How climate change affects the environment and subsequent risk for violent conflict has been a matter of debate, but there is no clear consensus as to the nature of this potential linkage (Bernauer et al., 2012; Burrows & Kinney, 2016). Risks from climate change differentially affect marginalized populations, but the vulnerabilities experienced are rarely caused by a single factor. Rather, it is the complex interplay of economic, political, demographic, and social factors with climate variability and change that affects vulnerability and exposure (Burrows & Kinney, 2016; Busby, 2010; Evans, 2010; Hsiang, Burke, & Miguel, 2013; Intergovernmental Panel on Climate Change [IPCC], 2014b; Scheffran et al., 2012). Climate-related hazards can exacerbate stress for those living in poverty through direct mechanisms such as loss of or impact to livelihoods, destruction of homes and businesses, or diminished crop production, or indirectly through food insecurity (IPCC, 2014b).

The World Bank estimates that 2 billion people live in areas of conflict, fragility, or large scale, organized criminal violence, with 46% of those living in poverty expected to live in fragile and conflict-affected areas by 2030. Currently, developing countries host 95% of refugees and those internally displaced (The World Bank, 2017). Negative impacts (direct and indirect) from climate-related changes will presumably only add additional stress on these highly vulnerable populations, including those suffering through a CHE.

Various scholars have studied the relationship of climate change and potential conflict through an array of approaches. Examining 60 rigorous quantitative studies from a variety of disciplines, Hsiang et al. (2013) concluded that there was strong causal evidence linking climatic events to conflict and that this relationship held across factors such as regions of the world, temporal scales, types of conflict, income levels, spatial scales, and various durations of climate changes. However, Hsiang et al. stressed that climatic influence was just one of many factors contributing to conflict. Bollfrass and Shaver (2015), using a subnational data set, concluded that a relationship between higher ambient temperatures and an increase in substate violence exists partially from a disruption of agricultural production. Their findings indicate that this mechanism holds at both the global and the substate level, and, even in areas without significant agricultural production, higher temperatures have been associated with increased conflict.

Consensus among scientists from the IPCC indicates a high agreement between varying studies and sources of evidence that climate change is projected to increase displacement in the future (IPCC, 2014a). Other scholars have examined possible linkages among climate change, migration, and conflict. Findings from these publications indicate that the linkages among these three factors are far from simplistic (Brzoska & Fröhlich, 2016). While climate change has the potential to cause increased migration and risk for conflict, this potential is highly location dependent (Burrows & Kinney, 2016). However, compared to other factors, the weight of the association between climate change and migration as a driving force for conflict is not known and requires additional research. The IPCC 2014 Synthesis Report notes, however, that violent conflict increases vulnerability to climate change by harming resources (such as infrastructure, social capital, or economic opportunities) that facilitate adaptation to the changing climatic conditions (IPCC, 2014a).

It has been argued that the nature of disasters may shift humanitarian response addressing consequences of war to that of more extreme climatic events dominating the need for humanitarian action. Demographically, populations are moving toward greater urbanization and will be vulnerable to new hazards (O’Keefe, O’Brien, & Jayawickrama, 2015). This has also been seen with refugees and internally displaced populations (IDPs) moving from traditional rural settings to more urban settings, as with the Syrian example mentioned earlier. In fact, the United Nation’s High Commissioner for Refugees (n.d.) estimates that as much as 60% of the world’s refugees and 80% of IDPs now live in urban areas.

Nurses will be engaged in the humanitarian situations that may result from extreme climatic changes. In order to best do so, educational preparation should include content about all phases of humanitarian emergencies and their consequences, from predisaster planning through mitigation, response, and recovery. It is also necessary to understand the differences between humanitarian relief provided domestically versus globally.

Numerous public health and specialty organizations have published core competencies for healthcare workers in disasters and emergencies (Gebbie & Qureshi, 2002; Walsh, Altman, King, & Strauss-Riggs, 2014; Wong et al., 2015; World Health Organization & International Council of Nurses, 2009), but few, if any, are specific for the types of CHEs as discussed above. The World Health Organization and the International Council of Nursing (2009) published the ICN Framework for Disaster Nursing Competencies to clarify the role of the generalist nurse in disasters. These competencies are based on the disaster management continuum and organized under the four areas of mitigation and prevention, preparedness, response, and recovery and rehabilitation. Figure 1 lists the 10 domains of the competencies. Drawing on these and other competencies, the authors developed a course specific to the nursing role. In addition to the listed competencies, the course includes content on self-care and security, which have been recommended based on a recent review of the ICN Framework for Disaster Nursing Competencies (Hutton, Veenema, & Gebbie, 2016).

Humanitarian response is a fairly narrow field of work and, as such, has not traditionally been included in nursing curriculum. While existing courses may prepare nurses for all hazard or disaster responses, we did not know of any school offering a course geared specifically to the nursing role within CHEs. Identifying this gap and realizing the strength of collaboration between nurses at the Centers for Disease Control and Prevention (CDC) and the Emory University Nell Hodgson School of Nursing (hereafter referred to as Emory), we, the authors of this article (a nurse anthropologist from the CDC and a family nurse practitioner from the faculty at Emory), developed a novel, 3-day (total 24 hr) intensive, graduate-level course focused on introducing nursing students to complex humanitarian emergencies, including natural disasters. Both of us have decades of experience working in humanitarian settings, both domestically and globally.

Student evaluation of this course has been consistently positive. On a 5-point scale, with 5 being the highest, the course received overall ratings of 4.8, 5, and 4.9, respectively. Students comment that they develop unique skills and competencies that better prepare them for disaster and emergency work. One student evaluation stated, “I learned a lot and have a lot better sense of the role of nurses, NPs, CNMs in complex humanitarian emergencies … liked the Sphere modules and the other online modules.” Another wrote, “Its timing over the course over fall break enables students to be fully engaged in the intense nature of the course (meets for 7–8 hours for 3 days).” These sentiments were consistently echoed in other evaluations from year to year. The certificates earned through online modules offer a unique addition to their resumes. As one student wrote, “They represented very manageable assignments, and were well-designed and interesting.” A successful outcome of this course may be the fact that students have been employed by some of the same key agencies they identify in course exercises. For example, students have gone on to work for NGOs during the Ebola response and subsequent recovery work and for the CDC. One student wrote back from Liberia to thank us for preparing her for the work. Furthermore, one student, realizing the complexity and intensity of this work, commented that the work is far more demanding than she ever imagined and she would need to give it far more thought as a career choice.

Climate change, as a catalyst to insecurity, will have an impact on CHEs. Sherri Goodman, a former U.S. Deputy Undersecretary of Defense, sees climate change as “ … a threat multiplier because it aggravates others tensions and conflicts that already exist” (Doherty, 2017, para. 2). In his confirmation hearing, James Mattis, the U.S. Secretary for Defense, stated, “Climate change is impacting stability in areas of the world … “ (Doherty, 2017, para. 25). As the impact of climate change increases the risks for natural disasters and CHEs, healthcare delivery and response will be compromised. Healthcare workers must have fundamental abilities and competencies. As the largest group of healthcare workers, nurses will be among the first to respond to disasters, “often working in difficult situations with limited resources … serving as first responders, triage officers and care providers, coordinators of care and services, providers of information or education, and counsellors” (World Health Organization & International Council of Nurses, 2009, p. iv). While not addressing the full set of request competencies, the course described in this article introduces students to the role of the nurse in CHEs. Educational courses (like the example described in this article) are of high relevance to future clinical practice. Students completing the course will be expected to integrate the information into their practice and be better prepared in the event of a humanitarian crisis associated with a climate change disaster.