Climate change clearly has health impacts which are mostly related to water. Health hazards may be caused by extreme temperatures, an increase in water temperature, water scarcity, and chemical and biological contamination of water used for different purposes (including food production and processing). Increasing water scarcity may limit access to water for drinking water and sanitation, increase the concentration of pollutants, reduce the self-cleaning capacity of sewers and limit the ability of natural ecosystems to assimilate wastes.

Flooding may cause contamination and, especially in large cities, storm-water overflows and pollution. In poor and rural areas, environmental health hazards are often even more significant, as water supply and sanitation infrastructure is lacking, in a bad state, or because small service suppliers cannot cope with adverse weather conditions.

These close links among water, climate change and health are often overlooked. However, the Pan-European region has a unique instrument to deal with these challenges: the Protocol on Water and Health to the Convention on the Protection and Use of Transboundary Watercourses and International Lakes (Water Convention), which aims to protect human health and well-being through improving water management and through preventing, controlling and reducing water-related disease. Ultimately, the Protocol, jointly serviced by the UN Economic Commission for Europe (UNECE) and the Regional Office for Europe of the World Health Organization, aims to achieve access to safe drinking water and adequate sanitation to everyone, which has recently been recognized as a basic human right both by the UN General Assembly and the Human Rights Council.

To meet these goals, Parties are required to establish national and local targets in a number of areas addressing the whole water and health nexus. Climate change impacts should be taken into account when setting targets. At the same time, the target-setting process by its own nature offers a useful tool for planning adaptation to climate change, as it requires the establishment of an intersectoral coordination mechanism, broad participation, and an analysis of gaps, development of scenarios and prioritization of measures based on development choices.

Many other provisions of the Protocol are also highly relevant to adaptation to climate change, for example the Protocol requires international cooperation to establish joint or coordinated systems for surveillance and early warning systems, contingency plans and response capacities, as well as mutual assistance to respond to outbreaks and incidents of water-related disease, especially those caused by extreme weather events.

Extreme weather events in particular affect the capacity and operations of existing water and sanitation infrastructures and services, and thereby threaten the protection such services offer to human health and the environment. Water supply and sanitation are crucial determinants of health, especially during emergencies, but failing or compromised water and sanitation services may in themselves pose a risk, a sometimes irreversible source of contamination, whose impact goes beyond local and national borders. Therefore, water and sanitation are key components of any adaptation strategy aimed a preserving human health in a changing world.

Parties to the Protocol recognized the need to ensure that water supply and sanitation services are prepared for the widely anticipated consequences of floods and droughts, as well as other climate change impacts, already in early 2007 and set up a Task Force on Extreme Weather Events, led by Italy. In 2007-2010, the Task Force developed a Guidance on Water Supply and Sanitation in Extreme Events, under the leadership of Italy and the WHO Regional Office for Europe. The Guidance, edited by Roger Aertgeerts and Luciana Sinisi, is intended to provide an overview on why and how adaptation policies should consider the vulnerability of and new risk elements for health and environment arising from water services management during adverse weather episodes. It recalls the basic scientific findings, provides advice on communication issues, addresses the vulnerability of coastal areas and bathing waters, discusses the impact on human health, places extreme weather events in the context of water safety plans and formulates advice for adaptation measures for water supply and sanitation services during such events.

The Guidance, available in English and Russian, was adopted at the second session of the Meeting of the Parties to the Protocol on Water and Health, which was held on 23-25 November 2010, in Bucharest, Romania. The meeting also discussed how to promote its implementation, notably through the exchange of experience, capacity building and training and by developing decision-support tools to balance new water resources — desalinization, groundwater recharge, use of treated wastewater in agriculture and rainwater harvesting — with quality needs.

This Guidance should be seen together with the Guidance on Water and Adaptation to Climate Change which was developed under the UNECE Water Convention and adopted by its Parties in 2009. The Guidance on Water and Adaptation to Climate Change describes step-by-step how to develop an adaptation strategy in the water area and especially in transboundary basins. [Guidance on Water Supply and Sanitation in Extreme Events] [Second Session of the Meeting of the Parties Website] [Guidance on Water and Adaptation to Climate Change]