Extreme heat compounds vulnerabilities in low income neighbourhoods

On June 7, as the temperatures remained high in the National Capital Region (NCR), Poonam Devi began her day at 6 a.m., sweeping the streets of Noida. The 30-year-old, who is eight months pregnant, had brought her husband home from the hospital a few days ago. He had severe vomiting and diarrhoea, symptoms of heat-related illness. At noon, after finishing her work, Devi joined a protest at a power substation, demanding power restoration in their informal settlement. The power outage at their settlement in Sector 78 in Noida, happened in April after an electric pole was damaged in a fire incident. The authorities have not repaired the pole. The electricity to the settlement, came through an illegal connection, say the residents.

In Devi’s two-room home in the settlement, heat builds up all day and lingers through the night. The scorching summer in Noida has been compounded by this electricity cut for two months now, making Devi’s pregnancy difficult and her husband’s health condition, worse. Each time Devi falls ill from the heat, she has to spend Rs. 500-600 on medication. She recently spent Rs. 6,000 on her husband’s hospital expenses, an amount that could buy groceries for a month for her family. Devi’s only way to keep her body cool is to soak her clothes in water three times every day. “I am scared. What if something happens to me?” she says.

Meanwhile, water supply to the settlement – released once a day in a communal tap, for an hour or less – is also weak.

Both Devi and her husband are sanitation workers with the Noida Authority. “We keep Noida clean and make it number one. Why can’t they [authorities] give us electricity and water? Why can’t we get our rights?” says Devi.

Devi’s neighbour, Prabha Chakravarty, runs a small shop lit by a solar-powered bulb. Small solar panels are popular in the neighbourhood due to frequent power cuts. However, these only run a light and fan for a short period. There is no power at night. “We can’t go to big hospitals if we get ill,” Chakravarty says. “Two children, aged 10 and 13 died recently and a man was hospitalised,” she says, attributing the incidents to extreme heat.

With increased indoor heat, lack of water and long hours without electricity, life in these settlements of NCR has become stressful for the residents, who are also engaged in daily wage labour and other low-income jobs, either done outdoors in the high heat or indoors in overheated homes. This impacts their health, productivity and income.

The unusual heat

In Delhi NCR, the extreme heat in May and June caused a public health crisis, with at least 275 people losing their lives to the heat wave in Delhi alone.

Delhi experienced 14 heat wave days this year since March 1, marking the longest stretch in 13 years. On June 18, Delhi recorded its warmest night in 55 years, with a temperature of 35.2°C. It was the highest daily minimum temperature recorded for any month between 1969 and 2024. The city recorded nine heat wave days and six continuous warm nights in June alone.

Dr. Sumit Ray, head of critical care medicine at Holy Family Hospital in New Delhi, notes that this summer he saw the highest number of heat-related cases he has ever encountered, with admissions likely doubling compared to previous years. He explains that exposure to high heat during the day and warm nights is like “running a marathon” for the body without breaks, leading to collapse. “During a hot day, the body’s metabolic rate goes up as it tries to lose heat by rushing blood to the skin and tissues. At night, the body needs to cool down to rest and rejuvenate. High nighttime temperatures disrupt this process, causing sleep deprivation and preventing the body and brain from recovering,” he says, adding that this continuous heat stress can lead to heatstroke, heart attacks, strokes, and acute kidney injury.

In May, the National Centre for Disease Control (NCDC) issued new guidelines to recognise heat-related deaths based on autopsy findings. But the number of heat-related deaths is underestimated, say experts. Many people from low-income backgrounds, who are dying from heat stress related illnesses, may not seek hospital treatment, leading to underreporting of their deaths, say experts. The official figures, hence, do not represent the accurate scale of the problem.

“In India, cause-of-death reporting is poorly managed. There is resistance to acknowledging deaths from public health issues and examining their rates. Official figures on heat-related deaths are likely grossly underreported. If routine deaths aren’t counted properly, how will heat-related deaths be accurately classified?” says Dileep Mavalankar, former director of the Indian Institute of Public Health in Gandhinagar, who has conducted extensive research on extreme heat and its impacts.

The most vulnerable to heat

Chandni Singh, Lead Researcher at the Indian Institute for Human Settlements (IIHS), Bengaluru, explains that identities such as caste, class, gender, age, and income intersect, increasing people’s vulnerability to extreme heat. “We have tools to assess this vulnerability, but these have not been applied to our Heat Action Plans (HAP). The Delhi HAP talks about vulnerable groups such as women, children, and elderly, but it does not specify, for example, which women and in what area,” she says. The Delhi Disaster Management Authority (DDMA) only made its first Heat Action Plan last in 2023. The updated plan for this year has a small section on vulnerable areas and groups.

In another informal settlement in East Delhi, Sanjay Amar Colony, women gather in the afternoon in the stifling heat to discuss their struggles. Ruksar, 28, a masseuse, lives with a family of ten in a tiny three-room home. Her two-year-old daughter, Mahinoor, has fallen ill twice this summer with diarrhoea. As the heat wave in Delhi peaked, the city also faced a severe water crisis. “We have to get private water tankers that cost Rs.2,000 each or fetch water from other places,” says Ruksar. This summer, she spent Rs. 2,000 on her daughter’s treatment at a small private clinic. “I prefer not to go to the nearby government hospital because it is too crowded and one has to wait outside in the heat,” she says. Another woman in the group, Shakeela, 55, says, “I feel suffocated indoors. I can’t sleep. I am going mad from itching.” The women nod in agreement and admit that they can’t openly discuss how the lack of water leads to urinary infections and poor menstrual hygiene. There has been no water supply in the public taps installed on their street for the last five years. While some people in the area dug borewells, those have also dried up over the past three months, note the women.

“We have not dealt with development deficits. Now you have this continual crisis of heatwaves. This is what we call compounding hazards when hazards multiply. This is when government systems are stretched, and the poorest and most vulnerable people fall through the cracks,” explains Singh, who stressed the need for targeted vulnerability assessments. “If you know that there are 100 heat hotspots [in the city], the water and power supply should not get disrupted there. But the urban governance machinery is designed in a way that it can’t address this crisis.”

Beating the heat

In Kishan Kunj, another low-income neighbourhood in East Delhi, the residents have makeshift solutions to deal with the heat wave. They are buying coolers or covering their roofs with thermal insulation sheets and jute bags to keep the heat from percolating through.

Neetu, 25, a homemaker, points to a shiny sheet wedged between two plastic sheets and the roof of her room. This is an aluminium foil air bubble sheet. It is as thick as a yoga mat, manufactured locally and costs Rs. 8-12 per square foot. It provides thermal insulation by reflecting light and creating an air gap to reduce heat absorption, keeping interiors cooler.

“My three-year-old daughter used to cry a lot in the summer. We couldn’t sleep at night and had to sit outdoors,” says Neetu. Last year, she bought a cooler and fitted the insulation sheet on her roof which has given some respite this summer. Her husband, Sunil, 30, who sells utensils in exchange for used clothes, was skeptical at first, but was convinced after seeing neighbours benefit from it.

Their home was among the 70 households that received insulation material and heat relief awareness from SEEDS, a local nonprofit focused on building climate resilience in vulnerable communities.

SEEDS has been working on disaster risk reduction in east Delhi settlements since 2012. “We learned that there was a high rate of school absenteeism, a spike in domestic violence, and cases of heat-related illnesses in a nearby children’s hospital during summer,” says Manu Gupta, the co-founder of SEEDS. In 2023, the non-profit began an intervention to build resilience against heat waves in Kishan Kunj, including equipping homes with thermal insulation. “We chose the aluminium bubble sheet because it is low-cost, flexible, reusable, and easy to fix,” says Parag Talankar, Director, Mobilisation and Partnerships at SEEDS. While the nonprofit is yet to measure temperature changes due to the initiative, a study in Malaysia showed that such sheets reduced heat by 26.6% in buildings.

Commenting on the insulation sheets, Mavalankar of IIPH says, “Some of these solutions may be good. We have to ask – is it cheap and sustainable? How many summers will it last? There is a need for more research and funding to study such solutions in India.”

Some residents in Kishan Kunj are still using the insulation sheets this summer, reporting cooler homes. However, not everyone could get an insulation sheet. Rajiya, 33, a domestic worker, covered her roof with jute bags, a cheaper alternative. She bought fifteen jute bags for Rs. 150 and spread them over her roof. Her husband splashes them with water each morning to keep their home cool. “We have to save our next generation. If their minds are disturbed by the heat, how will they act calmly?” she asks.

“Putting the onus on the most vulnerable to adapt is the wrong thing to do,” says Singh. “Government action also has its limits because the government is operating in a world that is warming at a much faster rate than it can act. Heat Action Plans and cooling centres are not enough. They are incremental. We need to sensitise the whole system on extreme heat by making changes across multiple sectors and scales.” She recommends conducting granular vulnerability risk assessments in Delhi and other cities and then revising the Heat Action Plans accordingly, expanding work on public awareness of heat stress over a longer period each year and making extreme heat a part of the curriculum of students studying architecture, urban planning, and medicine so that the next cadre of architects, doctors, and nurses can be prepared to work on the heat-related challenge in the long-term.

Mavalankar suggests that cities set up environment health departments to address environmental health risks, including climate change. Cities should monitor all-cause mortality to identify heat-related deaths, create public awareness, and prepare medical infrastructure for heat-related cases. “States need to fund research on extreme heat and public health and invest in cool roofing, greening, and shading in the long run,” he says.

As the onset of rains brings relief to the residents of NCR, experts call for regular monitoring as challenges related to heat will only increase in the future.

Banner image: Rajiya, a resident of Kishan Kunj, a slum in east Delhi, stands on her home’s roof where she has spread damp jute bags to create cooling indoors. Image by Vandana K. for Mongabay India.