Contents

List of Abbreviations vii

Acknowledgments viii

Key Takeaways ix

Executive Summary xi

Key Concepts and Metrics xiv

Introduction 1

SECTION I. Climate Risks 4

Rising Temperatures and Extreme Heat 5

Extreme Rainfall and Floods 6

Water Security and Drought 8

Desertification 8

Air Pollution, Sand, and Dust Storms 9

Sea Level Rise and Salination 9

Summary 10

SECTION II. Impact of Climate Shocks on Health Infrastructure 11

Facility Exposure to Floods 11

Impacts of Floods on Access to Emergency Care 13

Summary 14

SECTION III. The Rising Burden of Climate-Sensitive Health Conditions 15

Climate-Exacerbated Chronic Diseases 16

Other Priority Climate-Sensitive Health Conditions 16

Additional Risks Straining the Health System 18

Summary 19

SECTION IV. Adaptive Capacity of the Health System 20

Can Tunisia’s Health System Cope with Climate Shocks and Stressors? 21

Health Services and Programs 22

Summary 25

Health Resources 25

Health System Enabling Structures 28

Summary 30

SECTION V. Recommendations 31

Action Area 1: Enhance Climate-Resilient Health Emergency Preparedness and Response 32

Action Area 2: Improve WASH in Health Facilities 34

Action Area 3: Build Climate-Resilient Health Facilities 35

Action Area 4: Strengthen Financing and Supply Systems for a Climate-Resilient Health System 36

Conclusion 37

Appendices 38

Appendix A. Methodology 38

Appendix B. Assessment Caveats and Limitations 47

Appendix C. Technical Report: Climate Risks 49

Appendix D. Technical Report: Impact of Climate Shocks on Health Infrastructure 62

Appendix E. Technical Report: Impact on Climate-Sensitive Health Conditions 72

Appendix F. Recommendations 84

References 90