Why Sierra Leone needs climate-resilient health systems

Seven of the ten most climate-vulnerable countries with weak healthcare systems are located in Africa, grappling with climate-sensitive health issues such as vector-borne and waterborne diseases.

On 24th March 2025, UNICEF reported over 178,000 cholera cases in Eastern and Southern Africa over a period of 15 months, worsened by insufficient water, sanitation, and hygiene services, resulting in nearly 2,900 deaths.

The new study, published on March 24th, recommends allocating resources, equipping facilities, and constructing new healthcare centres in underserved areas of Sierra Leone. It encourages public-private partnerships to provide financial and technical support, while also advocating for the establishment of collaboration and accountability mechanisms to ensure sustained commitment. Additionally, the study highlights the need to enhance workforce capacity by training healthcare professionals to manage climate-related diseases and incentivising those who work in remote areas.

The study further emphasises community-based adaptation through education, environmental management, and community-driven monitoring to mitigate the impacts of climate change on the health system. Awareness campaigns should underline the health effects of climate change, while community initiatives, such as waste management and tree planting, can help reduce risks. Furthermore, international support and financing are crucial for strengthening climate-resilient health systems. This includes increasing healthcare funding, encouraging innovative revenue streams, and developing a climate-health emergency fund to address climate-related health emergencies and research.

Despite establishing a climate unit in the Ministry of Health in April 2024, Sierra Leone still struggles to integrate climate considerations effectively into its healthcare system. Poor implementation at district and community levels, alongside insufficient healthcare investment, limits the impact of these initiatives. Ongoing challenges, such as deforestation, low socioeconomic status, rapid urbanisation, and past public health crises like the Ebola outbreak, continue to strain the healthcare system.

In Sierra Leone, rising temperatures have exacerbated the spread of vector-borne and zoonotic diseases, making the population more vulnerable to illnesses such as malaria, Lassa fever, and diarrhoea. Climate change has created conditions that favour the proliferation of mosquitoes and other disease-carrying vectors, increasing the overall disease burden. Malaria, which accounts for 38% of hospital admissions, is one of the most significant diseases affected. Moreover, Lassa fever has a 90% fatality rate among pregnant women in their third trimester, further straining the healthcare system.

Flooding is another climate-related issue driving health crises in Sierra Leone. Recurrent floods create breeding grounds for disease vectors and increase the prevalence of waterborne diseases such as cholera and dysentery. Between 2012 and 2017, severe floods affected thousands and caused lasting damage to health infrastructure. Additionally, with 58% of the population lacking access to safe drinking water, waterborne diseases continue to pose a significant risk.

On February 6th, 2025, Sierra Leone launched the first-ever Heat Action Plan (HAP) in Africa to address the rising frequency of heatwaves and related deaths in the country. The HAP outlines targeted actions, policies, and partnerships to enhance heat resilience, including the creation of cooling corridors and green spaces to reduce heat exposure, infrastructure improvements to adapt urban areas to rising temperatures, and protective measures for vulnerable groups, including women, children, and the elderly.

With heavy floods occurring in Southern Africa and heatwaves in the Sahel, there has never been a more urgent time to act. South Africa and Botswana are currently facing devastating floods, leading to widespread trauma, infrastructure damage, and health crises. Reports indicate that deaths, particularly from drowning, have occurred, alongside a rise in waterborne diseases.

In March and April 2024, the Sahel and West Africa regions experienced extreme heat, with maximum temperatures exceeding 45°C and minimum temperatures reaching 32°C in Burkina Faso. Kayes in Mali recorded its hottest day in history, hitting 48.5°C on 3 April.

Between 1 and 4 April 2024, Gabriel Touré Hospital in Bamako, Mali, reported 102 deaths, a sharp increase compared to the 130 deaths recorded for the entire month of April 2023. While specific causes of death have not been reported, approximately half of the deceased were over 60, and heat is believed to have played a significant role.

In 2023, extreme climate events inflicted severe flooding and drought across Africa. Floods caused by Storm Daniel in Libya resulted in over 4,700 fatalities, while Kenya, Somalia, and Ethiopia experienced 350 deaths and 2.4 million displacements. Cyclone Freddy led to devastating floods in Malawi and Mozambique, with 679 deaths in Malawi and 165 in Mozambique. Central Africa also faced landslides, claiming 574 lives.

Droughts have severely affected parts of North, West, and Southern Africa, with Zambia experiencing its worst drought in 40 years, impacting six million people. Precipitation anomalies have highlighted significant deviations, with blue areas indicating above-average rainfall and brown areas reflecting extreme drought.