Decarbonisation is essential to limiting the electricity sector’s contributions to CO2 emissions. Simultaneously, there is recognition of the need to increase electricity access in many parts of sub-Saharan Africa, such as in Malawi, with renewable energies suggested as capable of meeting these needs. However, the drive for low carbon electrification, especially in settings where biomass use for cooking is widespread, may act as a driver of new and intersecting injustices. The energy justice framework is well posited to recognise injustices which emerge across energy supply chains, though existing analysis has typically focused on single energy systems. In order to capture injustices emerging in settings of dual biomass use and hydroelectricity generation, it is necessary to consider how energy systems impact on both human health (e.g. air pollution from biomass burning) and the functionality of ecosystems (through deforestation and resulting siltation of rivers). Thus, we argue for an Ecohealth approach to energy justice research, drawing on evidence from Malawi’s transition towards electrification.