 Hello everyone. I am Ritu Bharatwaj and I'm a senior researcher with the Climate Change Group at the International Institute for Environmental Development. Here I work on the issues of climate change, gross and damage, social protection, climate resilience and child-centered adaptation action. Prior to joining IAED, I have worked with Government of India, UK Government's Department for International Development as well as national and international NGOs. My research spans on the issues of climate change, disaster risk production, climate risk management and how climate-induced distress migration and displacement creates vulnerability for communities and the global south. In my presentation today I'll be talking about how climate change-driven loss and damage is causing physical health, mental health and well-being issues for communities at the front line of these impacts. Developing countries, particularly the least developed countries, are dealing with increasingly harmful effects of climate change. Many are experiencing new types and forms of climate impacts and of higher intensity and frequency which they are not equipped to handle and these are leading to loss and damage where the impacts are so severe that affected communities and countries are no longer able to absorb the effects of climate risks or adapt to the climate impacts. We conducted research in 12 different geographies in Asia, Africa and Pacific, each facing different types of climate impacts ranging from slow onset events like droughts, sea level rise, desertification to rapid onset events like cyclones and floods. But irrespective of geographies and the type of climate impacts, forced displacement and distress migration was a common consequence across all these 12 areas. And among those who were getting displaced or undertaking distress migration, once most poor and vulnerable or marginalized were the ones getting most exposed to physical health, mental health and well-being issues. We found that recurring and high-intensity climatic events couples with socioeconomic factors and development deficits that many communities in the global south are already facing. For example, weak infrastructure, poverty, marginalization or degrading environment and together they force communities to move either to find alternate ways of livelihood or purely for survival. They then create health and well-being issues for migrant and their families who are left behind or those who are not able to migrate. On the screen you can see five typologies of these impacts which I will explain in next couple of flights with the help of a few examples. The first typology is where recurring climatic impacts are causing loss and damage to the homes, land, crop and livelihoods, pushing people into hardship and despair and creating health issues. For example, climate-induced flooding in impacting women, children and the elderly in the Trito districts in Indonesia, where almost 93% of the children are experiencing moderate anxiety and about 29% have mild depression. Recreating drought and cyclones also have an impact on emotional well-being. During drought, feelings of worry, sadness, anger and fatigue have emerged in the community in the Cook Islands due to the chronic nature of the disaster and prolonged hardships. In the municipality of Singhita, Tanzania, flooding forced community members to pay more for health out of the household budget. This additional budget combined with the reduction in the incomes and insecurity in the livelihoods has increased livelihood stress and vulnerability. The second typology of impact is seen where people forced to shift their livelihoods undergo mental distress. Here communities are being pushed to undertake different types of livelihoods which they have not been doing traditionally or which they are not skilled to do. And that creates susceptibility to addiction, anxiety and emotional distress. For example, in case of Turkana County in Kenya, the traditional pastoralists are forced to give up their pastoralism and take up more subtle way of livelihoods. Cultural beliefs and customs which had provided a sense of protection to them from physical and social harm are being eroded and that leads to alcohol abuse. People who abuse alcohol are less able to work, further exposing them to poverty and hopelessness. For women, alcohol abuse leads to abundant abandonment of their caregiver roles. It also increases the exposure to sexual and gender-based violence. Some women even turn to prostitution as a way of survival. The third type of impact is seen when migrants stay in informal settlements and relief camps with limited health and sanitation facilities, creating health issues. The recent increase in the flood impacts in Ksese Uganda has led to large-scale displacement which has resulted in overcrowding of camps with limited facilities for women. This in turn has led to gender inequalities, gender-based violence and increase in teenage pregnancy. Similarly, migrating single men in Uchitrakoot in India because of lack of awareness are becoming susceptible to high-risk sexual behavior exposing them to HIV and AIDS. Here we need to understand that the conditions of those who stay back is not good either. Women left behind have to take on additional responsibilities when their husbands migrate or adult male migrate from the families, creating issues surrounding their mobility and immobility. Chitrakoot, for example, in India faces severe drinking water crisis owing to multiple drought spells. When men migrate, women have to walk long distances and queue many hours for water to meet their livestock and domestic needs. Many poor households are forced to sell their assets to make end meets because men don't start sending back money immediately after they migrate. When all hopes fail, we have seen that in many cases, society is a reality in many households. Similarly, in Turkana, in Kenya, access to improve water and sanitation facilities remains low, and in Lake Chad basin, girls are forced to forego schools to travel long distances in search of water and firewood. This impacts their physical well-being and puts them increasingly at the risk of gender-based violence during their travel. It is not just the women, but children are equally exposed to emotional trauma and physical harm, whether they migrate along with their family or stay back. Children are generally more vulnerable to climate and environmental impact than adults, and this is because they have a relatively weaker immune system and have less physical maturity. So, threats such as malaria, malnutrition often results in much higher level of illness and death among children compared to adults. And post-traumatic stress in children can also lead to illnesses later in life and result in poor cognitive development. I have illustrated about four examples on my slide there. I am not going to take you through that, each of them, but in most of these cases we have seen, at least in four locations, that children being exposed to these impacts are at much higher or greater level of vulnerability than adults. In my previous slides, I tried to explain what are the different typologies or types of physical health, mental health and well-being issues that are created because of climatic events on different vulnerable groups, whether it's men, women or children. But it's also important to understand what are the drivers that are exposing these vulnerable groups to these mental health and physical health impacts. So, in my subsequent slide, I've just tried to explain how these drivers really work alone and in combination with other factors. We try to unpack these drivers by exploring the underlying issues that are increasing farmer suicides in India. We saw that farmers who see years of their hard work destroyed by erratic weather events can experience a feeling of helplessness, anxiety and despair, and this can push them towards suicidality or suicide. Nearly 11,000 farmers took their own lives in 2021, which averages to around 30 deaths a day in India, making farmers most at risk group in India. Now, it is important to understand this figure in global context. So, while an estimated 75.5% of all suicides occur in low and middle income countries, India alone accounts for 27% of all suicides globally, where farmers hold a big proportion of that suicide number. So, we looked at the data of about five states where suicide of farmers was highest. And we found that there was a very strong correlation in years where there was a rainfall variation with the number of suicides. So, higher the deviation of rainfall from normal, more the suicides. So, if we take the example of one state, that is Telangana, we saw that in a year where the variation of the rainfall from normal was 5%, the average number of farmers dying by suicide was around 800. Now, based on our predicted value of our regression modeling for rainfall deficit of around 25%, we saw that the number of farmers dying by suicide in a year increases to around 1200. So, the deviation of rainfall from normal has a huge impact on the number of farmers taking their own lives through suicide. And this is a very big revelation for us. When trying to understand the impact of climate change on farmer's suicide, we have to be cautious that this is not a linear phenomenon. They are complex multi-dimensional risks or underlying factors or predisposing factors or development deficits that contribute to create vulnerability of a farmer to suicide when they are exposed to climatic impacts. For example, a small and marginal farmer may incur much higher loss and damage compared to a larger farmer because their level of savings is much less. So, they are less able to cope with the climatic impact. Similarly, we saw that the farmers who were undertaking BT cotton farming were more exposed to climate-related loss and damage because their input cost for farming, for example, the cost of seeds, cost of fertilizer, cost of pesticides was much higher compared to the traditional farming and that caused much higher damages or losses when a climatic event occurred compared to the traditional farmer. Therefore, they were most susceptible to committing suicide. Similarly, farmers who were more aware or more educated and they knew about their rights and entitlements under the social protection programs were less exposed to committing suicide. For example, we saw that in states which had better coverage of social protection programs called MGNREGS that provided social safety net or alternate livelihood during climatic events were less susceptible or there the farmer's suicide was much less compared to other areas. And therefore, when trying to understand what protective factors can really contribute to reducing the farmer's suicide, we have to understand that we just don't need to work on the climatic factors. We'll need to look at all these combined factors together and try to address them as a whole. Clearly, it is people's lives and the survival and the well-being of future generation which is at stake here. So, it's not just the men, the men, but children increasingly getting exposed to these physical health, mental health and well-being issues. We cannot afford to be reactive in terms of providing humanitarian response after a crisis has occurred. Rather, we need bold new action which are anticipatory in nature now. Millions of people exposed to climate impacts are being and will be exposed to physical and psychological health issues in the coming decade. A framework will be needed to integrate these issues into the action plan for urban and rural climate resilience, migration response plan and national health and development plans. Although there is a growing realization about this issue, but health and climate nexus are rarely acknowledged and integrated into the planning process. Secondly, we need to focus on rights-based access to basic material, emotional and social needs of men, women and children. Right now, we have social protection coverage, but they are very compartmentalized or very siloed in their approach and they probably cover only one or two basic needs of households which are exposed to climate impacts. Right now, a family or the individuals who are on the move or those who stay back require a holistic coverage or integrated support on a range of issues such as health, nutrition, education, psychological security, job security and vulnerable households need to be protected not just in the areas where they reside, but also because as they're increasingly being forced to move, these social protection coverage needs to be portable so that they are covered under the social protection program even at the destination site. Thirdly, there's a need for anticipatory risk responsiveness within the existing social protection program so that these support are provided before a crisis strikes and not after a crisis strikes. And there's ample evidence indicating that providing support before a crisis strikes can be much more economical, it can be cost-effective than providing support afterwards. Fourthly, we know that infectious diseases are leading cause of morbidity and mortality worldwide, but many of them are preventable through vaccine. But given the inequity in vaccine access that they've clearly seen during COVID times, unvaccinated migrants crossing border can potentially get exposed to dangerous infectious diseases which might be prevalent in the destination site. As we expect to see more cross-border migration, there's a need to undertake further research on the likely routes migrants are expected to take from common hotspots and the burden of disease, mortality and disease transmission that they could become vulnerable to based on their vaccination status and vaccine availability and how that could be prevented. Fifth, there's a need to undertake economic assessment of action but also in action for addressing the nexus between climate-induced migration and health issues. An economic assessment is needed to understand why investment on climate-related health issues are needed and how not investing in them can lead to larger costs to economy and well-being of the society and children later on. Lastly, we need to equip our relief camp and migration destinations with decent shelter, sanitation and drinking water facilities. Design of such camps and shelters should integrate the physical requirement of disabled people and the privacy needs of women and girls including support for menstrual hygiene. There's a need to invest in ventilated shelters, proper sanitation and drinking water facilities for refugees and migrants. From the examples presented in the previous slides, migration has emerged as a major reason contributing to creating vulnerability to health issues due to climatic impacts, whether those forced to undertake distress migration or those who are unable to migrate and remain trapped in those local areas. And this should be a cause of major concern because the latest IPCC report has noted that the greatest single impact of climate change could be on human migration with millions of people expected to be displaced because of shoreline erosion, coastal flooding and agricultural disruptions. World Bank estimates that about 216 million people will be internally displaced by 2050 due to climatic impacts and all these people could potentially be exposed to mental health and physical health impacts. The problem now is one of time because of the speed at which climate change is happening and the scale because of the number of people it is impacting. It is clear that the international community has to face up to the prospects of large-scale displacement caused because of climate change and because the current climate change scenario a certain amount of forced displacement or distress migration is already logged in and this will create large-scale health impact for people who are exposed to these impacts and many of these communities are in countries which are least developed countries and these communities have done least to contribute to climatic impacts. Therefore, there's a need to extend financial, technical and policy support to these least developed countries to manage the health risk of people who are exposed to these climate impacts. Thank you for listening. If you have an interest to further understand this nexus between climate and health, please have a read through some of the research that we have published in the recent times. We have more research coming out in the space in the near future so please be on the lookout for those research. Thank you.