As the world faces an increasing number of disasters, both natural and man-made, communities across sections of the society are becoming more vulnerable. These events — whether floods, droughts, earthquakes, or war, communal violence, pandemics — are impacting more people than ever before, with marginalized and vulnerable communities, particularly the women from there, bearing the deepest apathy. An often-overlooked consequence of these disasters is the impact on mental health around water insecurity which we call as water anxiety.
Water anxiety as a concept refers to combined psychological and physical distress people experience due to uncertainties about access to clean water and safe sanitation. This phenomenon is severe in disaster-affected areas highlighting the urgent need for a better understanding the intersectionality of water insecurity, gender, and mental health to address it. And since women are already overburdened with securing everyday water, the disaster situations followed by the relief works bring disproportionate social and political marginalization to them.
This essay digs into the intersectionality of disaster, displacement, water insecurity, gender, and mental health. The objective is to bring the concept of water anxiety into the discourse of disaster, distress, and relief work. The layout of the essay includes, water anxiety, its impact especially on women, the mental health consequence of water (in)security, the resilience building strength among women, and the need for mental health support in water security initiatives.
Water epidemics and anxiety
In the mainstream health issues globally, water epidemics are implicitly at the forefront with majority of illnesses around water borne diseases and the maximum death toll maximum attributed to it. While water and health are extensively studied independently in the respective disciplines, there is less cross pollination of knowledge between them thus, leaving a huge gap in the integrated scholarship of water epidemics. In this situation, water anxiety is a black box yet to be identified, let alone to be open.
Water anxiety must be seen as integral part of water (in)security caused by uncertainty about water availability, access, and quality. Since inadequate access to water is not just a physical health issue but also a significant mental health concern (Toivettula et al., 2023). Studies suggest that water anxiety often manifests as chronic stress, anxiety, and even depression, especially in disaster-prone areas where water shortages are frequent (Bisung & Elliott, 2017; Aihara et al., 2016).
This issue is not limited to low-income or rural communities; it affects both affluent and vulnerable populations worldwide, particularly as global water resources become increasingly stressed. While the physical impacts of poor water services have been well-documented and received continuous attention —such as waterborne diseases and dehydration — the mental toll has only recently started to receive attention.
Impact of disasters on water security
Natural disasters and conflicts can severely disrupt water access, exacerbating existing vulnerabilities. For example, in Bangladesh, floods and cyclones regularly damage water infrastructure, making access to clean water a persistent challenge (Cook & Foo, 2018). During these events, women, particularly those in rural areas, struggle to secure clean water, leading to heightened anxiety and stress. Similar challenges were observed during the 2017 Rohingya refugee crisis, where displaced women in refugee camps faced significant water shortages, compounding their mental and physical health burdens.
In conflict zones such as Gaza, where water infrastructure is frequently targeted, women face ongoing challenges in securing safe water for their families. Studies have shown that water insecurity in such settings can increase levels of psychological distress, particularly among women and children (Boateng et al., 2022). In many cases, water scarcity exacerbates existing inequalities, with marginalized groups facing additional barriers to accessing relief services (Brewis et al., 2021).
Impact of water insecurity on women
Water anxiety is inherently gendered and bringing the women aspect into it makes it more complex. In most cultures around the world, women are responsible for collecting and managing water for cooking, cleaning, and hygiene, which intensifies the pressure during times of scarcity or crisis (Stevenson et al., 2016). From the sheer naked eyes, the problem can be seen like this, since for women the family wellbeing comes first and often at the cost of their own self. It is therefore, crucial that there is scholarship highlighting this invisible and unavoidable existence of the insecurity so that the agencies take a cognizance to pen the policies and bring a system in practice for addressal.
Women in disaster-affected areas often face unique challenges that exacerbate their mental health struggles. Since, women are often at the forefront of managing household water needs, when access to water becomes uncertain, it adds an additional layer of stress to their already demanding roles. The intersectionality of disaster, displacement, gender, besides, class, race, and other social factors further complicates the impact of water insecurity.
This is particularly true in rural and low-income communities, where women have to travel long distances to find water, increasing their exposure to physical harm and mental stress (Bisung & Elliott, 2017). For example, women from marginalized communities, such as lower castes in India or displaced populations in conflict zones, often face systemic barriers to accessing water during and after disasters. These barriers not only worsen their physical living condition but also youth's
Mental health consequences of water (in)security
The mental health impacts of water insecurity are significant. Research shows that unequal access to water services can lead to feelings of injustice, anger, and frustration, all of which compound the anxiety surrounding water insecurity (Wutich et al., 2020). The inadequate water access can lead to various forms of psychological distress, including anxiety, depression, and trauma (Mushavi et al., 2020).
The relationship between water insecurity and mental health is complex. Water insecurity often exacerbates pre-existing mental health issues, and the constant worry about water availability can lead to a vicious cycle of stress and anxiety (Simiyu et al., 2022). In extreme cases like in scarcity and disasters, water insecurity can also lead to social tensions and conflicts within communities, further increasing the emotional burden on women.
For women, this distress is often linked to their roles as caregivers and household managers. The pressure to secure water for their families, combined with the uncertainties of disaster situations, can lead to chronic stress and anxiety (Brewis et al., 2021). Furthermore, the mental health toll of water insecurity is not always immediately apparent but can have long-term effects on women's well-being and resilience (Aihara et al., 2016). Ironically, the challenge to measure mental health out of the overall insecurity can be considered a reason for its exclusion in the water security schemes. If cannot be measured, factoring it for management is obviously going to be challenging.
Building resilience and coping mechanisms
Despite these challenges, women in disaster-affected areas have demonstrated remarkable resilience. In many communities, women have developed coping strategies to manage the stress of water insecurity, often working together to find solutions. By organizing and mobilizing within their communities, women are often able to mitigate some of the impacts of water insecurity and build collective resilience (Toivettula et al., 2023). The community-based strategies initiatives to secure water resources span from fetching water for each other, walking together for water and sanitation for safety, to cleaning water bodies, rainwater harvesting, advocacy for better water infrastructure.
In some cases, women’s leadership in water management has also led to greater social and political empowerment. By taking charge of water-related issues, women in disaster-prone areas are not only addressing immediate needs but also challenging traditional gender roles and advocating for more equitable access to resources (Brewis et al., 2020). These grassroots efforts are critical in building long-term resilience to water insecurity, particularly in regions where formal disaster relief efforts are insufficient or slow to respond.
Need for mental health support in water security initiatives
While women’s resilience is commendable, it is clear that more needs to be done to address the mental health aspect of water insecurity. Factoring mental health in the water insecurity from the policy and investments is utmost urgent and further to women is crucial.
Mental health services need to be integrated into water security programs, particularly in disaster prone and affected areas where the psychological toll of water insecurity is most severe. Current water management strategies often focus solely on the physical aspects of water access, neglecting the emotional and psychological dimensions of water insecurity (Stevenson et al., 2016). This gap in policy and practice needs to be addressed if we are to fully support women in managing the stress of water insecurity.
There is a serious shortage of psychologist and psychiatrists in the society. The professions are yet to emerge as important, because the mental health is not recognized and acknowledged by the majority of people and then revealed. We found from our case of studies at both natural and manmade disaster affected sites in Kalimpong and Kakching-Manipur, that psychologist and psychiatrists are not even engaged in the relief works which needs rethinking.
We also learned from women that they want to be heard regularly in order to optimize the relief work process. This hints that participatory approach is in relief measures will be more empowering thus effective and efficient besides making relief an act of governance than charity. They even suggested it may reduce the pity syndrome of the providers and make them realize that human dignity is prime.
Definitely, water matters have to be brought to mainstream education like started in Ahmedabad University as a Foundation Program. An interdisciplinary pedagogy touching upon the intersectionality of disaster, displacement, water insecurity, gender, and mental health must be taken up in the course curriculum. Education also needs to prepare the youth towards resilience and empathy by connecting with the onsite experience.
A colearning environment can be also experimented by bringing the people (especially) from the unaffected areas to the affected areas as part of field visits or educational trips besides volunteering for relief works. This may be a win-win situation to motivate the affected people’s moral and make the visitors learn the resilience building skills.
Way forward
Water insecurity is not just a physical challenge but a significant mental health crisis, particularly for women in disaster-affected areas. The concept of water anxiety highlights the psychological toll that uncertain access to water can have on individuals, especially women who bear the primary responsibility for water collection and management. By acknowledging the mental health consequences of water insecurity, we can begin to develop more holistic and effective water security strategies for everyday as well as during and post disaster situations.
Through the planned action research, our effort will be to push water anxiety discourse to the mainstream water security policies, programs and investments. To make the case stronger and to be able to substantially measure it qualitatively and quantitatively, we have chosen to study women in disaster affected areas since it calls for more targeted interventions. Drawing on recent studies that link water insecurity with psychological distress (Toivettula et al., 2023; Bisung & Elliott, 2017), the study focuses on understanding how different disaster contexts—whether natural disasters such as floods and droughts or human-induced crises such as war and communal violence exacerbate water anxiety.
The approach and recommendation are to integrate psychosocial support with water security solutions, informed by the growing body of literature that underscores the importance of mental health in water management (Wutich et al., 2020). From example, in Glacier Lake Outburst Flood (GLOF) impacted Rangpo, Kalimpong and Communal violence impacted Kakching-Imphal, the idea is to pilot community-based water management system designed for better access to water besides provide psychological counseling for women experiencing water-related stress (Cook & Foo, 2018). Similarly, in conflict zone such as Gaza/Ukraine, we hope to study how the destruction of water infrastructure fuels both physical insecurity and emotional trauma, aligning with findings that water insecurity can lead to chronic mental health disorders (Boateng et al., 2022). The overall plan is to focus on both immediate water needs and long-term mental health outcomes to arrive to a holistic gender-responsive interventions that address the full spectrum of challenges posed by water insecurity in disaster affected areas.
As natural and manmade disasters become more extreme and frequent, it is essential that we recognize the mental health impacts of water insecurity and integrate support services into disaster response and water management policies and programs. By doing so, we can help alleviate the burden of water anxiety and empower women to build more resilient communities in the face of ongoing environmental and social challenges. A simple way forward is to get Healers, Psychologists, Psychiatrists, and Youth engage with the affected communities for the latter to feel heard and healed. In addition, the youth engagement in return may help them learn the resilience building process and make them better prepared for future disasters as well as for relief works.
Through our work, there is a genuine effort to bring the water anxiety to the core of water (in)security discourse in policy, practice and pedagogy.
References
- Aihara, Y., Shrestha, S., & Sharma, J. (2016). Household water insecurity, depression, and quality of life among postnatal women in urban Nepal. Journal of Water and Health, 14(2), 317-324. https://doi.org/10.2166/wh.2015.166
- Bisung, E., & Elliott, S. J. (2017). Psychosocial impacts of the lack of access to water and sanitation in low- and middle-income countries: A scoping review. Journal of Water and Health, 15(1), 17-30. https://doi.org/10.2166/wh.2016.158
- Boateng, G. O., Workman, C. L., & Miller, J. D. (2022). The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women. Social Science & Medicine, 295, 113043. https://doi.org/10.1016/j.socscimed.2020.113043
- Brewis, A., Roba, K. T., & Wutich, A. (2021). Household water insecurity and psychological distress in Eastern Ethiopia: Unfairness and water sharing as under-theorized factors. SSM - Mental Health, 1, 100008. https://doi.org/10.1016/j.ssmmh.2021.100008
- Cook, A. D. B., & Foo, Y. N. (2018). Disaster risk context in Bangladesh. In Complex Humanitarian Emergencies and Disaster Management in Bangladesh: The 2017 Rohingya Exodus. S. Rajaratnam School of International Studies.
- Mushavi, R. C., Burns, B. F. O., & Cooper-Vince, C. E. (2020). Water insecurity and depression in rural Uganda: A mixed-methods, whole-population study. Social Science & Medicine, 245, 112561. https://doi.org/10.1016/j.socscimed.2019.112561
- Stevenson, E. G. J., Ambelu, A., Caruso, B. A., Tesfaye, Y., & Freeman, M. C. (2016). Community water improvement, household water insecurity, and women’s psychological distress: An intervention and control study in Ethiopia. PLoS One, 11(4). https://doi.org/10.1371/journal.pone.0153432
- Toivettula, A., Varis, O., Vahala, R., & Juvakoski, A. (2023). Making waves: Mental health impacts of inadequate drinking water services – From sidenote to research focus. Water Research, 243(120335). https://doi.org/10.1016/j.watres.2023.120335.
- Wutich, A., Brewis, A., & Tsai, A. (2020). Water and mental health. WIREs Water, 7(5), e1461. https://doi.org/10.1002/wat2.1461
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