SRINAGAR, INDIA – When record-breaking rains, landslides and cloudbursts lashed northern India in late August — across Jammu and Kashmir, Punjab and Himachal Pradesh — highways turned into rivers, homes collapsed and death tolls mounted. But beneath the visible destruction lies a quieter emergency: public health systems buckling under the strain.

In Kashmir, the Jhelum River, a lifeline for the region, swelled dangerously after days of relentless downpours. By the night of Aug. 26–27, its waters entered neighbourhoods in Srinagar, the largest city in Jammu and Kashmir, and a popular summer tourism destination known for its stunning lake and riverfront visages and houseboats.  Earlier in the month, on Aug. 14, a devastating cloudburst near Chisoti — the last motorable village en route to the Machail Mata temple in Jammu — had already triggered flash floods that killed at least 64 people.

Health experts warn these floods are not isolated disasters but part of a worsening cycle of extreme weather events that India remains ill-prepared to handle. From Kashmir to Punjab to Himachal, disrupted medical care, contaminated water, and surges in mosquito-borne disease are exposing how fragile India’s public health safety nets are in the face of weather extremes driven by climate change. Unless resilience is built into the health system, each new flood risks compounding existing crises — from mental health to infectious disease.

Life cut off, treatment interrupted

In Srinagar’s flooded Rajbagh neighborhood, 22-year-old student Maliha Zehra from Baramulla faced a harrowing wait for her psychiatric medication after landslides blocked the Srinagar–Jammu National Highway, delaying essential supplies from reaching the Valley.

“My mental health medicines were delayed,” she told Health Policy Watch. “Without them, the flooding felt even more suffocating.”

Normally, winter highway closures meant she could at least call her doctor or request an ambulance. But this time, there was no lifeline. For three days, mobile networks and internet services across much of Kashmir were down after flood damage, severing communication between patients and providers.

“I tried to go to a nearby hospital, but it was overcrowded, and without a phone I couldn’t contact the private clinic where my psychiatrist sees me,” Zehra said. “At least in the snow you can call for help. With the floods, there was nothing.”

Mental health needs in Kashmir are staggering. As Health Policy Watch reported earlier this year, a 2015 survey by Médecins Sans Frontières (MSF) found that 1.8 million adults in the Kashmir Valley — about 45% of the population — experience significant mental distress. Almost one in five showed symptoms of post-traumatic stress disorder. Meanwhile, 41% of women and 26% of men showed signs of depression.

Yet the system is woefully underprepared to cope with chronic disease conditions during a disaster. According to the 2011 Census, there were just 41 psychiatrists for Jammu and Kashmir’s 12.5 million people. Experts say that number has only modestly increased since, leaving much of the population without specialized care. Flood-related disruption, even for a few days, becomes catastrophic in this context.

Contaminated waters, sick communities

The health toll was not limited to delayed prescriptions. Aadil Dar, a science educator at a community education centre in southern Kashmir’s Anantnag district, said the flooding brought illness in its wake.

“After these floods, many people in my area fell sick with diarrhoea because of contaminated drinking water,” he said.

Such outbreaks are common.  Epidemiologist Dr. Shailesh told The Tribune that “stagnant and contaminated water becomes the primary source of infections in flood-affected areas.” He warned that diseases like cholera, diarrhoea, typhoid, hepatitis A and gastroenteritis are “very common after floods,” while stagnant pools also fuel malaria, dengue and chikungunya outbreaks. 

Flood-linked disease is not hypothetical. In the aftermath of the 2014 Kashmir floods, clusters of jaundice and diarrheal illness were documented within days of the waters rising 

This year, Punjab is already seeing a surge in dengue cases since 2023 ,  in  2023 11,000 infections were reported by mid-november). Flooding has only worsened mosquito breeding conditions.

Arshdeep Singh, 22, from central Kashmir, said his family has resorted to buying bottled water after past illnesses. “My elder sister and I both developed jaundice earlier. It took me months to recover, so now we don’t take risks,” he said. “But packaged water is expensive. Not everyone can afford it.”

Collapsing infrastructure

Health facilities themselves were not spared. Landslides cut off access to several district hospitals in Jammu and Kashmir. In Punjab’s flood prone  24  districts, floodwaters inundated primary health centres, forcing patients to travel long distances. Himachal Pradesh, already battered by landslides, reported damaged subcentres and stockouts of critical drugs.

According to the Indian Meteorological Department Jammu and Kashmir registered 612 mm of rain  in the last week of August. That is 726% above normal rainfall in the region during for this time of the year. 

“It is the highest rainfall in the region since 1950,” Mukhtar Ahmad, Director at the India Meteorological Department in Srinagar, told Reuters. 

Roads, bridges and power lines collapsed under the onslaught, crippling emergency services. Ambulances struggled to reach rural patients, especially pregnant women and children. Telemedicine, which proved vital during the COVID-19 pandemic, was rendered useless in Kashmir due to the communications blackout.

A broader and recurring pattern

Across the wider Himalayan arc and Gangetic plain, severe monsoon flooding has hammered neighboring countries this year too. In Pakistan, hundreds of deaths and mass displacement have been reported this season, with national  and UN flash updates detailing widespread damage along the Indus River basin. Regional weather and climate agencies  warn the Hindu Kush mountain range west of the Himalayas, which extends from Afghanistan into northwestern Pakistan, is also facing increasingly frequent, intense rain events that heighten risks of floods and landslides across borders. Afghanistan has thus also seen repeated flash floods across its northern and eastern provinces.

In Afghanistan, this season’s floods were compounded by another disaster. On Aug. 31, a 6.0-magnitude earthquake struck Afghanistan’s eastern region, killing more than 1,457 people and injuring over 3,394, according to the World Health Organization (WHO). 

More than 6,700 homes were destroyed, leaving thousands homeless and exposed to harsh conditions just as monsoon floods were already battering the country. Hospitals in Kunar, Nangarhar, Laghman and Nuristan provinces have been overwhelmed by trauma cases, while overcrowded shelters and limited sanitation are raising fears of cholera, diarrhoea and other post-disaster outbreaks.

“When we speak of casualties, we are speaking of families and communities in crisis,” said Dr. Mukta Sharma, deputy representative in  Afghanistan, which has launched a flash emergency aid appeal for $4 million. “Our teams are working around the clock to deliver lifesaving care in areas devastated by the earthquake. The needs are immense. We urgently require more resources to sustain our operations and prevent further losses.”

Kashmir’s 2014 floods were a historic benchmark 

In 2014, India-administered Jammu and Kashmir saw its worst flooding in sixty years: more than 500 lives were lost and tens of thousands displaced. Hospitals, water and power infrastructure, and communications were crippled, leaving health systems paralyzed. Outbreaks of diarrhoeal disease, jaundice and other waterborne illnesses were reported within days of the waters rising, compounding the humanitarian emergency.

A spatial analysis of the 2014 floods found that the provincial capital of Srinagar, which has nearly 1.7 million residents, also had one of the highest “Relief Deprivation Index” scores — showing that access to timely rescue and aid was uneven, and the poorest households were often last in line for assistance.

A decade later, the pattern is repeating in Jammu Kashmir and beyond, with increasing frequency.  Almost every year in the past ten years has seen significant flood events. The neighbouring State of Himachal Pradesh also has endured successive monsoon-triggered landslides and floods over the past five years. Punjab continues to battle back-to-back dengue waves, related to more rainfall.

Climate scientists link this to a warming atmosphere fueling increased rainfall, more intense rainfall and sudden cloudburst events.  A Srinagar based climate scientist told Health Policy Watch  that the Himalayan region recorded a 33% increase in extreme weather events compared to the previous decade. In addition, glacial lakes are expanding as glaciers shrink. Rapid urbanization and deforestation have undermined natural watershed drainage, while urban flood drainage is often deficient or non-existent.

Public health experts say that while disaster relief often focuses on food and shelter, health systems remain the weakest link.

Building resilience – what needs to change

WHO has repeatedly warned that health crises following floods can cause more deaths than the flooding itself if not addressed promptly.

Flood preparedness in India still centers on evacuation and rescue, but public health preparedness continues to lag.

“Health is always the weakest link in disaster planning,” said a senior official from a Srinagar-based NGO who asked not to be named. “We have evacuation drills, but no real disease surveillance system to catch cholera, hepatitis or dengue outbreaks early.”

Another challenge is ensuring medicines don’t run out. “We need emergency stockpiles of essential drugs — psychiatric medicines, insulin, oral rehydration salts, antibiotics,” said the official. “When the highway closes or communication lines are down, the delay becomes life-threatening.”

Health workers also stressed the need to strengthen facilities themselves. “Flood-proofing primary health centers and keeping backup power and communications should be non-negotiable,” said Shazia Bhat, a community volunteer in Anantnag. “Right now, one storm can knock out the only health unit for an entire district.”

Clean water remains an urgent priority. “Mobile water treatment units should be deployed within hours, not weeks,” said Arshdeep Singh, the young resident from central Kashmir who earlier described his family’s struggle with jaundice. “Boiling water is not enough when sewage has already entered the supply.”

“We Can’t Afford to Wait”

As floodwaters recede in parts of Jammu and Kashmir, Punjab and Himachal Pradesh, communities are left to confront not just destroyed homes, but the lingering health fallout.

“The government talks about roads and bridges,” said Aadil Dar from Anantnag. “But people are falling sick. We can’t afford to wait for medicines and clean water next time.”

For Maliha Zehra in Srinagar, the disruption felt deeply personal. “Even after the water goes,” she said, “the anxiety stays.”

Image Credits: Arshdeep Singh, Al Jazeera/Creative Commons Licensing, European Commission .