When conflict and climate overlap

We’re excited to share this collaboration with Doctors Without Border, a podcast devoted to stories about the overlaps between humanitarian work and climate impacts. How do we manage our fears, anxiety, and grief in the face of these intersecting issues?

In our first episode of the MSF Eco-Anxiety Podcast, our host Rachel Malena-Chan speaks with Canadian physician Reza Eshaghian about his experience providing medical care overseas in areas impacted by conflict.

Reza shares how his own feelings of eco-anxiety emerged as he witnessed the ways that climate change is compounding displacement, malnutrition, gender-based violence, and the spread of diseases in South Sudan. These global health and humanitarian issues are preventable and unjust.

Rachel and Reza talk about how eco-anxiety can be a key to connecting us to each other and to our role in making change. Join us!

EPISODE 1: Featuring Reza Eshaghian

Full Transcript

Reza:

I mean, imagine that everything that you’ve had, your home, your agriculture, your food is destroyed by this climate crisis, but also your future is unknown. When will the water go away? Will this place still be livable? Is this going to be a yearly problem? What is the future at stake? And there are so many uncertainties. The injustices of our world are all of our problem.

Rachel: 

Have you ever felt overwhelmed by your worry about climate change? This podcast is about making space for the stories that bring meaning to the climate crisis and reckoning with our personal and collective role in transforming the chapters to come. I’m your host, Rachel Malena-Chan, Story Strategist and Creator of Eco-Anxious Stories. Join me and Doctors Without Borders in exploring our climate emotions, the humanitarian and mental health impacts of climate change, and the opportunities we have to care for each other in a changing world.

Please note that while we will be sharing mental health stories and insights, this episode is not professional medical advice. If you are seeking mental health support, please contact your local health provider with your questions and concerns. 

Climate change is impacting mental health around the world, especially among young people. Researchers have been exploring this phenomenon, and a recent Canadian study found that 58% of the young people who participated reported feeling afraid, sad, anxious and powerless. And nearly 40% reported that feelings about climate change negatively affect their daily life. 

The American Psychiatric Association defines eco-anxiety as a chronic fear of environmental doom. But according to climate psychologist and researcher Caroline Hickman, anxiety, grief, despair, as well as guilt and shame are all bound up together in a complex emotional response as soon as we become aware of ecological destruction. Doctors Without Borders, Medicins Sans Frontier, MSF, has a unique perspective on how climate change impacts health at multiple levels.

This organization is a global movement with 63,000 staff across more than 70 countries providing medical assistance to people affected by conflict, epidemics, disasters or exclusion from health care wherever they may be. For doctors who’ve been around the world on assignments, climate change is not some far off perspective danger. Reza Eshaghian is a physician from Calgary, now living in Vancouver, B.C., Canada, where he works in emergency medicine.

Reza is one of many medical professionals who are providing hands-on care to address the health impacts of humanitarian crises. Reza, thanks so much for being here today. We’re grateful for your perspective on this topic of eco-anxiety, as well as hearing some of your stories from your work providing medical care.

Reza:

Well, thank you, Rachel. It is a pleasure to be part of this podcast.

Rachel:

So tell us a little bit about how and why you became a doctor and how you found yourself working with Doctors Without Borders?

Reza:

Yeah. So actually I chose to become a doctor when I was 16 years old. I kind of always knew I wanted to do some type of work that involved going to places of need and responding. I don’t know why I was drawn to that from a young age. I think it was just this – I found it fascinating, interesting to be part of a global movement.

It wasn’t long after until I was in my undergrad that I realized Doctors of Borders was the organization I’d like to do that through because of their record, the way that they  respond, their impartiality, their independence, neutrality. And so I kind of went into medicine with that intention. I trained in rural family medicine to provide me with a skill set that I thought would be ideal for that type of work.

And so for the past nine years, I’ve been going once a year overseas with Doctors Without Borders, and usually my experience has been in places with conflict zones.

Rachel:

So how does conflict and health interact? Like, there’s some pieces of that that feel obvious. But as someone who’s really witnessing that relationship up close, what is the connection point there? How does conflict shape our health or our ways of being healthy?

Reza:

That’s a great question. A lot of people assume that, you know, we just think of the trauma, the direct trauma, like from bombs or gunshot wounds. But the actual impact of health is way broader from conflict. So often in conflict, you have a displacement of people. People are trying to get away from further security, away from an area.

And so once you have displacement of people, people are cramped up in confined locations. You have infrastructure that’s collapsing, you have commercial trade, it’s changing and reducing. And so you have lack of access to food, lack of access to water, and confined locations, great spaces for infectious diseases to spread. So often in conflict situations, we see malnutrition, especially among children. We see things such as mental health problems. We start to see a spread of infectious diseases. Pregnant women requiring maternity, children requiring development, health, etc. All these things start to lead to huge health needs that are not actually directly from the conflict in terms of trauma, but all the secondary effects which are way bigger and challenging.

Rachel

Yeah, it makes me think of all of the things I take for granted that really are influencing my health day to day, but that just feel more like the absence of, you know, conflict or displacement or those things.

Reza

Most recently, I was with the emergency response to Bentiu in South Sudan. This is an example of a chronic conflict that is now a climate crisis. So South Sudan has been in a civil war now for over a decade and it’s been causing displacement of people. And of course, we see those secondary effects that I’ve described. Malnutrition, a lack of health care, and the spread of infectious disease.

People are displaced for their security due to the conflict. And then there’s been some worsening flooding over the years of the White Nile River.

Rachel:

Reza explained that the Sudd Marsh typically expands with water year by year, but in the last ten years, the flooding has severely increased. In 2021, when Reza was in the region, 835,000 people were affected by flooding when the marsh broke far beyond its normal borders.

Reza:

Already we had camps, what we refer to as internally displaced people. Because of the conflict, people were looking for security within these camps. So as the water started coming towards these camps, they had to build up soil around them to protect them from the water. So then this increased the displacement of people, we had more people moving into the camp in order to get not only security from now of conflict, but security or safety from the water.

Now, the water, the flooding is not only destroying food sources for the communities, but destroying homes and destroying all the other infrastructures that we’re developing, health care structures, etc., on top of an already susceptible population due to conflict, it’s causing lack of food, which is increasing malnutrition. People are cramped up in small areas. We saw, we have a hepatitis E outbreak, a lot of watery diarrhea and a lack of health care structures and increasing rates of malaria.

So we see more of the same thing that we see from conflict but as a result of climate change, compounded by already chronic conflict.

Rachel:

Can you tell us more about who this is impacting, like within those communities?

Reza:

We see that in a lot of these situations, more vulnerable populations are affected first from malnutrition. The first to be affected are children under the age of five. So Doctors Without Borders, we have the inpatient care. And then we also have these mobile clinics and the informal camps to find children who are getting on there, treat them as outpatients and bring them in.

When you have a loss of infrastructure and the loss of security, we see rates of sexual and gender-based violence start to occur. What I think was really remarkable is we had a community-based sexual and gender-based violence response where we would use community members that allow people who’ve been abused sexually or gender-based to come and seek care.

We had a great deal of success being able to provide that within the camp and all over.

Rachel:

This podcast is about eco-anxiety and it’s interesting as you kind of spell out the very real, you know, human impacts of climate change, and as it compounds on things like chronic conflict and who it’s affecting, like the fact that this is really a justice issue, that the people who have contributed the least to the problem of climate change globally, but also, you know, within their own communities, the people who have the least power are really the ones that are being harmed first and worst in all of this.

And it feels really overwhelming. It feels overwhelming for me as just someone here comfortable in Canada hearing about it. But I assume as someone who’s witnessing it upfront, there’s a degree of, you know, mental health impacts in all of this for us as a support team, but also for the people who are  suffering themselves.

Reza:

I mean, imagine that everything that you’ve had, your home, your agriculture, your food is destroyed by this climate crisis, but also your future is unknown. When will the water go away? Will this place still be livable? Is this going to be a yearly problem? What is the future at stake? And there are so many uncertainties about the climate changes that we’re seeing.

We still don’t know how big and how far sweeping different things will be. This flooding came quite as a surprise. Right. And the community and the international community was not prepared for it. We had to respond as an emergency because we weren’t mitigated and prepared for it. And so that uncertainty alone certainly has huge effects on your mental health and how you see your future. For myself and the other people who are trying to respond –

I’ll never forget when I first arrived, you know, to get to this camp, you have to take this propeller plane to an airstrip because it’s surrounded by water. You can’t drive there. We’re landing and you can see the dike of soil holding back the water. You realize you’re landing lower than water. And I would see these canoes that are or these boats that are elevated above me.

And this kind of impending sense of doom. When will a dike collapse and it be completely flooded? It took some time to even get used to that, but then also seeing the needs in a conflict zone like South Sudan. The World Food Program has only been able to provide 50% of the needs of an emergency for a person who needs nutrition.

So it’s already been underfunded, under supported, and then this new worsening crisis occurring, you certainly do immediately start to feel overwhelmed. The resources that we have toward disposal are so small compared to the needs and also we don’t have the long term solution to this. So, yes, I think you immediately, I immediately felt overwhelmed and helpless. But that does not mean that is the case.

So it takes, I think, that initial feeling lingered in me for a week or so. And then, of course, you start to move forward and start to see your role in the bigger picture in responding.

Rachel:

That actually is validating in a way to hear you say that even as you know someone who’s literally there to help curb this issue or help with solutions on the ground, you’re still experiencing that sense of helplessness just through the scale of the problem. And I think it’s an important reminder that there’s really nothing any of us can do individually that will feel like enough.

But I think it’s –  this is the question is how do we find that role? How do we find that thing that feels meaningful when the problem feels so insurmountable?

Reza:

And that feeling still comes back throughout now or throughout even the time that I was there, this wave over of this, like, my goodness, like where we’ve been going with all this, what are the next steps? The bleakness is hard to shake off and still, you know, justifiably there. The problem is huge and there’s so – the response is so small and so insufficient. 

And especially there, where we talk about the climate crisis, so the response in terms of the overall preventing greenhouse greenhouse gases, etc. And then also there’s the component of mitigating the crisis that is already at our doorstep. Now that they’re here, how do we reduce human suffering as a response now? But then also the humanitarian need that was already there was already lacking responding. So all these features can be certainly overwhelming and at times giving space and recognizing the magnitude of the problem is fine because it is the case.

Rachel:

It is a reckoning that I think is necessary and that really comes into focus, especially when we’re talking about these global examples of climate impacts, because so many of those vulnerabilities are really the result of, you know, centuries of oppression and colonialism. And it really forces the idea that we are connected. Historically connected, we’re connected through these physical, natural, global systems.

But that the dynamics that we’re seeing, you know, who’s being who is the most under-resourced, who is the most underfed? These really aren’t are not separate conversations, if we’re talking about climate change or if we’re talking about a history of colonization and white supremacy.

Reza:

Absolutely. I think the relationship we have with these communities – somehow we’ve been able to, our societies have distinguished them as separate from us, far from us. They have their own problems. But the reality is that we have a huge history of interconnectedness and of colonialism, imperialism that has shaped the situation that we are in now. Before the climate crisis came that the injustices of our world are all of our problem and do concern all of us. Climate change adds dynamic in that it’s the same, and that it is a global issue.

It’s all of our problem. It’s something that we all are going to have to live with and we should not see the suffering of one group as being separate from ours. But hopefully this component of climate crisis that is now coming will make it easier for people to grasp that it isn’t just someone else’s problem, and that the suffering of one is the suffering of all.

Rachel:

This humanitarian work, this charitable work really isn’t –  doesn’t have to be framed as charity. Like this really is solidarity when you think of it in the context of like all of us having to grapple with these, with conflict, with climate change, with changing norms, changing cultures, changing access to health and all the things that make us healthy.

This is a much more collective experience, I think, than I grew up learning about, you know.  When I saw Black and Brown people suffering, it was almost normalized in that way, that that’s what happens over there. And we’re going to give a dollar a day because that’s what happens over there. That we literally are connected. It’s not just an idea or like a warm, fuzzy feeling, like you’re human, I’m human and we’re all in this together.

But like literally these crises, these humanitarian crises are going to continue to pop up all over the place. They could even pop up in my neighborhood. And I hope people care. You know, I hope that those connection points are made, that we have a better capacity globally to witness and respond to these crises while also recognizing that, like, this is overwhelming work and we feel burnt out.

Reza:

I really do like that. It’s not charity solidarity, right? Seeing, I mean, there is definitely racism in the way that we’ve looked at it in the past, as you said, Black and Brown people in one part of the world. And this is kind of what little charity you could do. We need to change the way we see this in this framework.

This is our community. This is our planet. This is our Earth and this is our response. Right. And so that solidarity, I love that. That’s exactly the way we should look at it.

Rachel:

Yeah, I totally agree. And I think that eco-anxiety, there’s so much potential to see that conversation as a doorway to all of these interconnections and that can be really overwhelming. It’s sort of guaranteed to be a little overwhelming to really reckon with how dependent we are. And that sense of solidarity that one person’s suffering really is all of us suffering. It seems counterintuitive, but instead of sort of trying to relieve eco-anxiety, leaning into it and really sitting in that grief and sitting in that reality, I suppose.

Reza:

That actually, you know, reminds me a lot of one of my projects a few years ago I would turn to I saw a lot of suffering and it really impacted me. I end up spending a month feeling very numb. And then a month after I just was crying and I ended up seeing this counselor and a psychologist and we talked a bit about it.

And as she said to me, she says, you know, I think there’s nothing wrong with you. I think, as a matter of fact, what you just need is to grieve. It is the appropriate response to what you have seen is to feel these emotions, not to hide from them, to lean into them. And ever since then, I’ve kind of changed my attitude.

Like when I see a feeling that makes me feel sad or overwhelmed or helpless for a moment, leaning into a moment to it, because it helps to help frame exactly the reality of the situation. And then once I’ve kind of absorbed that feeling, then I can move out of it with this, like, okay, so now, now I’ll respond.

Rachel:

Often in my work and through Eco-Anxious Stories, what we’re trying to show is that you can reframe the story you’re telling yourself about your present or your future and include climate change in that and still find a meaningful way to move forward. That might actually be life-giving, that might actually make you feel better and actually feel like you’re using the things that you love and that that might actually be a great way to live out a lifelong relationship with eco-anxiety. 

But a lot of that is kind of connecting back to the things that bring you meaning anyway. For me, that’s storytelling and figuring out ways to help people share their experiences. I think it’s so important that each of us really finds what it is that lights us up and then figure out a way to support those climate movements with that energy.

Reza:

I became a doctor to do humanitarian relief in conflict zones, and now look at me. I’m now facing climate change as a big part of what I’m responding to. It is the reality that’s going to come your way, no matter whether that was the intention of what you’re doing or not.

Rachel:

I wonder if you have any message for people who are, let’s say, going into medical school or who are feeling like they want to be part of a solution, but who are also feeling just really overwhelmed by their own lives as well as the scale of the climate crisis.

Reza:

I think it’s going back to finding joy in what you’re doing. I think it’s back to finding what makes you happy and what brings you fulfillment and gratitude in life. You know, for me, for myself, like when I do this work,  I get to witness and I get to see the changes that I’m able to help support, seeing people who are being treated for malnutrition, some people that we could provide care for that.

And that ultimately brings me a lot of motivation and a lot of joy. And sometimes when  I feel overwhelmed by the magnitude or the uncertainty of the future or it seems bleak and clearly not going to move the right direction any time soon, seeing that my actions have these little successes, these little positive things, and deriving joy from that, I think is for me, I think, an important thing.

And so anyone who wants to work in this field, medical school, nurses, school, logistics, there’s all sorts of people who work in the field, is to be able to see that response and use that as motivation to keep you going.

Rachel:

How could this change? How could we be responding at  a more appropriate level in terms of that mitigation support? What would that look like if we actually like scaled up our response to be in line with the scale of the problem?

Reza:

So already, even though there’s so much neglected about, for example, this climate crisis occurring in South Sudan, there is at least some response. Here we are. There’s other organizations as well. We are present. We’re witnessing, we’re speaking out about it. These are successes. Even if it feels like you’re just hearing that that is bad news. The fact that it’s coming to you and getting to your podcasts you’re hearing about it is good news.

And that’s a first step towards many other steps to come forward. What I like to see in the future is I would like to see, well, a better understanding of that interconnectedness, both in terms of responding to the climate crisis, but also in terms of responding to humanitarian needs out there. And so recognizing that, although they’re certainly interlinked and influencing each other, they’re not to be put under one budget, you know, you just put money towards helping a susceptible population and that’s the budget for it. 

Recognizing that we need to mitigate the climate crisis, but also mitigate the suffering from the changes that are happening now and also still be able to respond to the emergencies that will continue to occur both within, and outside of the climate crisis context. So for me, I’d like to see an escalation of recognition of these needs better funding, a better response, and much more political will for that, I think.

And also in the consciousness of the people around the world, I think the climate crisis discussion has made people think much more globally, recognizing that it’s hard to individualize each of our worlds. We see it as a global, so I would say just connect that with the human, that planetary health. Also consider the health of your fellow human beings around the world.

Rachel:

Mm mm. And I think for the rest of us, just remembering that these are organizations that really have relationships in these communities, and you don’t have to reinvent the wheel if you want to start supporting this kind of work. Like they’re right here. They’re looking for, for donations from members, for staff. And I’m sure they would welcome like- minded people wanting to support the work as a first step, perhaps, in climate action, even, for those who are wanting to get involved.

Reza:

Right. So you could you, you can either donate your time, come work with us, but there’s so many other things, whether it’s you donate a certain amount, but also even just have a little bit of awareness about it. If you just read the newsletters, find out what’s going on, it will naturally become part of your conversations, your discussions with your friends and your family.

Like I think there’s so many different levels and ways to support. And so one shouldn’t just feel like, Oh, well, I’m not going to become a doctor and go to South Sudan. That’s fine. If you’re, you know, there’s so many other ways to be part of it, big and small. And it’s all it’s all important.

Rachel:

We can literally change things. We can literally redesign these systems and break them apart and have them actually work for us. I think eco-anxiety can so often be rooted in this idea that there’s nothing we can do and there’s so much we can do. There’s so much we are doing and so much we could scale up. And it really is a moment where if you want to make a difference, like support the stuff that’s working, support the people on the ground because there’s a huge difference between us not doing that and us doing that.

That gives me a lot of, a lot of hope and a lot of motivation just to keep finding ways to meaningfully engage, even if it doesn’t feel like those outcomes are always so easy to see. To know that there are people like you out there is a great reason to find out more about these solutions and support them actively.

Reza:

I agree. I think there’s something so valuable about talking about it, like this helps me manage my eco-anxiety. Recognizing that we are feeling in a similar way and have different ideas of how we can respond. So yeah, it’s been a pleasure being part of the podcast and I certainly do plan to keep talking about it.

Rachel:

As we say at Eco-Anxious Stories, eco anxiety is just the beginning of this story and we all have a role to play in shaping what happens next. If you’d like to explore resources, stories, tools and articles about eco-anxiety, or if you’d like to share your own story, visit ecoanxious.ca.

If this episode brought up uncomfortable emotions for you, please reach out for support. Note that this episode is not professional medical advice and if you are seeking mental health support, please contact your local health provider with your questions and concerns.

To support and engage with the important sustainability and humanitarian work being done every day by MSF, Visit doctorswithoutborder.ca and find us on Instagram, Twitter, TikTok, Facebook and LinkedIn. See you next time on our next episode featuring Communications Specialist Faith Toran.

Faith:

But I think what the climate crisis might be trying to teach us is how to reconnect with each other.

Rachel:

Thank you so much to our guest for being here today and sharing their story and making this episode possible. On behalf of Eco-Anxious Stories and Doctors Without Borders, thank you for joining us.