Migrant workers bear the brunt of extreme heat in Kuwait

"We don’t need to look at the future to see the health impacts of climate change. Heat exposure is already killing people in countries like Kuwait. Migrant workers are an especially vulnerable group in the region."

–Barrak Alahmad, MD, MPH – PhD Candidate at Harvard T.H. Chan School of Public Health & Mission Scholar at Kuwait University

In hot and arid regions such as the Arabian Peninsula, temperatures are soaring to unprecedented levels. In Kuwait, studies have shown that migrant workers are a group that is particularly vulnerable to extreme temperatures. Barrak Alahmad, from the Harvard T.H. Chan School of Public Health, and Mary A. Fox, from the Johns Hopkins Bloomberg School of Public Health, share some of the latest findings on heat and mortality in Kuwait and call for research and policies to protect people on a heating planet.

Background

The effects of temperature extremes on mortality have been well documented in many regions of the world. However, little is known about the current effects of extreme heat in already hot, hyper-arid regions. Future projections paint a bleak picture. A substantial increase in mortality risk from predicted high ambient temperatures was found in studies for the Gulf region. Some studies even suggest that some areas might be uninhabitable by the end of the century due to climate-induced extreme temperatures.

To better understand what the future might bring, Barrak and Mary's research team decided to study the recent past. They examined how extreme temperatures in the past decade have already exacerbated mortality, and identified who are the vulnerable subpopulations in hot countries like Kuwait. 

Figure: Distribution of daytime land surface temperatures in Kuwait from 2010 to 2016.

The Challenge

The research team encountered a number of challenges in order to accurately quantify the effects of extreme temperatures on mortality in Kuwait:

• While temperatures are soaring to unprecedented record highs, in this part of the world population health data is not abundantly available. They approached the Ministry of Health in Kuwait to obtain daily data on cause-specific deaths.
  
• Kuwait and other Gulf countries are relatively unique in their demographic profiles. This is due to the large number of migrant workers compared to the number of Kuwaiti citizens. Nearly two-thirds of the ~4.5 million population of Kuwait are comprised of migrant non-Kuwaitis, who might enjoy fewer social rights and protections, and are more likely to take on precarious jobs with unsafe working and living conditions. 
  

"Migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. They are more likely to take more demanding labor and hence get higher exposure to outdoor heat."

–Barrak Alahmad, MD, MPH – PhD Candidate at Harvard T.H. Chan School of Public Health & Mission Scholar at Kuwait University

Figure: Skewed population pyramids by nationality are characterized by migrant workers who are likely to be males in middle age.

Climate and Health Impacts

During extremely hot days, the researchers saw a doubling to tripling of the risk of death in Kuwait. They also saw that people with existing heart conditions have higher risks of dying from heat. This alarming evidence from the region highlights the potential devastation that extremely hot temperatures can have on populations.

More devastation is seen when the migrant worker population was carefully examined for the effects of extreme heat in Kuwait. Non-Kuwaiti males, who make up the majority of outdoor workers, were disproportionately affected by extreme hot temperatures, with the risk of dying being three times higher during extreme heat compared to optimum temperatures.  

Barrak and Mary have observed a health disparity, where less-advantaged non-Kuwaitis face greater adverse health impacts from heat exposure. With climate change further intensifying heatwaves over the next decades, the health gap between Kuwaitis and non-Kuwaitis is set to widen as temperatures continue to rise. This poses a serious environmental justice problem that policymakers must address.

"The warming of our planet is unevenly distributed. Regions that are inherently hot, like Kuwait and the Gulf, are witnessing soaring temperatures unlike ever before. Public health policies and interventions need to be responsive to the subpopulations most vulnerable to heat in the region.” 

–Mary A. Fox, PhD, MPH – Assistant Professor at Johns Hopkins Bloomberg School of Public Health

Figure: Relative risk of dying from heart disease and extremely hot temperatures in Kuwait.

Lessons Learned

There are key lessons to be learned from the studies the research team has carried out on extreme temperature and mortality in Kuwait.

• Potential for broader impacts: Data from the Middle East in general is largely lacking. The need for collaborative work between countries is essential due to the extreme magnitude, duration and frequency of unprecedented hot temperatures and the unique population dynamics in this region.
  
• Context-specific epidemiology: An epidemiological study on only the total population is likely going to miss fine distinctions of susceptibility such as the location of heat effects or which populations are more vulnerable (e.g., the elderly, migrant workers, refugees, etc.). Climate change and health studies have to be carefully designed to explore the local context and the impact on disadvantaged and vulnerable populations.
• Information for decision makers: It is crucial to translate scientific findings for a policy context, in order to better inform policy-makers on how to protect the most sensitive groups (e.g. by implementing heat warning systems, identifying relevant temperature thresholds for outdoor workers, etc.). An important element of this is to quantify the economic and public health burdens of high temperatures in light of climate change.
  

“We are calling for a close collaboration in the Middle East to develop the science that supports climate adaptation plans and fulfills the commitment made in the Paris Climate Accord” 

–Barrak Alahmad, MD, MPH - PhD Candidate at Harvard T.H. Chan School of Public Health & Mission Scholar at Kuwait University

Next Steps

In recent scientific studies they have conducted, the research team saw that the global climate change models overestimate cold temperatures and underestimate high temperatures in Kuwait. According to their recent projections (using a model called RCP 4.5), mean temperature will increase by 1.84°C by 2060 in Kuwait, which is higher than the Paris Agreement target of 1.5°C. In future studies, they will try to estimate the excess morality from heat in Kuwait that is attributable to climate change.  

This story is part of a series of case studies on climate change and health. Case studies are intended to highlight the connections between climate change and human health, and showcase some of the solutions that are being implemented by the health community. Case studies do not necessarily represent the views of WHO or any of its member states.