Intended for healthcare professionals


India and Pakistan emerge as early victims of extreme heat conditions due to climate injustice

BMJ 2022; 377 doi: (Published 13 May 2022) Cite this as: BMJ 2022;377:o1207
  1. Yogesh Jain, public health physician1,
  2. Rachna Jain, assistant professor in Obstetrics and Gynaecology2
  1. 1Chhattisgarh in rural central India
  2. 2Chhattisgarh Institute of Medical Sciences

Summer weather and extreme heat came unusually early to South Asia this year leading to the hottest March in the last 122 years. These extreme heat conditions, which typically affect northern, central, and western parts of India and Pakistan, have also extended to southern parts of India, where people and governments are not as well prepared.1 Ambient temperatures reached above 47C in India by the end of April and 49.5C in Pakistan in early May with land surface temperatures reaching an unprecedented 62C on 4 May in central India.2 We are still only in the middle of the hot season and await further high temperatures with dread, especially the peak heat period of Nau-tappa (nine-days of heat) usually around 25 May to 3 June. Although maximum temperatures are likely to decline in June and July, the heat may be more dangerous as humidity will increase in the moisture laden monsoon season.3

Unsurprisingly, the extreme heat has caused power outages, wheat crop failures, forest fires and other wildfires, floods due to glacier melting in Pakistan, and an increase in heat related illnesses and deaths. Poorer and marginalized communities have been disproportionately affected. India has had record wheat harvests each year in the last five years, but this year’s extreme heat has led to huge declines in the crop yield, compromising food security.4

The highest ever power demands in the last few weeks due to desert coolers, fans, and air conditioning, on top of ongoing demands, have strained the coal dominated energy systems resulting in power outages and curbs in most states of India and Pakistan. Households and businesses face ongoing disruptions as rising fuel prices due to the war in Ukraine have exacerbated the energy crisis.

The incidence of heat related illnesses and fatalities remains poorly recorded in India and Pakistan. Twenty five heat related deaths have been reported in the five weeks since end of March in the state of Maharashtra, which is already twice that of the last year, but likely an under-estimate. Mental health problems have been exacerbated due to the heat as have pre-existing illnesses.5 Physicians working in public hospitals in many states in India and Pakistan also report an increase in hospital admissions due to heat illnesses.

A substantial proportion of the population in South Asia work outside for their livelihoods. These outdoor workers are the first victims of climate injustice. Ramadan was observed this year through most of April, where fasting during the day also forbids drinking water, making heat related illnesses worse. The heat makes it impossible to work in demanding manual labour tasks after 11 am until late in the afternoon, compromising people’s livelihood. 35% of India’s urban population live in unsuitable housing to withstand this heat. Windowless “shacks” become like an oven during the day.

Issuing early warnings about the heat, providing quality information and educational communications with communities, as well as keeping the health system in a state of preparedness should be the bedrock of state interventions. The city of Ahmedabad in western India prevented thousands of deaths by preparing and implementing such plans in 2013.67 We need to do this throughout South Asia. States should introduce disaster insurance schemes so that workers can mitigate these losses, and not endanger their lives by continuing to work.

The frequency and severity of heat wave conditions will very likely worsen in the coming years even with the most ambitious reduction of greenhouse gas emissions by decarbonizing economies. We need accelerated adaptation techniques such as changing agricultural practices, as well as urban work practices, to reduce the vulnerabilities of populations to climate change and protect the health of people around the world.8 Growing less water intensive crops, using drip irrigation, and investing in urban greening by planting more trees, and building less concrete, and changing work timings are some of the techniques worth considering.

But, however much we try to adapt, clearly these heatwave conditions are not merely a weather issue, but a rude awakening to the real and catastrophic impact of climate change. When will we learn that climate change is a core threat to health, as well as to economies? Will our governments in India and Pakistan learn the lessons from inaction during covid-19, declare this as a national disaster, and roll out an appropriate response?


  • Competing interests: none declared

  • Provenance and peer review: commissioned, not peer reviewed.