Climate change, health inequities, and system gaps in marginalized Bedouin communities

Abstract

Abstract Background Climate change is a growing public health challenge, with unequal impacts across populations. In the Negev, rising temperatures and extreme weather intersect with entrenched structural inequalities. Marginalized Bedouin communities, particularly in unrecognized villages, face disproportionate health risks due to inadequate infrastructure, limited access to healthcare and social services, and exclusion from decision-making processes. Objectives To examine how Bedouin communities experience climate-related health impacts, identify structural and system-level barriers shaping vulnerability, and develop a policy-relevant framework for equitable climate adaptation. Methods A qualitative study including ten focus groups with Bedouin residents (n≈57) and thirty semi-structured interviews with healthcare providers, welfare professionals, policymakers, and community leaders. Data were analysed thematically to identify structural and system-level drivers of vulnerability. Results Climate change is experienced not only as an environmental phenomenon but as a socially and structurally mediated process shaping health inequities. Three dimensions emerged: (1) structural–environmental vulnerability, including inadequate infrastructure, limited access to services, and institutional mistrust; (2) intersectional vulnerabilities, reflected in disruptions to daily life and barriers to care during extreme events; and (3) community resilience, grounded in social solidarity and local knowledge, yet constrained by limited institutional recognition. Together, these findings reveal a misalignment between community needs and system responses. Conclusions Climate-related health vulnerability is shaped by structural inequalities and system gaps. Effective adaptation requires policy action addressing infrastructure gaps, improving equitable access to services, strengthening system preparedness, and integrating community knowledge into inclusive responses. Key messages • Climate change is not a standalone phenomenon but an intersection of structural inequalities and system gaps shaping health risks. • Effective policy requires moving beyond reactive responses toward equity-focused, system-level climate adaptation.