Kiribati’s remote location and the worsening impacts of climate change have led to high rates of non-communicable diseases and malnutrition, while health care access is extremely limited.
Leila Rafei
Batiua (pronounced Besiwa) is the sole medical assistant on Abaiang island, a sliver of land just 23 miles long and less than 300 feet wide in the Pacific nation of Kiribati.
With support from Doctors Without Borders/Médecins Sans Frontières (MSF) doctors, she provides essential care for a community of 6,000 people with limited resources, helping to tackle issues like malnutrition, infectious diseases, and pregnancy complications in a small primary health care center surrounded by coconut trees. Batiua is the main focal point for patients at the center, translating between i-Kiribati and English so they can communicate with MSF doctors as they support her in diagnosis, treatment plans, and patient care.
Support for a strained health system in Kiribati
The unique geographical challenges in Kiribati impact nearly every aspect of daily life. Spread across 33 atolls and reef islands, the country’s vast distances and limited infrastructure make it difficult to transport essential medical supplies, and for people to access specialized health care. Many outer islands rely on infrequent boat or air transport for critical supplies, and delays can lead to medicine shortages and limited health care access. Meanwhile, the lack of proper waste disposal infrastructure poses environmental and health risks, with medical waste often accumulating in unsafe conditions.
Facts about Kiribati
- Kiribati is made up of 33 atolls and islands in the Central Pacific Ocean, spanning over 2 million square miles. It’s the only nation in the world that straddles all four hemispheres.
- The population is 120,000, half of whom live on the main island of Tarawa.
- The distances between islands of Kiribati and its closest neighbors hinders the transport of food, goods, and medicines, as well as waste disposal, including medical waste.
- Diabetes, hypertension, and cardiovascular diseases are common.
- The prevalence of hypertensive disorders in pregnancy over 19 percent.
- 75 percent of deaths in the Pacific region are attributed to non-communicable diseases.
Kiribati has some of the poorest health outcomes and highest burdens of disease globally. At the same time, the country's health system is under immense strain, with a shortage of health care workers. People in Kiribati’s outer islands rely on skilled and dedicated members of their communities, including staff from the Ministry of Health and Medical Services. MSF’s medical teams have been supporting these professionals in Abaiang since 2024.
“We focus our energy here as there is a high incidence of referrals for maternal care from outer islands to Tungaru Central Hospital on the main island of Tarawa,” said Keira Sargeant, an MSF medical coordinator. This means women will be able to receive care closer to home. “We identified the need to support the medical assistants and nurses by implementing a community-based model of care.”
The impact of climate change on health
For the people of Kiribati, the climate crisis is a daily health threat. Rising sea levels contaminate freshwater, increasing diarrheal diseases, while extreme weather disrupts the food supply, worsening malnutrition. Warmer temperatures fuel mosquito-borne illnesses like dengue, and heat stress impacts people with heart disease and diabetes, as well as pregnant women. These challenges, combined with limited health care access, create a worsening cycle of poor health and vulnerability.
Erosion and the high salinity of soil as a result of rising sea levels have reduced the amount of arable land for farming. People instead rely on hyper-processed imported foods, which can lead to high weight and obesity and increase the risk of pregnancy-induced hypertension and gestational diabetes. Ninety percent of children live in food poverty, meaning they have limited access to a diverse and nutritious diet.
“Children are affected more as [malnutrition] directly impacts their growth,” said Batiua. Among children under 5 years old, more than 15 percent are stunted and 3.5 percent are affected by wasting. Malnutrition also makes children more susceptible to infectious diseases and other illnesses.
Mothers and children are especially vulnerable
While Kiribati has some of the highest burdens of disease in the Pacific region, it has one of the lowest rates of access to primary health care, increasing the vulnerability of pregnant women and children. A single nurse or medical assistant is responsible for each clinic. MSF is helping women have safer pregnancies by working with local health workers to help diagnose and treat diabetes and hypertension in pregnant women.
26%
of adult women in Kiribati have diabetes
9%
of pregnant women have gestational hypertension
10%
of pregnant women have pre-eclampsia
“It’s a big relief to the island when we have MSF’s doctor, Joseph, as he has more medical knowledge,” said Batiua. Any cases, including high-risk pregnancies, that are not treatable at the primary health care center are referred to Tungaru Central Hospital in the capital, Tarawa, via a two- to four-hour boat trip or a flight that leaves once or twice a week.
In 2024, MSF screened 888 women for non-communicable diseases in Abaiang. A quarter of the women had diabetes, with almost 20 percent having hypertensive disorders in pregnancy. More than 60 percent showed signs of obesity. Among the 514 children screened, 9 percent had recently experienced diarrhea, a result of the ongoing challenges related to water and sanitation.
Improving access to clean water in Kiribati
Accessing clean, safe water is a daily struggle for people in Kiribati. The main source of drinking water is shallow groundwater, which is contaminated with seawater, rubbish, and other waste. The limited access to potable water supply at the primary health care center poses a significant challenge, affecting both patient care and clinic sanitation. With no running water on the island, health clinics rely on rainwater or water carried from nearby homes.
The Ministry of Health and Medical Services is making efforts to secure the water supply. MSF has also been working with the ministry to test the quality of water in the groundwater table on the island and assess its correlation with health conditions such as hypertension or diarrhea in pregnancy.
“We’re also working on geo-mapping the various water wells so the community has more information about the water quality in each well and can make healthier choices about where they get their water,” said Kiera.
Climate impacts nutritional health on remote island
The people of Kiribati are on the forefront of climate change, which significantly affects their health. MSF is addressing issues including increased risks of infant and maternal death, birth complications, and waterborne and insect-related illnesses.
Logistics on a remote island
The remote location, high disease burden, and worsening effects of climate change continue to place immense strain on Kiribati’s health care system. With a growing population facing increasing health challenges, the need for sustained medical support is critical.
MSF’s partnership with the Ministry of Health and Medical Services aims to provide medical care, strengthen pharmacy management, and improve sanitation efforts. Working in collaboration with medical professionals at all levels—tertiary to grassroots—has been one of the key pillars of the collaboration.
“My mission in life is to eradicate malnutrition in Abaiang, especially among children under 5,” said Batiua.