliffe Institute and MSF in South Asia, where we know the impact will be enormous, and I know my time is running out, but the example of the app is that, how do we use open source data? For example, in Jakarta, 2.4% of the tweets in the world come from Jakarta, and when there's floods, there's this data. So MSF is looking at innovation and tech to say, how in real time, where are the floods, how do we respond? Some other examples are the Aral Sea, a past example where MSF found this enormous health problem, TB, violence, anemia, because the Aral Sea dried up because of irrigation. So on this map are several examples of what MSF is already doing, research, motions, discussions, so that then we can say, where do we go next? Thank you. Thank you, Carol. Lachlan, over to you, please. Thanks, David, and afternoon, everyone. I attempted to rise to Adil's challenge of reflecting on the three questions he posed while resisting the urge to be dazzled by his presentation and overall star power. So I've jotted a few notes on the questions that he put to us. What does global mean? This means in this context and in others that what we do has consequences for others, many of those are negative, and that those negative consequences are distributed inequitably. This applies particularly to climate change impacts, including on health. The age of adaptation, what does that mean for us? That means that climate change and its impacts are not a problem for the future or for others, they're problems for us and for now. Millions of people are already suffering every year and hundreds of thousands are dying every year due to climate change impacts on health. And we're already on a trajectory towards worse health for many because of this. People are gonna live shorter, uglier lives as a result. That doesn't mean that we should neglect mitigation with having passed the threshold for critical warming still need to find ways to slow, halt and reverse this process. And what does this mean for us as humanitarian actors? In general, it means that climate change is gonna continue to increase the number of people that are harmed and killed by the impacts of climate change. Hydro-mediological disasters are the most obvious with the trauma, vector-borne diseases, water-borne diseases that they entail. There are more insidious impacts such as those on non-communicable diseases, nutrition, mental health and refugees that we need to consider. And for us as MSF, the dilemmas that we face and the debates that we must have, first of all, do we want to wait and respond, continue to be reactive? Or do we want to be proactive in addressing these challenges? How can we use the available info that we can access to inform our operations? Key among these is gonna be climate-based or climate-informed early warning systems? And how can we be a more ethical and responsible carbon-emitting entity? So thanks for those questions, Del. Thank you, Anthony. Thanks, Dave. It's nice to be here as well because I think you're a great organisation actually takes evidence very seriously. Countdown has an annual report in the Lancet now and will have for the next few years looking at progress in the five areas that we're looking at and I'll let you go and download the reports which are there. The only thing to add to what was said is don't forget mitigation. Jim Hansen says we shouldn't go above 1.5 degrees. No one thinks that's gonna happen. UNFCC says two degrees, it's not gonna happen. If we meet Paris, all the agreements will probably hit beyond three degrees and a paper in Nature two months ago said that there is now a 93% chance we'll hit four degrees this century. That is a catastrophe. Carbon intensity of primary energy supplies on the planet haven't changed since 1990. Carbon pollution is accelerating. Only 13% of the world's economies have carbon pricing and this should have been introduced 20 years ago. Coal is still dominant, although renewables are coming up. Food insecurity, a huge threat and we're seeing all about flaviviruses. So take Brazil in 1970, everything had been wiped out. Now they have yellow fever, dengue, chikungunya, zika virus and that is largely or contributed to by climate. So my final thing is what can you guys do? I always quote Ambedkar, who was the architect of the Indian Constitution. He says, educate, agitate, mobilize. You are all in the front line of this as we heard in the talk and if you've got stories or like you ought to think about what climate might be doing in your environments where you're working and contributing to what you're seeing and ping a stories and write to me. I don't have any cards. I do have a blog and a podcast and it's www.antodigostello.net and I've got an email attached to that. So if you want to contact us, we will be publishing stuff each year and I think stories from the front line are very powerful. So thank you for everything you're doing. Good, thank you. We've run out of time for that battle discussion but I'm going to take some guidance. Yeah, I've been told that I've got, yeah, we can stretch time a bit. I've got a couple of points I want to add to the conversation. One is that there was a time when I would give lectures about global health to students and kind of general introduction to global health and the first picture I put up was a picture of a glass half full and I said to the audience, this I think is possibly the most important question for you to grapple with. Is the glass half full or is it half empty? And the reason for this is because I think how we approach these challenges, these problems, these threats that science is presenting us with is extremely important because it will guide our response. The mood music in global health, you listen to Bill Gates, you listen to all the big global health actors. The mood music is one of self-congratulation, generally speaking. We pat ourselves on the back and to some extent for good reason because mortality rates across the world are in decline. Life expectancy is increasing in most parts of the world. We talk about expanding access in terms of antiretrovirals, et cetera, et cetera. But generally speaking, the mood music is one of self-congratulation. I think one of the big challenges we have in global health is to understand how we get the balance right between looking at the data and the science in ways that are positive and while at the same time recognizing the seriousness of the threats that are already in place. Generally speaking, if we fail to take account of the seriousness of the science that is presented with us, we will tend to respond with the idea that we just need to do a little bit more than what we've already been doing. We just need to try a little harder with what we've been doing for the last 20, 30, 40 years. My view is that we can't afford to do that. We need radical transformative change, firstly. The second, and coming back to what you were talking about in terms of the various failures, the flip side of failure is triumph. In many ways, what we're also seeing is a picture of triumph. It's the triumph of greed, the triumph of malice, and the triumph of an ideology, which I describe very loosely as a neoliberal ideology, which has shaped very much the politics and economics of the last three or four decades, which has very much shaped the way in which globalization has unfolded over time. So I guess there's a humanitarian response. There's a scientific, academic response, but there has to also be a political response. And that must be shaped by the way in which we view and approach the data and the evidence. So as my contribution to the panel discussion, I am now going to allocate five minutes to some questions from the audience, and then I'm going to give an opportunity to the panelists to wrap up with final comments before moving on to the next session. Thank you. Over to you. Thanks. Thanks very much. I'm Tom Elman from MSF Southern Africa. To me, it seems clear that MSF is already stretched to its limits with what it does. So this isn't a question of increasing the volume of our humanitarian activities. I think, Anthony, you were pointing out this is ultimately about how we change the nature of our activism, how we change the nature of our witness towards recognizing what are ultimately less proximate causes and risks than we are usually happy to talk about. So I think my question a little bit to all is, how can MSF, given its history, given its sense of self-respect, which is based on doing and seeing directly, relate to problems that go so far beyond what we can do and see directly? Thanks, Tom. Two more questions from the floor. Hands up, one at the back there, please. Hi, thanks for the very inspiring presentation and talks. Amrish Bhaiji from Imperial College London. I think climate is so strongly interwoven, everything around it, that it's very hard to see what the exact impact is going to be. And I would like to kind of pose a question reflecting on the last things the panel chair has said, is that radical change is always a difficult thing. And change will happen here by the passing of time or necessity will change, as Carl Sagan wisely mentioned in one of his talks. I think the question is much more about, are we going to lead by example in many ways or are we going to keep on dictating what the problem is and what should change? And I think that our emphasis should shift to the last one as lead by example and I would be very happy if the panel could reflect on that a bit. Thank you. One more question? I can't believe the MSF audience, that's so quiet. Bear Stringer, I work in the Mountain Unit in MSF. Yeah, thank you very much. I really enjoyed all the speakers on your talk in particular. I guess I'm sort of probably going to oppose Tom here and say that we might be looking in the wrong places or working in the wrong places. And because of populations that are impoverished, populations we work with in Bangladesh you'll hear about this afternoon for example and in other parts of the world where we are addressing the consequences of climate change directly sort of present us with the reality that a lot of health problems that we come into contact with in these kinds of environments are to do with the violence that is hidden that is part of what you talked about with regards to, if I understood correctly, a structural problem of violence. So we will find ourselves probably working more in these kinds of environments if we decide that that is important. Great, thank you, Beverly. I'm going to start at that end, if that's all right, Anthony. Is that okay? Just to respond to some of the questions from the floor. Tom's point about how can we leverage what we're doing to have more impact. When we did the second report, people were saying, you know, what can you do if it's the greatest threat? And Chris Rappley who was the director of the British Antarctic Survey came to me and said we've failed completely on the environmental front if you could do something with health because people understand health impacts and if we can make that link in people's minds about that this is going to affect our children, not our grandchildren, our children in all kinds of ways and there's evidence mounting everywhere that that's going to happen, then that's actually more powerful to get political action. And you shouldn't underestimate the power of your organisation. I think MSF has almost a unique voice now in that, you know, going out into difficult places and collecting the stories that would enable us to get some more momentum. Hopefully, just before climate reaches its tipping point, we'll reach a political tipping point. I mean, things are very gloomy in the United States right now, but you know, he's not going to be there forever. And the mayors, the city states of America are going in a different direction because even Republican mayors understand about insurance policies. So, you know, I think there is a lot that can be done just because you've got a particular president for four years doesn't stop everything from still moving in that direction. Oh, and leading by example, I feel guilty every day. My carbon footprint for the last few years has been appalling and I'm trying now not to ever travel unsuccessfully. But I mean, I am going to, I think you're absolutely right. Why are we not doing many more video conferences and all the rest of it and thinking, but that's only a small thing. It's about the way we eat, the way we behave, the way we campaign for renewables. You know, we can all do something to try and deal with the problem of carbon pollution to say nothing of all the other environmental issues. I'd like to pick up briefly on the point Tom raised or that I think Tom was raising about the potential or actual tension between MSF's mandate and our capacity, acting on what are direct versus indirect consequences and where we see our role as an organisation. And I think this is going to be at the core of the debate we have about the actions that we as MSF take in relation to climate change and health, both internally and as an external actor. And my reflections on this up to this point are that typically, historically, MSF has not been timid when it comes to speaking out against injustice and fighting for better health for our patients and the communities where we work. So surely there is, within our mandate, an imperative to be a voice for the voiceless, a voice for the vulnerable, to use the evidence that's available and is being generated at a rapid rate and generate our own. And among that stories are key and continue to, including in this field, strive for better health for those being unequally and inequitably affected by the problems to which we are all contributing. Thanks. The questions... I'm going to share back with what we heard. The project that Sarah and I did was a bit like the Pied Piper because then we'd find another person and you'll know many of you in this room already. There's many people working on this issue already and others are still discussing. So what we've heard back from you is what about STARTWITH? We're worried about our patients. We've already published in different places. If you Google MSF and climate change, MSF statement about it, we talk about malaria on the increase in sub-Saharan Africa above all other years. We talk about, in Northern Nigeria, about how we're seeing higher, severe acute malnutrition than the last 10 years. So what our friend was telling us about storytelling, that's an incredibly important place to start. And then some of the debate we hear is, yes, but we can't show all causal links. But what we're hearing is, tell the stories of what you're seeing locally right now because we're concerned about our patients and also show up at the IPCC. We didn't think we would go before the World Trade Organization, but we're being encouraged. Now show up and say what we're seeing because we're in the places where the impact is. We're also hearing have a shared narrative, start using the same language. I think it's happening piecemeal, but there's momentum within MSF. We have a working group, several of you are in this room and we're meeting this evening. And there's a call for more research. Why in Latin America are we seeing this kidney disease? Is it linked to stress, heat? Are the industries denying that? Does MSF have an advocacy role towards industry like we did in Zamfara? I think that we have to be doing multiple actions is what we're hearing. And at the AGES, we're having more motions, we're having more discussions. Thanks, Carol. Thank you for these wonderful questions and some very, very good questions also from the panel. And someone says good questions, that means I have no answer for them. And that's true. Two and a half points. The half point is this is bigger than Trump. I wish it was as easy as Trump being not there. If Trump wasn't there, the only thing that would change in my presentation is that one slide and I've got plenty of others. So it's easy to dump it on this political moment. You're exactly right on the political point, but it's a bigger one, this is a bigger challenge. Two major points for MSF. Everyone is exactly right. This is not a horse race between mitigation and adaptation. The reason we have adaptation is the less mitigation you do, the more you will have to adapt. The reason we are in this mess is because we didn't do that right. So yes, we have to keep doing that and everyone has made that point. About you, and I'm a friend of MSF, but I don't know as much about you, but from the outside, MSF is the other folks who are working in the toughest, meanest, baddest, biggest crises in the world. And the challenge here is that the baddest, meanest, biggest crisis in the world today, I think, or one of them, doesn't happen in one place. It's the smallpox map of these small crises happening everywhere. To your point, you know, what is global? The global is the sum of the very, very local. So in some ways, the mindset changes that the one place where everything bad is happening, that's not how climate change happens. So think about the heat waves right now, or water. Think about what? Los Angeles, Cape Town, Sao Paulo, Thar. None of them probably is big enough in and of itself to become a major MSF crisis. All of them put together are about as bad as any you're working on. How you deal with that as an organization is a tough challenge. And the last, last point, in some ways, this is the place where prevention works. The way to deal with adaptation is not to wait for the big crisis, because the big crisis will not just be existential in the climate world, it will be non-reversible. So this is a moment for prevention. Thank you very much. Thank you.