The Amazon rainforest may or may not be the “lungs of the world.” But for those who rely on the ecosystem as a source of food, medicine, and home, the current network of wildfires burning in the region is more than a humanitarian crisis – it’s an urgent and potentially devastating health issue. Much of the media coverage of the thousands of fires currently rampaging through Brazil, Bolivia, Peru, and Paraguay has focused, not surprisingly, on their implications for the planet as a whole – in particular, their impact on global climate change. Far from just affecting those in the immediate area, the fires have also had a significant and widespread impact on public health. Media outlets have reported on an increase in hospital visits and respiratory ailments since the fires began. People in at least one affected area were instructed to stay inside and shut the windows against the polluted air. Of course, those same health effects are felt by people living throughout the Amazon, said Rayanne Cristine Máximo França, an indigenous activist and member of the Baré people of the Rio Negro basin, in Portuguese. In addition to her activist work, França is a nurse who researches the impact of environmental injustice on indigenous peoples’ health. But as the fires rage, they also raise the specter of long-term, permanent health consequences for the million indigenous people who make the Amazon rainforest their home. Direct Relief has developed relationships in the region, including with the Ministries of Health of both Bolivia and Paraguay, to facilitate both immediate and long-term care for affected populations. The organization has provided medicines and supplies to a number of South American partners responding to the fires. More than 9,000 fires have been detected in nearly 300 indigenous territories since January of this year, according to the NGO Amazon Watch, which advocates for forest conservation and indigenous rights. Approximately 4,700 sprang up in August alone. The good news about respiratory ailments and other illnesses caused by the fire, said Helen Ribeiro, a professor at the University of São Paulo who studies environmental health, is that they’re largely temporary, although persistent smoke can cause chronic problems. Dangerous changes to way of life, outbreaks of vector-borne disease, and increases in mental health issues, on the other hand, aren’t so easy to get rid of.

The Loss of Land

There are hundreds of indigenous groups currently living in the Amazon region. (Estimates range about 300 to 400.) These groups vary greatly in their practices and relationship with the surrounding ecosystem, according to Zaira Taveira, a social policy analyst for Brazil’s Ministry of Health who works with indigenous populations. However, some facts transcend individual differences. “For indigenous people here in Brazil, health and land are very much related,” Dr. Taveira said. “The relationship they have with nature, water, animals, is a different relationship from ours.” Traditionally, indigenous groups have practiced some combination of small-scale agriculture – often growing crops in small areas of land cleared by controlled fires, a practice that’s gone on for centuries – and hunting and fishing. Already, França said, that system has been significantly compromised. “The entire biological life cycle has been completely affected: the food chains of the animals, the lands where the food was grown will take years to be fertile again, given proper care and management in the coming years,” she said. Large-scale fires can also cause local rivers to be filled with toxins, poisoning fish and contaminating the water that people use for bathing and drinking, according to Christian Poirier, a program director for Amazon Watch. “You’re essentially poisoning yourself and your family, and you’re not able to bathe in this water,” he said. And in addition, said Marcia Castro, a professor who studies global health and tropical disease at Harvard University, the deforestation caused by burning creates an ideal set of conditions for mosquito breeding. “Deforestation is directly connected to malaria,” she said. The problem is so common that scientists have a term for the cycle of deforestation and outbreak: frontier malaria.

The Rise of Chronic Disease

But a loss or compromise of the delicate life cycle França described could also compound a problem that’s already been cropping up in indigenous cultures: the influx of a Western diet, and with it, chronic diseases like diabetes and obesity. Traditionally, Ribeiro said, indigenous populations have been comparatively healthy, although prone to picking up colds or even pneumonia when they deal with outside populations. But “it’s not appropriate to think of them as isolated anymore,” said James Welch, an anthropology researcher at the National School of Public Health in Rio de Janiero. “Some of them are, but most are in some sort of transition toward a rural Brazilian style of life.” In recent years, Welch explained, indigenous households have increasingly received income through social benefits, retirement pensions, and government salaries for teachers and health workers. While that may sound like a good thing, he said, it’s brought “a really dramatic change….people are buying food more than they are gardening or fishing or hunting.” On a worldwide scale, chronic diseases tend to be problems of poverty. “In indigenous populations in Brazil, many times it’s people with money who are suffering from these problems,” Welch said. “They can buy sugar, rice, treats for the kids.” If destructive fires make access to a traditional diet harder to maintain, indigenous groups will be more at risk of developing these chronic conditions.

A Mental Health Issue

Taveira explained that the indigenous people she’s talked to aren’t just thinking about the air quality or the potential for disease. “They have a different perspective,” she said. Maura dos Anjos is a member of the Arapium people living in the Tapajós region of Pará, Brazil – a group confronting a new wildfire that began on September 14, França said. “Knowing that people are at risk of dying because they live near the area that is being devastated by the fire, [knowing the] the animals that live there, the diversity of plants that we are losing, [and] the diversity of birds makes us angry, sad,” she told França, who recorded her comments in Portuguese. The compromise or loss of these meaningful relationships isn’t just an issue of physical health, Taveira said. It potentially affects the mental health of people already in a vulnerable position. “They would just suffer a lot, because of the animals, the relationship they have with the trees,” she said. “For them, it’s more than just getting food out of the forest.”