Abstract
Globally between the years 2008 and 2013, 93 million people have had to leave their residences and move due to extreme floods. This influence of climate and extreme weather events has played a significant role in human migration. People forced to flee from climatic disasters and other weather events are referred to as climate migrants or climate refugees. The migration of human population due to climatic events can be traced back to 45,000 years ago. Several factors determine the migration process due to climate change; climatic processes and climatic events. Amongst these, the added burden of decision-making on whether to stay or flee is influenced by their capacity to move, political instability, lack of access to services, discrimination, and unemployment. The health impacts of climate change range from the immediate effects ranging from loss of life, injuries, and lack of access to safe drinking water to infectious diseases and mental health disorders amongst displacement. When India accounted for the second largest disaster displacements in 2018; Kerala, the southern state of India reported more than half these displacements. With its changing weather pattern and incidence of extreme climatic events, the 34.6 million people of Kerala are left with the question of “Are we or are we not going to migrate?”.
Keywords: Climate change, climate refugees, disaster displacements, kerala, migration
BACKGROUND
Climate change has been referred to as any long-term change in the temperature and weather patterns due to natural causes like solar variations or as a result of human activity.[1] Climate change has many impacts on the planet and its beings.[2] Throughout history, one of the major consequences of climate change has been human migration. The influence of climate change on population distribution can be traced back to 45,000 years ago.[3] In the future, climatic events will influence and extensively change the patterns of human settlement.
People voluntarily moving due to the sudden or gradual climate change or people forced to flee from disasters and other weather events are referred to as climate migrants, climate refugees, or environmental migrants.[4,5] “Climate refugees” are predicted to be 200 million and 1.2 billion displaced by ecosystem threats by the year 2050.[4,6,7]
Globally, between the years 2008 to 2013, 93 million people have been displaced by floods, while around 17 thousand have been displaced by extreme heat and heat waves.[3,6] In the year 2018 alone, climate-induced disasters resulted in an extra 2 million displacements, with floods and droughts accounting for 32% and 29%, respectively, of the internally displaced persons. Furthermore, the mortality rate attributable to wildfires in that same year was estimated to be 1600.[8] Internal Migration due to climate change by 2050, will be the highest in Sub-Saharan Africa at 86 million and lowest in Eastern Europe and Central Asia at 5 million, according to the Groundswell Report.[7]
According to the 2019 World Economic Forum report, India topped the list of countries with approximately 5 million new displacements due to climate disasters.[4] In India, over the last decade, approximately USD 3 billion has been spent on economic damage from floods.[9] In a study carried out across four districts in Kerala nearly all of the study participants had experienced coastal floods at least 25–35 times during their period of residence in a coastal area and the average flood depth experienced was a meter.[10]
The different manifestations of environmental migration are diverse and can encompass a variety of scenarios, including farmers moving their livestock daily, individuals undertaking longer or permanent migration, and communities experiencing either temporary evacuations or enduring displacement. In the case of temporary migration, individuals relocate for a minimum of 6 months per year, sometimes traversing vast distances. The reasons for such migration are multifaceted, with individuals often seeking enhanced economic prospects, education, or to reconnect with relatives to overcome the adverse climatic hazards they have had to endure. The warming climate has resulted in prolonged droughts and catastrophic wildfires in some places and torrential rains, hurricanes, and floods in others, all resulting in a change in traditional lifestyles.[11]
Determinants of climate-induced migration
Several factors act as drivers and influencers for migration, with environmental drivers playing the significant role either due to exposure to hazards or the reliability and availability of ecosystem services.[3,12] As discussed in the IOM Migration series,[6] these can be further classified as Climatic and non-climatic drivers. The climatic drivers are;
-
Climate processes
slow onset changes such as sea-level rise, salinization of agricultural land, desertification and growing water scarcity, food insecurity
Sea level rise patently makes certain coastal areas and small island states uninhabitable. Cumulatively they erode livelihoods and change the incentives to “stick it out” in a particular location.
Some women in the Sahel, for example, already have to walk up to 25 km a day to fetch water. If their journey gets longer, they will simply have to move permanently.
Climate events: flooding, storms, and glacial lake outburst floods.
As part of the Foresight Project by the United Kingdom, they aimed to understand the global climatic drivers that could affect the volume and patterns of human migration.[6,13] According to the Foresight Conceptual framework, among the several factors that influence migration like political instability, lack of access to services, discrimination, and unemployment issues, environment-mediated migration plays a significant role. When these factors intertwine, the decision-making process of whether to stay or flee becomes challenging and adds to human suffering. This is of essence if we look at data presented by the International Office on Migration about the people displaced by environmental hazards.[11]
Health impacts of climate-induced migration
Apart from human displacement and forced migration, climate change increases the vulnerability of migrants to extreme heat-related illnesses and cardiovascular diseases, air pollution-induced respiratory illnesses, changes in vector ecology, water quality impacts like lack of freshwater sources and infectious disease outbreaks, coastal erosions, insufficient food and secure shelter.[8,14,15]
The economic burden of climate refugees to the country of origin and destination will be based on several factors like the ability to pay tax, type of labour available, education of the migrating individual, the level of health care available and accessible, and other provisions provided/available at the country of destination.
In a pre-existing unstable environment, be it social, economic, or political; climate change inflates the risk of conflict, undermines livelihoods, and influences human mobility. The health impacts have been depicted in Figure 1.[16,17,18]
Figure 1.

Climate-induced migration and its health risks[16,17,18]. VBD: Vector Borne Diseases
The adaptive capacity post-migration can be said to be a primary or anticipatory adaptation, secondary and tertiary or reactive adaptation. Community-based adaptive strategies to lessen health risks involve strategies in the health sector and beyond. The Foresight report was the first to significantly focus academic and policy attention on the challenge of trapped populations, which it identified as among the greatest concerns ahead, and to call for policies focusing on those who are unable to migrate from at-risk areas, by helping to build local resilience and providing opportunities for migration as an adaptation strategy. In the inevitable context of climate-induced migration, there is an imminent need within the existing healthcare system to build capacity to provide services to these climate refugees. Health Systems must acknowledge the probable rise in climate refugees and allocate appropriate budgetary resources in the future. Furthermore, health institutions should head the inter-sectoral measures for climate change mitigation within their jurisdictions. Currently, the United Nations High Commissioner for Refugees (UNHCR) helps in providing guidance and support to the international community in developing policies and legal frameworks for the protection of climate refugees.[5]
Will climate change act as a determinant for migration in Kerala?
Between May to October 2018, India accounted for the world’s second-largest disaster displacement; with Kerala being the most-affected state.[19] The floods of 2018 in the state of Kerala were described as the worst in a century, with 13 out of 14 districts reporting severe floods. Kerala reported more than half of the two million disaster displacements that took place in 2018, in India. The landslides in line with heavy rainfalls accounted for major displacements, with several people losing their livelihood. The number of children lost, accounted for about 15% of the total souls lost in the 2018 floods in Kerala.[20] The impact of floods on children returning from relief camps ranged from infectious diseases to malnutrition to declining mental health.[21,22,23]
An often-overlooked dimension is that Kerala is home to many labour migrants, from states that frequently witness extremes of climatic conditions.[24,25,26] We are yet to know the impact of the climate disasters in Kerala, on the labour migrant community in the state. The mounting distress among migrants, who are often separated from their families in their home states during severe climatic events, is a social phenomenon that needs to be studied and addressed.[27,28]
Post-2018, Kerala has been host to a variety of climatic events in the form of heavy monsoons, coastal erosions, landslides, and heat waves. With an increasing incidence of such climatic events, “are we or are we not” going to migrate remains a question to the 34.6 million people residing in the state.
CONCLUSION
The global estimates by various agencies provide a broad overview of climate-induced migration but monitoring and deeper knowledge are needed to understand what happens to people once they are displaced: how long they remain displaced; whether they move to cities, decide to return, or resettle elsewhere; whether they still require assistance or remain at risk from being displaced again. Nor do the global figures provide insights into the different needs and experiences of displaced people related to their age, gender, ethnicity, or background. They do show, however, that the most vulnerable countries and populations are being disproportionately affected by both, frequent small-scale events as well as by large-scale disasters, that make the headlines.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
This topic was discussed as part of the Health impacts of Migration for a coursework developed by the authors from the Dept. of Community Medicine, AIMS, Kochi, in collaboration with the DAAD-IVAC project, Heidelberg Institute of Global Health.
Funding Statement
Nil.
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