India’s Health Systems Need To Prepare Better For Rising Climate Risks

Palghar, a district where 37% of the population is tribal, is located along the coast of Maharashtra. It witnessed heavy rains in July, following which the India Meteorological Department issued an orange alert. The waters have receded since, but Kamble and the auxiliary nurse midwife (ANM) she reports to are dealing with the aftermath.

“Now we are seeing stage two diseases,” remarked the ANM, who does not wish to be named. The stages are not officially recognised, and her remark is based on 26 years of experience, as she explains.

“First, the water disrupts all the services, so we are unable to distribute the rations and medication. The women under our care are cut off because of the water all over, so their health deteriorates, and sometimes the pregnant women among them develop complications. That is stage one.” Stage two, according to her, is when people fall sick due to drinking from contaminated water sources. Then come the vector-borne diseases that happen after the rains stop.

Her observation about the changing seasonality of malaria is visible in the data: the total positive cases in Maharashtra in April 2025 were higher than the three-year average.

Palghar recorded 97 malaria cases in 2023, a small number compared to neighbouring Mumbai where 7,319 people contracted the mosquito-borne disease in the same year. The ASHAs, who are not paid employees of the state, along with the multipurpose health workers, go door to door looking for puddles of water around potted plants or under refrigerators that can serve as breeding sites for mosquitoes.

These observations about health impacts are echoed by research in recent years. For instance, a 2020 paper by researchers from Canada describes the short term and long term impacts of floods worldwide, and lists gastrointestinal and vector-borne diseases as the immediate effect of floods. Flood survivors also report mental health issues in the long run.

Frontline health workers typically do not look at the mental health impact. “I don’t want to call it post-traumatic stress disorder, but any mental health problem is not a priority for the ASHA workers at the moment because their training does not cover it,” says Sandeep Ghosh, executive director of the Development Intelligence Unit, a repository of data on rural health and education.

Aware that the new pattern needs to be dealt with differently, Kamble says she and other ASHAs in her block report the demands of the people in their care faithfully to those in authority. “If they tell me what to do and when to do it, why wouldn’t I?”

As extreme rainfall events and flooding affect several parts of the country, we examine the preparedness of health systems to handle the aftermath.

Pre-monsoon malaria and post-monsoon PTSD

Logistics is a roadblock to the work of the ASHA workers. The ORS sachets that they distribute to the people in the aftermath of the flood, to prevent dehydration deaths, arrive in the subcentres only after July, whereas they are required sooner. Electrolyte formulations administered during heat waves were required in March this year but they reached the subcentre a month later. Malaria and dengue no longer wait for the monsoon to set in, remarked Kamble.

ORS sachets are meant for the elderly and younger children during heatwaves and in the aftermath of heavy rains or floods that can contaminate the water source. Kamble, who lives in a peri-urban part of Palghar, finds it easier to track the people in her charge compared to the ASHAs who live elsewhere in the district. “Those who live in the interior hilly regions have to walk through snake-infested growth to get to the people in the hamlets.”

Rural, elderly residents were more seriously affected by natural disasters than their urban counterparts, found an analysis of data from the Longitudinal Aging Survey of India. Droughts were the most commonly reported cause of health impact, followed by floods.

Data for the period 1995 to 2020 show that floods are the most frequent climate-related disaster affecting almost the entire country--that is, 29 of 36 states and union territories. Bihar, West Bengal, Assam, Manipur and Tripura experienced the most frequent floods in these 26 years. In addition, in 2024, Asia’s average temperature was about 1.04°C above the 1991-2020 average, ranking this as the warmest or second warmest year on record, depending on the dataset.

During 1995-2020, a total of 1,058 climatic disaster events (floods, cyclones, droughts, cold waves and heat waves) were reported. These include 420 in the period 1995-2005, followed by 356 (2005-2015) and 282 (2015-2020) incidents. Floods accounted for 33% of India’s such incidents, followed by heat waves (24%), drought (22%), cold waves (16%), and cyclones (5%).

In 2024, India experienced extreme weather events on 322 of 366 days, surpassing the 318 days in 2023 and 314 days in 2022. This means that nearly 88% of the year saw extreme weather in one or more parts of the country, up from 87% in 2023 and 86% in 2022, highlighting a worsening trend.

The 2020 paper shows that the Sustainable Development Goals’ lack of multifactorial disease and mental health risk factors, as well as water-borne disease indicators, misses critical health-associated impacts of floods and droughts. In particular, the narrow focus on suicide as an indicator of mental health overlooks how anxiety disorders or post-traumatic stress disorder (PTSD) can also have severe consequences for those affected by disasters.

Odisha the exemplar of disaster risk reduction

With changing climate, these health risks are bound to be more frequent. South Asia and particularly India is already facing increased risks due to rising extreme weather events such as floods, landslides, droughts, cyclones, heatwaves and cold waves, and a rising sea level. A spike in heavy rain events and temperature will increase the risk of diarrhoeal diseases, dengue fever and malaria in tropical and sub-tropical Asia.

Extreme weather events resulting from climate change led to 495,000 deaths across the world in the period 1999-2018. Further, more than 12,000 extreme weather events led to losses worth $3.54 trillion during this period. Disaster planning and preparing for the health impact is possible. Take the case of Odisha.

Maharashtra ranks sixth on the NITI Aayog’s state health index, whereas Odisha, another flood-prone state, ranks 19th. Yet, they are among the states more responsive to climate change, according to Shyamal Santara, a climate change and health expert at Transforming Rural India, a team of practitioners, specialists and strategists working on creating local and scalable development design solutions for rural India.

“In UP and Bihar, this happens every year and there is not enough planning to mitigate the disaster at any level,” he told IndiaSpend.

Historically, every monsoon leaves behind a trail of disasters in its wake. India jumped nine places in climate vulnerability rankings and was ranked the fifth-most climate-vulnerable country in the world, according to the Climate Risk Index, 2018.

Odisha’s evacuation of over 1 million people in response to Cyclone Phailin in 2013 was cited by the United Nations as an example of disaster risk reduction. The following year, the state was hit by Cyclone Hudhud, which killed 45 people in one week in India, but only three in Odisha. The most devastating cyclone, after the one in 1999 that killed 10,000 people, came in 2019, in which 64 people lost their lives in the state.

Malnutrition, which made Odisha infamous in the 1990s, became a priority of flood-relief operations in the early 2000s. The prevalence of wasting was highest in the community affected by flooding in 2006 and 2008 (51.6%), second highest in a community affected by flooding only in 2008 (41.4%), and lowest in a community not affected by floods (21.2%).

To tide over the floods, Odisha has worked to weather-proof its health facilities. Between 1999 and 2019, the state upgraded its healthcare facilities to make them disaster resistant. It saw a flood every year from 2003 to 2015, a period in which it also saw two cyclones in the space of one year: Cyclone Phailin in 2013, which killed 59 people, and Cyclone Hudhud which killed 45 people in 2014.

However, Santara does not think that weather proofing primary health centres is enough. “The kind of floods we see, with people sitting on rooftops for days waiting to be rescued, what good is a weather-proof solar-powered PHC?”

IndiaSpend has written to the Ministry of Earth Sciences, Government of Odisha and Government of Maharashtra about the system of weather alerts that can help mitigate the effects of floods and heavy rain, the infrastructural changes to the health facilities required to keep them running during floods and the scope of relief operations. We will update this story when we receive a response.

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