Guinea-Bissau: One Place Among Many Facing Climate Catastrophe

Have you heard of Guinea-Bissau, a small country in the Sahel region on the west coast of Africa? I visited there on a medical service trip at the end of November 2023. With a population of just 2 million, Guinea-Bissau is one of the poorest and least-developed countries in the world. It endured extractive colonialism by Portugal, which focused only on turning the port of Bissau into a slave trading center.

When I arrived in Bissau, the country’s capital, the six-month rainy season had ended, and the dry season (November to April) had just begun. Red Saharan dust was covering the entire country in 95-degree heat. Once green in the rainy season, the tin rooftops were brown due to a thick layer of settling dust. The school classrooms I visited to donate soccer balls had windows without glass panes since there were no air conditioners or fans to combat the extreme heat. Thus, the red dust entered children’s respiratory tracts as they learned.

The children looked listless and hungry because their families could not provide them with breakfast. The school did not offer meals and held only morning classes. A teacher, Lifna, a farmer in his 50s, said farming yields were rapidly decreasing. Due to rising sea levels, seawater is slowly seeping into the bolanha (the low coastal plain used for rain-fed agriculture), ruining farming and infrastructure. Also, fishing yields are decreasing sharply due to rising sea temperatures. Moreover, the price of cashew nuts, a key export, has plummeted this year, making it difficult for many to put food on the table. Other teachers told me that the people were not just distressed, but in constant fear for their lives due to climate change.

When I reached a small village called Patcheiala, a two-hour drive from Bissau, with a team of a dozen health care workers to provide medical care, we encountered a surge of over 450 patients. Many reported chronic chest pain; severe high blood pressure, including hypertensive crises, was prevalent. Since there are no refrigeration facilities, people suffer from diseases due to spoiled food and bacterial infections. They are plagued by endemic typhoid fever and malaria, exacerbated by extreme temperatures. Children suffer from scabies, which causes mites to leave holes in their skin. With climate change, these conditions will only worsen. Even now, people go to Senegal for medical treatment due to a lack of well-equipped hospitals in Guinea-Bissau.

West Africa is among the most vulnerable and the least-resourced hotspots of climate change, with its temperature rising 1.5 times faster than the rest of the world. It has benefited little from industrialization and thus contributes little to global emissions, but it disproportionately suffers the consequences.

Neighboring countries of Senegal and Côte d'Ivoire, former colonies of France, are economically and politically more stable, reflected by the extensive presence of embassies and NGOs. Guinea-Bissau has had difficulty attracting foreign aid since coups and power struggles within the government are so frequent. On one December day, I heard sounds of heavy gunfire, with police fighting the military during an attempted coup while the president was attending the United Nations Climate Change Conference (COP28) in Dubai. In part due to poverty and unstable governance, Guinea-Bissau has been a major transit point for drug distribution to Europe for 20 years. Of the 88 small islands off Guinea-Bissau, approximately half are uninhabited and are used for trafficking drugs like cocaine. There are no police officers or helicopters to limit these criminal activities, and high-ranking executives and officials in the country have been linked to drug cartels.

Nowadays, climate adaptation and resilience have become buzzwords, yet these apply only when there is a stepwise plan for recovery, which Guinea-Bissau does not have. If climate change worsens, it will soon become inevitable for people to migrate to neighboring countries with more livable conditions and access to food, clean water, cooling centers, and medical facilities. I witnessed firsthand the severity of the country’s climate crisis, which not only poses physical health risks but also threatens mental well-being. Fear and anxiety about climate disaster/migration coupled with poverty and sickness will lead to significant mental health challenges, which this country’s medical infrastructure is not prepared to face. It is critical that we advocate to international organizations to mobilize the investment and support necessary for Guinea-Bissau to address the impending mental health crisis and develop a systematic recovery plan. ■

Carol Lim, M.D., M.P.H., is an instructor in psychiatry at Harvard Medical School and a psychiatrist at the Massachusetts General Hospital (MGH) Psychosis Clinical and Research Program. She is the Medical Director of the MGH Clozapine Clinic.