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Weathering the Storm: Why India’s Health Systems Must Brace for a Super El Niño
This year’s El Niño is shaping up to be one of the strongest on record, and India sits close to its centre. The India Meteorological Department has already cut its monsoon forecast to 90% of the long-period average, with a 60% probability of a deficient season. It has also flagged above-normal heatwave days across Uttar Pradesh, Punjab, Bihar, Odisha, Gujarat and several other states, along with below-normal rainfall in central and peninsular India. For a country whose agriculture, water security, and public health are all downstream of the monsoon, this could prove to be a stress test for the health system.
Picture a 66-year-old farmer with diabetes, making the long journey to his nearest Primary Health Centre (PHC) for medicines, after spending the day working under an unforgiving sun. Crop losses have already strained his income, food availability is marred by high prices, and the indoor temperatures offer little relief. Each of these events poses a distinct health risk; the larger challenge lies when they converge in real life. Heatstroke and heat-related illnesses disproportionately affect the elderly and those with chronic illness. With nearly one in five adults living with diabetes or hypertension (NFHS-6), India faces heightened risks from extreme heat. At the same time, erratic rainfall creates new breeding pockets for vector-borne diseases, expanding their range, while diarrhoeal disease lingers in water-stressed communities.
Water and nutrition requirements further aggravate the problem. Roughly 600 million Indians already live in river basins facing high-to-extreme water stress (NITI Aayog’s Composite Water Management Index, 2018). A weak monsoon tightens and feeds into the nutrition conundrum, with India already ranking 102nd out of 123 countries on the 2025 Global Hunger Index. Poor nutrition, in turn, worsens both infectious and chronic disease outcomes, continuing the vicious cycle.
Every one of these shock lands first at the PHC, the health system’s first point of contact, already stretched thin on staffing and referral capacity. It must now manage chronic disease follow-up, heat-casualty triage, infectious disease surveillance and elderly care simultaneously, year-round rather than seasonally.
Africa’s recent super El Niño experience highlights preparedness and inter-sectoral coordination as key lessons. Countries that tied heat-health early-warning systems to local weather data and sustained household-level NCD follow-up through primary care fared better than those that treated heat as a seasonal event. India’s health workers need heat-index alerts built into their protocols, not appended after the fact. A super El Niño is now close to certain. Whether India’s health system absorbs the shock or buckles under it depends on decisions and policy choices before the season peaks.
FAQs
Sources:
IMD Revises Monsoon Forecast to 90% of LPA, 60% Chance of Deficient Rainfall.” Down To Earth.
Composite Water Management Index. NITI Aayog.
“Global Hunger Index 2025: Rankings.” Global Hunger Index.
“A Super El Niño Is Coming: 5 Hard-Won Lessons the World Can Learn from Africa.” Down To Earth.
Author
Dr. Shalini Singh
Dr. Shalini Singh is a public health researcher with an MD in Community Medicine and currently serves as a Senior Research Associate at the Centre for Universal Health Assurance (CUHA). She specialises in universal health coverage, health financing, health equity, and climate health. Her work spans epidemiology and health systems research, with publications in peer-reviewed journals, policy papers, and newspapers. She focuses on translating evidence into policy and strengthening health access and financial protection.