Building resilience in post-flood health care

Indian states have witnessed floods on an annual basis. The loss of lives, livelihoods, and assets is one aspect; the emergence of public health issues post floods is another. What Punjab is witnessing is a phenomenal coming together of civil society and locals for the provision of immediate relief. But now, efforts need to be directed at addressing a potential developing public health emergency in the state.

With the floodwaters entering homes, leaving the surroundings contaminated, and affecting utilities supply, the outbreak of diseases becomes eminent. Flood affected populations tend to be at ‘immediate risk’ — which can be from days to weeks — of water and food-borne diseases including cholera and diarrhoea (NCDC). In 2022, over 1,000 cases of diarrhoea were reported from flood-hit districts of Odisha in just a fortnight of the floods hitting.

Vector-borne diseases constitute a major share of post-flood health concerns. Even where floods have not affected a major section of the population, the spread of such diseases is rapid. Delhi’s malaria numbers this year is a case in point. While the magnitude of floods in Delhi is no comparison to those in Punjab, the capital’s malaria cases are already at a five-year high.

Data from flood events across different states help us realise the seriousness of the post-flood crisis. In Kerala, in the aftermath of the 2018 floods, leptospirosis cases increased two fold – going up from nearly 150 in a month to 500+ just in the month of September 2018. Per data, there was a direct relationship between the spread of rat fever and floods. In Kerala, the lowest phase of the cases was witnessed during the floods, however the peak occurred 17 days after the floods. Similarly, deaths due to the same disease – earlier close to nil, went up to 20+ just in the month of September. A recent situation report by PANJ Foundation highlights the onset and rise of cases of high fever, rashes, skin infections emerging among the flood-affected populations in Gurdaspur district. This will soon no longer be limited to just one district.

We need an immediate response action plan. First, medical aid needs to spread out wide and ensure coverage for all. Punjab has a total of 422 primary health centres (PHCs), 150 CHCs, but on-ground surveys inform that access to most of the established health care services has been hindered. Moreover, the existing setups will prove to be insufficient in the situation of increasing load. Medical services need to go mobile, village-to-village, door-to-door. The battle against the impending flood of diseases has to be fought with the PHCs as the first line of defence. Out of 422 PHCs, only 50% are operational around the clock. A simple policy change at the state level—ensuring 24×7 operationality of PHCs—can significantly strengthen the state’s efforts in providing health screening services.

Second, as further highlighted in the report, there is a major lack of veterinary services in the affected villages. This is deeply concerning as at least 504 cattle, 73 sheep and goats have died across 14 districts, and 2.52 lakh animals and 5.88 lakh poultry birds were affected. Veterinary services are crucial on two fronts; first, livestock contributes a staggering 40% of Punjab’s agricultural Gross Value Added (GVA), and second, affected animals could be responsible for zoonotic disease or those diseases which transmit from infected animals to human beings.

Third, on-ground relief and medical care efforts need to be coordinated and focused. Our field survey of tehsils in Gurdaspur and Amritsar showed that there is a heavy presence of medical assistance in Dera Baba Nanak. A similar presence is, however, absent in other affected tehsils/villages. A crucial step in tackling the public crisis is also reducing the information asymmetry. We need collective efforts at recognising where there is ample help already and identify areas with dire need.

Fourth, authorities and civil societies need to learn from the lessons of other states. The state needs to focus on creating a longer-term action plan. Once the waters recede, the administration could benefit from Kerala’s action plan in the aftermath of the massive 2018 floods. government of Kerala’s DHS prescribed weekly preventive doses of doxycyclin and acyclovir as a measure to ensure disease prevention in the state. Further, the administration focussed on (a) restoration of existing water sources, (b) testing for chlorine content in water sources, (c) actioning a strategy for filtration of drinking water sources.

Fifth, with the civil society at the forefront of relief missions – it is important that they leverage verified public information by health departments. This is also crucial for people involved in the relief missions who are in direct contact with the contaminated water.

If immediate steps are not taken, this climate-induced disaster could turn into a public health emergency. Punjab needs a streamlined plan spearheaded by the local bodies, village panchayats and grassroot level organisations. Conclusively, this can follow a three-phase approach: (i) immediate relief in flood-hit areas with PHCs as the first line of defence, adherence to public health SOPs; (ii) Restoration of critical healthcare, veterinary services and drinking water sources; and (iii) long term resilience through elevated, health and veterinary centres, and integration of disaster health modules in the public health programmes.

This article is authored by Sehaj Singh, co-founder and Agastya Shukla, programme associate, PANJ Foundation, a Punjab-based policy research think tank.