When people think of Médecins Sans Frontières (MSF), they often picture emergency teams responding in conflict zones or epidemics. But MSF’s approach continues to evolve, particularly as climate and environmental changes increasingly intersect with public health, even outside traditional crisis settings. That’s why MSF is working in Kiribati, a remote Pacific Island nation where health challenges are quietly compounding under the weight of climate vulnerability.
Kiribati, like many Small Island Developing States (SIDS), faces the realities of rising sea levels, water and food insecurity and rapidly changing living environments. These environmental stressors are not future threats; they are here now, affecting how people live, eat and stay healthy. In early 2024, MSF partnered with the Kiribati Ministry of Health and Medical Services to develop a project built on a climate emergency model — acknowledging that human health is deeply interconnected with the health of the environment.
The initiative launched in October 2024 on the outer island of Abaiang, one of Kiribati’s northern atolls. It aims better to understand and address the health impacts of environmental change in small, remote communities, using a model that could be applied across other contexts.
At the heart of the project is a focus on women of childbearing age. MSF is screening them for non-communicable diseases (NCDs) like diabetes and hypertension, two of the region’s most pressing public health concerns. These conditions are intimately tied to shifting diets driven by food insecurity and reduced access to traditional food sources. Early results from screenings have revealed high rates of both conditions, surpassing rates in comparable populations in Australia or New Zealand.
But MSF’s work goes beyond diagnosis. By following women through pregnancy and into early childhood care, the project is building a rare longitudinal dataset — one that will help us understand how climate-related factors might be worsening health outcomes over time. This long-term lens is critical. As environmental pressures build, it is imperative to track how chronic conditions and healthcare access evolve in tandem.
Ecological deterioration also shows up in connection with one of the most important necessities for human life: drinking water. The salinisation of underground water sources and soil significantly affects the delicate makeup of the water system, exacerbating existing health vulnerabilities. Additionally, in Abaiang, several of the freshwater wells MSF tested were found to be contaminated, indicating just how susceptible the groundwater is when not protected or replenished through natural cycles.
In response, MSF plans to begin rehabilitating some of the most contaminated wells — especially those near clinics and schools — by covering open wells, improving drainage and running hygiene awareness campaigns. These are low-cost, high-impact interventions that directly reduce exposure to waterborne disease. MSF is also planning to install rainwater harvesting systems to provide a more climate-resilient drinking water source.
Environmental risks don’t end with water. MSF is also supporting improvements in healthcare waste management — another under-recognised threat in climate-fragile settings. Simple changes like proper waste segregation and covered burn-pits can dramatically reduce pollution and prevent hazardous materials from entering groundwater and the marine environment.
This is what tackling a climate crisis looks like in practice: recognising that health systems, human behaviour and environmental factors are deeply interwoven. In Abaiang, where the population is around 6,000 people, MSF is working at a scale that allows for community-wide tracking and evaluation. That makes this project a potential blueprint for other SIDS or remote areas facing similar pressures.
The model is already expanding to a second location, with signs of further growth in the coming year. Early results are promising and, with strong leadership from Kiribati’s Ministry of Health and Medical Services together with MSF, we are highlighting the links between climate change and health. This initiative shows how small nations can drive global lessons and, with the right support, it has the potential to become a roadmap for governments, NGOs and donors seeking to address health challenges in climate-exposed settings.
While Pacific Island nations may face existential threats from rising seas, everyday health and environmental crises are no less urgent: contaminated water, limited access to nutritious food and the rise of NCDs like hypertension and diabetes. These are slow-burning challenges but, with the right interventions, they are solvable.
Kiribati may be small, but its challenges are not isolated. What MSF learns here could inform future responses across the Pacific and beyond — ensuring that health systems evolve in step with a rapidly changing climate.
This blog is published as part of a partnership between the Development Policy Centre and Médecins Sans Frontières / Doctors Without Borders (MSF) Australia. MSF provides medical assistance to people affected by conflict, epidemics, disasters or exclusion from healthcare. Their actions are guided by medical ethics and the principles of impartiality, independence and neutrality. MSF Australia does not receive public institutional funding.
