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Feature Public Health in South Asia

Build back better: Why Indian construction must grapple with extreme heat

BMJ 2022; 377 doi: (Published 16 June 2022) Cite this as: BMJ 2022;377:o1473
  1. Kamala Thiagarajan, freelance journalist
  1. Delhi
  1. kamala.thiagarajan{at}

South Asia is suffering some of its worst heatwaves in a century. The public health implications are being made worse by a building infrastructure that is not designed to cope, Kamala Thiagarajan finds

For years, Revathi Pechi, 43, worked for 10 hours every day in a windowless two room shed with an asbestos roof. She, along with other men and women in the same room, suffered from nausea, dizziness, and a constant dull headache. It would intensify in the summer months, she says.

“The ventilation was so poor that I felt suffocated,” she complains. “And I experienced an overwhelming tiredness.”

Pechi’s job entailed painting clay dolls that are sold as idols for religious festivals in the southern Indian city of Madurai. Sick days would mean a loss of income. But symptoms were never too severe or pronounced for her to take time off. After feeling listless and sick for days, Pechi often recovered at home. She was never taken to an emergency department, hospitalised, or treated for heat sickness. In mid-May, however, when temperatures consistently hit 38°C, she collapsed, and hasn’t gone back to work since.

India has recorded its hottest temperatures in 120 years since March 2022, as the country grappled with a series of intense and prolonged heat waves.1 On 28 March, temperatures in New Delhi topped 43°C, sparking fires in the city’s landfills and exposing the slum residents of Ghazipur in particular to acrid smoke. Over central India during April, the average maximum temperature during the day was 38.04°C, the highest it’s ever been since 1901. According to media reports, more than 7000 people with heat rash (miliaria) were treated in the city of Nagpur in Maharashtra during the peak of the heat wave.

“It wasn’t just the daytime temperatures that were soaring; night time temperatures …

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