Study context: The case of Dominica, a Caribbean SIDS

The Commonwealth of Dominica is an independent SIDS located in the Eastern Caribbean region, between two French departments – Guadeloupe in the North and Martinique in the South. A map of Dominica is available at the Government of Dominica Web Portal (http://dominica.gov.dm/about-dominica/country-profile). Dominica is recognized as vulnerable to climate change impacts due to its mountainous terrain, changing wind patterns, and increased rainfall from July to December. Dominica is particularly exposed to environmental challenges such as sea-level rise, earthquakes, and volcanic eruptions [22]. The estimated population of 70,000 is classified as an upper middle-income country with per capita income of US$ 8 355 (2022) [23]. The country faces social challenges of poverty, unemployment, and inequality in the distribution of wealth and resources. The 2009 country poverty assessment found that 29% of the population lived below the poverty line and youth unemployment was at 31% [24].

Healthcare in Dominica is provided free of charge at the primary level, with 49 Primary Health Care (PHC) centers distributed across the island’s seven districts. Additionally, there is one hospital located in the capital city of Roseau, and smaller ones in Portsmouth and Marigot. Approximately 4% of the Dominican population is classified as Kalinago (Indigenous population), and this population, often labeled as vulnerable, faces historical and current environmental, social and health challenges [25]. Dominica’s economy also relies on sectors such as social services, agriculture, tourism, financial intermediation, transportation, trade, construction, electricity, gas, and water supply [23].

Dominica was exposed to climate extremes in recent years, including Tropical Storm (TS) Erika in August 2015 and Hurricane Maria in 2017. TS Erika unleashed 380 mm of rain in seven hours, followed by mudslides and flooding that resulted in extensive damage to infrastructure, loss of lives, and displacement of families and communities. With a devasting impact on Petite Savanne, a small village in the southeast region, TS Erika claimed about 30 lives (the deadliest since Hurricane David in 1979) and caused damages totaling $483 million USD, equivalent to approximately 90% of Dominica’s Gross Domestic Product. According to Dominica Government, there were ‘574 homeless and 713 evacuated with approximately 7,229 impacted by the event in disaster declared areas’ [26]. The storm has been described as an event with severe local impacts in Dominica, underscoring the island’s vulnerability to climate extremes and leaving lasting consequences for its economy, communities and infrastructure [26,27].

On September 19^th, 2017, Dominica faced a category 5 hurricane (Hurricane Maria). Bringing 580mm of rainfall and claiming at least 30 lives, Hurricane Maria resulted in staggering damages totaling US$931 million, with losses amounting to US$382 million, equivalent to 226% of the country’s gross domestic product. Damage assessments reported 67% of homes were moderately or severely damaged and 23% were completed destroyed [28–31]. The Hurricane damaged over 80% of the country’s infrastructure, causing severe social, financial, and economic repercussions and thousands of individuals to be displaced from their homes [32]. Following the destruction of homes and the loss of income-generating activities, thousands of residents of Dominica left the island in search of better opportunities in neighboring countries (e.g., Guadeloupe, Martinique or St. Lucia) [33,34]. Two months after Hurricane Maria, about 1,862 individuals (581 households) were still housed in 63 shelters [28].

Climate health risks for Dominica were identified and include: water and food insecurity, vector borne diseases, mental health, and non-communicable diseases, and the recommendation was to ‘develop and implement a health and climate change plan for Dominica’ [35]. Moreover, uncertainties and insecurities related to displacement and loss of livelihoods, housing, income and occupation, and lack of access to health care services were identified following climate extremes in Dominica [36]. In a recent study of the Dominica PHC system, authors raised concerns about the limited public health adaptation capacities (limited knowledge about CC and health, the need for community mental health services, lack of systematic assessment of access to health care, limited social perspective of health, and absence of a climate and health policy) [37].

There is an Office of Disaster Management, which is responsible for conducting hazard, vulnerability and risk assessments, disaster preparedness, and response and recovery operations in collaboration with regional and national stakeholders including ‘civil based organisations’ (odm.gov.dm). A Dominica Climate Resilience and Recovery Plan 2020-2030 identified several initiatives including: to support ‘vulnerable members of society’, ‘community emergency readiness’, and to ensure more resilient housing [38]. Importantly, it was recently announced that the Climate Resilience Execution Agency for Dominica (CREAD) was terminated by the end of December 2023 [39], which undoubtedly raises questions in relation to current and future adaptation processes to climate change.

Theoretical framework: Studying the links between social vulnerability, risks and adaptation to climate change

Our study is guided by authors who consider vulnerability, including adaptive capacity, and risks as being produced not only by climate change and related extremes but also by institutions (Fig 1). In this paper, vulnerability is studied through the capacity of individuals and households to call out coping mechanisms when exposed to climate extremes, like knowledge and awareness, risks perceptions and practices, accessing community resources including risk reduction programs, and mobilizing social networks. Local adaptive capacity is also shaped by social capital that is made by social networks which according to Wilhemi and Hayden ‘connect individuals to their community resources’ [40]. Vulnerability to climate extremes and the political and social context (level of development and adaptation) can lead to various types of mobility (relocation, displacement, and/or migration) or immobility (being trapped), which in turn lead to health and other climate risks like food and water insecurity, and barriers to resources and services [41].

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Fig 1. The links between vulnerability, risks and adaptation to climate change.

Adapted from Wilhelmi and Hayden (2010), Schwerdtle et al. (2018) and Field et al. (2012).

https://doi.org/10.1371/journal.pclm.0000275.g001

Study design, sampling, and data collection

This article is based on data from a larger study in Dominica entitled “Climate, Migration, and Health in the Caribbean (CliMiHealth)”. This interdisciplinary, cross-sectoral, and mixed-methods research project seeks to gain a better understanding of climate-related migration and its the impacts on the health of the population, to contribute to adaptation to climate change in Caribbean small islands [36]. CliMiHealth data collection used semi-structured interviews, which were conducted in Dominica and Guadeloupe. Interviews began in Dominica in March 2020 and ended in January 2021. Additional interviews were conducted in Guadeloupe from January 2021 to May 2021, to capture the experiences of Dominicans who had been displaced to Guadeloupe. Data collection was suspended from April until July 2020 due to lockdowns brought on by the COVID-19 pandemic in Dominica.

The interview guide was initially inspired by the frameworks stated above and constructed in collaboration with the research team. The initial interview guide can be found in S1 Text. The list of variables in the interview guide included vulnerability and exposure to environmental changes, adaptive capacity, and health issues. Our present study focuses more specifically on what respondents have to say about climate change perspectives, adaptation, and risks through a social vulnerability lens. Slight adaptation of the interview guide to the local context was necessary to include a question specific to cross-border mobility (S2 Text). Participants were given definitions, but only when it was necessary for clarity or understanding of the study questions.

The sampling strategy was guided by diversification [42] and by the empirical field based on gender, age, level of formal education, location, nationality, climate events, and mobility pathways (relocation, returned home, immobility). 25 participants were recruited for a total of 23 interviews (two interviews were conducted with two participants each). To be eligible, participants had to meet two criteria: (1) experiencing internal or external displacement because of a climate extreme in Dominica, and (2) being 18 years of age or older. External displacement referred to participants who left Dominica for Guadeloupe, while internal displacement applied to those who sought shelter before or after the storm.

19 participants were recruited in Dominica and 6 in Guadeloupe. NMP conducted the interviews in Dominica and the research professional (based in Guadeloupe) conducted those in Guadeloupe. Respondents were identified through key community persons, including members of the health teams and village council officials, who were considered to have known individuals who had been displaced. Recruitment was also undertaken with the support of local research partners like the Caribbean Laboratory in Social Sciences and the Center for Geopolitics and Internal Analysis. Consequent support was also given by the Consulate of Dominica in Guadeloupe to identify potential participants. Snowball sampling was also used to identify other potential participants. Except for one interview, which was done remotely in Dominica, all interviews were face-to-face. Interviews were conducted in English, lasted 45 to 60 minutes, and were audio-recorded.

The majority of participants in the study were women (18 out of 25), with most without a postsecondary education (16 out of 25) (Table 1). All were displaced following TS Erika and/or Hurricane Maria. Among those who were displaced within Dominica, 7 returned home after the climate event, while the remaining participants did not return home; instead, they were relocated to new dwellings, resided in shelters, or found other types of housing. In terms of displacement duration, 7 participants were displaced for 4-6 years, 14 participants for 1-3 years, and only 6 participants for less than a year. Additionally, 10 participants were still unemployed at the time of the interviews. Only one participant had house insurance.

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Table 1. Participants’ characteristics.

https://doi.org/10.1371/journal.pclm.0000275.t001

Data analysis

All interviews were verbatim transcribed by a specifically recruited research professional based in Guadeloupe using the online software Otter.ai, followed by manual corrections. Participants were anonymized and given numbers to protect their confidentiality. Transcriptions were uploaded to QDA Miner© for data processing and coding. In this paper, our analysis is focused on the local adaptive capacity to climate extremes and the related risks in Dominica. It is critical to understanding local-level determinants of vulnerability, as it involves one’s ability to adjust to and cope with changes and climate and non-climate stressors (i.e., lack of resources). The attribute of concern of our analysis is about characteristics of local adaptive capacity, as described earlier.

A mixed method of analysis - deductive and inductive - was initially conducted by the research professional, supervised by PC, and inspired by Miles et al. [43]. The first stage of the coding process was conducted using a preliminary list of codes related to the aforementioned frameworks on climate-related human mobility, health, and vulnerability factors (including adaptive capacity) that allowed in vivo codes to emerge from data [36]. SC carried out a second stage of analysis in collaboration with PC to, more specifically, pursue and deepen the analysis of preliminary codes related to local adaptive capacity, adaptation and response, and external drivers (i.e., public health programmes). This second stage allowed the identification of in vivo codes concerning the participants’ perspectives on social cohesion, their recommendations on preparedness and adaptation, and any political barriers to adaptation to climate change. SC and PC carried out the final steps of the analysis and made the final decision on the themes.

Ethical considerations

This research was approved by the Research Ethics Board (Society and Culture) of the University of Montreal (CERSC-2019-110-D-1). The Dominica National Board of Ethics also gave approval. All methods were performed following relevant guidelines and regulations. All participants provided written informed consent prior to participating in this research.

Knowledge, attitudes and practices around climate and other environmental changes

Interviews revealed that understanding what “climate change” refers to varies from participant to participant. In fact, six participants had never heard of the concept or had a vague understanding of its meaning. Others had a broad understanding of climate change and its environmental impacts. Their observations showed an awareness of the increased likelihood of weather and climate-related events such as higher intensity of storms, changes in weather patterns, increased precipitations, and changes in seasonality (dry and wet seasons being longer, shorter, and unpredictable). Participant 24, who was displaced to Guadeloupe, thinks that: “people [are] more aware of climate change now. They [are] actually taking it more into consideration after Erika and Maria”. Those participants who had knowledge about climate change had varying observations. Participant 14 observed that with climate change, “you get more intense rain, and intense sun”, while Participant 12 thinks that climate change is impacting the weather on the island as “it is so hot that it is affecting the plants, things are changing”. He also noted that a ravine close by deepened because of the heavy rainfall that accompanied both storms. “When rain falls it [the ravine] becomes a big river, so everything is changing.” Participant 20 raised the concern that: “some rivers are drying” which might be related to human activities, such as construction and deforestation.

Participant 14 stressed heightened awareness of subtle sea behavior changes: “we notice even the slightest change in the waves, the slightest changes in the way the sea behaves, and it has been rougher.” Discussions expanded to include slow onset events such as seasonality changes, warming of temperatures, and sea level rise. Some participants referred to other environmental threats, including volcanic activity, mudslides, earthquakes, and tsunamis. Participant 16 made connections to heavy rains and earth movements referring to other climate extremes including bushfires occurring on the West coast of Dominica.

“The void is left there, when the rains fall and [water] sips into these crevices because remember the roots had spaces [that] they were occupying. Now, [what’s] going to occupy the spaces? Earth? […] You can understand why the earth is moving now. [It is because], [there are] too many voids [s]. I think we [will] need to do a serious reforestation project in Dominica.”

Participant 7 raised the issue of temperatures that are hotter and droughts that affect and destroy crops. Participant 16 talked about heavy rain that can wash away topsoil and affect the crops and the subsequent risk for local farmers to produce less food. Overall, the participants demonstrate broad observations regarding environmental changes to which the population is exposed. Some participants have recognized climate change impacts as interlinked between broader environmental and human activities, including land use changes, climate-related events, and drying rivers.

Climate extremes, such as TS Erika or Hurricane Maria, have highlighted the relative capacity of individuals and families to cope with such hazards by leaving their home and taking shelter to seek protection. Following TS Erika and Hurricane Maria, many participants engaged in mobility before and after the climate extreme because they thought their house was not sturdy enough. While some chose to migrate to Guadeloupe, others who were displaced faced multiple challenges of varying degrees over a variable time scale. At the time of the interviews, only four participants had returned to their original houses following the climate extreme.

Rebuilding efforts were mainly reported as a household-level process involving cleaning, salvaging, and rebuilding damaged areas. Many participants had to leave due to unstable housing, with 17 out of 25 participants moving to a new dwelling that was not their original home before the TS or the hurricane. Six participants eventually returned home after being displaced for varying lengths of time. For Participant 2, life completely changed since relocating since she “had to start all over”. For others, like Participant 20, migrating to Guadeloupe was viewed as an opportunity. However, for others who migrated to Guadeloupe, they faced issues such as visa or passport related challenges.

Social capital, housing conditions and access to resources

The decision-making process for seeking shelter right before the hurricane was influenced by the individuals’ dwelling conditions and their social ties hence the role of social capital in response to a storm. Participants would either decide to go to a local shelter (e.g., church or school) or to a friend or family’s apartment/house whose structure was deemed resistant enough. Participant 2 who had been displaced for 4-6 years due to the two climate extremes made the decision to go to a friend’s house instead of the designated shelter.

“Well, the Grammar School was designated as a shelter for bringing the Petite Savane people. So, everybody was sticking together in there. But then when you get there, […] if you had somewhere else to go, then you could leave. So that’s what happened to us. We had a family friend, and she had a house. So we went, we went to [live] there but there were [people left] at the shelter.”

Participant 7 said that just before Hurricane Maria hit Dominica, she decided to stay with her sister-in-law because her house is more structured than mine, because she has a blockhouse and a concrete roof”. The effects of climate change, including housing conditions, potential food and water insecurity, and job loss, have created significant challenges for communities. Factors restraining participants from rebuilding were financial and material resources. The findings suggest that the participants’ ability to recover and rebuild their homes after the climate extreme was highly dependent on their access to support and resources.

Farming: source of food and income

Farming was mentioned by participants above as being heavily impacted in both aspects of job and food availability. With agriculture comprising 19.9% of Dominica’s economic activities and being the second most significant contributor to the economy [23], it is clear that Dominicans rely heavily on farming. However, with the looming threat of climate change, the potential long-term damage to Dominica’s economy raises concerns about increased dependency on external aid, and subsequent importance of external drivers to local adaptive capacity to food security. Regarding the impact on the farming community after Hurricane Maria Participant 16 said:

“We are a farming community. So, we depend on our agricultural produce more than we depend on [imported] rice and flour. So now that [agriculture products] are gone and the rice and flour [is]in shortage in Roseau (the capital city) and elsewhere, […] The State [then] had to come in and do what they had to do to provide the people with food daily. That’s what I mean when I say, “at the mercy of the State”.”

Participant 2 was relocated to a different area following Hurricane Maria. She declared:

“You find in certain areas if you did not have enough food at your home, and […] you were unable to access the shop because of the level of the disaster, there were landslides [and] road cuts. So [depending on] where the shop was located [in relation to] your home [...] then you [would] not be able to access food. Water was totally shut off.”

Given that farming is integral to local livelihoods and food security, the loss of agricultural income exacerbated participants’ vulnerability, affecting their adaptive capacity. Participants emphasized that the inability to engage in farming not only impacted their immediate food supply but also their economic well-being, which is central to their ability to adapt to climate-induced stress. While participants in this study described different experiences, the loss of food and income was a common threat that influenced their capacity to cope.

Risk reduction initiatives

One of the objectives of the community risk reduction programs is to put in place ‘Disaster Management Committees in each community’ to cope with basic needs in case of emergency and to avoid mental stress’ [38]. Participant 15, who was a shelter’s assistant after Hurricane Maria, noted that, some initiatives have recently been undertaken at the community level:

“Before Maria, there was not a lot of training being done, as it relates to food distribution, or how to manage shelters or people after a disaster. Just recently, I see a lot of programs coming forward, for shelter management, training, and food distribution.”

Participant 16 noted that people’s engagement in community risk reduction activities is made on a voluntary basis. Moreover, he added that the disaster committee is only active when “we are approaching the hurricane season”. So, there are indications that, at the community level, there might be a lack of continuity in risk reduction initiatives. Participant 1 suggested that there might be a lack of awareness, trust, and social ties between people from the community, some of whom are supposedly involved in risk reduction committees. According to Participant 2, community disasters committees are supposed to have a plan. She said that in her village, there is a draft that was prepared, but when she was asked to describe the disaster risk reduction plan, she replied: “I’m not sure. Because we just did the draft. And we have not met as a committee to go over it”. Finally, Participant 1 added that to be effective, the disaster management program requires more resources and training to have people with skills in this domain.

Healthcare access needs and challenges for public health

The multifaceted risks individuals and communities face in the wake of climate extremes include mobility, healthcare access and potential mental health impacts. A particular finding was that of varied perceptions of healthcare needs among participants. Eight participants did not perceive a need for healthcare following the impacts of the climate extreme. Others described pre-existing diseases or injuries that necessitated medical attention in the aftermath of climate extremes. Participant 13 stated that her health had deteriorated following Hurricane Maria, which resulted in increased issues related to diabetes, blood pressure, and mobility. Participant 4, who was displaced within Dominica, had a pre-existing health issue and decided to self-treat because “the hospital had enough [patients] […] so I decide to look after myself”. This reflects the strain the healthcare system faces during and after a climate extreme and perhaps the need for alternative healthcare approaches.

Participants also described the challenges encountered in accessing healthcare services in the aftermath of either TS Erika or Hurricane Maria. They described several obstacles, including lack of confidence in public healthcare facilities, difficulties in reaching healthcare centers due to blocked roads, or the unavailability of services resulting from closure or structural damages. The deliberate decision to not seek services was also attributed to fear or distrust of caregivers and community members. Participant 9, who was displaced within Dominica, expressed that: “There are nurses but […] sometimes you don’t know, I don’t know who to trust....”. This lack of trust in some healthcare providers and the system hindered individuals’ access to needed care.

Narratives of those participants who were displaced to the neighbouring island of Guadeloupe highlighted the consequences of limited healthcare access. Four individuals who migrate to Guadeloupe described lack of access to healthcare as the primary reason for their displacement. Some participants even compared the healthcare experiences between that of Guadeloupe and Dominica. Amongst the participants who moved to Guadeloupe, all six mentioned a medical condition that they or someone in their family needed attention for in Guadeloupe. Participant 21 left Dominica following Hurricane Maria and is currently renting a home in Guadeloupe. He believes his health is fair and explained:

“I had some injur[ies], I had a cut there, [from the hurricane and] I had some stitches […] and I decided no more, I just [needed to go] to Guadeloupe, to take this to a hospital, [see] a doctor to take care of that thing you know, it’s better, so that is the reason I left Dominica.”

Mental health in the context of climate change and displacement

Additionally, the study uncovered the mental health challenges experienced by participants in the aftermath of Hurricane Maria, such as shocks, anxiety or fears. Participant 2 described a general panic among community members due to a lack of communication and access to necessities such as water, stating that “for the majority of persons, their state of mind was - panic”. Moreover, participants expressed concerns about the potential recurrence of new hurricanes and the precarious living conditions they were faced with, such as leaking rooves and unstable housing. Participant 15, for instance, described the fear, stress, and anxiety arising from climate-related impacts such as landslides, floods, and displacement, painting a grim picture of the emotional distress experienced by those affected. Ines shared a poignant account of the deteriorating health of older people in her community after relocation, highlighting their challenges in adapting to a new urban environment. Participant 2 explained how her father’s health significantly declined after Hurricane Maria. He had been accustomed to living in the rural community where he grew up, taking his morning walks. However, after being relocated by the government in a new housing project, due to TS Erika, his mobility became restricted, he “could not adjust”, leading to a noticeable deterioration in his health. She explained:

“My father is a classic example. My father died, not soon after, but his health deteriorated quite a bit since the storm. He was living at his house, […][but] someone took him, put him in a house in [a new housing project], He was not able to move around at all. So, he was restricted, and […] his health deteriorated.”.

She also expressed concerns about gender roles and how men may suffer more in a disaster:

“We focus a lot on the women, but I think the men tend to suffer more in a disaster than women. […] The men, they kind of get scared because they feel that they are the protector and they are not sure how are they going to continue protecting their family, continue doing what they have to do for their family”.

A team comprising a few mental health professionals from the Caribbean regions provided psychosocial support to some residents affected by TS Erika [27]. Psychological aid was offered to displaced people after Hurricane Maria but mostly for those living in temporary shelters like a school. Overall, our study revealed various challenges faced by individuals and communities in the aftermath of climate extremes such a TS or hurricanes, including limited access to healthcare facilities, negative perceptions of public healthcare, a lack of trust in caregivers and healthcare providers, and the exacerbation of pre-existing medical conditions.

The need to inform, improve communication and include communities to build knowledge

Participants highlighted the need for awareness initiatives to inform individuals and communities on the impacts of climate change. As Participant 12 points out there is the need for education, discussions and access to information on climate change and its potential impacts:

“We have to sit down and talk about climate change. What can we change? Some people might just be hearing the word climate change, and [they] don’t understand. Because he may have a lower [education] level.”

Education was a key theme in the recommendation for future adaptation plans, with suggestions including education in the community about the meaning of climate change, the inclusion of the churches, and more community mental health programs to deal with the stress and anxiety in relation to climate extremes. Some participants expressed the need for educative programs about climate change in schools. Participant 24 had this to say:

“Yes, I feel that it’s not only talking about CC, […] on the radio, they should go into different sectors, [such as] schools, and give practical[examples] with children and show them how it can impact on their lives.”

Participant 16 suggests that local farmers need more exchanges of knowledge and practices with scientific experts: “We [have the] experience but the experience is not enough. We need scientific evidence; we need scientific advice. So yes, it [climate change] is affecting me with my agriculture.”

The need for distribution and equitable access to resources (income, material and food)

In Dominica, the impacts of TS Erika and hurricane Maria on infrastructure led to damaged houses, road closures and water shortages. This, in turn, disrupted people’s lives and livelihoods, making it challenging for people to access jobs and essential supplies. Access to assistance during this period was crucial, but participants reported experiencing varying waiting times. Despite challenges, support in the form of temporary roof coverings and food supplies was provided. However, the vigorous rebuilding efforts took up to two years.

Four participants who returned to their original houses with limited external support expressed an important mental burden in assuming this process by themselves. Some participants had to make do with “intended to be temporary” makeshift homes, which were still in use at the time of the study (approximately 2-3 years post the climate extreme). Participant 19, who was displaced after the hurricane, initially praised the government’s immediate response, but felt that assistance waned afterward, citing ongoing issues since the time of the extreme climate event as he “still see rooves uncovered as [I am] talking right now” and that individuals “still live under tarpaulin rooves”.

And according to Participant 24 who relocated to Guadeloupe following Hurricane Maria: “I know that there are a number of persons still living in bad conditions after the hurricane, their homes are not repaired, some people that are [still] living under tents in poor conditions really.” Unequal access to assistance was reported in various sectors from the identification of damages and needs to food distribution and housing assistance. A feeling of unfairness was shared by some. Participant 4 said: “nobody ever come to me to ask me well, what are you missing or what did you lose? Nobody never came to my home.” When asked what assistance he had received after hurricane Maria, Participant 6 said: “Nothing, nothing, nothing (…) imagine my house break down, and everybody get, everybody get, while people were getting, I myself I never got nothing. Nothing, nothing.” For her part, Participant 8 questioned community fairness in food distribution after hurricane Maria:

“When they’re sharing the food, [they should] share it. Don’t just choose their favorite, ‘cause I saw it happens a lot … Let me tell you if they have flour to share out, then give it out. Everybody should get a pound of flour, not your friend 10 lbs and me half a pound. Give it to the people and don’t hold it back. During Maria time, a whole lot of things happened. Yeah, you’d be surprised... it wasn’t done fairly. No!.”

Opinions on the role of the government (operating through village councils in various parishes) and the various organizations, both international (such as The Red Cross or Samaritan’s Purse), in response of a climate extreme like a hurricane varied widely among participants. Some felt that the government should work to benefit all communities and put aside party politics and differences. They emphasized the need for the government to help everyone affected by the climate event. Participant 7 said:

“The government […] needs to work [for] both sides, they need to come together […] Forget about party politics and all [the] differences […] You need to help everybody.”

The need for stronger public health resources and outreach programmes

Participant 16 thinks that the healthcare centers should be better equipped to better respond to hurricanes, especially in relation to the Kalinago Territory. He added:

“The health facilities, in the community, in the entire Kalinago territory, should be well equipped. That is the first thing, because if […] something happens, how would you treat people? So that is the most important [to] be properly equipped, and properly manned […] And our disaster preparedness committees and all the agents who are working with them [need to] be ready to work.”

Regarding public health adaptation measures, the study shed light on the mental health impacts experienced by participants, underscoring the urgent need for comprehensive support systems that address the mental health of affected populations. According to Participant 1 who was able to return home after being displaced by Hurricane Maria:

“I don’t think we have enough resources invested in the human resources in the island to prepare us mentally [for] climate change. That’s my opinion [...] […], anytime […] persons [would] hear [of] a disaster, [they] would start to panic and want to stay home because they have a certain level of fear. Some of the fear is because they still don’t feel they are prepared enough to deal with climate change.”

The need for better coordination and participation in response to climate extremes

Regarding the response to climate extremes, Participant 12 expressed a need for clearer roles and better coordination between the government and village councils in the field after a climate extreme. He suggested that the government should work with the council and people on the ground, rather than trying to control everything from a central position. He also raised concerns about selective or preferential intervention in the distribution of relief resources as they were “picking and choosing who to give” material to, which can lead to “some people [getting] too much” while others do not receive enough. This can be a barrier to proper adaptation and could potentially increase the health vulnerability of those affected by the climate extreme. These extracts suggest that selective or preferential intervention, as well as government control, in terms of resource assistance after a climate extreme can create barriers to proper adaptation or maladaptation, potentially leading to increased health vulnerability to the climate extreme. Some participants also expressed the need for stronger buildings to reduce vulnerabilities to climate risks. Participant 3, displaced within Dominica, suggests “a lot of adjustments need to be made and one of them is [in] housing.” These examples demonstrate very well the political, health and social components of what is qualified a disaster, which should not be reduced to a so-called ‘natural’ event.

Strengths, Limitations and future research

The findings of this study underscore the relevance of exploring and integrating local approaches and knowledge to address climate risks and vulnerabilities, including local adaptive capacity, as a crucial component of building adaptation strategies to climate change in Caribbean SIDS. This study has some limitations that should be considered when interpreting the results. First, the climate change discussions during the interviews resulted in a heightened focus on Tropical Storm Erika, Hurricane Maria and hurricane preparedness and response. These recent climate extremes and their impacts on human mobility did influence research recruitment and participant responses. Hence, we note the strong focus on two climate events. The emphasis was on responding to emergencies and disasters following a storm or hurricane. Thus, this study represents a limited diversity of experiences and situations of vulnerability and risk. Despite these limitations, the study provides valuable insights to inform future adaptation measures from the experiences and perspectives of the participants in this case study and could be transferable to similar islands contexts. To address these limitations and contribute to a more comprehensive understanding of climate change in the Caribbean, future research should explore the social and environmental vulnerabilities and risks in other territories based on other climate-related events (e.g., sea-level rise, heatwaves, flooding). It is crucial to understand the impacts of other climate extremes such as flooding and droughts and slow onset events (e.g., sea-level rise) in diverse Caribbean contexts. Additionally, evaluating the effectiveness of post-displacement interventions and policies is crucial.