ABSTRACT:
Climate change is amplifying water insecurity, disease transmission and sanitation challenges across low-resource humanitarian settings, yet locally rooted adaptation strategies remain under-documented in global public health discourse. This case study examines integrated water, sanitation and hygiene (WASH) interventions implemented by Médecins Sans Frontières (MSF) with communities in Gwanda District, Zimbabwe and Nampula Province, Mozambique within the broader context of climate-sensitive health risks. In Gwanda, recurrent droughts and floods have undermined livelihoods, driving many farmers into informal gold mining where unsafe drinking water emerged as a key health risk. MSF worked with communities to identify contaminated water sources, implement well decontamination and provide safe drinking water. A peer network approach involving village health workers is supporting the formation of mining site-based health committees to sustain WASH interventions, alongside the development of operational research to better understand patterns of water contamination. In Nampula, prolonged irregular rainfall and depletion of groundwater have intensified the prevalence of neglected tropical diseases (NTDs) such as schistosomiasis and lymphatic filariasis – conditions closely linked to inadequate sanitation and unsafe water. MSF’s interventions included establishing water infrastructure through the rehabilitation of traditional wells, rainwater harvesting systems and community-managed water sources. These interventions were coupled with health education, hygiene promotion and capacity building of local water committees to catalyse ownership and resilience. Central to both contexts was prioritising indigenous knowledge and lived experience through participatory project design, ensuring that solutions were culturally relevant, sustainable and built trust between health actors and communities. By centering communities as partners rather than beneficiaries, these approaches not only addressed immediate WASH deficits but also enhanced adaptive capacity to climate risks. This case study illustrates the importance of community-led WASH strategies as critical public health responses to climate change, with implications for policy, practice and the pursuit of equitable, resilient systems in vulnerable settings.