He lives in the things he left behind: frayed slippers, a TVS-XL moped with a rigged guard to carry trays, shirts and pants, and the scales he used to weigh grapes and other seasonal fruit. In the photo up on the almirah, he has a shaven head (they went to Chinna Tirupati) and a two-day stubble.

On the night of May 10, the last of his life, Sattibabu, a 45-year-old street fruit vendor in Tadepalligudem, West Godavari district of Andhra Pradesh, came home around 11.30 p.m., had dinner, and went to bed. He had woken up at 4 a.m. that day and gone to the wholesale market, about 25 kilometres away, bought mangoes, returned around 8 a.m., arranged them in trays on his cart, and sold them all day, standing beside the main road, which shimmered in the heat. “It felt like being near a blazing fire all the time,” his son, Saiganesh, 17, says.

Just before returning home, Sattibabu told his son that they would together fetch mangoes from the wholesale market the next day and sell them. It was how his days went, selling fruits. If all went well, he earned Rs 300 a day.

For 15 days before May 10, Sattibabu hadn’t gone to work, saying he felt weak. “My father complained of pains in the leg, felt weak,” his 20-year-old daughter Lakshmi, a mother herself, says.

Normally, Sattibabu was up by 6 a.m. at the latest. On May 11, he didn’t get up even after 6.30 a.m. “We called our local practitioner, and he was pronounced dead,” she says. He was just another casualty of the summer.

Sattibabu had no known illness except back pain for which he used an orthopaedic belt. It was an injury from long ago, in his twenties, when he fell down in a train while selling bananas. Doctors advised him not to lift bunches of plantains, and six years ago, he switched to selling grapes, sapota, apples, mangoes and other seasonal fruit.

His friends say he was a good man. His daughter says he was peaceful man; he never beat her or her younger brother even once, even when they made mischief.

An anonymous man quietly slipped into oblivion, but for his little circle of family and friends, he is a 5.1-foot column of absence that can never be filled.

Lakshmi says she feels her father walking nearby, hears him knock on the door. Saiganesh feels like he’s lost his compass. An anonymous man quietly slipped into oblivion, but for his little circle of family and friends, he is a 5.1-foot column of absence that can never be filled.


The one word to describe summer in Andhra Pradesh and Telangana is infernal. This year was no exception, only it was hotter. In the worst period, May 18-31, temperatures peaked at 47°C and 48°C degrees, respectively, in the two states. Khammam in Telangana saw 48°C on May 22, the hottest since 1940. The northern districts of Telangana—Karimnagar, Nizamabad, and Nalgonda and Khammam—had temperatures swinging between 40°C and 48°C. Medak, Rangareddy and Mahabubnagar were a little better.

In the south coastal districts of Andhra Pradesh—Krishna, Guntur, Ongole, Machilipatnam, and Nellore—the mercury hovered between 40°C and 47°C. Prakasam district topped the death chart with 333 while Guntur had had 233 and East Godavari 192.

Even though temperatures were a few degrees lower in coastal districts in Andhra Pradesh, humidity worsened the situation, and made lives miserable.

“Even though temperatures were a few degrees lower in coastal districts in Andhra Pradesh, humidity worsened the situation, and made lives miserable,” says P. V. Rama Rao, former director of the India Meteorological Department (IMD) in Hyderabad. Due to synoptic features (wind and pressure distribution) the upland areas of the north coastal districts—Vijayanagaram, Srikakulam and Visakhapatnam—had even worse weather. As these synoptic features are common along the coast, Odisha too was severely affected.

Although the criteria of a heat wave or a hot day could not be applied in the case of Rayalaseema, people experienced extreme discomfort, and died due to the hot, dry spell. Temperatures there were consistently above 40°C.

The National Disaster Management Authority’s records show that by May 31, the death toll was 2,207. This year’s heat wave was the second deadliest according to official records. In 1998, 2,541 people perished. Of these numbers (2,207), Andhra Pradesh accounted for 1,636 deaths and Telangana 541.

On the worst days, it felt as if everything was radiating heat—walls, floor, the roads and vehicles, clothes and bodies, the earth itself. Early mornings were like noon, a furnace at full blast. The heat caused a number of electric transformers to blow up, like improvised explosive devices. Touching metal exposed to the sun was a trial in itself. In the heat haze the whole landscape seemed to stagger drunkenly, the hot, stagnant, dry air full of dust and grit.

“This year the heat was too much,” says Dr Suribabu, civil assistant surgeon at the Tadepalligudem government hospital. Heat deaths were not reported to hospitals because of lack of awareness.


Heat waves are normal and frequent climatic phenomena in many parts of the world. Public health researchers from abroad generally define a heat wave or cold snap as a sustained period of some days, usually two or more, of high or low temperatures, while the IMD defines it as a day here when the temperature is abnormally high or low. It need not necessarily be sustained for some days.

Benjamin I. Cook, a climate scientist with NASA’s Goddard Institute for Space Studies, says, “A common feature of most heat waves is a high pressure system—also called an anticyclone—in the atmosphere, allowing heat to accumulate and build up near the surface.”

High pressure systems are just part of the normal variability of the atmosphere. In the northern hemisphere they are associated with the clockwise movement of winds spiralling out from the centre of the high pressure system, leading to clear skies and stagnant air. When these systems occur in summer, it allows lots of heat to build up, resulting in a heat wave.

In addition to the anticyclone, for the heat wave that just was, Cook explains, “There are also anomalous winds pulling in warm, dry air from Pakistan into India, helping to heat things up.”

One thing that makes heat waves worse is drought. “When soils are dry, all or most of the energy from the sun is used to heat up the soils and the air, instead of evaporating water. So when you get a high pressure, plus drought conditions, things can heat up really rapidly,” he says.

Explaining the climate component on heat waves, Cook says, “The big impact of climate change on heat waves is to basically make the background normal state warmer, on average. So when heat waves do occur in a warmer world (arising from natural variations in the atmosphere) they will be that much warmer and that much worse.”

Climate change probably made the heat wave in India worse. But how much worse is a much more difficult question at this time, and will require very careful analysis, he adds.

What makes the situation particularly bad in Andhra Pradesh, Telangana and Odisha is that they are prone to heat waves meteorologically, says IMD’s B. P. Yadav. It happened in 1998, 2003 and 2005. 

What makes the situation particularly bad in Andhra Pradesh, Telangana and Odisha is that they are prone to heat waves meteorologically, says IMD’s B. P. Yadav. It happened in 1998, 2003 and 2005. “Whenever the westerly winds become strong, the sea breeze is cut off. Therefore it doesn’t cool in the afternoon and evening.” Hot, dry air blows in from hotter regions such as Pakistan and Rajasthan. Temperatures rise higher and higher.

The main factor, Rama Rao says, is hot dry winds from north-west India and central India blow over Telangana and Andhra Pradesh in May and the first half of June before the onset of monsoon.

Because people experienced and died in weather that doesn’t come under the present conventions of a heat wave or a hot day—as happened in Rayalaseema—Rama Rao suggests the phrase “hot weather with temperatures more than 40°C” be incorporated with respect to south India. This assumes importance when people experience extreme discomfort and, in effect, die while the present conventions don’t show the period as a heat wave or a hot day.

Moreover, governments declare a period as calamity with the help of IMD’s records.


In addition to extreme day temperatures, it’s the rise in night temperatures that spell doom for the body.

Sarah E. Perkins, a climate scientist at the University of New South Wales in Australia, says in her article “A review article on the scientific understanding of heat waves—their measurement, driving mechanisms, and changes at the global scale” published in the Journal of Atmospheric Research, in May: “It is not necessarily the daytime heat which is always responsible for morbidity and mortality. Humans need lower night-time temperatures to recuperate so that they can handle any extreme heat on the following day. In the most extreme heat waves, such as the 2003 European heat wave, night-time temperatures were abnormally high, which contributed largely to the final death toll.” And, in India, average night-time temperatures are rising too.

Ultimately, as warming gets stronger and stronger in the coming decades, researchers expect heat waves to get worse.

According to “Intensification of future severe heat waves in India and their effect on heat stress and mortality” published in the Regional Environmental Change Journal, future heat waves will appear earlier, last longer, and be more frequent and intense. Researchers analysed data from pre-monsoon temperatures from 1970 and 1999 and projected changes in temperature through the rest of this century.

They conclude: “Southern India, currently not influenced by heat waves, is expected to be severely affected by the end of the 21st century.” Also, “In northern India, the average number of days with extreme heat stress condition during pre-monsoon hot season will reach 30.”

If you consider long-term data, you may find that on the east coast heat wave occurrences are less. Last year and this year it is huge. Just two years’ data cannot be linked to climate change. However, climate change projections show a likely increase in heat waves in these areas. The present year’s mortality shows how devastating it could be.

The present may be a precursor to the future. “If you consider long-term data, you may find that on the east coast heat wave occurrences are less. Last year and this year it is huge. Just two years’ data cannot be linked to climate change. However, climate change projections show a likely increase in heat waves in these areas. The present year’s mortality shows how devastating it could be,” says one of the authors, Subimal Ghosh, an assistant professor in the civil engineering department, IIT-B.

As for urban centres, Dr Hem Dholakia, a research associate with the Council on Energy, Environment and Water, an independent policy research institution, and his colleague, analysed daily all-cause mortality, temperature and humidity data from 2005 to 2012 for Ahmedabad, Hyderabad, Shimla, Bangalore, and Mumbai. The cities are in different climate zones. In “A Tale of Five Cities: Heat Waves, Cold Spells and Mortality Risk in Urban India”, they catalogue “varying vulnerability to climate change-related impacts”.

People living in these cities are acclimatised to a certain temperature range. For instance, those in Ahmedabad are used to very hot summers and fairly cold winters. In future, the expected changes in temperature for these cities could be very different. Thus people in different cities will have to adapt to different temperatures, Dholakia explains, laying out the future scenario.

For example, “The risk faced by people living in Ahmedabad vis-à-vis Shimla may be very different in future and consequently the related health impacts.”

The paper goes into that distinction by mathematically modelling whether extreme temperatures cause heat stroke and death or temperatures need to be sustained over time. The paper terms the former as main risk and the latter as the additional risk. General effects refer to the intensity of temperature (how extreme it is). Additional effects bring in the dimension of time—how long (that is, consecutive days) these intense temperatures are sustained.

The additional risks or impacts are not, Dholakia says, “statistically significant. However, it does not mean that sustained temperature over a period of days is not detrimental to human physiology.” It means that “the effects we saw were due to general effects of extreme temperature. It does not mean that sustained temperatures do not have an impact on health. It just means that maybe we need to look at alternate models that can explain this phenomenon better.”

The paper states that even a single day of exposure to extreme heat could be fatal.  Lifestyles contribute to rising temperatures, their intensity, and duration.  For example, the use of air-conditioning in cities and towns and even villages increases the risk.

“The AC is ensuring that future heat waves will be worse, through release of large quantities of greenhouse gases: carbon dioxide and methane from power plants that produce the huge amounts of electricity required by AC, as well as refrigerants (powerful greenhouse gases) leaked during manufacture, transport, use in AC, and disposal,” says  Dr Stan Cox, a senior scientist at the Land Institute and author of Losing Our Cool, which has a chapter on the impact air conditioning for the elite has had on India.

Greenhouse gases from burning coal for power plants, from vehicles, and burning forests, trash, and stoves that use biomass and wood—the latter two uniquely India-related—rise high into atmosphere and act like a blanket, trapping solar energy that is absorbed and then released by the earth, further heating up the atmosphere. It is a process akin to people covering themselves with a rug to keep warm in winter.

Speaking of his experience, Cox notes, “In America, by designing our housing, office space, transportation, etc., over the past 50 years on the assumption of AC, we have built ourselves into a corner. We will need a lot of rebuilding and retrofitting. Most of India’s AC demand remains in the future. That creates an opportunity to start building for natural ventilation. India is a leader in this, with  examples like the Torrent complex in Ahmedabad, or for AC only in extreme conditions. India’s rush toward a car culture is also creating a huge AC demand.”


Human-induced climate change is worsening the situation. The magnitude of risk and death due to heat waves is higher than all the other natural disasters combined. But it’s a silent killer so death by heat is underreported. The problem is that it’s hard to determine death due to heat. Heat waves aggravate pre-existing conditions—heart, kidney and respiratory—and when people die in hospitals their deaths are registered as such, not as heat deaths.

Temperatures in India are also under-reported. The IMD’s weather stations, located near airports where it is relatively green, serve the district while in the city, in centres of human activity temperatures may be 2, 3, or even 4°C higher due to the urban heat island effect. Moreover, the data available on heat-related casualties are mostly from urban areas, not from rural areas. So there could be many people lost to heat who are simply not accounted for.

Migrant workers are among the most vulnerable. Gulrez Shah Azhar, previously an assistant professor at the Indian Institute of Public Health (IIPH), Gandhinagar, and now an assistant policy analyst at a US thinktank in California, says, “When they come from places with less extreme temperatures and arrive in places with high temperatures, they cannot adapt. They don’t know the local language. Either they leave or fall sick. When any of them dies, there is no mention of him or her being a heat-related death.”

Anjamma, from the interior of Telangana, is a migrant worker. She is among the many who regularly migrate to Jharkhand or Maharashtra or wherever else work is available. This summer, their group went to Jharkhand for canal work.

“There was no water in summer. There were no works. They stopped works there in Karnataka too. That is why we went to Jharkhand,” she says.

Our people, she says, filled up Hyderabad and Mumbai and other places. “People pull out their roots and move to distant places for livelihood,” she says. In her village, everything dried up. Everything was bone-dry. Borewells in some fields went dead. And there were lots of deaths as well.

Rahman is another of the nomads. An automobile welder from Vijayawada, he stays in Hyderabad and goes wherever he can find work. “In motor field works, the temperature is already high. We do welding, which adds to the heat. Normal times are horrible enough. In the summer, it’s indescribable,” he says. “Our supervising engineer collapsed in the heat.”

In their peripatetic life, bonds—forged since childhood, frozen in friendship, steeped in practical jokes and well-directed curses—sustain them.

“I have been in this since I was 12, hell, heat or rain,” says one man, naked from the waist up. “If there is work somewhere, we get together, five or 10 of us, and go there.”

“You see that fellow,” he says, pointing to another sitting and laughing. “We have been together since I was 12. He wanted to get married and he told us, so we married him off two years ago. He will be a father in two months.”

In their villages, many people died of the heat, they say. “The elderly simply stopped breathing.”

For these nomads, though, their close-knit relationship helps in all disasters. “We are together and that saves us. We know each other, we care for each other, and if anyone falls sick, we take him to a doctor.”

Although this group weathered the recent heat wave because they are in their twenties and thirties and look after each other, that may not be true of many other migrant workers who may not have the same sort of community. They may not know what to do or where to take a sick person.

Already, the movement of people in search of livelihoods is beginning to resemble refugees fleeing a war zone. As India faces plunging water tables, floods, and heat waves that are increasing in frequency and intensity, more and more livelihoods are being put at risk. Indeed, the country may be looking at a magnitude of internal migration that it has never before seen.


The other problem with heat waves is that heat-related deaths don’t register on the alarm scale among the public and governments. They don’t leave a trail of visible mayhem along the way. No charred bodies, no skeletal remains of houses, no mangled metal, no storm-tossed vehicles, no overflowing water. They are not made for disaster television. A person like Sattibabu may work through the day in acute discomfort, come home, collapse, and die. Deaths don’t occur at a single location as in fires and floods. They are spatially distributed. While all deaths are lonely affairs, heat-related death may be the loneliest.

The story of Simhadri, a daily labourer, around 70 years old, is one example. He was perfectly healthy. His widow Narsamma says, “He had not known a headache or fever in his life.”

Simhadri was an oak of a man, carrying loads and going wherever work was available. Narasamma too was a labourer and both worked their backs off. In the last week of May, he took three days off because of the heat. One morning he got up, asked for water which Narsamma gave, and then he collapsed and died.

They have a one-room home, roofed with a cement sheet. “Both inside and outside, it was very hot,” she says. For a small home there’s been a lot of death. The couple had a son and a daughter. The son worked as a lorry driver and died of a heart attack. The daughter worked as an agricultural labourer, and she too died. As Narasamma feeds her grandchild, she says, “I lost everything when my son passed away. Now my husband collapsed. After some days, my mother-in-law died.”

You swallow the pain and grief and live, she says. “The heat came to snuff out our life”.


Finding the vulnerable people is the job of Priya Dutta and her colleagues. A senior researcher with IIPH, Gandhinagar, she knows from personal experience what a heat wave can do. When in the summer of 2014 she visited some women’s groups in Ahmedabad, she found them staggering and disoriented by the heat. Using a non-contact infrared thermometer, she measured their body temperature and found it had shot from 37°C to 40°C.

Women working indoors in cottage industries such as kite- and incense stick-making are under stress because they don’t want to lose livelihoods. One young woman, Dutta reports in her study, says they don’t drink much water, despite the heat and thirst, because there are no bathrooms. Kite-makers cannot use fans because it blows the paper and other things away.

“We couldn’t bear the heat when we went there,” Dutta says. Gulrez, who was with Dutta for the indoor female worker dara collection, says, “It’s was like an oven inside.”

Women working outdoors as street vendors, ragpickers, and construction workers complain of severe dizziness, thirst, fever, and throbbing headaches. Construction workers, especially, lose their bearings and coordination, faint, and feel dizzy.

During the data collection on construction workers, Ajit Rajiva reports that their constant refrain is they don’t have any option except to work, come hell or high water. Rushing family members or colleagues to hospitals for heat-related fevers is quite common.

Dress codes tied to culture, religion or local customs make it harder. Women wear saris made of synthetic material, cover themselves from head to foot, sometimes even their faces. Black clothes and synthetics such as nylon absorb more heat. That makes it more difficult for women to perspire. 

Dress codes tied to culture, religion or local customs make it harder. Women wear saris made of synthetic material, cover themselves from head to foot, sometimes even their faces. Black clothes and synthetics such as nylon absorb more heat. That makes it more difficult for women to perspire. Evaporated perspiration cools the body and keeps the rising temperature in check. That means a vital physiological mechanism goes out of whack.

In IIPH’s continuing study of vulnerable populations, the harrowing work situation of traffic cops comes up. All the conditions for extreme heat stress and stroke exist: no proper shed or station to stand, no place to rest. They have to stand long hours in the heat. They lack toilets to relieve themselves. With no potable water available nearby unless purchased or requested from nearby hotels, traffic cops often drink less water than required. Their uniforms, distributed once in five years, are not made of cotton, and stick to their bodies.

“Their clothing and their equipment don’t take note of any environmental conditions,” Dutta says.

IIPH’s research and intervention started after a disastrous heat wave hit Ahmedabad in May 2010. Temperatures then reached 46.8°C. The study established a link between mortality and heat. Although the relationship is well-documented in North America and Europe, the Ahmedabad study was the first of its kind in India. Since reliable data about individual heat-related deaths—somebody who was diagnosed with heat stroke and died of it—are not available, the study considered all-cause, excess mortality during this period and correlated it with reference periods from various years. The researchers carried out an ecological analysis to evaluate relationships between “daily all-cause mortality and maximum daily temperatures.” They found an excess of 1,344 all-cause deaths in May 2010.

“It was shocking and saddening,” says Gulrez, lead author of the paper. “These deaths were preventable.”


Prior to the May heat wave, IIPH had written to governments in Andhra Pradesh and Telangana, warning them of the impending problem and suggesting simple steps to save lives. The warnings and suggestions fell on deaf ears. While official estimates of death are over 2,000, anecdotally, at least 8,000 deaths have occurred in both states combined. Odisha, on the other hand, learned from its 1998 experience and minimised fatalities.

The Andhra Pradesh government announced an ex-gratia of Rs 1 lakh to the families of below-poverty line persons who died in the heat wave. It set up a committee consisting of the mandal revenue officer, sub-inspector, and doctor, to determine and certify heat deaths.

At first, a post-mortem was a necessary part of certification. The idea is to look for heat stroke signs. Dr Suribabu says, “It’s to check for petechial haemorrhage (blood leaks from capillaries in the eyes), enlargement of left ventricle, shrunken eyes, dry tongue, dehydration, and pinching of skin.”

Suribabu helped certify two or three deaths and says it was not easy to convince families to give the body for post-mortem. In one case, they had to plead and persuade the family for three to four hours. By that time, it was late afternoon. “We cannot do post-mortem after evening,” he told them, and the family finally agreed to it. Already traumatised, the families wouldn’t accept their loved ones, even if dead, being cut up. “That gives them more pain,” he says.

As the number of victims mounted across the state, it would not have been possible for government hospitals to handle post-mortems. If the body comes in late in the evening, he says, it would have to be kept in a freezer until the next day. Many hospitals are not equipped to do that.

Perhaps, due to public unwillingness to consent to post-mortems, the large numbers of fatalities, and lack of facilities, the government “overnight” changed its order to physical examination.

“It was enough to examine for shrunken eyes, dry tongue, mouth and lips, and pinching of skin,” he says. By putting your finger in the mouth, you feel whether the tongue is dry or not, he explains. For a living person, if you pinch the skin, it returns to its normal state after you release it, but if you pinch a dead body’s skin, it stays pinched.

Even the reporting of these minuscule cases was possible because somebody in the lane or alley where the person died was aware of the need for certification and compensation. In the case of villages, the local panchayat sarpanch or employee has to inform the nearby mandal revenue office. In many cases, it would not have been done. Officials say the numbers mounted after the government announced compensation.

The tragedy was largely preventable. “It’s ironic that the both governments didn’t pay attention to warnings issued and information coming in,” says a government official.

Odisha, on the other hand, came off as a master of disaster response in comparison. It’s simple things instituted that saved lives, says Prabat Ranjan Mohapatra, deputy relief commissioner of Odisha. “Mainly spreading awareness among people,” he says, “Also restrictions on working hours of labourers, school and college schedules, noon was avoided, and making arrangements in hospitals to treat heat-related illnesses.” Due to widespread shortage of water in summer, water was also supplied during this time.

In 1998, more than 2,000 died from the heat wave in Odisha. “We had no knowledge but since then we have been preparing meticulously,” says Mohapatra. Still, he conceded, in 2000 and 2006, there were more 200 deaths. That was period of long heat.

This year, “We confirmed 63 deaths as on 22 June, and 12 are pending. It won’t exceed 70,” he says.

The government called meetings and sent circulars about the impending heat wave on February 25. District collectors were instructed to take measures.

All these can be done at a very small cost, Mohapatra says. Moreover, “the government has responsibility to do this. It’s our duty.” He adds that not much money is required to take these preventive steps.

Most of the people who died were poor, children, elderly, homeless or worked outdoors. That’s the bad news. The good news, though, is that it’s easy to avoid heat-related deaths.

“It’s not rocket science,” says Dutta. “We need immediate attention and intervention to save lives.”

Based on their 2010 study, they came up with the Ahmedabad Heat Action Plan (HAP). The plan was piloted in 2013 in Ahmedabad and so far its implementation has saved more than 1,000 lives. The recent evaluation is yet to be published.

The key factors that led to its success are, first and foremost, raising awareness of heat-related illnesses among the community. “If a person knows the risk of heat wave and preventive measures, there are fewer chances of him or her falling ill due to heat,” says Dutta.

In their study of construction workers, she says 10 per cent were hospitalised at least once in summer. The first step of the heat action plan is public awareness and community outreach, training and workshops. Secondly, it’s getting everyone on board—the government, municipalities, doctors, and the IMD.  Coordination among different agencies helps in early warning messages reach grass-roots level faster.

For example, Dutta says, in the recent heat wave, a nodal officer from Ahmedabad Municipal Corporation went in person to check on the availability of water at construction sites and helped reschedule work to mornings and evenings rather than peak times in the afternoon. New initiatives are being launched as part of this year’s plan that include the use of modern media such as text messages, email, radio and mobile applications like WhatsApp. Such simple measures and coordination save many lives.

The plan’s third step is sensitising the medical community and health workers. Research suggests that the medical community may not recognise heat-related fevers, and instead treat the victim for some other kind of fever, eating up valuable time.

In one simple measure, all 108 ambulances carry ice packs and relevant medication to bring down the temperature if one has high heat-related illness. Adaptive measures such as establishing cooling places, rescheduling work, mapping high-risk areas, and working with NGOs, are suggested.

At the national level, the previous government constituted a committee that ended up fussing over questions such as what constitutes a heat wave, or a heat-related death and associated labels. The present government has yet to take a step on designating heat wave as a natural disaster. Other countries and cities also grapple with those questions and what criteria to use.

To function normally, a consistent internal body temperature of 98.6° Fahrenheit is essential. According to the United States Environmental Protection Agency’s Excessive Heat Event Guide Book, Philadelphia was using the criterion of core body temperature in excess of 105°F as a heat-related death. The breakthrough came when the city’s medical examiner broke from it and expanded the criterion to include “a body that was found in an enclosed environment with a high
ambient temperature without adequate cooling devices and the individual had been known to be alive at the onset of the heat wave”.

That paved way for a robust Excessive Heat Event (EHE) notification and response system. Even better, Toronto’s EHE programme, according to the Guide Book, “evolved primarily as a proactive, precautionary response to a perceived public health risk by local politicians”.

Apart from political will, the medical community views everything from the medical point of view. Doctors don’t admit that every illness has a broader socio-economic-ecological aspect to it. “There is a lack of recognition among health people on the effects of non-health dimensions,” Gulrez says. In fact, social epidemiology investigates those dimensions.

“The medical community has to accept that you cannot address health challenges only from a medical point of view,” Gulrez says. Interventions to beat back heat-related illness fall in the socioeconomic-ecological category.


If India were a developed country, it would be facing some other challenges. “India is in a very interesting situation. It’s in epidemiological transition.” In a poor country, Gulrez says, the persistent problem is malnutrition and under-nutrition. If the country addresses that, it has to deal with infectious disease. If the country addresses sanitation and hygiene and arrests infectious diseases, it is followed by non-communicable, lifestyle diseases such as diabetes. The next stage will be environmental diseases, consequent to pollution and toxins, resulting in cancers and such. If a country addresses that, it will have developmental disorders and genetic disorders. India, being a hugely diverse country, finds itself facing a welter of challenges.

“We have the entire gamut of people, of different social segments, vulnerable,” Gulrez says.

Among heat researchers, there is a belief that the 2003 European and 2010 Russian heat waves were fundamentally different from the others. Something similar may be happening regarding Indian heat waves. What’s more, internationally, a person generally dies of heat stroke after one or two days, called lag time, after the day of exposure. In India, to a great extent, as Gulrez says, people were “literally dropping dead” like birds shot in the sky.

Apart from a lack of potable water at the place where they happened to be at that time, and in case of the body’s core temperature rising with no way to cool it immediately, Gulrez says the underlying cause could be under-nutrition, although no study shows its link. A vast number of people suffer from that, which makes it easier to breach the body’s defences, exposing people to many stresses and illnesses.

Added to under-nutrition is rampant alcoholism among communities. They drink, and drink some more. One kuccha hotel owner knows a rickshaw puller who died of heat stroke. “He would come here often, and one day he collapsed and died.” If somebody had given him water when he collapsed, the hotel owner feels the man would have survived. But the man himself could have had water.

“He drinks. When you drink you’re not aware of thirst. There is no lucidity and you cannot even recognise you need water, and you get dehydrated in the heat, collapse and die.”

The liquor they consume, he continues, is a lethal brew. “If one has money, they may buy good quality stuff, but for these people, it’s cheap liquor.”

So, you are looking at vast segments of people whose constitution is already broken or breaking.

Dasu is a washerman and he lays out his rationale for drinking. “People don’t know how the body aches after a day’s work. We drink to get rid of these aches. Otherwise, the whole body feels sensitive after work. We cannot get up the next day and work. Then who feeds my family?” In the heat you suffer, of course, he says. Whoever cannot stand it, they die, he says.

It seems the addiction crisis is matched only by the government’s addiction to the revenue from it. It’s a web of complicated elements, each reinforcing the other in positive feedback loops, finally making the human body vulnerable to every kind of disaster.

Some segments are more vulnerable. As climate change stokes weather-related calamities like heat waves and floods, workers in construction, mining and quarries are at great risk.

Also, in India, women relieve themselves outside and go out in the early morning or late evening to do so. Therefore they drink less water during the day so that they need not go outside, leading to dehydration. “Dehydration among women is a unique Indian problem,” says Gulrez.

Research in the United States has shown that heat wave deaths are caused overwhelmingly by socioeconomic factors: poor living conditions, poor health, advanced age, social isolation, fear of crime (so windows aren’t opened), poverty (for example, not being able to afford electricity to run fans), and other factors.

“Research in the United States has shown that heat wave deaths are caused overwhelmingly by socioeconomic factors: poor living conditions, poor health, advanced age, social isolation, fear of crime (so windows aren’t opened), poverty (for example, not being able to afford electricity to run fans), and other factors,” Cox says.

According to the UN’s Climate Panel report, 2014, it’s always the poor that bear the brunt of climate change-related calamities.

“Even among countries, the poorer, southern, tropical countries, which did little to cause climate change, will be suffering the most severe consequences because they do not have the capacity to handle such disasters,” Gulrez says.

Preventing heat deaths is simple enough and it doesn’t cost much either. The Ahmedabad Heat Action Plan, tweaked for local conditions, is the answer.

“But these steps are so simple that our people are not doing it,” says Gulrez.