Floods and vulnerable health care in Assam’s Barak Valley

I have witnessed floods first-hand—an annual calamity that has plagued my community for as long as I can remember. I grew up in Karimganj, one of the districts in the Barak Valley region of southern Assam. I remember leaving the house during the monsoon season wearing huge boots. During those months, I would only go out for emergencies—to see a doctor or to get something from the market. Our schools remained closed for months as people from nearby villages took refuge in the school buildings, their homes uninhabitable due to rising floodwaters.

I can still remember my mother’s warnings: “Kichu hole ei jole dactar paoa jabe na” (if anything happens, we will not find doctors in these floods), “Oshudh er dokan e jol dhukegeche, osukh hole osudh nei” (pharmacies are flooded, we will not be able to get medicine if we get sick) and “sanp ache jole jash na” (there are snakes in the water, don’t get out!).

Floods have been plaguing the people of Assam for decades and the people of Barak Valley are the most affected and vulnerable. 60 people have died and 2.4 million have been displaced or affected by floods in Assam in 2024. More than 386,000 people have been displaced and forced to take shelter in the 515 relief camps set up in schools, colleges and hospitals in flood-affected districts of the state.

My hometown of Karimaganj is reportedly the worst affected district in Assam with over 152,000 people affected, of which 41,000 are children bearing the brunt of this disaster. There are currently 30 shelters in Karimaganj district housing nearly 9,212 people, but these numbers do not fully capture the true scale of the disruption and distress that unfolds there every year during the monsoon.

The public health infrastructure in the Barak Valley region is the most deficient in Assam. It also bears a disproportionate burden of neglected tropical diseases such as lymphatic filariasis and giardia intestinalis. Diseases such as acute diphtheria, rabies, diarrhoea, dysentery, typhoid fever, malaria and dengue are also prevalent in this region.

Moreover, the rise of non-communicable diseases (NCDs) such as diabetes, acute cardiac diseases and several types of cancer has further burdened the already fragile health care system of the region. National Health Mission (NHM), Assam reported the rise of water-borne and vector-borne diseases due to floods, leading to lack of clean drinking water and sanitation facilities in the affected areas.

As of the last census, the estimated population of Barak Valley was 4,377,612 and the Silchar Medical College and Hospital (SMCH) in Cachar district is the only referral hospital for the entire Barak Valley region. Unfortunately, it does not have even basic angioplasty facilities, making it difficult for patients to access necessary emergency care without travelling to major urban centres such as Guwahati and Shillong, which are at least 8-12 hours away by bus. Annual floods disrupt even this option, as road and rail connectivity are severely affected, leaving many in dire need of basic medical care stranded with nowhere to go.

My father, who is 71 years old, had to go to SMCH earlier this year for a heart check-up. This is normally a three-hour bus ride from my hometown. He could not get his check-up done and had to travel three hours back home because the entire town was flooded, transport was stopped and there were landslides. We were forced to take him back home without getting his check-up done for fear of getting stranded.

Flying him to another city in Upper Assam or Shillong was not possible as the nearest airport in Kumbirgram is 70 km away and the only road to the airport was submerged, making it impossible to use any means of transport. This is not a one-off incident; people in the region are too used to being cut off from basic healthcare. If this is what my father had to go through, I shudder to think of the plight of people with more urgent and emergency medical needs or even those with limited mobility.

As horrible as this was, it’s nothing compared to what happened last year.

As a global health professional trained at Oxford University who has studied health equity, and with my experience in the Barak Valley, I now understand the importance of where and how we live in determining what care we can receive and, ultimately, whether we survive. How would health care professionals and the public react if critical procedures like chemotherapy were performed down the road in another part of the country or the world? Ultimately, this comes down to the question of who matters in a country—whose health is considered important and, conversely, where negligence can be normalized.

Medical professionals, including community health workers (ASHA workers), are nothing short of heroes in Barak Valley and other neglected regions. In conversations with a few ASHA workers, I was told that even during floods, they continue to visit homes and camps to provide care. They carry the burden of almost the entire health system—from diagnosing malaria to assisting with deliveries and talking to women and their families about family planning.

Similarly, doctors and other medical professionals in hospitals never stop working despite power outages, limited supply of medicines, etc. They persevere under extreme circumstances and resource-strapped situations and perhaps the only reason this periodic disaster is not worse is because of their dedication and tireless efforts.

I am proud of the resilience of my community – that they have come back to their feet despite decades of endless cycles of disasters. But I do not want to romanticize their struggles – as equal citizens of India, my people deserve the same attention from the state as those in big cities. They deserve to be treated with dignity. Floods are an annual event that has unfortunately been normalized by both the government and the people. Political campaigns rarely focus on flood control measures that parties will implement once elected.

The hardships of the monsoon months are so frequent and have been experienced by people for generations that it has become the ‘new norm’. Like any other natural disaster, floods in this region deserve the attention of both the media and our political leaders, but that has never been the case – and that makes me both immensely sad and angry.

Although the picture looks bleak, I still have hope in our government, civil society and my community – everyone will come together and solve this intergenerational problem in Barak Valley. We must realize that this is the best gift we can give to our future generations. With all my heart, I hope that flood control and building flood-resilient health care systems in the Barak Valley region becomes a priority for the government, the people and civil society. Together, we can alleviate the hardships that so many suffer and save countless lives that are lost every year.

(Shuma Banik is a global health professional with an MSc in International Health and Tropical Medicine from the University of Oxford. Abhishek Ranjan Datta is studying for a DPhil in International Development at the University of Oxford.)