It is April 2026, and India is on fire. Nineteen of the world’s twenty hottest cities are in India. Temperatures in several regions are already touching 42–45°C, and the India Meteorological Department has warned that intense heatwaves will persist through June. This is not merely a climate story. It is a public health emergency—one that is killing people, destroying livelihoods, and exposing a catastrophic failure of the state to protect its most vulnerable citizens.
India officially recorded 360 heatstroke deaths in 2024. Independent researchers, after scanning reports across 17 states, counted 733—more than double. With 40,000 confirmed heatstroke cases that year, and medical literature placing expected heat mortality at 20–30% of such cases, thousands of deaths went unattributed. When a construction worker collapses on a 46°C afternoon, his death certificate reads cardiac arrest. When a farmer dies during peak harvesting hours in May, it is chalked up to exhaustion. The heat is always the invisible cause, never the official one—and because India does not count its dead properly, it cannot prepare adequately for what is coming.
The People Bearing the Burden
The 380 to 490 million informal workers—construction labourers, street vendors, farmers, sanitation workers, and delivery riders—are India’s most heat-exposed population. They work outdoors with no legal right to shade, rest breaks, or clean water.
A February 2026 study of 115 garment workers in Tamil Nadu and Delhi found that 87% had suffered heat-related illness in the past year. Three in four described their workstation as “like working in a furnace.” Nearly 97% of female workers reported a burning sensation during urination, a direct consequence of not drinking water because there are no clean toilets or no time to use them. A survey of 519 street vendors found that 89% had no access to free, clean water while working, and more than 70% had no access to toilets at all.
Beyond workers, the elderly face compounding cardiovascular and kidney risks. Pregnant women exposed to extreme heat face elevated risks of preterm births and low birth weight. Children in poorly ventilated schools suffer in silence. Rural communities, with limited access to healthcare, bear the highest mortality risk when temperatures climb; deaths in Ahmedabad and Hyderabad have risen by 43% and 57% respectively when temperatures reach or exceed 40°C.
Heat is not a democratic crisis. The wealthy retreat into air conditioning. The poor have no such option. The crisis is identical across the country; the capacity to survive it is not.
The Regulatory Gap That Is Killing People
The Factories Act of 1948—still India’s primary workplace safety law—applies only to indoor factory settings. It says nothing about outdoor workers. The Occupational Safety, Health and Working Conditions Code of 2020, billed as a modernisation of labour law, failed to explicitly recognise heat as an occupational hazard. Heatwaves are not classified as a national disaster, meaning relief funds remain capped and worker deaths are not compensable.
Several states issue seasonal advisories asking workers to avoid outdoor labour between noon and 4 p.m. The IMD’s own forecast explicitly names outdoor workers as a vulnerable population. The NDMA has issued guidelines since 2019. Not one of these measures is enforceable by law. The gap between a government advisory and an enforceable right is the gap in which people are dying.
The Economic and Health System Cost
India lost 181 billion potential labour hours to heat exposure in 2023 alone, translating to approximately Rs 13 lakh crore in income losses, according to the Lancet Countdown India 2024. Informal workers in Delhi saw their net earnings drop by 40% during heatwave periods. McKinsey Global Institute projects that India could lose up to 4.5% of GDP annually by the end of this decade if no adaptation is undertaken.
India’s public health budget for 2026–27 stands at just 0.27% of GDP—far below the National Health Policy’s own target of 2.5%, and lower in real terms than COVID-era spending. There is no dedicated national fund for heat emergency preparedness. There is no heat-specific compensation framework for informal workers. Public hospitals improvise heatstroke units season by season, while the Integrated Health Information Platform that tracks heat deaths remains closed to public scrutiny.
Conclusion
India is not short of data on this crisis. It is short of political will to act on it. The deaths are undercounted. The workers are unprotected. The economic losses are unbudgeted. The health system is underfunded. And every summer, the cycle repeats: temperatures rise, advisories are issued, a government meeting is held, the monsoon arrives, and nothing structurally changes before the next summer begins.
Recognising heatwaves as a national disaster, extending occupational safety law to all outdoor workers, mandating shade and water at worksites, and publishing transparent heat mortality data are not radical demands. They are the minimum the evidence requires. Ahmedabad’s heat action plan, built after 1,300 people died in 2010, reduced heat mortality by up to 40%. What worked in one city can be made law across the country. The only thing standing between that possibility and the present reality is political will.
The sun does not discriminate. Our policies do. And every summer we delay, the toll compounds. The heat does not.
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Master of Public Health, Dr BR Ambedkar University, Delhi
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