Health Impacts of Extreme Climate on Under-Fives in the Sahel: Adaptive Strategies

Background

Children under five in the Sahel face disproportionate health risks from extreme climate events (ECE), including extreme heat, droughts, and floods. However, limited evidence synthesizes their impacts on this age group and how emergency responses and program adaptations address their needs.

Methods

A literature review of peer-reviewed and grey literature sources (up to July 30th 2025), complemented by four key informant interviews with humanitarian health actors from MSF, UNICEF, IFRC, and Action Against Hunger, was conducted in July 2025. Findings were analyzed by ECE type using the UNICEF climate change and child health framework, focusing on northern Nigeria, Sudan, and Chad.

Results

Extreme heat was linked to malnutrition, dehydration, birth complications, and disrupted care delivery. Adaptations included vaccination campaigns, early warning systems, and shade infrastructure. Droughts heightened malnutrition (food insecurity) and diarrhea, triggering responses such as mobile clinics, therapeutic feeding programs, and community-led early action protocols. Floods increased malnutrition, diarrhea, malaria, and service disruption. Interventions included mosquito net distribution, mobile health brigades, WASH infrastructure support, and child protection services. Wildfire-related air pollution was associated with increased child mortality. Across contexts, anticipatory action remained limited, while local actors often led first responses. Interventions often miss maternal and mental health needs. ECE preparedness remains ad hoc and poorly integrated.

Conclusions

ECEs like drought, floods, and extreme heat in the Sahel threaten child health, specifically malnutrition, diarrhoea, and malaria. and all ECEs hamper access to health care. Yet program responses remain reactive and fragmented. Strengthening anticipatory systems and community-based preparedness are critical to protecting children under five in climate-affected regions.

Key messages

• Extreme heat, droughts and floods in the Sahel worsen malnutrition, diarrhoea and malaria in children under five and disrupt access to essential health services.

• Current responses remain reactive and fragmented; stronger anticipatory action and community-based preparedness are needed to better protect young children from climate-related health risks.