Rwanda Climate and Health Assessment Identifies High-Risk Districts and Gaps in Healthcare Preparedness

A new government assessment warns that rising temperatures, extreme weather and changing rainfall patterns are intensifying health risks across Rwanda, while hospitals remain poorly equipped to respond to climate-related emergencies.

KIGALI, Rwanda – Climate change is increasingly threatening public health in Rwanda, with rising temperatures, changing rainfall patterns and extreme weather events contributing to the spread of diseases, food insecurity and growing pressure on healthcare facilities.

A new Rwanda Climate and Health Vulnerability and Adaptation (V&A) Assessment, released by the Ministry of Health, identifies significant differences in climate-related health risks across the country’s 30 districts and highlights weaknesses in the health system’s preparedness to respond.

The assessment warns that climate change is no longer simply an environmental concern but an increasingly important factor influencing disease patterns, access to healthcare and the wellbeing of vulnerable populations.

According to the report, Rwanda has experienced an estimated 1.4°C increase in average temperatures since 1970, exceeding the global average rate of warming over the same period.

Temperatures are projected to increase by up to 2.0°C by the 2030s. Under a high-emissions scenario, national warming could exceed 4.0°C towards the end of the century, potentially intensifying existing public health challenges.

Western highlands face multiple climate-related health risks

The assessment identifies a clear geographical variation in climate-health vulnerability, with western and northern highland districts facing significant exposure to floods, landslides and heavy rainfall, while eastern districts experience increasing heat and drought pressures.

Ngororero District records the highest overall climate-health risk among Rwanda’s 30 districts.

Other highly exposed western districts include Rubavu, Rutsiro and Nyamasheke, where steep terrain, intense rainfall, flooding and landslides combine with infrastructure vulnerabilities to threaten communities and disrupt access to essential services.

In northeastern districts, particularly Nyagatare and Gatsibo, prolonged dry spells and extreme temperatures contribute to water scarcity, agricultural disruption and respiratory health problems.

Kigali also faces distinct climate-related challenges. Gasabo District is identified as particularly vulnerable to population exposure associated with urban heat, densely populated informal settlements and flooding caused by intense rainfall.

Air pollution represents another major public health concern.

The assessment estimates that Rwanda’s average concentration of fine particulate matter (PM2.5) stands at 38.8 micrograms per cubic metre, approximately seven to ten times higher than the World Health Organization’s recommended air-quality guideline, depending on the averaging period considered.

Rubavu records some of the highest concentrations, reaching approximately 47–48 micrograms per cubic metre. Biomass burning and geographical conditions are among the factors associated with the high pollution levels.

Malaria and other diseases follow changing weather patterns

The assessment establishes important relationships between climatic conditions, including temperature, rainfall and relative humidity, and the occurrence of several diseases in Rwanda.

Malaria remains one of the major climate-sensitive health concerns.

According to the findings, malaria transmission follows a bimodal seasonal pattern influenced by rainfall and humidity. The report identifies estimated annual peaks of approximately 465,000 cases in January, following the short rainy season, and 377,000 cases in October.

Southern and western districts, including Gisagara, Nyamasheke, Kamonyi and Ruhango, record particularly high malaria burdens, with Standardized Morbidity Ratios (SMRs) ranging from 2.0 to 2.9.

The assessment also identifies a significant concentration of schistosomiasis cases around Lake Kivu.

Nyamasheke District records an SMR of 11.07, indicating a disease burden more than eleven times the national reference level. Water-contact patterns and the presence of habitats suitable for disease-transmitting snails are identified as important factors.

Waterborne diseases also increase during periods of heavy rainfall.

Diarrhoeal diseases reach an estimated peak of approximately 241,000 cases in May, when heavy rains can contribute to contamination of water sources and expose weaknesses in water, sanitation and hygiene (WASH) infrastructure.

Nyarugenge and Gakenke record particularly high burdens, with SMRs of 1.89 and 1.51 respectively.

Respiratory illnesses also show distinct geographical patterns.

Pneumonia and bronchitis are concentrated in colder, humid northern highland districts, particularly Gicumbi, which records an SMR of 3.17, and Burera at 2.52.

Meanwhile, asthma and chronic obstructive pulmonary disease (COPD) are more prevalent in urban areas, with Nyarugenge recording an SMR of 4.11 and Kicukiro 3.05. The assessment points to urban air pollution and vehicle emissions as contributing environmental factors.

Climate change also affects mental health and nutrition

Beyond infectious and respiratory diseases, the assessment highlights the growing implications of climate-related disasters for mental health and nutrition.

Anxiety and depression are associated with changing climatic conditions, with the assessment reporting an incidence rate ratio (IRR) of 1.41 in relation to higher relative humidity.

Reported cases reach approximately 2,483 in October, during a period when heavy rainfall, flooding and landslides can cause displacement, damage property and disrupt household livelihoods.

The report also identifies seasonal increases in malnutrition among children under five.

Cases rise to approximately 31,822 in June and 31,829 in December, following rainy-season periods that can affect food production, household food availability and nutritional security.

Nyamagabe District records an SMR of 3.12, indicating a burden more than three times the national reference level.

These findings underline the relationship between environmental conditions, agricultural production, household incomes and public health.

Women, children and persons with disabilities face heightened risks

The assessment warns that climate-related health threats do not affect all population groups equally.

Pregnant women face particular risks during floods and landslides, which can block roads and delay emergency referrals to health facilities.

The report identifies a seasonal increase in the maternal mortality ratio, reaching approximately 213 deaths per 100,000 live births in February.

Adolescent girls and women also face additional social and health vulnerabilities.

Facility deliveries among girls below 20 years of age reach late-year peaks of approximately 7.5%, with rates of between 8% and 10% reported in parts of Eastern Province.

The assessment further reports increases in gender-based violence (GBV) during periods of extreme heat and heavy rainfall, particularly between August and October.

Persons with disabilities are another group facing significant challenges during climate emergencies.

Rwanda has more than 392,000 people living with disabilities, according to the assessment, many of whom may encounter difficulties accessing evacuation services and emergency assistance because of mobility, visual and other accessibility barriers.

Rural communities, which account for approximately 72% of the population, also face challenges linked to limited access to reliable water supplies and digital early-warning information.

Hospitals face serious preparedness and infrastructure gaps

Despite the growing health risks associated with climate change, the assessment identifies major weaknesses in the preparedness of Rwanda’s healthcare infrastructure.

A field assessment covering ten representative district hospitals found that overall health workforce readiness to respond to climate-related health risks averages just 42%.

Preparedness for extreme temperature events is even lower, at approximately 34%.

The report also raises concerns about the reliability of electricity supplies and the capacity of backup power systems to support essential medical services during emergencies.

Some health facilities reportedly operate with backup generators of approximately 75 KVA, while the assessment cites a requirement of at least 500 KVA to support critical care equipment and services, including neonatal incubators.

Lightning strikes are also identified as a threat to medical equipment and information technology infrastructure, particularly where adequate protection systems are lacking.

The weaknesses extend to health information management and institutional preparedness.

Approximately 80% of assessed health facilities lack dedicated systems for reporting climate-health information, while none of the facilities assessed had established formal facility-level climate-health policies.

These gaps could limit the ability of hospitals to anticipate climate-related disease outbreaks, prepare for extreme weather events and maintain essential services during emergencies.

Rwanda prepares a Health National Adaptation Plan

The findings are expected to inform Rwanda’s response through a Health National Adaptation Plan (H-NAP) for the 2025–2030 period.

Health Minister Dr. Sabin Nsanzimana has emphasized the importance of the assessment as an evidence base for strengthening the country’s capacity to address climate-related health threats.

The proposed strategic direction includes improving disease surveillance, strengthening early-warning systems and preparing healthcare facilities for climate-related emergencies.

One recommendation is to introduce anticipatory action by positioning essential medical supplies, vector-control materials and water, sanitation and hygiene supplies two to four weeks before anticipated seasonal disease surges.

The assessment also calls for climate-resilient healthcare infrastructure, including improved backup electricity systems, stronger drainage networks and reliable emergency transport routes that remain accessible during extreme weather.

Interventions are expected to be adapted to the specific risks facing different parts of the country.

In the Western Highlands, priorities include slope stabilization and measures to reduce landslide and flood risks. In northeastern districts, heat-health action plans and responses to drought-related health challenges are considered important.

For Kigali, improved urban drainage and stormwater management are among the proposed measures to reduce flooding risks.

The assessment ultimately points to the need for closer coordination between the health sector, environmental institutions, agriculture authorities, local governments and disaster-management agencies.

As climate pressures intensify, Rwanda’s ability to protect public health will increasingly depend on whether its healthcare system can anticipate environmental risks, maintain essential services during emergencies and reach communities most exposed to climate-related threats.

The challenge is no longer limited to responding to diseases after they occur, but also preparing the health system to prevent and manage the growing health consequences of a changing climate.

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