Figure 1
Africa’s arc of instability – a belt of countries facing converging climate, conflict, and health vulnerabilities, stretching from Mauritania through the Sahel to the Horn of Africa.
Source: Author’s own elaboration, adapted from Evans and Munslow [3] and the UN Security Council briefing on arc‑of‑instability dynamics [4].
Table 1
Inclusion and exclusion criteria.
| CRITERION | INCLUSION | EXCLUSION |
|---|---|---|
| Population | Populations residing within the arc of instability (Mauritania, Mali, Burkina Faso, Niger, Northern Nigeria, Chad, Sudan, South Sudan, Eritrea, Ethiopia, and Somalia) | Studies outside this geography or where the arc population cannot be disaggregated |
| Concept | Studies addressing at least two of: (a) climate variability or change; (b) communal or inter‑group violence; (c) population health outcomes | Studies addressing only one domain, or treating these as background context, without analytical engagement |
| Context | Community, household, district, sub‑national, or national levels within the arc | Purely laboratory, modelling, or experimental studies without contextual grounding in the arc |
| Study design | Empirical observational, qualitative, mixed‑methods, cross‑sectional surveys, scoping or systematic reviews, and evaluations of interventions | Editorials, opinion pieces, news commentary, and conference abstracts without full text |
| Time period | January 2010 to March 2025 | Studies outside this window |
| Language | English or French | Other languages (Arabic and Portuguese‑language studies were noted but not extracted due to resource constraints) |
[i] Source: Author’s own elaboration, adapted from Lokotola and colleagues’ scoping review framework for climate change and primary healthcare in Africa [10].
Figure 2
PRISMA‑ScR flow diagram of study identification and selection.
Source: Author’s own elaboration, adapted from the PRISMA‑ScR checklist [15].
Table 2
Summary of included studies by domain pairing and dominant pathway.
| DOMAIN PAIRING | PATHWAY | REPRESENTATIVE HEALTH OUTCOMES AND FINDINGS | STUDIES (N) |
|---|---|---|---|
| Climate × violence × health | Resource scarcity → communal violence → displacement → disease | Outbreaks of cholera, measles, and diarrhoeal disease in displacement settings; immuno‑naïve populations exposed to new pathogens; disruption of immunisation programmes [3, 5, 8] | 12 |
| Climate × health (conflict as context) | Drought and food insecurity → malnutrition → child morbidity and mortality | Increased stunting and wasting among children under five; rising acute malnutrition during prolonged drought; reduced antenatal attendance [2, 8] | 14 |
| Climate × mental health | Heat extremes and weather events → mental health and service disruption | Heightened depression, anxiety, and post‑traumatic symptoms following floods and prolonged drought; ecological grief and solastalgia among displaced pastoralists [11] | 8 |
| Violence × health systems | State fragility and access constraints → health‑system disruption → maternal and child health deterioration | Attacks on healthcare facilities and staff; supply‑chain failure; reduced antenatal and skilled‑birth attendance; vaccine coverage collapse [10] | 9 |
| Health‑system preparedness (cross‑cutting) | Capacity assessment | Health professionals report inadequate training, infrastructure, surveillance, and emergency response resources; budget allocations rarely incorporate climate considerations [16] | 4 |
[i] Source: Author’s synthesis from included studies. Reference numbers shown are illustrative key sources within each pathway and do not exhaust the evidence base.