The 2024 South America ablaze: health impacts and policy imperatives for protecting population health in an era of wildfires

Summary

The 2024 wildfires in South America, particularly in the Amazon and Pantanal, were not only a disaster for ecosystems, but also for public health and people's health and wellbeing. These record-breaking fires were likely driven by overlapping triggers: climate change-related heat and droughts and human-driven land-use change. We documented that rapidly evolving wildfires together with limited preparedness and slow responses from emergency and health agencies resulted in severe health impacts, including several fatalities and thousands people displaced, injured, and/or with cardiorespiratory symptoms. These, however, partially represent the situation as mental health outcomes were largely unrecorded and other impacts are yet to be seen. In a climate increasingly prone to severe wildfires, comprehensive action is key. Integrated disaster risk reduction strategies, strengthened health systems, and improved risk communication are essential to protect human health from this escalating threat.

Search strategy and selection criteria.

References for the section “Overall impacts of wildfires on human livelihoods, health, and wellbeing” of this personal view were identified through a literature search using PubMed. We focused on reviews and literature reviews published in English, Spanish, and Portuguese. The time frame for the publications searched was from 1 January 2000 to 10 November 2024. The search query used was: (“Environmental Exposure” [MeSH Terms] AND “Wildfires” [MeSH Terms]) AND ((review [Filter] OR systematic review [Filter]) AND (humans [Filter])).

The search was conducted on November 08, 2024, yielding a total of 33 results. All titles and abstracts were screened for relevance. Three authors (SH, LB and CL) conducted a full-text review on the selected articles to extract key findings.

Introduction

In 2024, we witnessed exceptional and widespread wildfires across South America. The most affected areas include the Amazon rainforest, the Pantanal (the world's largest tropical wetland) and the Cerrado in Brazil, and the Chiquitanía dry forests in Bolivia. These fires have not only brought damaging short- and long-term consequences to the health of natural ecosystems and non-human animals, but have also affected people's livelihoods, health and wellbeing.^1,2

The diverse ecosystems of South America are crucial to Earth's carbon and hydrological balance. Among them, the Amazon rainforest is one of the most important tropical rainforests on Earth: it regulates global climate³ and is considered a potential tipping element for the Earth's climate system.³ Traditionally a major carbon sink⁴ and an area of extraordinary biodiversity,⁵ these ecosystems also provide indispensable resources, and cultural, social, and psychological benefits to millions, including approximately 1.5 million Indigenous people.^6,7 Although wildfires have always occurred and are part of natural processes in many ecosystems,^8,9 there has been a shift in fire regimes during the industrial era.¹⁰ In tropical rainforests, fires used to be infrequent and of low intensity but have become more frequent due to forest clearing activities that have transformed the land into a more flammable landscape (grasslands and agricultural fields).^10,11

Between May and November 2024, several South American countries experienced some of the most severe wildfires on record, with more than 85% of the fire activity occurring in Brazil and Bolivia.¹² During these months, more than 350,000 megatons of carbon were emitted by these fires, the highest for these months since 2011.¹²

These wildfires have directly affected more than 18 million people in Brazil (especially in Acre, Rondônia, Maranhão, Minas Gerais, and Bahia), more than 60,000 families in Bolivia, and dozens of people in Ecuador, Colombia, and Peru.¹³ In addition to the direct impacts of wildfires on people's livelihoods, health, and wellbeing, the smoke derived from the wildfires worsened the air quality up to very unhealthy levels in several populated cities, including São Paulo in Brazil and Puerto Maldonado and Pucallpa in Peru.¹³

Some questions that emerge from this recurrent disaster are: What is driving these record-breaking fires across South American, and particularly Amazonian, ecosystems? What are the impacts of these fires on the planet, local ecosystems, human livelihoods, health, and wellbeing? How has the region responded to these wildfires? And what do we need to do to mitigate these events and protect people's health in a continuously changing climate?

In this personal view on the occurrence of the 2024 wildfires, we focus on the South American ecosystems located east of the Andes, particularly the Amazon basin. We assess this problem from a broad perspective, covering analyses of climatic conditions and human activities that increase the likelihood of wildfires. We also analyse how these drivers affect human livelihoods and health, among other impacts. Without being prescriptive regarding which policy actions need to be taken, we call for a bold and quick response to protect the natural environment that sustains us and the health and wellbeing of current and future generations.

A climate increasingly suitable to wildfires and the effect of interacting human activities

Wildfires are typically the result of a complex interplay between natural and human-driven factors. Here, we analyse two main drivers (excluding lightning, which is beyond the scope of this discussion). Firstly, natural climate variability, such as El Niño-Southern Oscillation (ENSO), together with long-term and human-induced climate change create increasingly fire-prone environmental conditions. Secondly, human activities cause and/or facilitate wildfires by degrading, destroying, or changing the natural environment (e.g., land-use change) and/or promoting ignition of fires either accidentally or intentionally.¹⁴ Studies estimate that over 80% of wildfires are human-caused,¹⁵ with many fires in tropical forests closely linked to deforestation activities.¹⁰ The complex interaction between environmental and social factors determines not only the annual and seasonal occurrence of fires, but also the extent of these and, therefore, the difficulty in controlling them.

Human-induced climate change is reshaping fire weather conditions (e.g., weather conditions that are favourable for wildfires to occur and spread) across different geographical areas.¹⁶ Recent evidence suggests there is medium-to-high-confidence in the increase of fire weather conditions across South America.¹⁶ Decreasing precipitation and low humidity, extended and prolonged droughts, dry and flammable vegetation (i.e., wildfire fuel), and high ambient temperatures¹⁷ are making some areas more suitable for ignition and easy spread of fires.¹⁸ Increases in fire weather translate into increases in the likelihood of fires when fuels are available.¹¹

Globally, annual fire weather season length (FWSL) and the 95th percentile extreme fire weather (FWI_95d) have increased by 14 and 10 days per year during 1979–2019, respectively.¹¹ In South America, Southern Amazonia has seen the highest proportional increase among the studied ecoregions, with an increase of 39 and 37 days per year (during 1979–2019) in the FWSL and FWI_95d, respectively. The increasing trend in fire weather in this ecoregion (and other neighbouring areas such as Pantanal) aligns with observed reductions in dry season precipitation, increases in the duration of the dry season, and increases in the frequency of drought conditions.^19,20 Complementarily, the number of days in which people were exposed to very or extremely high fire danger increased in 11 of 17 Latin American countries between 2001–2010 and 2013–2022.²¹

These long-term climate changes interact with natural cycles, such as ENSO, exacerbating droughts and hot environmental conditions that further promote wildfires.²² However, several of the major wildfires in recent years have occurred amidst fire weather conditions that were considerably more likely due to climate change.¹¹ A rapid climate attribution study showed that hot, dry, and windy conditions that drove the devastating 2024 Pantanal wildfires were 40% more intense due to climate change.²³

Yet, fire weather conditions represent only one part of the wildfire equation. Human activities (apart from those contributing to climate change) play a substantial role in igniting and expanding wildfires. Historically, controlled fires have been part of traditional ancestral and Indigenous practices, especially prior to the onset of colonialism in South America.^24,25 However, modern and current uses of fire by humans have changed, and are now commonly linked to facilitating deforestation for agriculture and land-use conversion.²⁶ This situation has been widely seen in the Amazon and other tropical rainforests,^10,27 as well as in boreal forests and other natural environments. Deforestation for agriculture, logging, and cattle ranching²⁸ accelerates wildfire risks, as fragmented forests dry out quickly and become ignition points.²⁶ Ecosystem degradation and forest cover loss destabilise local climates and disrupt entire ecosystems, creating positive feedback with uncertain outcomes.²⁶ In addition, human-driven wildfires alter spatial and temporal patterns of fires,¹¹ collectively impacting local-to-global climate and ecosystems’ balance.

Overall impacts of wildfires on human livelihoods, health, and wellbeing

Global evidence indicates that wildfires have short- and long-term impacts on the livelihoods, health, and wellbeing of people and communities. While much of the focus has been documented on the immediate impacts, such as injuries, fatalities, financial losses, firefighting efforts, and altered landscapes, the long-term effects of exposure to wildfire smoke in South America and the Amazon are less documented.²⁹

Wildfire smoke (WFS) consists of breathable particulate matter, environmental gases, and various hazardous pollutants,³⁰ thus health effects can also vary depending on the source.³¹ The World Health Organization (WHO) identifies particulate matter (PM) as a key indicator of outdoor air pollution, noting that PM_2.5 and ultrafine particles (UFP)—with diameters ≤2.5 and ≤ 0.1 μm, respectively—are small enough to reach the bronchioles and alveoli, causing local irritation and lung damage. Particles as small as ≤0.1 μm can even penetrate the bloodstream through the lungs, significantly increasing risks for respiratory and cardiovascular diseases.³⁰

Wildfire-related pollutants are linked to a range of health issues. Short-term exposure to wildfire-related smoke has been associated with a range of human health outcomes, from respiratory and cardiovascular outcomes to mental health impacts.¹ During wildfires, PM levels increase, impacting not only areas close to the fire but also those extending thousands of kilometres downwind.

Smoke plumes from the Amazon wildfires predominantly followed a northward or north-westward trajectory during the fire season (July–October) due to prevailing wind patterns in the region, but at the same time, this plume followed a southward direction, affecting southeastern areas in Brazil. This movement resulted in transboundary smoke pollution affecting neighbouring countries like Peru, Ecuador, and Colombia, as documented through satellite imagery tracking PM_2.5 and aerosols.³² Fig. 1 illustrates how smoke from the 2024 wildfires extended into Peru and other countries before dissipating in the Andes. These plumes exemplify the significant air quality and public health impacts of wildfire emissions, with exposure levels influenced by factors such as fire intensity, burnt area, fuel type, dispersion dynamics, and the proximity of populations—even those far from the source.

Fig. 1.

View of smoke billowing from the blazes on 3 September 2024. Credit: NASA's EPIC (Earth Polychromatic Imaging Camera) imager on the DSCOVR (Deep Space Climate Observatory) satellite.

The significance of this transboundary air pollution lies in the health impacts on large proportions of the population at a regional scale. A recent meta-analysis estimated that same-day all-cause mortality increases by 0.15% per 1 μg/m³ rise in wildfire-specific PM_2.5. Strong positive associations were found between wildfire PM_2.5 and respiratory outcomes, with hospitalisations and emergency department visits increasing as well.²⁹ Another analysis found that an increase of 10 μg/m³ wildfire-related PM_2.5 was linked to a 1.65% increase in all-cause hospital admissions, 5.09% in respiratory admissions, and 1.10% in cardiovascular admissions within 24 h after exposure.³³ Additionally, an association was found between wildfire-related PM_2.5 and a 3.1% increase in all-cause mortality, 2.6% in cardiovascular mortality, and 7.7% in respiratory mortality.³³

Evidence linking PM_2.5 exposure and hospital admissions for cardiovascular morbidity is still limited but increasing.¹ Some population groups, such as older individuals and those with pre-existing cardio-metabolic conditions (e.g., diabetes, heart failure, and ischemic heart diseases) are more likely to seek medical help following exposure to wildfire smoke.^34,35 A Brazilian study estimated that for people aged 65 and older, each 10 μg/m³ increase in PM_2.5 raised the risk of physician visits for congestive heart failure and ischaemic heart disease by 11% and 19%, respectively.³⁴ Similarly, in California, older adults above 65+ years old had a higher risk of admission due to cardiovascular and cerebrovascular diseases when wildfire smoke density exceeded 10.5 μg/m³ of PM_2.5.³⁵ Children represent another vulnerable group. A systematic review found a notable increase in respiratory emergency department visits and asthma hospitalisations within the first three days following wildfire smoke exposure, with the effect especially pronounced in children under five years of age.³⁶

Multiple studies have highlighted the significant health impacts of fire-related emissions in Brazil. In the 2019 fire season, PM_2.5 emissions were linked to 4966 (95% CI, 2427–8340) premature deaths, representing 10% of PM_2.5-related mortality in the country.³⁷ Additionally, wildfire-related PM_2.5 was associated with annual economic losses of $5.07 billion USD (2000–2016).³⁸ Increased deforestation between 2003 and 2019 is estimated to have worsened air quality, contributing further to mortality in 2019.³⁹

Understanding the 2024 wildfires

This section characterises the 2024 wildfires and gives a brief summary of the impacts on ecosystems and biodiversity as well as on human livelihoods, health, and wellbeing. We conclude by providing some information on the public response to them.

Development of 2024 fires at a glance

Wildfires started in May 2024 in the Pantanal wetlands with a record number of fire detections in June.⁴⁰ In September 2024, more than 340,000 hotspots were identified via satellite imaging (Fig. 2), with fire spots mainly in Bolivia, Brazil, Paraguay, and Peru (representing an increase of about 15–20% compared to the period 2012–2024).⁴¹ By 6 September, blazes tore through more than 10 million hectares of Bolivia (nearly 9% of the country's total area).⁴² As of November 2024, more than 60 million hectares had been burnt in the region.⁴¹

Fig. 2.

Map showing MODIS hotspots from 1 January 2024 to 31 October 2024.

Source: MODIS Collection 6.1 NRT Hotspot/Active Fire Detections MCD14DL distributed from NASA FIRMS.

Although wildfires usually happen between July and October of each year in the affected region, the 2024 wildfires are considered unusual due to their quick ignition and expansion as well as geographical location.⁴³ In general, wildfires in tropical rainforests and wetlands are rare as humid conditions do not allow wildfires to develop easily. According to CAMS and based on data from the Instituto Nacional de Pesquisas Espaciais (INPE), in August 2024 the Pantanal saw a 3910% increase in the number of fires compared to August 2023.³² As previously explained, these wildfires are likely the result of several overlapping causes, including natural climate variability (El Niño event), long-term human-induced climate change, and human activities.

The 2023/24 El Niño event contributed to higher ambient temperatures and exacerbated already long-lasting and intense droughts in some parts of the region, especially in the Amazon, the Pantanal and the Cerrado in Brazil, and the Chiquitanía dry forests in Bolivia (Fig. 3). By August 2024, several rivers in the Amazon basin were depleted, triggering important consequences for wildfires. These environmental conditions caused increased moisture evaporation from soil and plants, drying out this vegetation and turning it into wildfire fuel, creating ideal conditions for fires to start and spread more rapidly than ever. Additionally, a rapid attribution study showed that human-induced climate change made the 2024 wildfires in Brazil's Pantanal between four and five times more likely.²³

Fig. 3.

Warmer than average surface air temperature in South America compared to the 1991–2020 reference period (left). Less humid soil conditions for South America compared to the 1991–2020 reference period (right).

Source: C3S.

Wildfires significantly contributed to air pollution during 2024, worsening air quality in the affected region and across several other cities and countries in South America (Fig. 1). The cities of Porto Velho, Rio Branco and São Paulo in Brazil topped the ranking of the world's most polluted major cities on 9 September.⁴⁴ A preliminary analysis using low-cost monitors⁴⁵ in Peruvian Amazon cities (Bagua Grande, Iquitos, and Tarapoto) showed that fires increased PM_2.5 daily average, reaching an average of 106.7 μg/m³ at the end of August and remaining elevated for more than a month (Fig. 4).

Fig. 4.

Purple Air, low-cost monitors daily average of PM_2.5 (μg/m³) in Bagua Grande, Iquitos, and Tarapoto in the northern Peruvian Amazon, from 20 April to 10 November 2024. The dashed-black horizontal line indicates the WHO recommended values for daily PM_2.5 (10 μg/m³).

Source: PurpleAir.

Impacts on the Amazon's ecosystem health and the global climate in 2024

Although the impacts of the 2024 wildfires on the Amazon's ecosystem and the global climate have not been well-documented, we know from scientific evidence and past experiences that these wildfires have devastating short- and long-term consequences at local, regional, and global levels.

The health of the Amazon biome depends on maintaining its complex hydrological and ecological balance.⁴⁶ The 2024 wildfires irreversibly impacted the Amazon's health. Wildfires are affecting and will continue to affect species richness and abundance through direct (e.g., injuries and burns) and indirect (e.g., starvation) mortality of fauna and flora.^47,48 One of the biggest consequences is the degradation of large forest areas.^49,50 Unlike deforestation, forest degradation is characterised by a loss of biomass within the forest. This degradation further increases tree mortality rates, reduces carbon sequestration, and is a major cause of natural habitat loss, which can be devastating for species with very small or specific habitat ranges.⁵¹ Additionally, forest degradation affects all trophic levels, compromising the forests' biodiversity levels and ecological functions. The loss of ecological functions will also affect the ability of these forests to provide humans with goods, services and ultimately NCPs (Nature's Contributions to People).⁵¹ Moreover, it has been shown that most intense forest fires tend to occur in areas undergoing intense land-use change, as agricultural and deforestation fires often escape into adjacent forests.⁵¹ In such areas, and because of border effects and encroachment of wildlife, most of the burnt forest will not recover, as it will most probably be converted to grassland or cropland, further decreasing the biome's stability.⁵⁰

The Amazon was once considered a natural carbon sink, but due to wildfires, it is now considered a minor carbon source.⁴ For example, the total cumulative wildfire carbon emissions by the end of October 2024 was the highest ever recorded in Bolivia, more than 60% higher than 2010, the second year on record.¹² It was also one of the highest ever recorded in Brazil (highest emissions in Amazonas and Mato Grosso do Sul).³² Scientific evidence suggests that forest degradation, deforestation, and other stresses may lead the Amazon to a tipping point by 2050,⁵² bringing significant consequences to local ecosystems and the global climate's balance. Although we cannot yet evaluate the full impacts of the 2024 wildfires given the long–term processes of the climate system, it is possible that the vast amount of carbon emitted due to forest burning and continuous forest degradation could trigger unexpected local to regional ecosystem transitions and further contribute to global climate change.

Impacts on human livelihoods, health, and wellbeing in 2024

Similar to the previous section, presently there are no well-systematised and comprehensive documentation of the impacts of the 2024 wildfires on human livelihoods, health, and wellbeing. Nevertheless, based on the literature (see above), wildfires can be associated with direct injuries and deaths, indirect impacts related to air pollution exposure, stress and anxiety symptoms and disorders, and loss of livelihoods and economic sources, as well as forced displacement.^53,54

From preliminary reports and governmental official communications, a range of diverse impacts on people's livelihoods, health, and wellbeing have been reported.

In Bolivia, wildfires have forced the displacement of families and severely impacted livelihoods, particularly in Santa Cruz.¹³ The Bolivian government has reported five people dead, and 54,597 families affected, with 11,184 families facing direct impacts, including the destruction of homes.¹³ In Robore, Santa Cruz, Bolivia, 32 families had to be evacuated.¹³ Additionally, as the fires spread across the country, agricultural production in Santa Cruz had been severely disrupted. This not only endangers food security but also poses economic risks to a sector critical for Bolivia's economy. Previous analyses have found that wildfire events are also associated with significant short-term increases in poverty, mainly due to decreases in agricultural income.⁵⁵

In Brazil, the 2021 wildfires severely disrupted daily life, with five people dead, 18.9 million people reportedly affected, and at least 10,700 people evacuated across 684 municipalities. States such as Acre, Rondônia, and Maranhão have been particularly impacted.¹³ Hospitals and clinics, such as the government polyclinic in Porto Velho, reported a surge in respiratory medical consultations, migraines, eye irritation, and other health issues caused by dense smoke.⁵⁶ The scale of these fires interrupted essential services, forced school closures, and impacted transportation, with smoke grounding flights in Rondônia.⁵⁶ Large cities historically unaffected by wildfire smoke, such as Rio de Janeiro and São Paulo, experienced hazardous air quality levels.⁵⁶

In Ecuador, there was a 140% increase in the number of people affected from the last week of September to 8 October.¹³ Additionally, 11 houses were destroyed. Ecuador experienced other challenges, with schools closing temporarily and authorities advising residents to stay indoors.¹³ In Peru, wildfires led to severe human costs. As of September 2024, at least 21 people lost their lives, and 165 were injured due to wildfire-related incidents, according to the National Centre for Emergency Operations (COEN in Spanish). Fires spread across 23 of the country's 24 departments, affecting urban and rural communities alike.⁵⁷

Briefly, other South American countries also faced substantial indirect impacts, especially derived from smoke. In Paraguay, smoke from fires blanketed the capital, Asunción, exacerbating air pollution levels.⁵⁶ In Argentina, wildfire smoke led to an “epidemiological alert” due to deteriorating air quality, forcing schools to shift to remote learning.^58,59 Uruguay, though not directly impacted by the fires, advised individuals with respiratory and cardiovascular conditions to avoid exposure to smoke originating from nearby countries.⁵⁸

Public responses in 2024

The 2024 wildfires highlight the lack of structural governance, long-standing funding limitations, and limited implementation means in terms of preparing and responding to a wildfire-related disaster, revealing slow and ineffective responses despite the many existing plans and legislation.⁶⁰ Box 1 illustrates the challenges in this regard by describing the context of the Peruvian wildfire disaster risk management system.

Box 1. Peruvian wildfire disaster risk management system.

Peru's disaster risk management system, led by the Ministry of Defence (MINDEF) and supported by various agencies, takes a multisectoral approach to disaster prevention, preparedness, and response. Established by Law No. 29664 in 2011, the National Disaster Risk Management System (SINAGERD) includes the National Centre for Disaster Risk Estimation, Prevention, and Reduction (CENEPRED), responsible for developing forest fire risk scenarios at national and regional levels. The National Institute of Civil Defence (INDECI), another core SINAGERD component, coordinates immediate disaster responses across all government levels, with local governments as primary responders and monitors. Each local government formulates its disaster risk management plans, including risk prevention, reduction, and contingency strategies. Seven out of 24 regions in Peru have published forest fire prevention and risk reduction plans.⁶¹ In addition, sixteen regions have forest fire risk assessments, classifying 19.6% of Peru's territory as high or very high risk for forest fires.⁶² These findings will inform the Multisectoral Plan for Wildfire Response 2025–2027, currently in development.

In 2018, Peru's Ministry of Agriculture, through the National Forest and Wildlife Authority (SERFOR), developed the Forest Fire Risk Prevention and Reduction Plan (2019–2022) to strengthen wildfire management. This plan aimed to update the regulatory framework, establish a National Wildfire Control Plan, enhance capacity-building, standardise information management, and promote wildfire risk awareness. While SERFOR has not released an updated plan or reported on the outcomes of the 2019–2022 initiative, it has made progress by launching a Wildfire Monitoring Platform that provides daily reports on heat sources, conducting training sessions, offering technical support to regional professionals, and running awareness campaigns. In the event of a wildfire, the local government activates a response through its Local Emergency Operations Centre (COEL) by issuing an alert on the National Information System for Response and Rehabilitation (SINPAD), based on the scale and severity of the incident. Key response agencies are mobilised, including the Armed Forces, the National Police, the Volunteer Firefighters of Peru, and the Emergency and Disaster Response Brigades from the Ministry of Health (MINSA). MINSA operates in real-time through the Health Emergency Operations Center (COE Salud), using EMED Health (Health Emergency and Disaster Monitoring Space) to coordinate nationwide. If the local response capacity is exceeded, provincial and then regional governments step in to provide additional support.

Despite awareness campaigns, preventive regulations, and penalties for fire-promoting activities, effective governance for large-scale wildfire response remains a challenge in Peru. Recent fires continue to reveal gaps in management and preparedness. In response to severe events in 2024, the Ministry of Environment proposed a Forest Fire Prevention and Control Law to establish regional firefighting brigades and prohibit changes in land use in areas affected by wildfires. However, recent amendments to the Forest Law (Law No. 31973) may undermine this approach, creating potential setbacks in the enforcement and coherence of wildfire prevention efforts.⁶³

Brazil activated various governmental structures and emergency measures. By August 2024 (almost three months since the wildfires started), a state of emergency was decreed in 45 municipalities and 48 Brazilian cities were put on high alert. Also, at least 7300 government workers and volunteers, plus military aircraft were deployed.⁶⁴ At the same time, the Federal Supreme Court ordered the Federal Government to adopt repressive and preventive actions to combat the fires in the Pantanal and the Amazon, involving increased hiring of firefighters, deployment of the National Force, and use of Armed Forces structures. This order resulted in extraordinary funding of R$514.4 million (∼USD$88 million).⁶⁵

In Bolivia, the government declared a national emergency on 7 September, and then a national disaster on 30 September, when 7 million hectares had already been burnt in Santa Cruz alone.⁶⁶ These emergency declarations allowed for the channelling of international aid and the transfer of financial resources from the central government to departmental (or local) governments.

In Peru, while emergency declarations were made, the timing was critically delayed. The government approved a 60-day emergency declaration on 18 September, after repeated pleas from regional authorities and civil society. By then, 16 people had lost their lives, and the fires had caused extensive damage to forests and nearby communities. Even after the declaration, there were no (publicly) clear steps outlined on how to manage an event of this scale, leaving the response fragmented and slow.

From a public health perspective, governments struggled to effectively communicate the risk to local populations. Publicly, there was limited information on the health hazards posed by wildfires and smoke, and very little advice on how to protect oneself and the most vulnerable people. Also, there was almost no information on whether these health communications reached rural and isolated areas. This lack of clear and coordinated communication left communities dangerously exposed to and at risk of misinformation or disinformation. Countries with a longer history of wildfires often communicate about the health risks of wildfires; however, even their messages lack information about personal and administrative interventions to reduce risk.⁶⁷

Recommendations for protecting human livelihoods, health, and wellbeing from wildfire risks in a changing climate

Disaster risk reduction (DRR) strategies that integrate not only environmental preparedness and response but also the protection of people's health and wellbeing are essential. These strategies should also be accompanied by strong disaster governance and regulations of land-use and deforestation, as well as real-time monitoring and law enforcement. These measures, taken holistically and proactively, might reduce the risk of wildfires in a changing climate and protect ecosystems and people's livelihoods, health, and wellbeing.⁶⁸ In the following paragraphs, we delineate three areas related to DRR and population health to be strongly strengthened.

Strengthening a whole-of-society disaster risk reduction policy in which integrated wildfire preparedness, sustainable land management, enhanced governance, and population health protection are key pillars

A whole-of-society DRR approach to wildfires involves all sectors of society, including different levels of government (i.e., national, regional, Indigenous, local), communities, and non-governmental actors. This approach promotes new perspectives and better understanding of problems and solutions by complementing resources, knowledge, and capabilities to adapt to wildfire challenges.⁶⁹ At the same time, this provides opportunities to include integrated wildfire preparedness, sustainable land management, enhanced governance, and population health protection as essential components.

Wildfires should not be seen as isolated events, but rather as consequences of a series of elements (natural and human-caused) and cascading effects. Therefore, integrated wildfire preparedness and management should move from a traditional fire-suppression perspective to a more comprehensive approach, including components related to continuous review and analysis; readiness, risk mitigation, and prevention; response and fire suppression; and post-disaster recovery (the 5 Rs).^70,71 However, for this approach to be effective, it needs to be co-developed with local communities and Indigenous groups, incorporating their traditional knowledge and adapting to the specific forest types. Local knowledge and prepared communities might lead to wildfire preparedness and management strategies becoming more sustainable over time, adaptive to different scenarios, and aligned with local needs.⁷²

Uncontrolled and massive deforestation, land-use conversion, and unregulated fire-setting are major drivers of wildfire risk, particularly in ecologically sensitive areas such as the Amazon. Therefore, sustainable land management is also fundamental for effective DRR, particularly for preventing wildfires. In this regard, well-established regulations and effective enforcement of land-use and deforestation laws are essential.^73,74

Strong governance is critical to support all these efforts.⁷⁵ Well-established responsibilities, action plans, and coordination between governmental agencies, local authorities, and community organisations are essential for creating unified preparedness and responses to wildfires. International partnerships also play a key role in mobilising resources, sharing best practices, and fostering regional cooperation.^70,76 Importantly, DRR policies must be backed by consistent and sufficient funding, not reliant on temporary emergency allocations, to maintain essential programs and infrastructure.

Research is also crucial for co-designing strategies tailored to the needs of local communities and Indigenous groups in the Amazon. A socio-ecological systems perspective, utilising frameworks such as panarchy and adaptive cycles, is essential for understanding and managing the Amazon's complexities.⁷⁷ Promoting transdisciplinary studies can clarify the interplay between human activities, ecosystem functions, climate change, and global demands. Without such integrative approaches, key drivers like tele-coupling and globalisation pressures may be neglected.

Finally, integrating health protection into DRR policy ensures that the wellbeing of populations at risk is prioritised.^78,79 By embedding health considerations into wildfire preparedness and response efforts, South American countries can better protect vulnerable populations, prevent health emergencies, and support community resilience. In combination, these pillars form a proactive and resilient approach to managing wildfire risks, protecting both people and ecosystems in the face of a warming climate.

Strengthening health systems and public health surveillance systems to monitor, prepare, and respond to wildfire-related health impacts

Health systems and public health agencies in South America must be central actors in DRR policies and actions before, during, and after wildfires.⁸⁰ As already presented, wildfires affect human health and wellbeing from the very short-to the long-term; therefore, public health strategies and actions should be central in the preparedness and management of wildfires, especially when people are directly exposed to them.

Establishing multi-level emergency mechanisms that monitor and provide healthcare services, especially those related to injuries, cardiovascular, respiratory, and mental health needs, is essential to safeguard communities affected by wildfires. This might include deploying emergency care units and creating clean-air shelters for vulnerable populations.⁸¹ These mechanisms should be accompanied by clear and timely communications to the targeted public, ensuring that affected communities adequately receive messages on resources and guidance. In addition to the short-term emergency response, monitoring long-term outcomes related to exposure to pollutants and mental health disorders, such as post-traumatic stress disorder, are key functions of public health and would allow better planning and service delivery.⁸²

The traditional role of public health surveillance systems can be expanded, once again, before, during, and after wildfires. Real-time air quality and wildfire monitoring information are vital for issuing early warnings that enable public health authorities to issue timely alert to populations at high risk on what to do, as well as to prepare health facilities for incoming patients and manage the increased health demand, especially due to injuries, respiratory, cardiovascular, and mental health issues.⁸⁰ To date, information on wildfire-related air quality and health effects in the region is still limited, highlighting the need for better integration of continuous air quality monitoring into public health surveillance and responses.

Strengthening health systems and public health surveillance systems cannot happen in isolation and other supporting elements are required, including strong governance, inter-sectoral and interdisciplinary collaboration, long-term funding, integration of new technology, interoperability of information systems, and a trained and supported workforce.⁸⁰ For South America, training primary and community health workers is essential for effective community preparation and response to wildfires.

Strengthening effective health-related risk communication before, during, and after wildfires

Risk communication involves acknowledging and conveying information about evolving hazards, exposures, and vulnerabilities, facilitating efforts to reduce or eliminate risks.⁸³ As an essential process in public health and health emergencies,⁸⁴ the WHO recommends that risk communication should be transparent, timely, and easy to understand, acknowledging uncertainties in information and using diverse platforms to reach various audiences. This approach builds trust, empowers communities, and enables more informed responses to wildfire risks.⁸⁵

Coordinated risk communication by public health agencies and authorities at different administrative levels can significantly reduce wildfire-related health risks, as well as the risk of misinformation or disinformation.⁸⁶ Also, community and bottom-up approaches to this process might significantly support community uptake of preparedness and response strategies to wildfires^67,87 by including relevant, adequate, and culturally-adapted messages and information.

Risk communication is not only critical in emergencies, but in the whole DRR process. Pre-event risk communication (i.e., before the event) educates and alerts the public about fire weather levels and potential wildfire and health risks, aiming to promote preparation for potential events and mitigate risks. This includes informing citizens about the relationship between wildfires and direct and indirect health impacts, including injuries, burns, and cardiorespiratory issues due to smoke exposure. It is also essential to be prepared for wildfires by having clear information on what actions to take during an emergency, as well as access to emergency hotlines for assistance and health-related guidance.⁶⁷ Such proactive communication can encourage a culture of wildfire awareness and preparedness.

As wildfires become imminent or begin, crisis communication becomes critical.⁸³ This form of communication aims to provide timely, actionable information to at-risk populations, such as evacuation notices, safety protocols, and air quality warnings. Ensuring that information is disseminated quickly and across multiple platforms, such as radio, social media, and community networks, allows people to make informed choices to protect their health. In fire-prone rural areas, protocols should also include limiting access to high-risk zones and reinforcing health guidance on smoke exposure and respiratory protection.

Finally, post-event communication plays a key role in supporting recovery.⁸³ After a wildfire, health-related messaging should address both physical and mental health impacts, offering resources for coping with respiratory issues and trauma. This phase is also an opportunity to reinforce preventive behaviours and improve community resilience by fostering long-term understanding of wildfire preparedness and management.

Conclusion

The massive 2024 wildfires in South America and the Amazon are a clear example of the health threat posed by unsustainable human practices and climate change. These wildfires most probably caused major health impacts and also exposed critical governance gaps, underfunding of state agencies, and inadequate disaster response mechanisms in the region, leading to ineffective action despite the existence of wildfire response plans and policies.

With rising temperatures, prolonged droughts, and extreme rainfall patterns expected to intensify, environmental conditions conducive to frequent and severe wildfires will persist. Without urgent measures to curb forest degradation, deforestation, unsustainable land use, and uncontrolled fire ignition, the severity and frequency of wildfires will escalate, jeopardising the health and livelihoods of the most vulnerable populations.

To safeguard human health, a comprehensive disaster risk reduction strategy is essential. This includes strengthening governance and governmental agencies responsible for wildfire prevention and response, promoting economic development schemes coherent with the Amazon ecosystem's integrity, and prioritising health system readiness to monitor and address wildfire-related health impacts.

Moreover, addressing the Amazon's unsustainable extractivist economic model is imperative. Transitioning to a bioeconomic framework prioritising sustainable forest and ecosystem use while avoiding land-use changes is critical for preserving the region's resilience. Such a shift would support ecological integrity, sustain livelihoods, and contribute to global climate stability and human well-being.

Finally, coordinated action among Amazonian countries is vital to tackle the current wildfire crisis and establish a unified, long-term vision for preserving this irreplaceable ecosystem. A healthy Amazon is not only a regional priority but a global imperative.

Contributors

YPS and SH conceptualized this Personal View, guided the development of the manuscript, and participated in its writing and editing. CLl and LBV conducted the literature review and synthesis, wrote the manuscript, and assisted with editing. DRR, NBA, ZVC, and TSC contributed their specialized knowledge, ideas, and expertise to the sections relevant to their areas of specialty. MR and AVV provided additional insights and participated in text revision.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the author(s) used GEMINI to improve grammar. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.

Editor note

The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

Declaration of interests

The authors declare no competing interests.