Most of the over 70 countries Médecins Sans Frontières /Doctors Without Borders (MSF) works in are in lower-income regions. They are facing not only humanitarian crises but also the most severe impacts of the climate emergency. In 2023, MSF continued to witness and respond to the consequences of extreme weather events around the world, including unprecedented flooding in South Sudan, severe cyclones in Myanmar and Madagascar, and the relentless heat and extended droughts that have driven millions to the edge of starvation throughout the Horn of Africa.1 This year, the organisation has also responded to epidemics of climate-sensitive diseases, including multiple concurrent cholera outbreaks and the rise of dengue and malaria in several areas, including in conflict-affected settings.