Climate justice as a public health imperative: a perspective from Sierra Leone considering the 2025 International Court of Justice opinion.

Climate change poses an escalating threat to health, livelihoods, and economic development in Sierra Leone, a coastal, low-income country highly dependent on rain-fed agriculture for sustenance and revenue. Rising temperatures, erratic rainfall, floods, landslides, sea-level rise, and coastal erosion disrupt food systems and damage infrastructure, subsequently entrenching poverty, with projected gross domestic product losses of up to 10% by 2050. The health impacts fall disproportionately on children, adolescents and young people, pregnant women, the elderly, and the urban poor, including increased vector- and water-borne diseases, heat-related morbidity, non-communicable diseases, malnutrition, mental illness, and gender-based violence, particularly in informal coastal settlements. Despite these risks, climate adaptation and mitigation remain weakly integrated across sectors. Conflicting policies, fragmented governance systems, inadequate domestic financing, and over-reliance on unpredictable donor support undermine implementation of existing frameworks such as the National Adaptation Programme of Action. An example of policy conflicts is the extractive-sector priorities directly countering those of environmental protection and public health. This correspondence interrogates global and local institutional readiness to mitigate climate-related health risks, drawing on the WHO Operational Framework for Climate-Resilient Health Systems and the multidimensional climate justice approach. Using the July 2025 International Court of Justice advisory opinion on climate change as a legal and moral anchor, we argue for urgent, health-centred, and justice-oriented climate actions. We highlight the need for strengthened cross-sectoral governance, community-level implementation, and legal accountability, particularly in securing international climate financing for adaptation as part of States' human rights obligations under the United Nations Framework Convention on Climate Change Loss and Damage Framework. We contend that the International Court of Justice opinion provides Sierra Leone with a critical new basis to advocate for international support to protect the fundamental right to health.