Hospital Decarbonization : International Climate Obligations and Implementation in Indonesia
Keywords:
Climate Justice, Comparative Legal Analysis, Hospital Decarbonization, Health Environmental Law, International Climate Obligations, Indonesia, MRV, Net-Zero EmissionsAbstract
Climate change is a global health threat, yet health systems also contribute significantly to greenhouse gas (GHG) emissions. Hospitals, as centers of energy consumption, supply chains and medical waste management, are a critical node in the decarbonization of the health sector. This article analyzes how international climate obligations and global technical standards can be translated into an effective and just national legal framework to drive the transition of hospitals toward net-zero emissions in Indonesia. The research employs a normative juridical method with a comparative approach, examining (i) international climate instruments and the evolving interpretation of state obligations, (ii) sustainability regulation and accountability practices in developed jurisdictions, and (iii) Indonesia’s sectoral regulations and guidelines on climate-resilient health facilities. The analysis identifies three major gaps: weak mandates for reporting and emission audit standards for hospitals; fragmented enforcement across health and environmental institutions; and limited capacity and access to transition financing. This article proposes an integrative governance design and a 2025-2045 roadmap that positions measurement-reporting-verification (MRV), carbon economic instruments and the principle of Just Transition as prerequisites for hospital decarbonization without compromising service access and the protection of medical and health workers.
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References
Abel, Andrew and others, ‘Emissions and Energy Use Reporting by Hospitals in the United States’, INQUIRY: The Journal of Health Care Organization, Provision and Financing, 61 (2024) https://doi.org/10.1177/00469580241304309
Adeniran, Adiyemi A., and others, ‘The Enforcement of Environmenttal Laws in Developing Countries: Challenges and Prospects’, Journal of Business and Social Science Review, 4.6 (2023), 34 – 52 https://bpasjournas.com/library-science/index.php/journal/article/download/1168/2226/4997
ATACH Community, ‘Lao PDR: Integration of Health in NDCs’ 11 November 2025, https://www.atachcommunity.com/our-impact/case-studies/lao-pdr-integration-of-health-in-ndcs
Bhopal, Anant and others, ‘Fair Pathway to Net-Zero Healthcare’, Nature Medicine, 29 (2023), 1087-93 https://doi.org/10.1038/s4191-023-02351-2
Bipartisan, Anant and others, ‘Fair Pathway to Net-Zero Healthcare’, Nature Medicine, 29 (2023), 1087-93 https://doiorg/10.1038/s41591-023-02351-2
Bodansky, Daniel, ‘The Legal Charactre of the Paris Agreement’, Review of European, Policy and Planning, 39. Suppl 3 (2024), iii6 – iii17 (pp. iii10 – iii12) https://doi.org/10.1111/reel.12154
Carbon Brief, ‘What the World Court’s Landmark Opinion Means for Climate Change’, 27 July 2025 https://www.carbonbrief.org/icj-what-courts-landmark-opinion-menas-for-climate-change/
Devex, ’Here’s How Much Is Needed to Meet SDGs’ Global Health Targets by 2030’, 20 July 2017 https://www.devex.com/news/here-s-how-much-is-needed-to-meet-sdgs-global-health-targets-by-2030-90693
Eckelman, Matthew J., and others, ‘Health Care Pollition and Public Health Damage in the United Stated: An Update’, Health Affairs, 39.12 (2020), 2071-79 https://doi.org/101277/hlthaff.2020.01247
European Commission, ‘Corporate Sustainability Reporting Directive (CSRD)’, Directive (EU) 2022/2464 (Brussels: European Commision, 2022) https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32022L2464
Foster, Caroline E., ‘The 2025 International Court of Justice Advisory Opinion on Obligations of States in Respect of Climate Change’, International and Comparative Law Quartely, FirstView (published online 4 January 2026), 75.1, 1–35 https://doi.org/10.1017/S0020589324000137.
Government of Lao PDR, Health National Adaption Plan (H-NAP) (Vientiane: Government of Lao PDR, 2021), pp. 26 – 29 Ministry of Health, 2024) https://www.atachcommunity.com/fileadmnin /uplpads/atach/Documents/Country_documents/LAO_HNAP_2024.pdf
----, Nationally Determined Contribution (NDC) 2.0 (Vientiane: Ministry of Health, 2024
Grabs, Janina, and others, ‘The effectiveness of Private Sustainability Standards: A Systematic Review of Rigorous Evidence’, Environmental Research Letters, 18.6 (2023), 063004 https://doi.org/10.1088/1748-9326/acd207
Green Climate Fund, ‘Accreditation: Overview; 16 November 2025 https://www.greenclimate.fund/accreditation
----, Annex IV: Accreditation Framework of the GCF, Decision B.31/14 (October 2024), paras 17 – 20, 48 – 51 https://www.greenclimate.fund/sites/default/files/decision/ b31/decision-b31-06-b31-a04.pdf
----, ‘SAP030: Strenghening Climate resilience of the Lao Health System – Project Document’ (October 2023), Section E.6.1 https://www.greenclimate.fund/ project/sap030
Hare, Darragh and Max Harwood, ‘Financing Climate Change Adaptation in the Healthcare Sector;, Yale Global Health Review, 17 May 2015 https://yaleglobalhealththreview.com/2025/05/18/financing-climate-change-adaptation-in-the-healthcare-sector
Hough, Emily and others, ‘Supporting Decarbonization of Health Systems: A review of National Commitments, Policies and Actions’, BMC Public Health, 24 (2024), 420 https://doi.org/10.1186/s12889-024-17917-y
Indonesia, Enhanced Nationally Determined Contribution (Jakarta: Ministry of Environment and Forestry, 2022) https://unfccc,int/sites/efault/files/NDC/2022-09/23.09.2022_Enhanced %20NDC%Indonesia.pdf
----, Peraturan Pemerintah Nomor 26 Tahun 2025 tentang Perencanaan Perlindungan dan Pengelolaan Lingkungan Hidup, Lembaran Negara Republik Indonesia Tahun 2025 Nomor 96
----, Peraturan Presiden Nomor 110 Tahun 2025 tentang Penyelenggaraan Instrumen Nilai Ekonomi Karbon dan Pengendalian Emisi Gas Rumah Kaca Nasional, Lembaran Negara Republik Indonesia Tahun 2025 Nomor 172
International Court Of Justice, Obligations of States in Respect of Climate Change (Request for Advisory Opinion), Advisory Opinion, 23 July 2025, ICJ report 2025 https://www.icj-cij.org/case/187
International Energy Agency, Life Cycle Upstream Emission Factors 2024 (Paris: IEA, 2024), p. 3 https://iea.blob.core.windows.net/assets/62c02614-3753-4816-b5f8-2206ecf356f0/IEAupstreamlifecycleemissionfactors_2024.pdf
International Hospital Federation, Accredtation and Certification’, in Geneva Sustainability Centre (Geneva: IHF, 2025) https://ihf-fih.org/what-we-do/geneva-sustainability-centre/sustainability-standards/
Jacur, Francesca Romana.’Climate Change and Corporate Accountability: What the ICJ Advisory Opinion Means for Business and Human Right’, Business and Human Rigth Journal Blog, 26 August 2025 https://bhfj.blog/2025/08/27/climate-change-and-corporate-accountability-what-the-icj-advisory-opinion-means -for-business-and-human-right/
Joint Commission International, Accreditation Standards for Hospitals, 8th Edition (Oak Brook, Terrace, IL: Joint Commission International, 2024) https://store.jointcommissioninternational.org/joint-commision-international-standards-for-hospital -8th-edition/
Karliner, Joshua, and others, Global Road Map for Health Care Decarbonization: A Navigational Tool for Achieving Zero Emissions with Climate Resilience and Health Equity (Reston, VA: Health Care Without Harm, 2021), pp. 6, 13 - 15 https://healthcareclimateaction.org/roadmap.
----, Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action (Reston, VA: Health care Without Harm and Arup, 2019), p. 6 https://global.noharm.org/sites/default/files/documents-files/5961/HealthcaresClimateFootprint_092319.pdf
Kementerian Kesehatan Republik Indonesia, Pedoman Penilaian Fasilitas Keseahatan Berketahanan Iklim dan Lestari Lingkungan di Indonesia (Jakarta: Kementerian Keseahatan RI, 2020) https:///kemkes.go.id/pedoman-penilaian-fasilitas-kesehatan-berketahanan-iklim-lestari-dan-lingkungan
Kesek, Megawati N, ‘The Role of Environmental Law in Addressing Climate Change in Indonesia: An Assessment of Enforcement Mechanisms and Compliance Behavior’, Indonesian Journal of Business Law and Entrepreneurship, 6.2 (2025), 1265-93 (pp. 1270, 1276-78) https://ijble.com/index.php/journal/article /download/1179/1044
Khanal, Syam and others, ‘Exploring Barriers and Facilitators to Integrating Health Equity within Climate Change-Related Policies at the Federal Level in Nepal’, Environmental Health, 24 (2025), 42, pp. 6 – 8 https://doi.org/10.1186/s12940-025-01230-y
Khogali, Aisha and others, ‘The Impact of Electrification on Health Outcomes in Low-and Midle-Income Countries: A Systematic Review’, Health & Place, 74 (2022), 102766 (p.2) https://doi.org/10.1016/j.healthplace.2022.102766
Less, Emma and Jorge E Vinuales, ‘Historic International Court of Justice Opinion Confirms States’ Climate Obligations’, IISD, 23 July 2025 https://www.iisd.org/articles/dee-dive/icj-advisory-opinion-climate-change
Lenzen, Manfred and others, ‘The Environmental Footprint of Health Care: A Global Assessment’, The Lancet Planetary Health, 4.7 (2020), e271-e279 (p. 2275) https://doi.org//10.1016/S2542-5196(20)30121-2
Malerba Daniele, ‘Just Transitions: A Review of How to Decarbonise Energy System while Addressing Poverty and Inequality Reduction’, IDOS Discussion paper 6/2022 (Bonn: German Development Institute/Deutsches Institut fur Entwicklungspolitik, 2022), pp. 3 – 5 https://doi.org/10.23661/dp6.2022
Mayer, Benoit, ‘Article 4: Mitigation’, in The Paris Agreement on Climate Change: Analysis and Commentary, ed.by Daniel Klein and others (Oxford: Oxford University Press, 2017), pp. 103-20, paras 4.09 – 4.12, 4.18 https://benoitmayer.com/wp-content/uploads/2021/03/PA-art-4-commentary.pdf
----, ‘Doing the Utmost’: Due Diligence as the Standard of Conduct in International Climate Law;, Columbia Law Scool Climate law Blog, 3 September 2025 https://blogs.law.columbia.edu/climatechange/2025/09/03doing-the-utmost-due-diligence-as-the-standard-of-conduct-in-international-climate-law
Merner, Delta, ‘Five Reasons Why the ICJ Climate Advisory Opinion Matters’, Union of Cocerned Scientists Blog, 22 July 2025 https://blog.ucs.org/delta-merner/five-reasons-why-the-icj-climate-advisory-opinion-matters
NHS England, Building Net Zero into NHS Procurenment – The Supplier Roadmap (London: NHS England, last updated August 2022) https://www.lpp.nhs.uk/media/477397/Net-Zero-Suplier-Roadmap.pdf
----, ‘Carbon Reduction Plan and Net Zero Commitment for the Pronurement of NHS Goods, Services and Works’, 13 February 2023 https://www.england.nhs.uk/long-read/carbon-reduction-plan-requirements-for-the-procurement-of-nhs goods-services-and-works/
----, Delivering a ‘Net Zero’National Health Service (London: NHS England, 2020), pp. 6 – 9 https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/ 2020/10/delivering-a-net-zero-national-health-service.pdf
----, “National Ambitioan: Our Journey to Net Zero’, 2021 https://www.england.nhs.uk/greenernhs/national-ambition/
NHS Knowledge and Library Services, ‘NHS and Sustainability’, 7 May 2025 https://library.nhs.uk/about/sustainability/nhs-and-sustainability
OECD, Decarbonising Health Systems Across OECD Countries (Paris: OECD Publishing, 2025) https://doi.org/10.1787/5ac2b24b-en
----, Measuring Greenhouse Gas Enission in the Halth Sector (Paris: OECD Publishing, 2025) https://doi.org/10.1787/59643a96-en
Obligations of States in respect of Climate Change (Advisory Opinion), 23 July 2025, ICJ General List No. 187.
Owley, Jessica, ‘The Paris Agreement Compliance Mechanism’, University of Miami International and Comparative Law Review, 11.1 (2021), 152 – 71 (pp. 155 – 58) https://resposity.law.miami.edu/cgi/viewcontent.cgi?article=2034&context=fac_artcles
PwC Indonesia, Indonesia Carbon Market White Paper (Jakarta: Pwc, 2024), p.7 https://www.pwc.com/id/en/publications/esg/indonesia-carbon-market-white-paper.pdf
Quitmann, Charlote and others, ‘Assessing Greenhouse Gas Emission in Hospitals: Methodological Chalengges and Solutionas;, The Journal of Climate Change and Health, 21 (2025), 100364, pp. 3 – 5 https://doi.org/10.1016/ j.joclim.2024.100364
Rasheed, Fawzia Niat and others, ‘Decarbonising Healthcare in Low and Middle Income Countries: Potential Pathways to Net Zero Emissions’, The BMJ, 375 (2021), n1284 https://doi.org/10.1136/bmj.n1284
Raza, Muhammad Azhar and others, ‘Managing the Laow Carbon Transition Pathways Through Solid Waste Electricity’, Ssientific Report, 14 (2024), 5225, Table 2 https://doi.org/10.1038/s41598-024-55283-9
ReliefWeb, ‘WHO Guidance for Climate Resilient and Environmentally Sustainable Health care Facilities’, 12 October 2020 https://reliefweb.int//report/world/who-guidance-climate-resilient-and-environmentally-sustainable-health-care-facilities
Romanello, Marina and others, ‘ The 2022 Report of the Lancet Coundown on Health and Climate Change: Health at the Mercy of Fossil Fuels’, The Lancet, 400.10363 (2022), 1619 – 54 (p. 1643) https://doi.org/10.1016/S0140-6736(22)01540-9
Save the Childen UK, “Major New Programme to Support a Fifth of Southern Malawi’s Population to Tackie Climate-Induced Health Risks’, 22 October 2024 https://www.avethechildres.org.uk/news/media-centre/press-releases/2024/major-new-climate-programme-in-malawi-announced
SSEK law Firm, ‘Climate Regulations in Indonesia’, 18 September 2023, pp. 3 6
Tigre, Maria Antonia, ‘The ICJ’s Historic Advisory Opinion: A New Era for Climate Justice?’, Sciences Po Chair for Sustainable Development, 24 August 2025 https://www.sciencespo.fr/psia/chair-sustainable-development/2025/08/25/the-icjs-historic-advisory-opinion-a-new-era-for-climate-justice/
Frauendorfer, Julia, ‘From de Jure to de Facto Transparency: Analysing the Implementation Gap in Freedom of Information laws’, Regulation ^ Governance, 19.4 (2025), 1081 – 1100 https://doi.org/10.1111/rego.12615
United Nations, Paris Agreement (adopted 12 December 2015, entered into force 4 November 2016), UNTS 3156, arts 2(1)(a), 4 (2) https://unfccc.int/process-and-mettings/the-paris-agreement
University of California San Francisco, Improving Investments in Climate Change and Global Health (San Fransico: UCSF Global Health Sciences, 2023), pp. 5 – 7 https://globalhealthsciences.ucsf.edu/wp-content/uploads/2023/11/climate_and_health-finance_finanl.pdf
Van Asselt, Haroo, ‘The Private Life of the ICJ Advisory Opinion on Climate Change’, Volkerrechtsblog, 14 August 2025 https://voelkerrechtsblog.org/the-private-life-of-the-icj-advisory-opinion-on-climate-change
WHO Lao PDR, ‘ Lao PDR Strengthens Health Commitment to Climate Change in Nationally Determined Contributions (NDC 3.0)’, 2 August 2025 https://www.who.int/laos/news/detail/03-08-2025-lao-pdr-strengthens-health-commitments-to-climate-change-in-nationally-determined-contributions-ndc-3-0
Wild, Katherine and others, ‘Balancing Short-Term and Long-term Climate-Health Wquity in Mitigation and Adaptation Strategies’, Journal of Public Health, 47.1 (2025), e135 – e146 https://doi.org/10.1093/pubmed/fdae334
World Bank, Environmental and Social Systems Assessment (ESSA): Indonesia – Supporting Primary Health Care Reform (Washington, D.C: World Bank, 2018), pp. 31, 45 – 47 https://documents1.worldbank.org/curated/en/9770115227489817004/pdf/ Environmental-and-social-system-assessment.pdf
World health Organization, 2023 WHO review of Health in Nationally Determined Cntributions and Long-Term Stratergies (Geneva: WHO, 2023), pp. x, 6 – 8 https://cdn.who.int/media/docs/default-source/climate-change/979924007 4729-v2.pdf
----, Draft Global Action Plan on Climate Change and Health (Geneva: WHO, 2025), para 32 https://apps.who.int/gb/ebhha/pdf_files/AHA78/A78/A78_4Add2-en.pdf
----, Primary Health Care on the Road to Universal Health Coverage: 2019 Global Monitoring Report (Geneva: WHO, 2024), pp. 10 32 https://www.who.int/media/docs/default-souce/documents/2019-uhc-report.pdf
----, Quality Criteria for Intergrating Health into Nationally Determined Contributions (NDCs) (Geneva: WHO, 2024), pp. 10 – 32 https://cdn.who.int/media/docs/default-source/environment-climate-change-and-health/quality-criteria-for-integrating-health -in-ndcs.pdf
----, WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Fasilities (Genewa: WHO, 2020) https://iris.who.int/bitstream/handle/10665/ 335909/9789240012226-eng.pdf
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Copyright (c) 2026 Kana Purwadi, Ade Maman Suherman, Sulistyadari Sulistyadari, Siti Kunarti, Hajar Salamah Salsabila Hariz
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