Source: SPC

Advisory on the potential impacts of drought on

human health and health systems in Pacific Island
countries and territories
Produced by the
Surveillance, Preparedness and Response Programme
Public Health Division, Pacific Community (SPC)
Focal Point of the Pacific Public Health Surveillance Network (PPHSN) Coordinating Body
February 2024
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TABLE OF CONTENTS

About this Advisory .......................................................................................................................................... 1

Acknowledgements .......................................................................................................................................... 1
Introduction ...................................................................................................................................................... 2
Health risks linked to freshwater scarcity: quantity and quality .................................................................... 3
1. Increased risk of diarrheal diseases as a direct effect of stress on potable water ............................... 4
2. Increased risk of respiratory infections and healthcare associated infections due to indirect effects
of stress on clean freshwater ........................................................................................................................ 4
Health risks linked to ecological changes......................................................................................................... 5
Other health risks associated with drought..................................................................................................... 6
Dust, risk of wildfires and air quality ............................................................................................................... 6
Heatwaves......................................................................................................................................................... 6
Climate change and water ................................................................................................................................ 6
Key recommendations and actions for strengthening health system resilience during droughts ................ 7
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About this Advisory

This advisory has been prepared in response to the Pohnpei State of the Federated States of
Micronesia (FSM) declaring a State of Emergency1 due to severe drought on 12 January 2024. The
severe drought conditions have been brought about by climatic impacts of the El Niño weather
patterns that has affected both the main island and outer islands.
The El Niño weather patterns was declared for FSM in September 20232 and the risk of severe
drought condition was anticipated for the ensuing months. FSM is heavily reliant on underground,
surface water and rainfall for daily water needs so it is vulnerable to water scarcity during the El
Nino events.
Additionally, this advisory was prepared to increase awareness on the potential impacts of drought
conditions on the health of people in the Pacific region as well as on the health systems.

Acknowledgements
We are grateful to the Geoscience, Energy and Maritime (GEM) Division at the Pacific Community
and the Division of Pacific Technical Support, WHO Suva Office for their review and inputs.

1
https://pohnpeistate.gov.fm/2024/01/15/emergency-declaration-2024-01-declaring-a-state-of-emergency-relative-
to-inadequate-water-supply-for-pohnpei/
2
https://reliefweb.int/report/micronesia-federated-states/federated-states-micronesia-drought-imminent-2023-dref-
operational-update-mdrfm002
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Introduction
The Pacific is home to the El Niño Southern Oscillation, which has major impacts on the weather
conditions in the Pacific Island countries and territories (PICTs). The current situation is that of a
major El Niño phase which strongly impacts the rainfall pattern of the Western Pacific, with many
PICTs exposed to drought conditions. At the same time some PICTs in the Eastern Pacific face higher
levels of rainfall, which can have impacts on health due to flooding.

El Niño effects on the weather in the Pacific

from December through February (top) and from June to August (bottom)
(Source NOAA: https://www.noaa.gov/jetstream/enso_impacts)
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Droughts have been declared in multiple PICTs over the past 2 years including Kiribati, FSM, Tonga3,
Tuvalu. PICTs are particularly vulnerable to the impacts of severe drought due to the following
factors:
- reliance on surface water and rainfall
- changes to water table due to water use and land use
- diminished agricultural capacity may lead to changes to food security in country and in
downstream markets
- high prevalence of non-communicable diseases
- limited nutritional surveillance across PICTs
The aim of this advisory is to highlight the risks to human health during severe drought conditions
and to ensure that PICT health systems are prepared and able to respond appropriately.

Health risks linked to freshwater scarcity: quantity and quality

The first and major impact of drought for people is a stress on freshwater quantity, as well as quality.
This stress on freshwater has both direct and indirect impacts on health. The map below shows
water stress alerts for parts of Palau, Federated States of Micronesia (FSM), Marshall Islands, PNG,
Tuvalu, New Caledonia, Vanuatu, Fiji, Wallis and Futuna, Samoa, American Samoa, Tonga, Niue,
southern Cook Islands, Austral Islands, Tuamotu Archipelago and Pitcairn Islands during the period
October to December 2023.

Water Stress alerts for severely or seriously dry conditions affecting Pacific Island countries and territories
from October to December 2023 (Source: NIWA)

3
Tonga Meteorological Services: https://met.gov.to/wp-content/uploads/2023/10/Drought_Report-Sep2023.pdf
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1. Increased risk of diarrheal diseases as a direct effect of stress on potable water

Drought impacts the quantity of freshwater availability,
impacting water quality in many ways: Reduced flows in running
waterways can increase the concentration of microbial and
chemical pollutants and/or cause water stagnation. This also
leads to increased temperature in both running and standing
water, promoting microbial growth. This phenomenon can affect
natural surface water stocks used for collective water supplies.
Water distribution systems equipped with particulate removal
and disinfection systems must adapt. Of note, it can also affect
rainwater tanks used by households in some communities,
where populations usually do not treat water before use.
Although groundwater resources usually have a higher resilience,
they are decreasingly renewed during drought periods and may
also be affected after prolonged drought periods.
Failures and weaknesses in sanitation systems, wastewater
management and treatment systems and sewage systems can
significantly increase these risks.

Consequently, water resources that are usually potable can rapidly turn to non-potable and be a
source for diarrheal diseases particularly for children under 5 years of age. Surveillance systems and
healthcare must be prepared for an increase in diarrheal diseases in populations exposed to
droughts.
Risk communication encouraging to filter and boil water before use can be implemented.

2. Increased risk of respiratory infections and healthcare associated infections due to indirect
effects of stress on clean freshwater

In addition to these direct effects on freshwater quality and

potability, the scarcity of freshwater frequently leads to decreased
personal hygiene. Therefore, there is usually insufficient
handwashing, aggravating the risk of infectious diseases
transmission, including both diarrheal and respiratory infections, or
others like hand-foot-mouth disease, conjunctivitis, etc... Water
scarcity can increase air pollution due to dust, smoke, and other
particulars, triggering respiratory issues or worsening existing
respiratory conditions. The risk of diarrheal diseases can also be
increased by improper washing of food (mostly vegetables) and
dishes.
This stress on clean freshwater availability can sometimes also affect health centers, leading to
decreased Infection and Prevention Control and general hygiene.
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Consequently, the stress on clean freshwater availability frequently leads to an increased incidence
of respiratory infections and other hand-transmitted infectious diseases. In healthcare settings,
this can result in an increase in healthcare-associated infections. Surveillance systems must be
enhanced to monitor these impacts and risk communication can also target the very need to
maintain infection prevention and control with emphasis on hand and personal hygiene practices.

Health risks linked to ecological changes

These risks are indirect consequences of ecological changes associated with reduced surface
freshwater. Therefore, they will be specific to each ecosystem and only a few general patterns can
be identified.
Consequences can arise from more humans and animals using the same surface water points,
leading to an increased risk of zoonotic transmission.
Changes in mosquito vector population dynamics are
frequently observed patterns (including mosquitoes
breeding in rainwater tanks). For example, the reduced
size of water bodies and increased stagnant water points
can provide more breeding grounds for Culex spp.
mosquitoes, which can be vectors for parasites
(Lymphatic filariasis) and viruses (e.g. West Nile virus,
Japanese Encephalitis virus, Ross River virus). PICTs labs
are poorly equipped to diagnose human infections with such viruses and should refer to Level 2 or
Level 3 reference laboratories.
Toxic algal blooms can also occur in stagnant water bodies. These usually involve toxic cyanobacteria
(blue-green algae) that can prove toxic to both humans and animals by ingestion and inhalation.
Likewise, several protozoan parasites such as Amoeba, Giardia and Cryptosporidium can proliferate
in stagnant water bodies. This is prone to create unusual clinical conditions, notably arising from
recreational or occupational exposure.

The ecological changes imposed to the ecosystems by drought can induce changes in the risk of
zoonotic and vector-borne diseases and create additional risk, including toxic algal blooms.
The possible change in vector-borne disease risk should prompt referral to reference laboratories
to identify etiological agents.
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Other health risks associated with drought

Impact on agriculture and food safety and security. Beside the effects on infectious
diseases described above, drought may affect human health and well-being through
a number of other pathways. Water is also used for crops and droughts can
jeopardize some of the expected agricultural production. In some settings, the
severity of this phenomenon can lead to stress on food systems, impacting both
food safety and food security.
Water is also used for animal farming, creating another risk for food security
through lack of drinking water for livestock and poultry.

Given the impacts on both crops and farm animals, drought can challenge food security in
communities relying on food self-sufficiency. The welfare of farming communities can also be put
at risk, which can have significant mental health impacts.

Dust, risk of wildfires and air quality

Drought is also frequently associated with decreased air quality. This is notably caused by increased
concentration of air-borne dust particles, including aeroallergens. This can be an additional risk
factor for respiratory infection, but also a significant risk for people with chronic respiratory and
cardiovascular conditions. In addition, drought exacerbates the risk of wildfires, creating another
risk per se and further decreasing air quality.

Heatwaves
Drought is frequently associated with higher temperatures. In the event of heatwaves, attention
must be paid to heat-vulnerable populations, which includes pregnant mothers, babies, the elderly,
those with underlying conditions such as NCDs, those with disabilities, outdoor workers among
others.

Decreased air quality and heatwaves are frequently associated with drought. These factors are
likely to affect specific vulnerable populations. Increased hospitalizations for asthma or chronic
cardio-respiratory decompensation may be seen. Risk communication can be used to specifically
inform these populations and their families about the risk and preventative measures.

Climate change and water

The Intergovernmental Panel on Climate Change (IPCC)
acknowledges that PICTs have higher climate-related risks
than the global average. These include more droughts and
extreme rainfall.
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Climate change is associated with more frequent extreme weather events, including extreme heat
and drought. Rising temperatures will make already dry areas even drier. Indeed, with high
temperatures, water evaporates more quickly and thus exacerbates drought conditions.

The PICTs are most vulnerable to

health impacts of climate change
including drought, and this is
predicted to increase in
frequency and severity in the
coming years.

This underscores the need for PICTs to have a strategy to prepare, adapt and respond to more
frequent or more severe extreme weather events due to Climate Change that incorporates a
drought preparedness and response plan.

Key recommendations and actions for strengthening health system resilience during
droughts

 Undertake a risk and vulnerability assessment of health system to the impact of drought
 Prepare a drought preparedness and response plan that includes health and health systems
 Maintain or enhance water management and surveillance plans

 Establish or enhance water storage capacity from national to household level; every health
facility should have a functional water storage system
 Establish desalination capacity
 Prepare for water trucking/transport of potable water to remote areas
 Evaluate water usage, prepare and communicate plans for water restriction
 Ensure sufficient water for health facilities, schools and other priority activities
 Strengthen surveillance of water-related, respiratory, vector-borne, heat-related illness and
healthcare-associated infections
 Monitor food security (consider WFP mVAM system)
 Implement or strengthen national / subnational nutritional surveillance systems
 Implement and strengthen infection prevention and control mechanisms in health facilities
 Consider alternative hand hygiene through use of alcohol gels and hand rubs
 Enhance risk communication and community engagement in a timely manner
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Resources
 Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, National Oceanic
and Atmospheric Agency, and American Water Works Association. 2010.: When Every Drop Counts:
Protecting Public Health During Drought Conditions—A Guide for Public Health Professionals
 Centers for Disease Control and Prevention: Health Implications of Drought
 Centers for Disease Control and Prevention: Preparing for the Health Effects of Drought: A Resource
Guide for Public Health Professionals
 COP28 UAE Declaration on Climate and Health (PDF)
 National Oceanic and Atmospheric Administration: Weather Impacts of ENSO
 National Drought Mitigation Centre, University of Nebraska: Drought Education
 National Drought Mitigation Centre, University of Nebraska: How Does Drought Affect Our Lives?
 New Zealand National Institute of Water and Atmospheric Research (NIWA): Island Climate Update
 Pacific Drought Knowledge Exchange: Drought in the Pacific
 Pacific Islands Climate Adaptation Science Centre: Pacific Drought Knowledge Exchange - Drought in
Hawaiʻi and the Pacific
 Reliefweb: Pacific: Drought - May 2022
 Reliefweb: Pacific: Drought 2015-2017
 Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. (2013). "Health effects of drought: a
systematic review of the evidence." PLoS currents 5: free article online
 U.S. Drought Monitor: U.S. Affiliated Pacific Islands (USAPI)
 U.S. Geological Survey: Drought in the U.S Affiliated Pacific Islands
 U.S. National Weather Service: Drought Information Statement
 U.S. National Weather Service: Pohnpei Weather Service Office
 World Health Organization: El Niño and health in the Pacific
 World Health Organization: Health topics: Drought

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