When the River Rises, Clinics Must Stay Open: A gender test for COP30
Co-authored by Lydia Zigomo, Regional Director UNFPA East and Southern Africa and Salla Tuominen, President of Zonta International
When floodwaters rose in Malakal, Upper Nile State, South Sudan, clinic doors shut and reports of gender-based violence surged; at COP30 in Belém, leaders can either hard-wire women’s health into climate policy or leave it to drown.
Akot, 36, remembers the night the river climbed her doorstep in Malakal. Food ran out, tempers rose, and the health post that provided contraception and antenatal and post-rape care was suddenly unreachable. “Floods don’t just take houses,” she says. “They bring violence, and more women suffer in silence.” Her story is not a single incident but multiplies across the region whenever droughts, cyclones, or floods strike. Services close, journeys for water and firewood grow longer and riskier, and protection systems fray just as needs intensify. In countries like Madagascar and Mozambique, early marriage for girls becomes a coping strategy when harvests fail and families face impossible choices.
This is the gap we must close. Climate action that forgets sexual and reproductive health and rights (SRHR) is not only unjust, but also ineffective. If clinics cannot stay open, supply chains fail and women have nowhere safe to seek help, and adaptation plans are failing half the population they claim to protect. Climate-resilient systems are those that keep sexual and reproductive health (SRH) and gender-based violence (GBV) services running when roads are cut and power is down.
Through ClimateEmpower, UNFPA, the UN’s sexual and reproductive health agency, and Zonta International are building a better world for women and girls. The initiative also backs locally-led solutions that keep women and girls safer before, during and after climate shocks. We are training young women leaders to design practical fixes, challenge and reshape social norms exacerbated in climate contexts, incubate community innovations and connect a continent-wide youth network to share what works.
By 2026, more than 450 women and girls will be trained to lead 300 local solutions. About 140,000 young people will be linked in a learning network and around 27,000 people will have directly benefited from safer access to water, health, protection and care. From GBV-aware messages in early-warning systems to peer-led safe spaces during and after floods or drought seasons, we are funding what communities build.
COP30 is a chance to expand this know-how through policy and finance. Success in Belém means countries embedding SRHR and GBV and harmful practices prevention in the next generation of Nationally Determined Contributions (NDCs) and National Adaptation Plans (NAPs) with real budget lines. It means renewing and funding the Gender Action Plan (GAP), committing to the Belem Health Action Plan (BHAP) and strengthening the Global Goal on Adaptation (GGA) with measurable indicators that track SRH service continuity in crises and agreeing on gender-responsive targets that keep early-warning, safe spaces and survivor-centered services operational when shocks hit.
It also means directing adaptation finance to primary-level SRHR and GBV services, which are often the first facilities to close on climate impact and the first that must reopen, and ensuring funding can cover GBV risk mitigation, safe shelter and the rapid restoration of care.
None of this is abstract. In every climate emergency we see the same pattern of girls dropping out of school, adolescent pregnancy rising, intimate-partner violence increasing and women giving birth without skilled care because clinics are cut off. The costs are borne quietly. In maternal deaths that were preventable, in trauma that goes unreported, in dreams deferred when families marry girls off to survive a failed harvest. Climate policy that counts tonnes of carbon but not the safety of women and girls is incomplete and, in the end, ineffective.
We also know what works. Keep services open by pre-positioning supplies and deploying mobile clinics. Fund the women-led organizations who are the first and last responders. Design early-warning systems that include GBV risk messaging. Protect the journeys from fetching water, to reaching a clinic, to getting a birth certificate that becomes dangerous when floods arrive and crops fail. Bring young leaders on board to co-design and monitor these fixes so they last beyond a single project cycle.
Accountability must match ambition. We urge governments and partners to publish gender-responsive climate budgets, track SRHR and GBV service continuity as core adaptation indicators and report results transparently. What’s measured is what matters: donors can leverage these metrics in proposals and evaluations, and reward countries and local organizations that keep services running through the worst months of the year. Let’s count what truly counts, and financing will follow.
At Belém, leaders can set a new standard. Every climate plan protects SRHR and prevents GBV, every budget funds it and every dashboard counts it. Let’s build a world where the next time the river rises, Akot still finds a clinic open, a safe path to reach it and a system ready to protect her dignity and her future.
30 OCTOBER 2025