London has already had its first warning shot of the summer.

In late May, the UK Health Security Agency issued its first amber heat-health alert of 2026, covering London and other parts of England, warning that high temperatures could put vulnerable people at increased risk and that health and social care services needed to prepare. The heat then broke records. Temperatures reached 35.1°C at Heathrow and Kew Gardens, the highest May temperature recorded in the UK.

The media, as ever, reported the whole thing with pictures of young people enjoying the sun and people eating ice creams.

Heat waves such as this are lethal.

The emerging El Nino patterns make an urgent issue much worse

As older people suffer in flats that do not cool down, children’s asthma worsens in hot and polluted air, care homes try to keep residents hydrated, and nurses toil in hospital buildings designed for another climate.

The UK does have a plan for this. The UKHSA Adverse Weather and Health Plan sets out how health and social care, local government, voluntary organisations and communities should prepare for weather-related harm. It is sensible enough as a document, but talking is one thing; walking is quite another.

Much of that ‘walking’ workload will land on nurses.

Climate change is now routinely described as a health emergency, and that is right, although the phrase can still sit rather comfortably above the more awkward practical question of who is expected to notice, absorb and respond to the consequences. In ordinary clinical life, the response begins with someone recognising the heat-exhausted patient before they deteriorate, someone keeping an eye on the older person who lives alone through three hot nights in a flat that does not cool down, and someone noticing that a child’s breathing has worsened because the air outside has worsened too.

In most health systems, that someone is often a nurse.

WHO describes climate change as a threat to the basic conditions for health: clean air, safe drinking water, food and shelter. That is useful because it keeps the issue out of the abstract. Climate change does not only create new problems. It makes old problems harder to manage, and it presses on the bits of the system that were already weak.

Heat makes this obvious. WHO’s heat and health guidance says heatwaves and prolonged excess heat are increasing because of climate change, and that even low and moderate heatwaves can affect vulnerable people. That sounds simple until you imagine the actual shift required.

The UK has already had a small taste of what this means in practice, even if we are still inclined to treat it as an unusual inconvenience rather than a predictable pressure on health services. Older buildings overheat, hospital wards become uncomfortable and sometimes unsafe, and staff respond in the way health workers usually respond when the system has not caught up: they improvise with fans, fluids, ice, opened windows, closed blinds and a fair amount of common sense.

That is something, and it may prevent harm in the moment, although it should not be mistaken for adaptation. It is people making do inside infrastructure built for a climate that no longer quite exists.

In lower-resource settings, the margin is thinner because heat may arrive where clinics already lack reliable electricity, flooding may arrive where roads are already fragile, and drought may arrive where malnutrition is already part of the clinical picture. Climate risk rarely arrives as a neat, single hazard that can be managed in isolation; it tends to turn up alongside the existing failures in housing, transport, staffing, water, food security and access to care, which is why the burden falls so quickly on the people trying to keep services working.

This is why climate health planning has to move beyond risk registers and tidy lists of hazards. A plan that identifies heat, flooding and disease risks is only half useful unless it is equally clear about the workforce expected to respond when those risks become patients, families and disrupted services. Someone has to visit the isolated older person, triage the breathless child, explain to families what deterioration looks like, maintain routine care while emergency work expands, and keep enough of the ordinary health system functioning so that the climate response does not simply consume everything else.

If the answer is “the existing workforce”, then the plan needs to admit what that means.

Nurses already hold together parts of health systems that do not quite work. In many countries they are the most accessible professional group, especially in rural and community settings. They are also the workforce most likely to see the early signs that climate pressure is becoming clinical risk. Heat stress, dehydration, diarrhoeal illness after flooding, missed medicines after displacement, worsening asthma, maternal risk, mental distress after repeated shocks.

The health of Children should make this harder to ignore. UNICEF describes climate change as a major threat to children’s health, nutrition, education, development and survival. Children are less able than adults to withstand extreme weather and are more vulnerable to temperature changes and disease.

That language is grant, but the consequences are ordinary enough to recognise: a child missing school after displacement, a baby with diarrhoea after contaminated water, a teenager anxious after another flood, a child with asthma breathing hotter and dirtier air.

These are not only paediatric problems. They become family problems, school problems, community problems and nursing problems.

Global nursing needs to say this more clearly because climate adaptation is not only about greener hospitals, although health care emissions matter. Adaptation is also about whether nurses are educated, staffed and supported to deliver care in a changing climate. A carbon plan without a workforce plan is useless.

This is where global health language becomes slippery. We talk about resilient systems as if resilience is something that can be written into a strategy. In practice, resilience often means people absorbing more than they should. Nurses are told to adapt. Communities are told to cope. Facilities are told to prepare. Then the heatwave, flood or outbreak arrives, and the same thin workforce is expected to make the plan real, often from a standing start.

I am not against plans. I have seen enough chaos to appreciate a decent one. The problem is the gap between a plan and the conditions needed to deliver it. A climate health plan that does not reach the rota, the curriculum, the placement, the medicine supply chain, then it is worthless.

Nursing education has to catch up with this as it is clear climate change cannot sit as a decorative lecture somewhere near the end of a public health module. It needs to be woven into the practical formation of nurses. What does heat illness look like in an older adult? How does flooding change infection risk? What happens to long-term medication when families are displaced? What does safe care look like when a clinic loses power?

Many years ago I worked in South Sudan and watched as carefully applied wound dressings washed away as the population walked home from the clinic through a series of knee-deep rivers, without the tools to adapt; I fear our efforts were often undone by the water that surrounded us.

There is also a leadership issue. Nurses are often close enough to see what is changing, but not always powerful enough to shape the response, hardly unique to this topic. The people who understand the practical system are consulted late, asked to implement quickly, and then blamed if reality refuses to match the plan.

Climate adaptation will fail if nurses are treated only as delivery staff. They need to be involved in risk mapping, service design, education planning, emergency preparedness and community communication. That is not because nurses are morally better than anyone else. It is because they know where the plan on paper will fall apart in reality.

In conflict-affected and fragile settings, climate risk does not wait politely behind political crisis. Floods hit displaced populations. Heat affects people living in temporary shelters. Drought worsens malnutrition. Disease patterns shift while surveillance systems are already weak. Nursing staff are then expected to continue care with fewer supplies, less security and less support.

It is also the places facing the greatest climate health risks that are often not the places most responsible for creating them. They are also often the places with the least spare workforce capacity to respond. When global climate finance talks about health adaptation, nursing should be in the middle of the conversation.

That means investing in community nursing, public health nursing, emergency preparedness, infection prevention, mental health support, maternal and child health, and the education systems that produce nurses capable of working in more unstable conditions. It means protecting nurses during disasters and conflict.

It means designing facilities where staff and patients can survive heat.

The phrase “emerging infection” can make an outbreak sound like a biological event first and a systems problem second. The two outbreaks that raced across our newsfeeds this week show something more.

In one setting, there is testing, quarantine, repatriation, monitoring, and a public health machinery that moves quickly. In another, health workers lack masks, transport, basic medicines and enough staff to keep services open, they are dying as a result. The virus matters, but the response is more clearly shaped by the system it lands in.

This week gives us two very different examples.

In the Democratic Republic of the Congo and Uganda, the WHO has declared an Ebola disease outbreak caused by Bundibugyo virus (Also known as Ebola) a Public Health Emergency of International Concern. WHO was alerted on 5 May 2026 to a high-mortality illness in Mongbwalu Health Zone in Ituri Province, DRC. The outbreak includes deaths among health workers, and the WHO has specifically noted that the infection and death of four healthcare workers within four days at Mongbwalu General Referral Hospital point to serious infection prevention and control breaches.[

At the same time, a hantavirus cluster linked to the MV Hondius cruise ship has produced a very different public health response: laboratory investigation, contact monitoring, quarantine, repatriation arrangements and international coordination across several countries. WHO reported severe respiratory illness cases aboard the ship in early May, with testing confirming Andes virus infection. The CDC later confirmed that 18 recently repatriated US passengers had been asked to remain at the Nebraska Quarantine Facility until 31 May 2026, the 21-day mark of their monitoring period.

The temptation is to write about these as two scary viruses, but Ebola and hantavirus are not the same problem. Ebola spreads through direct contact with the blood or body fluids of symptomatic patients and has a long history of transmission in health facilities. The Andes virus (hantavirus) is unusual because person-to-person transmission is rare. However, the wider public health risk in the current cruise ship outbreak has been described by WHO as low.

One outbreak is unfolding in conflict-affected central Africa, where responders are dealing with deaths among health workers, uncertain spread and shortages of basic supplies. The other is linked to a cruise ship, where passengers can be traced, repatriated and monitored through formal systems with a level of logistical capacity that most outbreak responses can only envy.

Reuters reported that first responders in the DRC were short of basic supplies, including pain medicine, masks, and motorbikes for contact tracing. Without wishing to state the obvious, a contact tracer without transport is not a contact tracer in any useful sense.

A nurse without protective equipment is at an exceptionally high risk. A facility without basic infection prevention is not simply under-resourced; it can become part of the chain of transmission. The damage beyond those suspected of having the virus and the delays in care can be colossal.

In outbreaks, nurses are not a decorative part of the response. They are usually the people closest to the risk - Triaging the fever, liaising with close contacts, and cleaning up infectious body fluids.

When health workers die early in an outbreak, it is not only a personal tragedy; it is a screaming warning about the system. It tells us something about training, supervision, protective equipment, water and sanitation, triage, isolation, staffing and trust.

The hantavirus outbreak on the cruise ship shows another side of outbreak management. Here, the issue is less about the collapse of basic infection prevention and more about public health logistics. Who was exposed? Who needs monitoring? Who can travel? Where can people be safely quarantined? Who explains the risk without turning uncertainty into a macabre theatre?

To move away from the more sensationalist to, for me, the central question - why some outbreak responses have transport, testing, quarantine capacity and international coordination, while others are still asking for masks and motorbikes?

We are very good at saying that pathogens do not respect borders. We are less good at admitting that outbreak response capacity is profoundly affected by the places immediately at risk, the countries where it is detected, and often, the nationalities of the people it kills.

A cruise ship outbreak involving international passengers triggers a certain machinery. An outbreak in a conflict-affected health zone in the DRC triggers another, slower and far less effective one.

That does not mean wealthy countries should ignore imported risk and wait until an outbreak becomes their problem. It should mean the opposite, if the world wants early containment, it has to fund the basic infrastructure that makes it possible. Surveillance does not begin with a dashboard in Geneva.

It begins with a nurse who spots a symptom or a pattern among patients, a laboratory that can process a sample, a vehicle that can reach a village, a facility that can safely isolate, and a workforce that trusts it will not be left to cope with the pathogen unprotected.

The Global Preparedness Monitoring Board has again warned that preparedness reforms have not kept up with pandemic risk.

Nursing has a dog in this race because outbreak response relies on forms of work that are often poorly valued until they fail. Infection prevention is not glamorous. Triage is not glamorous. Cleaning, waste disposal, donning and doffing, explaining isolation, monitoring contacts, and maintaining records do not gain world attention in the way a scary, uncontrollable virus does.

Ebola has taught this repeatedly. Health facilities can save lives, but they can also amplify transmission if the basics are missing. That is not a criticism of individual nurses. It is the predictable consequence of asking staff to manage high-risk care without the conditions required to do it safely.

Hantavirus teaches a different lesson: when we really want to do outbreak control properly, we can. Still, good quality nursing, from the first nurse on the cruise ship all the way along the chain, is essential and demands effective funding.

The danger is that we talk about nurses in outbreaks only when they become symbols: brave nurse, fallen nurse, heroic nurse in PPE. It’s not difficult to see why, but it would seem preferable to focus on what would have kept the nurse safer before bravery became necessary.

International Nurses Day is meant to make nursing visible. It often does this through familiar language about gratitude, contribution, and skill; a word salad of positive vibes.

Look at almost any social media post about nursing, and you will see pictures of diverse nursing teams, often with specific reference to the global nature of the workforce. This did not happen overnight and it did not happen by accident.

Wealthy health systems have relied on internationally educated and experienced nurses for years, often while speaking warmly about partnership with the countries those nurses leave behind. Nurse migration can be good for individual nurses. It can also expose the utter failure of destination countries to educate and retain enough staff of their own.

In the UK, Health and Care Worker visas issued to nursing professionals fell from around 26,100 in 2022 to 1,777 in 2025, a fall of about 93%. The route that once brought more than 26,000 nursing professionals in a year is now producing fewer than 2,000.

The UK is one example of a wider pattern. High-income countries have treated international recruitment as a pressure valve for domestic workforce failure. When services were short, recruitment expanded. When migration became politically difficult, the route narrowed. The result is nurses left in limbo, source countries unable to employ all the staff they have trained, and destination countries behaving as though workforce supply can be switched on and off.

Ghana shows why rich nations switching the vacuum off and on again is so bad for everyone. In 2025, Ghana’s Ministry of Health confirmed that more than 100,000 trained health professionals were unemployed, including nurses and other licensed staff, largely due to insufficient financial resources for employment. At the same time, Ghana remains a country with serious health workforce pressures, and its government has explored managed migration agreements with countries including the UK, the US, Jamaica, and Barbados, but that clearly isn’t going to work overnight. In the meantime, a globe with a nursing shortage has thousands of degree-qualified nurses making cappuccinos.

That is the damage caused by the current model. A country may decide to expand nurse training because it has real health workforce shortages, because students see nursing as a route into secure work, and because overseas recruitment has made nursing education appear to be a viable investment for the country. The country may educate nurses to meet long-term workforce needs, replace staff lost to migration, or expand access to care.

Why would they do this if they weren’t sure they could employ them?

Bluntly, because we live in an age of short-term governmental thinking and because education programs are often easier to fund and politically easier to announce than recurrent salaries, funded posts, and functioning long-term workforce planning systems.

This represents the arrival of a problem that seemed very far away, when, in many cases, a previous administration decided to open the tap on nursing education without a plan for where all the water would go, but with clear assurances that richer nations would employ a sizable proportion.

But when the destination-country route narrows, often through horrible immigration ‘island of strangers’ type narratives, the individual nurse is left between two failures: no funded job at home and no stable route abroad.

The Philippines has lived with a version of this problem for decades. It has trained nurses for a global market, and many Filipino nurses have built careers in destination countries. Their movement has brought income, professional opportunities, and remittances. It has also made the Philippines central to rich-country workforce planning in a way that should make those countries stop and think, what happens when we treat three and four-year nursing education programmes as a vacuum we can turn off and on.

The Nursing and Midwifery Council has reported this vacuum-on, vacuum-off effect in its numbers. In December 2025, it said growth of the register had slowed significantly because of a sharp fall in international recruitment. During the April to September periods from 2021 to 2024, international joiners made up around half of new recruitment to the register. From April to September 2025, they made up 25.8%.

Canada is working through a version of the same problem. Its federal government says the health workforce has faced shortages for some time and has invested in faster integration of internationally educated health professionals. That may be sensible policy if you are Canada’s Ministry of Health but also shows how quickly wealthy systems reach for overseas-trained staff when domestic supply falls short. The vacuum that was off is now on again.

Australia tells a similar story. The government has been developing a National Nursing Workforce Strategy, using modelling to understand workforce supply and demand over the next 12 years. At the same time, registration reform has created a faster route for internationally qualified nurses from comparable countries.7 Workforce strategy sits beside accelerated international recruitment because services need staff now.

Nursing is a global profession. The point is not that the UK, Canada or Australia should stop recruiting internationally. The point is that this model becomes fragile when wealthy systems assume the global workforce will keep absorbing their planning failures. Destination countries should also pay properly towards the education systems that produce the nurses they recruit (more on that in another post)

Put at its most basic, why should the people of, to pluck an example, Uganda pay to educate nurses whose clinical careers may then benefit the UK/Canada/Australia, when we screwed up our workforce planning?

WHO’s State of the World’s Nursing 2025 report says the global nursing workforce grew from 27.9 million in 2018 to 29.8 million in 2023, while distribution remains deeply unequal. The same report projects a global shortage of 4.1 million nurses by 2030 if current trends continue.

Those numbers should sit uneasily beside any simple claim that high-income countries are merely filling their own gaps. The world does not have a spare nursing workforce waiting at the airport when rich countries get a bit short. It has nurses making choices inside unequal systems. These are choices that the vast majority of us would make if we were in similar circumstances.

The ethical argument is often handled as if a code can tidy it away - ‘we don’t actively recruit from Red List countries’ is, frankly, doublespeak.

Responsible recruitment codes matter; do not remove the central problem: a high-income country that fails to plan and turns its global recruitment vacuum on and off haphazardly causes damage far beyond its borders.

That is hard to square with the language of gratitude when it looks a lot more like asset stripping. No amount of International Nurses Day messaging fixes that.

To be clear, there is no fully correct version of the world map. I am willing to concede that any two-dimensional representation of a three-dimensional globe will have to make some compromises.

The Mercator version, which adorns our schools, offices and homes, was designed largely for navigation and does an exceptionally bad job of showing the countries of the world as they really are. Mercator’s projection champions direction, but it severely distorts land area, especially the further you go from the equator.

Greenland can appear similar in size to Africa. In reality, Africa is around fourteen times larger.

If we can misread something as basic as the size of countries in our world, we should be careful about the other assumptions we carry into global health and nursing.

Global nursing has its own maps. They are less visible, but they shape how we think. They tell us where knowledge sits, where expertise comes from, where problems are located and where solutions are expected to begin.

These maps are often wrong too.

Much of global nursing still works from assumptions that are rarely examined. Some countries are treated as natural sources of expertise. Others are treated as sites of need. Some nurses are invited to teach, but others are invited to describe hardship.

Distorted assumptions sit inside curricula, conferences, funding models, authorship patterns and the language of international work. They sit inside words that sound reasonable: support, capacity building, technical assistance, partnership.

Capacity building is a useful example. The phrase often starts from a deficit assumption. It implies that capacity exists in one place and needs to be transferred somewhere else. Sometimes that may be true, but it is rarely the whole story. Sometimes it is simply wrong.

Nurses working in low-resource settings, crisis-affected systems, rural services, overcrowded hospitals or politically unstable environments often develop highly sophisticated forms of judgement, improvisation, leadership and professional discipline.

Their expertise may not always be written up in the journals we read. It may not sit inside the regulatory frameworks we recognise. It may not be described using the language of quality improvement, implementation science or systems strengthening.

That does not make it less important.

A distorted map can be very misleading in ways that go beyond the relative size of each country. It makes some places look larger than they are, and in doing so, it makes others look smaller.

The same thing happens in nursing.

If UK nurses are educated mainly through UK examples, UK regulatory assumptions, UK workforce debates and UK models of practice, familiarity can start to look like universality. We may know that nursing is practiced differently across the world. That is not the same as understanding it. It is certainly not the same as allowing it to change how we think.

Global nursing should therefore begin with more humility.

It requires us to notice when one part of the world is treated as the default and another as the variation. It requires us to ask who sets the agenda before we praise the partnership. It requires us to be more careful about what we think we know before we arrive.

Weak global understanding leads to weak global engagement.

For those of us in Europe we can easily overestimate what we can offer and then underestimate what we need to learn. Too many times, we design interventions and programmes around our own interpretation of what we think we see and then wonder why they do not sustain after we have gone.

We use the language of partnership while retaining control of the money, the agenda, the authorship and the microphone. Calling it a partnership does not make it so.

For global nursing, humility should be a professional discipline.

Before we teach, we should ask what we have failed to understand.

Before we build capacity, we should ask what capacity is already there.

Before we describe a problem, we should ask who has already defined it differently.

Before we claim a partnership, we should ask who holds power when decisions become difficult.

The world map most of us learned has shaped what we see.

Global nursing should care because the same is true of the professional maps of the assumptions we still use