Families wait in the intensive care unit of Sri Krishna Medical College and Hospital in Bihar, India, during an intense heat wave. (Ritesh Shukla/NurPhoto/Getty Images)

As Temperatures Soar in India, One City’s Efforts Are Saving Lives

The western city of Ahmedabad is preparing residents to cope with the longer and more intense heat waves sweeping across South Asia—and inspiring other Indian cities and states to follow suit.

Anjali Jaiswal still remembers when scientists at a workshop she was attending in Ahmedabad, a city in western India with a population of about eight million, declared themselves unable to fathom the possibility that the country could soon see temperatures reaching 50 degrees Celsius, or 122 degrees Fahrenheit. Jaiswal, director of the India Program and a senior attorney for NRDC, was there to help launch a countrywide effort to prepare for and protect against extreme heat. 

Impossible, some in the group said. Not in our lifetimes.

That was in 2009. The following year, a devastating heat wave caused more than 1,300 deaths in Ahmedabad, and in 2016, the mercury hit a record-breaking 123.8 ℉ in the northern desert city of Phalodi. In the decade since that workshop, India has regularly experienced not just higher temperatures but also more frequent and longer periods of severely hot days.

This past June, when the country experienced one of its longest heat waves on record, with temperatures soaring as high as 122 ℉, the scorching conditions killed more than 200 people and exacerbated a deadly encephalitis outbreak among children. “This virus has really sparked an important conversation here about what it means to be prepared for heat, and why heat is as valid a national emergency as, say, drought or flooding or earthquakes,” says Polash Mukerjee, a Delhi-based consultant who focuses on air quality and climate resilience with NRDC’s India Program.  

In a country already suffering from drought and dry conditions, the 2019 heat season arrived earlier than usual, and the monsoons that typically provide some relief arrived late. Scientists forecast that the climate crisis in South Asia will only intensify—and so will the extreme weather and the dire health consequences it bears.

This is just the scenario that Jaiswal and her colleague Kim Knowlton, senior scientist and deputy director of the NRDC Science Center, were imagining 10 years ago when they began crafting a plan with government officials, local partners, and international experts to protect communities in India from the increasingly deadly heat.

In the summer of 2013, after several years of research and collaboration, the city of Ahmedabad, with NRDC and other partners including the Indian Institute of Public Health, released the Ahmedabad Heat Action Plan. Through it, Ahmedabad became the first city in South Asia to address comprehensively the threat of extreme heat caused by climate change. In addition to early-warning alert systems to communicate impending severe heat and robust public outreach campaigns, the plan called for local health workers to receive more medical training and support to address heat-related illnesses. It also ensured that the city’s most vulnerable populations, including outdoor workers and the 800,000 people who live in slum conditions, would have more access to drinking water stations and shaded areas like parks and shelters. 

“The people of Ahmedabad, the city leaders, really owned [the plan], and they have improved it every year since,” says Knowlton. “And we are very proud to be a part of that climate adaptation action in a place that’s intensely vulnerable. But our Indian partners are really energized and leading on this.”

A tanker truck distributes drinking water in a neighborhood of New Delhi during a recent heat wave.

Anushree Fadnavis/Reuters

New research on Ahmedabad’s Heat Action Plan published in the Journal of Environmental and Public Health shows that the city’s commitment is yielding results. It has avoided an estimated 1,100 deaths annually since the plan’s implementation in 2013. To ensure ongoing success, local officials have continued to make regular updates; for example, Ahmedabad  now activates “cooling centers” such as temples, parks, public buildings, and malls during heat alerts and runs temporary night shelters for those without access to water or electricity during extreme conditions. And during last month’s heat wave, the city government ordered a stop to all construction and distributed free buttermilk to quench people’s thirst in parks and other public spaces—new actions added this year, according to Dr. Dileep Mavalankar, director of the Indian Institute of Public Health. 

As another update to the Heat Action Plan, Ahmedabad and Hyderabad have rolled out a cool roofs program over the past few years, another simple and cost-effective way to beat the heat. Cool roofs, now mandatory for all municipal, commercial, and government buildings and prioritized for low-income housing, can be made from a variety of materials, depending on the building’s existing roofing and other factors. Some are created by covering or coating a roof with reflective layers; others are made of coconut husk and paper waste. (Houses around Gujarat and Delhi also feature such roofs, an alternative to concrete or metal ones.) Adding vegetation also does the trick, making buildings more comfortable during heat waves while also saving energy and improving air quality. 

Meanwhile, Ahmedabad’s pilot program has inspired 23 other heat-prone states and more than 100 cities and districts in India to adopt their own Heat Action Plans, with coordination assistance provided by the National Disaster Management Authority and the India Meteorological Department.

“It’s a real case study in how to scale,” says Jaiswal. “It’s just so rewarding to go back and see that these are really simple, low-cost solutions that can be implemented to save lives—and how quickly they can be done.”

She notes that in countries like India, where less than 10 percent of households have air conditioning, high temperatures are far more than an inconvenience. They can cause heatstroke and heat stress, with symptoms including diarrhea, stomachaches, headaches, and leg cramps. In extreme cases, they can bring on cardiac arrest. But all of that is preventable through relatively easy measures, Jaiswal says, and as the heat risks continue to rise with climate change, these life-saving plans will become critical.

Mavalankar emphasizes that having good health statistics is critical to understanding the toll that extreme heat takes on a population. “If cities are not looking at their own daily mortality figures, they are not able to correlate the temperature with that mortality,” he says. Mavalankar is currently working with the national government to expand statistics gathering and publication with the hope of making people even more aware of extreme heat’s deadly impacts. 

Knowlton adds that health risk communication—letting people know that there’s a connection between climate change and health—has become for NRDC an important entry point. “It helps us develop plans for other kinds of climate resilience. The Heat Action Plan in Ahmedabad, for example, has served as a model for a plan to work on air pollution in that city,” she says.

Ahmedabad’s Air Information and Response Plan (AIR), launched in 2016 to address the worsening ground-level ozone smog caused by rising temperatures, uses the same building blocks as the Heat Action Plans: early warning systems, engagement of health professionals, and public outreach. (AIR was a collaboration of the Indian Institute of Tropical Meteorology, NRDC, and other partners.) The city now uses a set of 10 continuous air quality monitors to measure levels of harmful pollution and communicates the risk to residents through a color-coded warning system displayed on digital LED boards in public spaces and on flags placed in schoolyards. The Indian cities of Pune, Mumbai, and New Delhi have put similar systems in place. 

Heat-related advice posters adorn tuk-tuks in Ahmedabad.

Despite the creative solutions rolling out across Ahmedabad and other cities, Knowlton admits that it remains sobering to confront the range of challenges the country faces. But these on-the-ground changes do inspire hope for the future, she says. She recalls seeing the colorful posters with heat-related tips, designed with the help of NRDC, on the back of tuk-tuks in India. “It’s quite beautiful to know that something that we have had a hand in developing with our partners is getting out into the community. And now you hear people in Ahmedabad talking about the plan with pride because it is their plan. They’re the people who have brought it to life. So that’s very satisfying.”

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