Photo Essay: Diseases Spike for Indian Farm Workers As Climate Changes

Sanket Jain June 9, 2022 Sanket Jain Admin, Archives, Asia

Residents of Ghalwad village were evacuated by the volunteers of a local non-profit organization / credit: Sanket Jain — Residents of Ghalwad village were evacuated during a flood by the volunteers of a local non-profit organization / credit: Sanket Jain

Only after collapsing did Reshma Koli realize she had been working amid heat waves. The temperature had soared to 45 degrees Celsius (113 degrees Fahrenheit) in April , but the only thing on Reshma’s mind was the monthly repayment of 3,000 Indian rupees ($38 USD) that helped her family meet everyday needs.

A 37-year-old farm worker, it takes her over 120 hours of bending and squatting in the fields to earn that money. An hour’s delay could cost her daily wages and incur interest.

While working in this scorching heat for over two months, all she had was a piece of cotton cloth wrapped around her head. Four fellow women farmworkers rushed to offer lemon juice as she collapsed. Koli then resumed her work in 20 minutes. But this is not a story of resilience.

“Even if we die, no one will notice. Every day, when we leave for work, we consider ourselves lucky if we return alive,” says fellow farmworker Akkatai Khot, 62, who tends to sugarcane saplings at a nursery in the Khutwad village of the western Indian state of Maharashtra’s Kolhapur district.

India witnessed the hottest March in 122 years. With temperatures several times crossing 49 degrees Celsius (120 degrees Fahrenheit) in northern India, heat waves amplified the existing fault lines between the few well-off and the ignored, unseen and unheard—women farm workers.

‘If We Take a Break, What Will We Eat?’

Koli, Khot and over 500 women agricultural laborers in Khutwad couldn’t afford to take a minute’s break in the heat waves.

“Ever since the 2021 floods, we barely get work for 15 days a month,” Koli said. “So if we take a break here, what will we eat?”

The number of working days for farmers is declining in India’s flood-affected regions because of the fluctuating regional climatic patterns. For example, what followed after the 2021 floods in Kolhapur district was an extended dry spell, a sudden drop in temperatures, incessant rainfall, and now heat waves.

‘Relocation Should Be Last Solution’

The Maharashtra government has proposed a plan to move people from the flood-affected areas, which scares Koli even more.

“Where will the government relocate us when almost all the villages here are facing the same conditions?” she asked. “At least there’s farmland in this area. What if the relocated place has no source of earning a livelihood?”

For communities that rely on agriculture, Indian Institute of Tropical Meteorology climate scientist Roxy Mathew Koll suggested information on drought and flood-resilient crop varieties should be made accessible.

“Relocating should be the last solution because these events will further intensify in several areas,” he said.

After the floods ravaged Reshma Koli’s house in 2019, she started experiencing a severe headache that persisted for two months. From analgesics to indigenous balms, nothing helped. Then, one afternoon as she felt dizzy, she was diagnosed with extremely high blood pressure and was immediately prescribed medications that she says will continue for a lifetime.

Community healthcare worker Maya Patil explains why chronic illnesses are rising in rural women in flood-affected villages.

“After the floods, almost every family took out a loan, as there was no farm work for three months,” she said. “Now, with the changing climate, farm productivity is falling rapidly, and they aren’t getting enough work to repay. The wages have dwindled, forcing their children to join the workforce, and this adds more stress.”

National Family Health Survey’s latest report confirms her analysis.

It shows a 151 percent rise in hypertension cases amongst rural women in Maharashtra’s Kolhapur district alone from 2015 to 2020.

Relying on Medicine to Labor in the Heat

With the onset of monsoon season, Ujjwala Chavan’s stress keeps mounting.

“Earlier, we waited for rain, but now every rainfall scares us,” she said. Chavan and her sister-in-law, Sampada—both in their 40s—collectively took out a loan of 400,000 rupees ($5,150) after the 2021 floods to sustain their joint family of more than 14 people.

Repaying this hefty amount had its impact. Chavan was diagnosed with hypothyroidism and Sampada with hypertension. Moreover, Chavan has taken a nonsteroidal anti-inflammatory drug every alternate day for close to a year now. “If I skip this, I won’t be able to work because of the body pain and weakness,” she said.

The ongoing heat waves have aggravated the existing medical conditions of several flood-affected women. Thirty scientists from the World Weather Attribution Network found climate change has made the current heatwaves in South Asia—especially in India and Pakistan—30 times more likely.

Despite drinking five liters of water daily, Sampada said she still feels thirsty and dizzy.

“I couldn’t understand what was happening,” she said. “There’s no alternative to facing a heat wave when you can’t make ends meet.”

In July, as the floodwater started reaching Khutwad from the nearby Krishna river, 10 farm workers—including Sampada—rushed to save over 800,000 sugarcane saplings.

“Meanwhile, floods washed away everything in our house,” Sampada said.

A split-second delay could have cost their lives as the water gushed speedily.

“In both of the floods, I collectively lost over a million sugarcane saplings, three sugarcane-bud cutting machines, and 50 metric tons of coco peat,” said Amol Mahatme, 34, the owner of the sugarcane nursery.

During the heat waves, too, several saplings couldn’t germinate, further affecting everyone in the farm cycle. Women farmworkers are the most affected, as they remain the least paid and most overworked.

Rising Chronic Illnesses

For the first time, the United Nations’ Intergovernmental Panel on Climate Change (IPCC) report mentioned climate change has “adversely impacted” mental health. It warns, “Mental health challenges, including anxiety and stress, are expected to increase under further global warming in all assessed regions, particularly for children, adolescents, elderly, and those with underlying health conditions.”

Dr. Madhuri Panhalkar, the only public doctor for 8,000 people in three villages in the Kolhapur district, has been treating many flood-affected patients. She says, “Even if the patients eat healthy food, that isn’t enough,” she said. “The stress levels are rising rapidly as the climate keeps fluctuating.” So Panhalkar is holding awareness sessions in the flood-affected villages, in an attempt to normalize conversations around mental health.

In 1990, non-communicable diseases (NCD) contributed to 37 percent of deaths in India. That figure almost doubled to 66 percent in 2019. Government figures reveal one in four Indians are at the risk of dying from NCD before the age of 70.

“We need gender-based village-level data on what kind of illnesses are rising rapidly in the region,” Koll said. “Then, based on this data, we can have early warning systems for health, also.”

In 2021, India lost 5.04 million hectares (12.45 million acres) of farm area to floods, cyclones, landslides, cloudbursts and other climate events. India has been experiencing 17 flood events every year since 2000, making it the second-worst flood-affected country in the world after China. This has impacted 345 million Indians, the equivalent of nine Californias.

An agricultural laborer for over two decades, Sampada said she had never experienced such devastation. But, with the rising incidences of heat waves, she has also experienced fading vision in her eyes, pointing to something serious. “If I go to a doctor, I’ll have to take a day off, which I can’t afford.” Women in sugarcane nurseries of the Kolhapur region are paid around $2 to $4 for 10 to 12 hours of work daily.

While medications have kept her going, she has been worried about overusing them and being unable to seek proper treatment in time. Her resort, though, can be fatalistic.

“It’s a dilemma, with suffering as the only answer,” she said, lifting over 20 kilograms (44 pounds) of soil on her head.

Akkatai Khot, 62, said her husband abandoned her three decades ago, and her son is an alcoholic, putting on her the burden for supporting her family. “Even if we die, no one will notice. Every day, when we leave for work, we consider ourselves lucky if we return alive,” she said / credit: Sanket Jain

Often, workers aren’t provided with proper safety gear, making them vulnerable to cuts and other injuries / credit: Sanket Jain

Sampada Chavan said the heat waves have affected sugarcane saplings, and many could not germinate properly / credit: Sanket Jain

The rapidly changing local climate is forcing nursery owners to increasingly use chemical fertilizers and pesticides to ensure sugarcane buds germinate on time / credit: Sanket Jain

The rapidly changing local climate is forcing nursery owners to increase the use of chemical fertilizers and pesticides to ensure the sugarcane buds germinate in time / credit: Sanket Jain

Akkatai Khot, 62, says carrying a heavy load has become difficult in the heat waves. “If we collapse doing this work, we drink lemon juice or take medicine." / credit: Sanket Jain — Akkatai Khot, 62, says carrying a heavy load has become difficult in the heat waves. “If we collapse doing this work, we drink lemon juice or take medicine.” / credit: Sanket Jain

Ujjwala Chavan (left) and Shalan Khot cut sugarcane buds in the Khutwad village in the western Indian state of Maharastra / credit: Sanket Jain

A soybean field on the outskirts of Khutwad village destroyed by floods / credit: Sanket Jain

While there’s no relief from floods, it’s the lighter moments that bring a smile to farmworkers’ faces. Sampada playing with Shreyas, a community child / credit: Sanket Jain

After the 2019 floods, Reshma Koli started experiencing severe headaches. With the rising stress caused by fear of another flood and unable to repay her loan in time, she was diagnosed with hypertension / credit: Sanket Jain

Sunita Mane, in her early 40s, has been experiencing weakness and fatigue since the heat waves started in March. “Often lifting heavy load causes a headache, but we don’t have any other option,” she says / credit: Sanket Jain

Ujjwala Mahatme, 40, separating the sugarcane from its leaves / credit: Sanket Jain

The road leading to Khutwad village was at least 14-feet underwater during the 2019 and 2021 floods / credit: Sanket Jain

Several villagers were stranded in the floods as the water level rapidly rose. With no flood alert system, many people were left behind in the villages / credit: Sanket Jain

Several houses in Kolhapur district were devastated by floods, forcing people to take out loans, further burdening them as farm work is rapidly declining because of the changing climate / credit: Sanket Jain

Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.

Garbage piled up in the Tunisian city of Sfax / credit: Alessandra Bajec

Long-Running Mismanagement Behind Waste Disaster in Tunisia’s Sfax Region

Alessandra Bajec January 19, 2022 Alessandra Bajec Admin, Africa, Archives

SFAX, Tunisia—Until the first week of December, mountains of garbage littered the center of the coastal city of Sfax. For more than two months, locals put up with thousands of tons of rotten household trash and hazardous medical waste left uncollected in public areas.

The crisis began after Sfax governorate authorities closed in late September the governorate’s main controlled landfill, El Gonna, in the town of Agareb, some 22 kilometers (13.6 miles) from the city of Sfax, due to opposition from the local population. (Tunisia is divided into provinces called governorates. Sfax governorate contains a city by the same name.)

The people of Agareb rejected the Ministry of Environment reopening the controversial dumping site. Residents said it was full and being used to dump toxic chemical waste, causing the spread of several diseases. Reported health complications include respiratory and skin disorders, sight problems, and infertility.

A map of Tunisia within the broader region / credit: Google

Some private waste-management companies are known to illegally dispose of toxic material—such as medical refuse and industrial waste from factories—in the landfill to avoid expensive treatment processes.

Protest over garbage pileup in 2021 / credit: Middle East Monitor/Houssem Zouari/Anadolu Agency

Protests Turn Deadly

Opened in 2008 as a near-term fix to ease the burden on the Sfax governorate, the dump at Agareb was originally supposed to close after five years.

“We had a problem of trust with the government, which has still not implemented the solutions that they had announced,” said Sami Bahri, a Agareb-based environmental activist, during a webinar Paris-based think tank Arab Reform Initiative organized in December.

Map of Tunisia, with a red pin indicating the location of the city of Sfax / credit: Google

Weeks of protests against the trash crisis and the reopening of the landfill last month escalated on November 8 when security forces’ tear gas killed a protester. The next day, angry demonstrators burned a local national guard station. “We are choking on all this garbage!” was one of the main slogans of the day’s rallies.

The closure of the El Gonna site, which had already been overloaded since September, led to the accumulation of garbage and industrial waste on the streets of Sfax city. Local municipal services had stopped trash collection, citing a lack of alternatives for waste disposal.

“We are in a situation where seeing garbage in the open air becomes something ordinary,” said Hafez Hentati, coordinator of Collectif de l’environnement et du développement de Sfax (Environmental and Development Collective of Sfax) in the city of Sfax, speaking in an exclusive interview with Toward Freedom. “It’s dangerous for all economic and social activity, besides being a human health issue.”

The militant, who’s been campaigning on environmental issues for nearly 40 years, estimated above 44,000 tons of rubbish were discharged into the environment without any treatment for more than 70 days after the main landfill shut down.

“Sfax’s garbage issues have been ongoing since long ago,” said Aida Kchaou, a painter and active member of civil society in Sfax, in an interview with Toward Freedom. She alluded to years of government neglect. “People are used to dumping trash carelessly as if they want to punish the state somehow.”

The artist cannot remain indifferent to how environmental conditions have degraded in her region. In 2015, she performed an act of protest on Chaffar Beach, 26 kilometers (or 16 miles) south of the city of Sfax, by wearing plastic garbage bags and picking litter to raise awareness of the decaying state of the seashore because of long-time chemical industries in Sfax governorate.

Kchaou has paid more than one visit to Agareb, meeting residents and local activists, and taking part in small actions in the vicinity of uncontrolled hazardous landfills, very close to residential areas. Recently, she staged an action by standing in the middle of a dump near Agareb, holding her paintbrush as if she was going to cover all of the rubbish with paint. She ended by planting an olive tree. “I live my environment: I see there’s something wrong and I react,” the painter said.

Monem Kallel, professor at the National School of Engineering of Sfax and an environmental expert, pointed out the waste crisis is essentially connected with the method of burying waste in open dumps, which Tunisia has adopted for about 24 years.

“It’s an old policy—one of the worst approaches to waste management—that leaves the fate of the litter unknown and makes people think the state will take care of it,” the expert observed while speaking to Toward Freedom. “Meanwhile, the country’s dumps are getting filled up, and people are growing fed up with the accumulation of unremoved garbage.” He stressed an urgent solution to waste dumping, such as immediately hauling it away, must be accompanied by the longer-term sustainable process of sorting, treatment and recycling.

In 2015, artist Aida Kchaou performed an act of protest on Chaffar Beach, 26 kilometers (or 16 miles) south of the city of Sfax. She wore plastic garbage bags and picked litter to raise awareness of the decaying state of the seashore because of long-time chemical industries in Sfax governorate / credit: instagram.com/aidakchaoukhroufart

Striking Against Structural Stench

In the face of growing waste mismanagement, posing serious health and environmental risks, civil society groups in Sfax governorate announced they would hold a general regional strike on December 10. They also successfully filed a legal complaint against the parties responsible for the ecological catastrophe, namely the environment ministry, the National Waste Management Agency (Agence Nationale de Gestion des Déchets, or ANGED for short) and the region’s municipalities.

With the local and national government coming under pressure—just a few days before the anticipated strike—the prime minister’s cabinet decided to resume on December 8 the clearance and dumping of household waste in a temporary collection point located near the port. This plan depended on the rubbish heaps being transported within five months to a new landfill to be created on the road to a town in Sfax governorate’s countryside called Menzel Chaker, about 62 kilometers (about 38 miles) from the city of Sfax. The cabinet also resolved to develop a regional plan for recycling and waste recovery within three to five years.

For Hentati, postponing the general strike was a mistake because pressure that should have served to obtain guarantees from authorities dissipated. The government quickly came up with a package of urgent measures to solve the crisis to avert the labor action. Though, he said, “It did not make any real commitment.” He added residents in the city of Sfax have been left in a disarray, as they are cautiously watching the government’s decisions.

The environmental activist made clear the issue is fundamentally a structural one.

“Today, the garbage crisis in Sfax shows the limits of the long-applied waste treatment system, which only bypasses the problem without resolving it,” Hentati said.

Increasing numbers of local people are demanding the government introduce waste disposal policies that will protect their right to a safe environment because they refuse to allow their neighborhoods to be turned into landfills.

Poor responsibility sharing between the state and regional and local institutions have resulted in a deadlock in the handling of the ongoing crisis: The central government expects municipal councils to provide much of the waste management, while municipalities call on the state to find sustainable solutions.

Untransported garbage heaps, like this one in the Tunisian city of Sfax, have caused environmental and health challenges / credit: Alessandra Bajec

Trust In the Dumps

Given their proximity to citizens, local governments are the first bodies held responsible for failing to effectively deal with waste treatment. Yet, it should be noted Tunisia’s elected local councils, which have been operating since 2018, “face severe budgetary and human capital constraints,” as Lana Salman, researcher in urban governance and international development, wrote in a research paper published in April. “[It] is a highly lucrative sector where opacity and corruption are not only endemic, but also institutionalized,” she penned.

While municipalities are responsible for hauling garbage to temporary transfer centers with the ANGED’s assistance, the agency is in charge of transporting waste to the final destination at sanitary landfills and managing such landfills.

Kallel specified greater efforts are needed to raise environmental awareness among the concerned institutions as well as among people, and that an adequate budget should be allocated to make possible feasible solutions. “Rather than shifting the responsibility from one to another, if everyone is involved responsibly through the whole waste management chain, the crisis will be overcome,” he said, underscoring the important role citizens can play in contributing to environmental protection.

The specialist maintained that trust in state institutions needs to be restored, after years of unfulfilled promises. “If the state engages by taking serious gradual steps, the average citizen will be confident that a real solution to this crisis will come,” Kallel said. “Else, it will persist.”

Kchaou similarly referred to lack of public trust as a critical matter, blaming the country’s successive governments for appointing incompetent people to ministerial posts over the past decade. She contended people will hardly act in respect of environmental protection as long as they see the relevant government structures—local, regional and national—not providing waste treatment.

Long-standing dysfunctional governance and corruption within Tunisia’s state administration underlie the garbage emergency in the Sfax province. More than half of the country’s landfill sites have reached their maximum capacity, threatening the environment and human health.

The state neglect mirrors the lack of national strategy to develop recycling capacity to deal with solid waste in Tunisia. The Ministry of the Environment has opposed the closure of dumps as no alternatives exist. In October, the new environment minister, Leila Chikhaoui, said while visiting the city of Sfax that no immediate solutions were available in the governorate.

Raouia Amira, head of the sanitation, health and environmental committee in the municipality of Sfax, pointed to the country’s solid waste management strategy being discontinued in 2016. “We need a national strategy,” Amira told Toward Freedom. “To that end, the state needs to put in place a communication campaign and spare no expense.”

She thinks incineration is the most realistic approach to treating household waste in the Sfax governorate. Tunisia has long suffered waste management problems, with an estimated 2.5 million tonnes of rubbish produced annually, 63% of which is organic, and most of it buried in landfills without being processed, recycled or incinerated.

Sustainable Solutions

The thorny matter is aggravated by lack of investment in sustainable solutions and endemic corruption within the sector in the North African country.

In a press conference in 2014, lawyer Faouzia Bacha Amdouni presented findings of an independent audit revealing “colossal funds” intended for environmental projects were channeled through the Ministry of Environment and its agencies, ending up in the hands of the government of Prime Minister Zine El Abidine Ben Ali (1987-2011) and its allies. The advocate declared several figures within the agencies were working to conceal their involvement in corruption as well as their plan not to design new strategies. “The department of the environment itself was created in 2005, not to develop policies and innovative projects for waste treatment or sanitation stations, but to receive resources from international donors and invest them in personal projects benefiting the clans in power and their relatives,” she said at the press conference. Some of those international donors reportedly include the European Investment Bank, the Italian Agency for Development Cooperation, the World Bank and the French Development Agency.

In July 2020, then-Prime Minister Elyes Fakhfakh resigned following allegations of corrupt links to the waste industry. In December 2020, the environment minister was dismissed and arrested along with 23 other officials—including members of the ANGED, or National Waste Management Agency—for being linked to a scandal involving the illegal transfer from Naples, Italy, to the Tunisian port of Sousse of more than 200 shipping containers packed full of decaying household and medical waste disguised as post-industrial plastic waste. The Italian and Tunisian companies embroiled had signed a contract worth €5 million ($5.76 million) to dispose of 120,000 tons of Italian waste in Tunisian landfills.

An investigation published by Inkyfada last March revealed a vast network of corruption involving Italian waste.

The critical environmental situation in Sfax governorate poses a clear social challenge for President Kais Saied, who promised to close the El Gonna landfill during his 2019 presidential campaign. This came in a region that strongly supported his July 25 power seizure, in what his critics have called a coup.

The mobilizations against the re-opening of the toxic dump and the wider trash crisis in Sfax demonstrates Tunisian citizens’ yearning for a clean and sustainable environment. This, as they escalate their calls on the government to stop imposing short-sighted decisions without popular consent and demand it find alternatives to landfill sites.

“The extent of the garbage crisis we’ve experienced in Sfax has been of some use,” the artist Kchaou remarked. “If that didn’t happen, no one would be taking the issue seriously.”

Alessandra Bajec is a freelance journalist specializing in West Asia and North Africa. Between 2010 and 2011, she lived in Palestine. She was based in Cairo from 2013 to 2017, and since 2018 has been based in Tunis.

Sinking Cities Project: ‘Alexandria: Layers of History, Levels of Threat’

Rehab Abdalmohsen November 17, 2022 Rehab Abdalmohsen Admin, Africa, Archives

Editor’s Note: This article, originally published by Unbias the News, is part of the Sinking Cities Project, which covers six cities’ responses to sea-level rise. The investigation was developed with the support of Journalismfund.eu, European Cultural Foundation and the German Postcode Lottery.

In order to visit Alexandria’s most famous museum, you need to dive into its sea. Much of this ancient Egyptian city was lost to sea, and sank beneath the waves of the Mediterranean around the 3rd or 2nd century.

Located 2.5 kilometers (1.55 miles) off the coast of Alexandria, “Abu Qir Sunken Cities Museum” hosts the underwater ruins of both the Thonis-Heracleion and Canopus cities, where visitors can see the lighthouse that was one of the world’s Seven Wonders, along with anchors, gold coins, and the remains of the palace where Cleopatra and Anthony lived their last days, all lying at the bottom of the sea, as a testament of how vulnerable humans are to nature’s forces.

Since the discovery of the two long-lost cities and other underwater sites, scientists and researchers have been striving to unravel the reason behind the collapse and submergence of these great cities more than 1,500 years ago. They are also investigating the probability of history repeating itself.

Historical Precedent

Franck Goddio, the French underwater archaeologist who, in 2000, discovered the city of Thonis-Heracleion said that parts of the city’s ancient coastline sank beneath the sea “due to a combination of natural phenomena, including a series of earthquakes and tidal waves.”

Spending most of his long career studying ancient Alexandria, Magdy Torab, professor of Geomorphology at the Faculty of Arts, Damanhour University, suggests the same reasons for what happened there. “Alexandria is located close to some active tectonic plates, we witness a lot of earthquakes from near and distant sources that caused damages to the city, both in historical and recent times. One of the effects of those land movements is causing land subsidence,” he said.

In a study published by the Austrian Academy of Sciences Press in 2018, Torab also investigated sea level variation at Alexandria over the last millennia. “There is an abrupt relative sea level rise that occurred from the mid-8th century to the end of 9th century that explains the wide movement of sinking that happened at this time.”

Exploring the different reasons that led to the disappearance of this coastal city has a special importance as it is used by scientists to predict earthquake hazards in the coastal areas today.

Torab describes the effect of the seismic activities that the ancient city of Alexandria faced at this time, “land may have subsided as a result of an earthquake that followed an undersea earthquake or tsunamis.”

Land subsidence is a gradual or sudden sinking of the earth’s surface. The phenomenon can be caused by many reasons. Some of them might be related to human activities or part of a natural process like earthquakes.

The Mediterranean region has a witnessed many destructive earthquakes, among them the 365 Crete earthquake, which happened between the fourth and sixth centuries and was followed by a devastating tsunami that swept out Alexandria, and the Nile Delta, killing thousands.

So the great port that hosted the legendary Alexandria library flooded by a giant wall of water that puts big parts of the city under the water. Does this indicate that this might happen again?

According to the UNESCO, Alexandria is among five cities in the Mediterranean sea that is under the threat and need to be “tsunami-ready” by 2030. “Statistics show that the probability of a tsunami wave exceeding 1 meter in the Mediterranean in the next 30 years is close to 100 percent.”

Between the Sky and the Sea

Ziad Morsy knows Alexandria by heart. That’s hardly surprising, considerings he and his ancestors have lived in the city for decades. But what is remarkable is how much he knows about the invisible part of Alexandria, the part settling underwater.

For more than 12 years, Morsy’s work was under the water, as a scholar at Alexandria Centre for Maritime Archaeology and Underwater Cultural Heritage, then a visiting Lecturer of Maritime Archaeology. His job was to dive in the sea and collect data, because, as he said, “to be prepared for the future we need to understand the past”.

“Global warming will definitely affect Alexandria’s shoreline. But is it going to be the reason behind its sinking? I don’t think so. From my point of view, there is a long list of reasons, and global warming comes at the end of this list,” Morsy told Unbias the News.

He summarized the factors that determine “whether Alexandria is going to stay above the water or sink under the water” in three points: The city land level, the Mediterranean sea level, and Lake Mariout.

Geographical Precarity

If you search for Alexandria in the map, you will notice the port’s unique location, at the western end of the Nile River Delta and between two water bodies: the Mediterranean Sea in the north and Lake Mariout in the south.

The lake, which used to be much larger, is filled with brackish water because it receives a large amount of sewerage output and discharge of untreated irrigation wastewater that comes from the western delta. Although it connects to neither the Mediterranean Sea nor the River Nile, in order to keep the water level in this landlocked lake below sea level, water gets pumped and discharged from the lake into the sea.

“Imagine if the pumps didn’t work for any reason, the water level in the lake would increase and overflow, which means that parts of southern Alexandria would be flooded by the water,” said Morsy, citing another infrastructure risk.

Morsy believes that researchers are turning their heads toward the sea level rise effect, when the real focus should be on the land of Alexandria:

“A tsunami will not remove Alexandria from the map. Tidal waves will certainly cause damage. But what will swallow this city are earthquakes and land subsidence. We will go down to the bottom of the sea, just the way it happened before.”

The Mermaid of the Mediterranean

The spot where Alexandria was constructed is playing a vital role in the city’s sinking scenarios. It dates back to 331 B.C, when Alexander the Great chose to build a city surrounded by two water bodies: the Mediterranean Sea in the north to make it a trade center, and Lake Mariout to the south, where he directed the Greek architect Dinocrat to design “Alexander’s Harbor.”

But the chosen location was a barren area. So the engineer needed to establish a complex, intelligent system to supply water from the Nile through canals, and then distribute water through a branched pipeline system and store it in underground tanks.

Parts of this old pipeline system still exist but are not functioning, as the new city is built on the top of the many ancient cities that came ahead of it, “And this is in itself another cause of subsidence,” said Torab.

“If you are living in Alexandria, it will be normal for you to suddenly pass by a big hole in the middle of a road you are used to walking on every day, or see a building with visible cracks. It is an obvious form of land subsidence,” Morsy said.

This issue inspired the Goethe Institute in Alexandria to join the project “Atlas of Mediterranean Liquidity,” which aims to show the impact of climate change on the Mediterranean through interactive maps and artwork.

Morsy contributed to the project. He sees it as a good way to raise awareness on how the city water sector was historically managed, and the challenges the city is going through. All is done through an interactive map done based on historical maps and city plans.

The ancient Alexandria was also built on limestone coastal ridges covered by a layer of clay, then a layer of the Nile river silt accumulated through the years. These landforms added to the fragility of the land toward subsidence, Morsy explained. The ancient Alexandria was also built on limestone coastal ridges that were covered by a layer of clay, then a layer of the Nile river silt that was accumulated through the years and these landforms added to the fragility of the land toward subsidence, Morsy explained.

Land Regression

Before reaching the Mediterranean, the Nile divides into two branches, Damietta and Rosetta. The number of branches is not clear, but they used to empty themselves in the Mediterranean Sea. One went through Alexandria even during the time of Queen Cleopatra. The blockage of the “Canopic branch,” due to the lack of maintenance, affected the sediment supply to the delta and the shoreline, which was vital for compensating the soil that got swept away by the waves, and caused land regression.

“Since the construction of the High Aswan Dam (HAD) across the Nile at Aswan in 1964, fresh water and sediment delivery to the coast of Alexandria declined every year. Because of the absence of sediments, the rates of soil erosion, land subsidence and groundwater salinity increased. This led to losing some lands to the sea, and we will be losing more,” said Ahmed Radwan, professor at National Institutes of Oceanography and Fisheries of Egypt (NIOF).

Daniel Jean Stanley and Andrew G. Warne published a well-recognized paper, “The Sea level and Initiation of Predynastic Culture in the Nile Delta.” They mentioned that, since 1964, essentially no sediment has been transported by the Nile River to the coast and also concluded that the Nile Delta “… is no longer an active delta but, rather, a completely wave-dominated coastal plain along the Mediterranean coast.”

He added that, without this dam, Egyptians would have survived neither the Nile flood, which killed hundreds of souls, nor the drought that hit the east African countries in the late ’80s and early ’90s: “The HAD was the real engine behind the development that happened in the country at this time.”

Land Reclamation

Radwan lives in Alexandria. He witnesses the coastal protection project that gets implemented by the government every day, and researches many hot spots. He believes the government’s reclamation and nourishment efforts are the safeguards for much of the coastland we are witnessing today:

“Let me give you an example. Abu Quir bay Headland is gained from the sea. Without the governmental effort to fill the gap in sediments, the area would have been lost to the sea. This is why sand feeding is important – to compensate for what nature was doing and bring in some ecological balance to the area that was lost to the sea with soil, cements or rocks.”

Between 1987 and 1994, artificial beach nourishment projects were implemented at Abu Qir, Stanley, El Asafra, Mandara and El Shatby beaches, with and without concrete jetties.

According to the UNESCO report, every year, 20-ton blocks are dumped into the water to protect the Corniche (road built along a coast) wall from wave action and seasonal winter floods.

“Land nourishment is not a permanent solution,” said Hisham Elsafti, who participated in the design and evaluation of many projects in marine civil engineering in Alexandria as a researcher at Alexandria University.

Elsafti works for the Department of Hydromechanics and Coastal Engineering at Leichtweiß Institute for Hydraulic Engineering and Water Resources of the Technical University of Braunschweig in Germany. He explained that “soft” solutions like beach nourishment might be more favorable because the global direction nowadays is to implement an Integrated Coastal Zone Management (ICZM). It is an interdisciplinary, iterative approach for sustainable use of the coastal zone combined with nature-based solutions, sometimes also referred to as building/engineering with nature.

He gave an example of nature-based solutions supporting local coastal ecosystems to protect the coast, “in Indonesia, the country is using mangrove forests to dampen tsunamis’ damage to its coast.”

Hard and Soft Solutions

In 1984, the American engineering services company Tetra Tech, Inc. developed a Shore Protection Master Plan (SPMP) for the Nile Delta Shoreline and Alexandria for the Shore Protection Authority (SPA) of Egypt. It designed specific schemes for 13 selected shore protection projects, which were then categorized as “first priority projects,” and “second priority projects.”

The solutions applied by the Egyptian government are mostly “hard engineering solutions.” It is a well-known technique to protect its shoreline by placing coastal concrete armor units that change the patterns of seabed erosion and siltation for a long distance along the shore, as Elsafti said.

Before the soft and hard engineering solutions, Alexandria used to get its shore protection from two natural sources, the long shore parallel breakwater called “Pharos Island,” an island composed of a series of ridges. The Nile and the Litani—especially the Nile river—were significant in supplying sediment along the shore and filling the deficiency in the coastal sediment budget.

Humans tried to mimic those natural islands, and make artificial islands through land reclamation. Part of the supposed benefits of those islands is protecting the main shoreline. The government reclaimed a big part of the shore in Alexandria. In the north coast, and in Al-Alamein city to the west of Alexandria, a big project of land reclamation took place, aiming to build more than 25 high buildings, each including more than 41 floors.

“The benefits of those projects are economical but their relation to coastal protection is limited,” said Elsafti who also explains how any human interference in nature should be studied well, in order to avoid fixing a problem in one location only to cause problems in others.

He added that if sand nourishment is done at a place in the sea where the sand doesn’t belong, then the sand will shift from that spot, and sediment in another. “This is why any sand nourishment project takes into consideration the annual sand feed process.”

The Shore Protection Authority released a report titled “Adaptation to Climate Change in the Nile Delta through Integrated Coastal Zone Management.” It mentioned that “even if these measures—of coastal protection—were fully in place some of them may eventually prove to have negative impacts without a proper understanding of longer-term coastal dynamics associated with climate change. Therefore, more complex (mixed) approaches are required to increase the robustness of the coast and ensure sustainable long-term adaptation.”

Unlike the old city of Alexandria, the new Al-Alamein is considering coastal protection mechanisms throughout the construction process. During my visit to the place, I witnessed the large scale of engineering coastal protection work even before the completion of the construction.

Buildings under construction tower in the distance of blue-green water

Buildings under construction along the beach

Buildings under construction as seen from the highway in Alexandria, Egypt

The IPCC (Intergovernmental Panel on Climate Change) Special Report on the Ocean and Cryosphere in a Changing Climate (SROCC) mentioned that the Egyptian government has committed $200 million to hard coastal protection at Alexandria and adopted integrated coastal zone management for the northern coast, including jetties, groins, seawalls, and breakwaters to combat beach erosion. “Recent activities include integrating SLR (sea level rise) risks within adaptation planning for social-ecological systems, with special focus on coastal urban areas, agriculture, migration and other human security dimensions,” says the report.

Lack of Coordination

Working as climate change advisor at the technical office in the Ministry of Environment and Environmental Affairs Agency has given Nadia Mohamed Elmasry a chance to witness what is happening on the ground to save Alexandria from sinking.

In 2017, she was involved in a project with the Public Authority for Shore Protection on a project to map the hotspots that urgently need the construction of tide breakers, to decrease erosion in these areas.

“After finishing the study, we noticed that some spots got eroded more than our expectations. Does this mean that the study was wrong? No, there were some unplanned development projects not included in our study, and they were built without considering the erosion map, such as the North Coast Compounds and new Al-Alamein.”

Nadia Mohamed Elmasry

This explains why the beach looks different before and after the establishment of the compounds oin the north coast. “Before the construction you could see a sandy, beautiful beach. But after it you will notice the sudden appearance of a rocky beach,” said Elmasry.

She explained this normally happens when extensive engineering projects take place in the sea—such as those undertaken to create yacht marina or jetties—without studying the erosion rates, the shoreline change pattern and the tidal movements. These affect the tides’ direction and the erosion pattern, and cause high erosion rate in one place and increase in sedimentation in another one.

Elmasry opened the map and pointed her finger at the coastline of Alexandria and northcoast and said:

“Look at this shoreline. Some spots here were under high threat, but the situation in those spots improved a lot. Unfortunately some other spots deteriorated. I believe it’s not because of the lack of environmental studies, but the lack of cooperation between the different entities.”

The Egyptian government is facing this threat from many quarters. At the top of the list come the Egyptian Coastal Research Institute and the Egyptian Public Authority for Shore Protection, whose roles are to monitor the evolution of the Egyptian coasts to determine the near shore zone changes of the coasts. They predict future changes in the coastal zone by using mathematical models to select the most economical and effective protective measures.

They also prepared the Alexandria Integrated Coastal Zone Management Project (AICZM) under climate change scenarios, along with other entities such as the Egyptian Environmental Affairs Agency (EEAA) which, they say, is providing the most efficient, low cost and effective control works to protect the heavily populated areas.

Who Can See the Sea?

Alexandria has gone through many phases of abundance and deterioration throughout its modern history. The city lost its prestigious place and importance as a cultural and commercial center, and its population notably declined. It happened just before the earthquake that hit the city and caused big damage to its infrastructure and buildings, including ruining the lighthouse around 956 AD.

But gradually the city regained its place. Now it is facing the opposite problem. An over-growing population shrunk the space for houses, which encouraged the construction of tall buildings by the seaside. Many cafes and restaurants sprung up on the now-concrete shore, and together all these structures added big pressure on the infrastructure and the land.

If you plan to visit the remarkable coastal city, there is a high chance you won’t be able to see the sea, or sit on a sandy shore. The coastline mostly consists of big blocks of concrete to protect the shore from erosion, with either cubic shapes or four-legged quadripods, or restaurants and cafes that will stand as a barrier between you and the sea view.

Elsafti clarified that coastal defenses along Alexandria’s coast were developed to support the widening of the Corniche by means of a revetment structure. These sloping structures erode the power of the waves behind them, but it is not related to SLR. “Revetments should be designed to prevent the seepage of fine soil material from the large gaps between the coastal concrete armor.”

He described how hard it used to be to move from one place to another using the Corniche road before the widening, and the shore nourishment that had been done years ago, “Traffic used to be a nightmare. The Corniche widening project helped a lot in facilitating the movement.”

Yasmine Hussein is a research director at the Human and the City for Social Research (HCSR), and her family members are old residents of Alexandria. Before talking about the city, she took a deep breath and, with a voice full of sadness, she said: “Yes, there used to be sand and shores, and walking on the Corniche was a basic outing for Alexandrian families. I built hundreds of sand castles just like all kids my age at the time. Those childhood memories are gone, and now, there is almost no shore. There are either concrete blocks, or restaurants and cafes constructed on the shore. The generation that witnessed Alexandria 15 or 20 years ago is feeling a great amount of sorrow and nostalgia.”

Hussein contributed to many studies about Alexandria. One of them is “Alexandria Corniche: Between privatization and the right to see the sea ,” which investigated how the highly populated city of Alexandria, with its more than half a million inhabitants nowadays, lost most of its shores. She attributed this loss to the urbanization projects implemented without enough consideration to the environment, or before the completion of the project’s environmental studies.

“The threat comes not only from sea level rise but other factors, such as land subsidence and the threat of earthquakes. This is what happened in the past and led to the sinking of this city twice, in 956 AD and 1303 AD,” said Hussein.

“We are inside the climate change, not waiting for it to happen,” Hussein added with a strong voice, “We used to have seasonal rain in the winter. It is locally called ‘NOAA’. It is more intense now. The rain is heavier, the storms are faster, and the tides are higher. This situation is causing damages; almost every year we are witnessing (extreme weather events).”

She explained that Alexandria faces two challenges. The first is repeating the same scenario and sinking again by tsunamis or earthquakes, and the second is the seasonal sinking every winter because of the extreme weather events.

One of the challenges that adds to the fragility of the city is the heavy construction and housing projects that took place everywhere: “This is a heavy weight on the land. It is an unbearable load … that doesn’t consider the environment or climate change.”

This increased privatization also takes a toll on public space. In 2019, the research center HCSR launched a campaign called, “Alexandria can’t see the sea,” to create awareness and encourage communities to get involved and be aware of the situation in their city before it’s too late. Hussein recalled, “We received good feedback from the community members. We asked people to send photos of the sea view to compare between the view in the past and now, collected those “before and after” photos, held an exhibition where we showcased what is going on the ground, and presented our studies.”

Top of the List

In their annual report, the IPCC said that “in the absence of any adaptation, Egypt, Mozambique, and Nigeria are projected to be worst affected by sea level rise in terms of the number of people at risk of flooding annually in a 4℃ (39.2°F) warming scenario.”

The report explored the potential damages due to SLR and coastal extreme events in 12 major African cities. The city of Alexandria in North Africa leads the ranking, with an aggregate expected damage of $36 billion and $50 billion under the moderate scenario, where emissions peak around 2040 and then decline.

The Egyptian Ministry of Water Resources and Irrigation reports a sea level rise at an average rate of 1.8 mm (0.7 inches) per year until 1993. The following two decades, the water level rose by 2.1 mm (0.8 inches) per year, and since 2012 it reached 3.2 mm (0.12 inches) per year. The Nile delta is reported to sink at the same rate, which amplifying the negative impacts of SLR.

But Morsy believes that a satellite view might not give the most accurate data regarding the effect of SLR in Alexandria, “We need studies that will focus on small scales and local environmental aspects and their effects. The effect of climate change and SLR is not equal everywhere in Alexandria.”

Morsy agreed that sometimes researchers focus on the worst case scenarios to encourage governments to take actions: “There was an old study that predicted that Alexandria will sink in 2023. But look how the situation is now; the city didn’t sink.”

He said that if the city is going down it’s because of all the factors that get mentioned:“Every thousand years the city goes down by one meter.”

Morsy leaves me to dive again and swim beside the ancient Alexandria. His dream now is to live on a ship in the Nile in Aswan, so that if a flood happens he will be safe in his Ark.

Rehab Abdalmohsen is an independent science journalist and water reporter whose work has appeared in ScieDev.net, @NatureNews, the Niles magazine, among others.

Accredited Social Health Activist (ASHA) worker Kavita Magdum monitors the health of infants and children / credit: Sanket Jain

Childhood Immunization Schedules Increasingly Delayed in India As Floods and Other Climate Change Impacts Get In the Way

Sanket Jain July 10, 2023 Sanket Jain Admin, Archives, Asia

Accredited Social Health Activist (ASHA) worker Kavita Magdum monitors the health of infants and children. Here, she weighs one of twins of Hasina Hajukhan / credit: Sanket Jain

Hasina Hajukhan never imagined that returning to her maternal house would turn into a near-death experience. In April, the 28-year-old was seven months pregnant, and her medical parameters were normal. “I was taking extra care to ensure no complications during childbirth,” she told Toward Freedom.

As is customary in many parts of India, pregnant women return to their parents’ homes to give birth. When Hajukhan first reached her mother’s house in Ganeshwadi village of the western Indian state of Maharashtra, she felt nauseated. “It was April’s final week, and I couldn’t even breathe properly,” she recounted. A heat wave had taken hold. “The climate was the stark opposite of what it was in my husband’s village.” In Ganeshwadi, things kept getting complicated with the rising heat. “Every day, I was breathless and would feel dizzy.”

Using a desk fan at the highest speed didn’t help, as it just circulated more hot air. An air conditioning system was something her family could not afford. The tin sheet roof would get extremely hot. During this crucial time, Hajukhan needed rest. However, she spent most of her day stepping out to gasp for cold air. In May’s final week, things got worse. “I felt as if I was going to die,” she recalled, teary-eyed.

Immediately, her mother dialed Ranjana Gavade, an accredited social health activist (ASHA worker), part of a community of 1 million women healthcare workers appointed for every 1,000 people in India’s villages. ASHAs are responsible for more than 70 healthcare tasks, with a particular focus on maternal and child health.

ASHA worker Shubhangi Kamble spends a significant amount of time each day talking to community women to help them understand the impact of climate change on children / credit: Sanket Jain

“I was worried looking at her rapidly deteriorating health and informed my colleagues.” Upon their instructions, Gavade called a government ambulance and swiftly took her to the district hospital, 33 kilometers (20.5 miles) away. Hajukhan gave birth to underweight twins. Her troubles still hadn’t ended when she was discharged after three days. For a month since then, Hajukhan has been trying to ensure her twins gain weight, but all efforts have failed. As a result, they weren’t administered the necessary Bacillus Calmette–Guérin (BCG vaccine used against tuberculosis), Hepatitis B, and Polio vaccines.

The Kolhapur district, where Hajukhan lives, has been reporting recurring floods, heat waves, incessant rainfall, and hailstorms triggered by climate change. She said everything would have been normal had she not returned to her parents’ home to give birth in the heat waves. “My children wouldn’t have had to live such a dangerous life,” she said.

Like in the village of Ganeshwadi, climate change impacts have been delaying children’s immunization schedules throughout India, making them vulnerable to diseases. Research has found that if a child belonged to a district highly vulnerable to climate change, the odds of stunting rose by 32 percent, low weight by 45 percent, anemia by 63 percent and acute malnutrition by 42 percent. An analysis by global nonprofit Save the Children found that, globally, 774 million children are living in poverty and at a high risk of climate-related disasters. Weather disasters ranging from floods to droughts prevent children from obtaining nourishment, causing low weight, and these disasters put a break on children receiving vaccinations on time. Their weakened immune systems, as a result of a lack of proper nourishment in crisis times, make them vulnerable to other diseases. Being sick can halt the necessary immunizations, and these delays have led to a rise in epidemics and diseases.

ASHA worker Shubhangi Kamble often works beyond her duty to ensure every child completes the universal immunization on time. Here, she speaks to a woman to help her understand how climate change can impact her son’s health / credit: Sanket Jain

How Floods Impact Universal Immunization

Snehal Kamble, 24, a resident of Maharashtra’s flood-prone Arjunwad village, remembers the year 2019 in meticulous detail. “A day before the floods, I was preparing to go to my parent’s house.” Five months pregnant, she was looking for iron folic acid tablets. “Instead, all of us went to a flood relief camp,” she recounted. From there, she moved to another relief camp within a few days, as the water rose further. “During this time, I was worried about my house and belongings,” she said. She fell sick and was away from home for 15 days. “Those were the most difficult days of my life,” she shared. Then in January 2020, she gave birth to a boy named Sangarsh, who has often fallen sick. “When I went to my maternal house, he just couldn’t bear the heat there,” she said. The dehydration and spells of fever he experienced affected his immunization schedule. “His Pentavalent vaccine was delayed by several months because of health ailments,” said ASHA worker Shubhangi Kamble (no relation to Snehal), who has been monitoring this child since birth.

Further, his Measles-Rubella vaccine and Vitamin A dose were also delayed, making him vulnerable to diseases. “Vaccines need to be administered on time,” said Sachin Kamble, a nursing officer at the district women’s hospital in Maharashtra’s Osmanabad district. “Otherwise, it affects a child’s immunity, making them more vulnerable to diseases.”

He pointed out how the lack of vaccinations led to 2,692 cases in 2022 in Maharashtra, which reported the highest measles count in India. That was an eight-fold increase from the previous year. During this time, India reported 12,773 cases. India’s National Family Health Survey (NFHS) said only 31.9 percent of children ages 24 months to 35 months had received a second dose of measles-containing vaccine in 2019-21.

Another healthcare worker, Kavita Magdum, from flood-affected Ganeshwadi village, said that children in her surveying area never fell ill so frequently. She started noticing such stark changes only in the past five years. Upon inspecting this, she found, “Stress caused by the changing climate is leading to this.” For instance, Magdum sees that many children aren’t drinking breast milk, which has impacted their medical parameters. These drastic changes reflect in Indian government statistics, as well. During 2015-16, 58.6 percent of children ages 6 months to 59 months (just under 5 years old) were anemic in India. By 2019-20, this number rose to 67.1 percent. In addition, 32 percent of children nationally remain underweight.

After a year-and-a-half, Snehal’s son started getting better, thanks to Shubhangi’s consistent visits, when she monitored every parameter and ensured the best possible treatment by working hours beyond her duty. “Once the vaccination schedule started falling in place, his health, too, began improving,” Shubhangi shared.

ASHA worker Ranjana Gavade frequently visits Hajukhan’s home to monitor the health of her children / credit: Sanket Jain

Untimely Administration of Vaccines

While climate change is making it difficult for these healthcare workers to complete universal immunization, another challenge is the untimely vaccine administration.

“There are many instances, where vaccines in several villages are just not available,” said Netradipa Patil, leader of more than 3,000 ASHA workers and co-founder of Deep-Maya Foundation, a non-profit that works for women and children. “During such times, it becomes extremely challenging for us healthcare workers to manage everyone.”

Patil has observed that the workload has increased tremendously for all the ASHA workers because of the delay in vaccination. This is because ASHA workers are responsible for immunization, and in case of any discrepancy or error, they are held accountable. Research published in 2016 concluded, “Lack of timely administration of key childhood vaccines, especially DPT3 (the three doses of the Diphtheria, Tetanus and Pertussis vaccine) and MCV (measles-containing vaccine), remains a major challenge in India and likely contributes to the significant burden of vaccine-preventable disease-related morbidity and mortality in children.” Another paper published in 2019 inferred, “The proportion of children with delayed vaccination is high in India.”

In 2021, the World Health Organization found that 25 million children around the world under the age of 1 didn’t receive vaccines, a figure not seen since 2009. “Many children never get the Vitamin A doses on time. These doses are just not available when required,” Patil said, suggesting the Indian government should consult local healthcare workers to arrange vaccination. “We need to reach more and more people, and, currently, looking at the changing climate, we aren’t prepared to do this,” she shared. Patil made simple suggestions like identifying vulnerable children and their locality and monitoring them from the earlier stages, even before the disaster strikes. “Just by proper identification, we can save so many children,” she said.

A woman playing with her child in Maharashtra’s Kolhapur district / credit: Sanket Jain

Rising Undernourishment

Fed up with feeding medications and tonics that didn’t seem to help increase his weight and prevent him from continually falling ill due to the changing weather conditions, Rashi Patil, 23, quit taking her son to the doctor every month after 18 months. “My son just wouldn’t eat anything,” Patil said.

Moreover, the changes in local climatic patterns affected her son’s health, and he often fell sick. Last year, he was hospitalized for a week as his platelets fell and a fever intensified. What followed next were recurring illnesses that delayed his immunization schedule. Because of the fever in March, he wasn’t administered the Pentavalent 1 vaccine (it protects from five life-threatening diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib [Haemophilus Influenzae Type b]). Her son soon became weak and began recovering only after the vaccine’s administration. All this while, her son struggled with good eating habits. After several trials and errors, Rashi and her husband, Rajkumar, discovered the climate affected their son’s health and eating habits.

“Now, their son makes it a point to eat only outside the house, where he gets some cold air,” says Rashi. “Contrastingly, this was never the case with my elder daughter.”

Toward Freedom reached out to Ganeshwadi’s community health officer, Dr. Prajakta Gurav, regarding what steps her team was taking to deal with delayed immunization. Gurav hasn’t replied as of press time.

The impact of poor diets is more obvious at the national level. For instance, just 11.3 percent of children between the ages of 6 months and 23 months receive an adequate diet. Plus, in 2022, India ranked 107 out of 121 countries on the global hunger index. These numbers further reveal how climate change is exacerbating the existing faultlines.

The problem is not restricted to India. Of the countries at severe risk of being adversely affected by climate change, the report by Save the Children says, “Burundi has the highest rate of stunted children (54 percent), followed by Niger (47 percent), Yemen (46 percent), Papua New Guinea (43 percent), Mozambique (42 percent) and Madagascar (42 percent).”

Research published in PLOS Medicine found that in 22 sub-saharan African countries, drought led to lower chances of completion of BCG (Bacillus Calmette-Guérin), Polio and DPT (diphtheria, tetanus, and pertussis) vaccines. “We took vaccines to the last mile. Now, climate change is eroding progress.”

For Komal Kamble, 30, vaccinating her 2-year-old daughter remains challenging. Her remote mountainous village of Kerle, in Maharashtra’s Kolhapur district, remains inaccessible most of the year.

For the village population of less than 1,100 people, the nearest healthcare facility is 15 kilometers away. Last year, within a week of October rains, the road that connects her village to the nearest hospital was completely under floodwater.

Komal’s daughter couldn’t get proper medical care for two days, worsening her health. Her chest was full of cough, and the fever rose, making things difficult for the agrarian Kamble family. This wasn’t restricted to heavy rainfall, though. Since her birth in 2021, Komal has taken her daughter to a private doctor at least 20 times, spending over Rs 15,000 ($182). Last year, she was feverish and wasn’t given the crucial Japanese encephalitis vaccine, a Vitamin A dose and the Measles-Rubella vaccine. This made her vulnerable to more diseases, challenging the Kamble family.

Healthcare worker Shubhangi Kamble from Arjunwad says that instances of children missing their vaccination are rising rapidly. When she went to find out why this was happening in her village, Arjunwad, she saw that children fell sick during floods and heat waves. “This was the time that coincided with their vaccination schedule, and so many couldn’t get the vaccines,” she shared.

However, a delay in vaccination has caused more problems than she had anticipated.

“Almost every day, at least one parent dials me asking where they should get their children hospitalized,” she said.

Now, every rainfall brings a health issue for Komal’s daughter. “I am tired of going to the healthcare center to hear that my daughter is underweight or sick and can’t be given the vaccine,” Komal said, with frustration in her voice.

Meanwhile, with every climate disaster, it will become increasingly difficult for many families to complete the immunization in time. “I’ve been vaccinating children for over a decade, but things never got this difficult. We took vaccines to the last mile. Now, climate change is eroding progress,” said healthcare worker Kavita Magdum.

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