Human Settlements Discussion Paper – Climate Change 2


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Health and survival

  • Mortality in extreme events: In low-income countries, the loss of life is repeatedly shown to be disproportionately high among children, women and the elderly, especially among the poor during such extreme events as flooding, high winds and landslides. A study of flood related mortalities in Nepal, for instance, found deaths for children 2-9 were more than double those of adults; preschool girls were 5 times more likely to die than adult men. The risk for poor households was 6 times that of higher income households.

  • Water and sanitation-related illnesses: Children under 5 are the main victims (80% globally) of sanitation-related illnesses (diarrhoeal disease primarily) because of their less developed immunity, and because their play behaviour can bring them into contact with pathogens. This results also in higher levels of malnutrition and increased vulnerability to other illnesses, with effects for overall development. Droughts, heavy or prolonged rains, flooding, and conditions after disasters all intensify the risks, which are already very high in poor urban areas.

  • Malaria and other tropical diseases: Warmer average temperatures are expanding areas where many tropical diseases can occur, with children most often the victims. In many locations the most serious threat is malaria. Up to 50 percent of the world’s population is now considered to be at risk. In Africa, 65% of mortality is among children under 5. Malaria also increases the severity of other diseases, more than doubling overall mortality for young children.
  • Heat stress: Young children, along with the elderly, are at highest risk from heat stress. Research in São Paulo found that for every degree increase above 20°C, there was a 2.6 percent increase in overall mortality in children under 15 (same as for those over 65.) Risks for younger children are higher. Those in poor urban areas may be at highest risk because of the “urban heat-island” effect, high levels of congestion and little open-space and vegetation.

  • Malnutrition: Malnutrition results from food shortages (from reduced rainfall, other changes affecting agriculture, interruptions in supplies in sudden acute events), and is also closely tied to unsanitary conditions and to children’s general state of health. If children are already undernourished, they are less likely to withstand the stress of an extreme event. Malnutrition increases vulnerability on every front, and can result in long term physical and mental stunting.

  • Injury: After extreme events, injury rates go up. Children, because of their size and developmental immaturity, are particularly susceptible, and are more likely to experience serious and long term effects (from burns, broken bones, head injuries e.g.) because of their size and physiological immaturity.

  • Quality of care: As conditions become more challenging to health, so do the burdens faced by caregivers. These problems are seldom faced one at a time – risk factors generally exist in clusters. Overstretched and exhausted caregivers are more likely to leave children unsupervised and to cut corners in all the chores that are necessary for healthy living.

Children’s learning and competence

For some children in some places, the added challenges brought by climate change could contribute to an erosion of both their mental capacity and their opportunities for learning and growth. Abundant research relates lower cognitive capacity and performance to undernutrition, intestinal parasites, diarrhoeal diseases, malaria, maternal health and nutrition during pregnancy, as well as maternal stress during and after pregnancy. Learning is also dependent on supportive social and physical environments, and the opportunities to master new skills. When supportive environments break down, so do opportunities for engagement in purposeful goal directed activities. Disaster can also result in the interruption of formal schooling for months at a time, and children are more likely to be withdrawn from school when households face shocks.

Coping with adversity

Levels of psychological vulnerability and resilience depend on children’s health and internal strengths, as well as household dynamics and levels of social support. Children who have experienced success and approval in their lives are more likely to adapt well than those who have suffered rejection and failure. Poverty and social status can play an important role in this regard. But without question, the losses, hardships and uncertainties surrounding stressful events can have high costs for children.

Increased levels of irritability, withdrawal and family conflict are not unusual after disasters. Even gradually worsening conditions can contribute to mental health problems, which are closely tied to unpredictability, uncertainty and general insecurity. High stress for adults can have serious implications for children, contributing to higher levels of neglect. Increased rates of child abuse have long been associated with such factors as parental depression, increased poverty, loss of property or a breakdown in social support. (For instance, after a hurricane in the US, rates of inflicted head injury to children under 2 increased five-fold.)

Displacement and life in emergency or transitional housing have been noted in many contexts to lead to an erosion of the social controls that normally regulate behaviour within households and communities. Overcrowding, chaotic conditions, lack of privacy and the collapse of regular routines can contribute to anger, frustration, violence. Adolescent girls especially report sexual harassment and abuse. The synergistic and cumulative effects of such physical and social stressors can affect children’s development on all fronts. As the numbers of displaced people grow, these dysfunctional environments are likely to become the setting within which more and more children spend their early years. Children’s capacity to cope well in these difficult situations has been related to their own active engagement, opportunities for problem solving and for interaction with peers, and the presence of at least one consistently supportive adult in their lives.

Even less extreme events can create havoc in families’ lives, deepening the level of poverty. When times are hard, children can become an asset that is drawn on to maintain the stability of the household. Child may be pulled from school to work or take care of siblings.. Some children may be considered more “expendable” than others. Many of Bombay’s young prostitutes are from poor rural villages in Nepal, where inadequate crop yields lead families to sacrifice one child so others may survive.


In seeking to reduce vulnerability and enhance resilience in the face of various hazards and risks, how can the multiplicity of concerns for children of different ages be adequately represented without completely overwhelming any agenda?

In every aspect of adaptation – protection, preparation, relief and rebuilding, and at every level of response (community, local government, NGO, international agencies etc) some basic concerns need to be taken into account. These must be based on adequate knowledge of children’s lives and experience, and the challenges faced by their caregivers; and they must be integrated into planning, decision-making and action, not treated as add-ons after the fact.

  • Ensuring children’s optimal health and nutrition: Ensuring children’s health through preventive care and environmental health measures is a potent form of disaster risk reduction. Food aid and supports for health are vital after crises, but when health is already compromised by malnutrition or illness, children are more likely to suffer long term damage from extreme events and worsening conditions, and also to be a drain on the family capacity to cope.

  • Strengthening families’ capacity to cope:All adaptive measures should ideally enhance the capacity of households to come through periods of shock with minimal upset. But “coping” may take on broader meaning where children are concerned, and will include the capacity to manage hardship without compromising the well being of their children.
  • Maintaining and restoring children’s routines, networks and activities : Children rely on daily routines and activities as a context for stability and optimal development. Other functions, more critical to survival, will inevitably be prioritized (food, health, livelihoods), but in the course of addressing these, it is important not to compromise children’s spaces, activities, networks and opportunities for gaining competence.

  • Respecting children’s capacities; supporting their active involvement: The chance to solve problems, contribute, take action, is a potent protective force for children in adversity. But the contribution of children and young people is also a potential community asset too seldom tapped in the process of development and adaptation. There are numerous precedents for effective action in this area in disaster risk reduction, preparedness and rebuilding.

Addressing these concerns for children may appear to be an unrealistic burden in the face of so many other compelling priorities. Fortunately, this is not a zero sum game. There are strong synergies between what children need and the adaptations required to reduce or respond to more general risks. For instance, the most useful measures to protect children’s health are also fundamental in reducing risks from potential disasters – like adequate drainage, waste removal, proper sanitation. Supporting adults so that they are better able to address their children’s needs also leaves them better equipped to work collaboratively on reducing risks, preparing for disasters, and rebuilding their lives after a crisis.




Sheridan Bartlett

a. Climate change and children

This paper explores the particular and often disproportionate implications of extreme weather events and other aspects of climate change for urban children in low and middle income countries. In recent decades, there has been an increase in the intensity of extreme weather events which have contributed to injury, illness, impoverishment, displacement and hunger for hundreds of millions of people. We do not know precisely the contribution of rising greenhouse gas emissions to the mounting risks that people are facing. But it is clear that human-induced climate change is playing a role, and that there is an urgent need for the reduction of greenhouse gas emissions (or mitigation). However, even if an effective international agreement on this front is rapidly achieved and implemented, much of the world’s population will still face increasingly frequent and intense extreme weather events and potentially damaging changes in weather for the next few decades. Attention to adaptation is as urgently needed as attention to mitigation. This paper discusses the kinds of adaptations that will be most useful in ensuring that children’s needs are met.

There is growing discussion in the child advocacy world of the implications of climate change for children.1. But systematic attention to children and young people does not feature much in the broader discourse on climate change and the adaptations needed to respond to it. The most recent IPCC report on adaptation demonstrates the imbalance in this regard: the chapter on health, for instance, gives excellent attention to some of the disproportionate vulnerabilities of young children.2 However, the chapter on adaptation practices makes only two references to children (and old people), both embedded in a box on the vulnerability of women.3 In some overviews, there is not even this level of attention: a 2003 report on urban indicators of climate change, for instance, makes only two references to children, both related to their susceptibility to asthma.4 In fact, most of the numerous public health problems discussed in this report are likely to have significantly more severe impacts for children, a reality that has policy implications and that surely deserves closer attention.

A focus on children has implications not only for public health measures, but for a range of actions, calling for a reconsideration of the scope and nature of the evolving adaptation agenda. A useful parallel is the growing understanding of the disproportionate vulnerability of the urban poor to the impacts of climate change in many low and middle income countries. Adaptations and responses in these urban areas that fail to take this into account are likely to fall seriously short of the mark.5 To some degree, the same thing is true of children and young people.6 This is not to say that all children are vulnerable to all aspects and impacts of climate change in ways that are not true of adults. We must be wary of the kind of sentimental oversimplifications that present children always as helpless victims. In fact, many children can be extraordinarily resilient in the face of significant challenges.7 But there are also concrete, particular ways in which children of different ages and in different places are at more serious risk (see Table 1). As in the case of many poor groups, if adaptations to climate change do not take account of this, they will be less than adequate in responding to the challenges.

Table 1: Some likely impacts of climate change


Impact on natural systems, agri-culture, water

Impact on urban areas

Impact on health and household coping

Implications for children

Warm spells and heat waves frequency up on most land areas

Reduced crop yields in warmer regions, wildfire risk up; wider range for disease vectors

Heat islands with higher temperatures (up to 10˚ higher); often large concentrations of vulnerable people; air pollution worsened.

Increased risk of heat-related mortality and morbidity; more vector-borne disease; impacts for those doing strenuous labour; increased respiratory disease where air pollution worsens; food shortages

Greatest vulnerability to heat stress for young children; high vulnerability to respiratory diseases, vector-borne diseases, highest vulnerability to malnutrition with long term implications

Heavy precipitation events, frequency up over most areas

Damage to crops, soil erosion, water-logging, water quality problems

Floods and landslide risks up; disruption to livelihoods and city economies, damage to homes, possessions, businesses and to transport and infra-structure; loss of income and assets; often large displacements of population, with risks to social networks and assets

Deaths, injuries, increased food and both water-borne and water-washed diseases; more malaria from standing water; decreased mobility with implications for livelihoods; dis-locations; food shortages; risks to mental health, especially associated with displacement

Higher risk of death and injury than adults; more vulnerable to water borne/water washed illness, and to malaria; risk of acute malnutrition; reduced options for play and social interaction; likelihood of being removed from school /put into work as income is lost; higher risk of neglect, abuse and maltreatment associated with household stress and/or displacement, long term risks for development and future prospects

Intense tropical cyclone activity increases

Damage to crops, trees and coral reefs, disruption to water supplies

Increased area affected by drought

Land degradation, lower crop yields, livestock deaths, wildfire risks and water stress up

Water shortages, distress migration into urban centres, hydro-electric constraints, lower rural demand for goods/services, higher food prices

Increased food & water shortages, malnutrition and food and water borne diseases up; risk of mental health problems up; respiratory problems from wildfires

Young children at highest health risk from inadequate water supplies; at highest risk of malnutrition, with long term implications for overall development; risk of early entry into work, exploitation.

Increased incidence of extreme high sea level

Salinization of water sources

Loss of property and enterprises;, damage to tourism, damage to buildings from rising water table

Coastal flooding, increasing risk of death and injuries; loss of livelihoods; health problems from salinated water

Highest rates of death for children; highest health risks from salinization of water supplies, long term developmental implications.

What stands out in this table is not only the disproportionate vulnerability of children, and young children especially, to many of the hazards posed by climate change, but also the sheer repetitiveness of the impacts for children. Despite the numerous impacts and outcomes of climate change – land degradation, reduced crop yields, wildfires, decreased water quality and quantity, migration and displacement, higher food prices, property loss, disruptions to livelihoods and social networks, to name just some – the same few outcomes for children show up repeatedly: more malnutrition, more disease, more death and injury, more risk of neglect, abuse and exploitation. At issue for children, as indicated in the table, is not only their greater vulnerability to many of the stresses associated with climate change, but also the long term developmental implications of these vulnerabilities. Box 1 provides a hypothetical scenario that follows in greater detail the potential child outcomes of a certain chain of events related to climate change.

Box 1: A possible scenario in one African city
A small city in Africa has suffered several unbroken years of drought, in the course of which migrants from hard-hit surrounding areas have settled in such hazardous areas as the dry stream beds that are some of the only land available in the city. Food prices are high, water supplies are scarce, and there is no provision in these new settlements for sanitation or waste collection – nor is there in many of the low-income parts of this city. Hygiene is generally poor as a result, and many children are badly undernourished and prone to frequent illness. Mortality rates, especially for the youngest children, are high.
Despite the challenging conditions, low-income groups in this city have been resourceful in creating livelihoods. Many residents, for instance, have developed vending businesses, set up small workshops and are struggling to make a decent lives for themselves and their children despite the drought. It is uphill work however. Although many want an education for their children, for instance, children who are malnourished, infected by worms and frequently ill do not make the best students. Despite their families’ ambitions for them, many are stunted both physically and mentally and their prospects for climbing out of poverty are slim.

After nine years of drought, the rains finally come. They are unexpectedly intense and prolonged however, and the water rises quickly in the old stream beds. Hundreds of shacks are washed away or destroyed. Most people are able to run to safety, but the elderly and those carrying small children are more easily caught by the rapid waters. Shacks, small businesses, family possessions are washed away in the torrent. Even in other parts of the city which should have been safe, accumulations of waste have blocked the long unused storm drains. Many houses are flooded and possessions destroyed. Thousands of people take refuge in local schools or camp on higher land.

Conditions are extremely difficult over the following months. Temporary shelters are overcrowded, hot and lacking in any privacy. Sanitation is appalling. Food supplies are scarce and prices are higher than ever, except for a few weeks of government and NGO aid. With many livelihoods destroyed, survival in these conditions becomes very difficult. Many people, young children in particular, fall ill from diarrhoeal diseases. Many of those who were already malnourished and sick succumb to these more extreme threats. Schools, all being used for shelter, have been closed for the duration. Many children, bored with nothing to do, are injured as they play in the receding waters, or hunt among the debris for objects they can sell or trade for food. Tensions run high within families, and among people overcrowded in shelters, and often small children become an outlet for taking out frustration and anxiety.

People start almost immediately to rebuild, attempting to regain some control of their lives, and to re-establish their livelihoods. In most cases, they are forced to construct their new shacks in places that they know are risky, but there is little choice. Competition for land and materials is high, resulting in further tensions and mutual mistrust. With resources very tight, families become more dependent on their older children, either to care for younger siblings or help with work, and many nine and ten year olds are carrying an adult load. When schools finally re-open, many are pulled out because families no longer have the money for fees, and continue to need their children’s help. Rates of illness continue to be high, especially among young children, whose resilience has been further undermined, and families lack the resources to turn to health services. Mental health problems are also rife, especially among women worried about their children, about their inability to feed them adequately, and about the possibility of another flood next year.

Almost all of the disproportionate implications for children are intensified by poverty and by the difficult choices that must be made by low-income households as they adapt to more challenging conditions. Events that might have little or no effect for children in high income countries and communities can have critical implications for children in poverty. The pathways between poverty and poor developmental outcomes for children are numerous and well established.8 In poor urban areas, these connections can be especially striking.

b. Why a concern for urban children?

Urban children generally speaking are better off than their rural counterparts – healthier, better educated, and with a wider range of options in life. But this is not true for the hundreds of millions of urban children living in overcrowded tenements or informal settlements, where challenging conditions and concentrations of people and wastes are unrelieved by the services and facilities that can turn urban living into an advantage for all groups 9 In the absence of adequate planning and good governance, poor urban areas can be some of the world’s most life-threatening environments. There are informal settlements where a quarter of all children still die before they reach the age of five, in dramatic contrast to other areas in the same cities, and to their countries as a whole.10 Poor quality, overcrowded housing and a lack of provision for water, sanitation, drainage and waste management all contribute to high rates of preventable disease and injury. Nor does the “urban advantage” come into play for these children in terms of their education and long term opportunities. The failure to complete, or even start, primary education is likely to be especially high among the urban poor, and the prospects of upward mobility can be dim.11 Well over 900 million people in the world are now estimated to live in poverty in these overcrowded, insecure and underserved urban areas, and a large percentage of them are children.12

In high income countries, people under 18 make up about 20 percent of the population. In the countries most exposed and most vulnerable to climate change, they are closer to half the population (for instance, 42 percent in Bangladesh, 51 percent in Nigeria, 57 percent in Uganda.) Even more to the point is the proportion of very highly vulnerable children under 5 – they make up between 10 and 20 percent of the population in countries more likely to be seriously affected (for instance, 11 percent in India, 12 percent in Bangladesh, 17 percent in Nigeria and Mozambique, 21 percent in Uganda.) In higher income countries, the proportion of under-fives is closer to 4 or 5 percent (UNICEF 2007). If we consider children in urban areas alone, there are about 200 million in Africa, and more like 400 million in Asia. In other words, these poor urban children are not a special interest group, but a significant part of the world’s population.

The risks these children face – to health, survival and long term prospects – are likely in many urban areas to be intensified by climate change, whether directly or indirectly. Urban slums house not only a large and increasing proportion of the world’s population, but also of the people and enterprises most seriously at risk from extreme weather events and rising sea levels. There is a high concentration of large cities on the coast13 and in regions where hurricanes, cyclones or typhoons already have very serious impacts.14 The urban poor live where they can best find land or afford rents within reach of livelihood opportunities. This can mean considerable compromises in terms of health, safety and the general quality of life. They often live in the most hazardous areas – flood plains, or other areas at risk of floods, places at risk from landslides, sites close to industrial wastes, areas unserved by the kind of infrastructure that can be strengthened and adapted to withstand more extreme conditions. Settlement in these areas can, in turn, increase the risk of flooding and landslides by changing drainage patterns or destabilizing slopes,15 The urban poor are also the people least able to invest in preventive measures, or to find such investments worth the gamble when their land tenure is insecure or when they are renting accomodation. Although they are at highest risk of loss and harm, they are the least likely to have their needs for risk reduction taken seriously by local governments.
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