Frontlines of Climate Change and Global Health Inequity: How Recurring Cyclones Undermine Health, Livelihoods, and Development in the Indian Sundarbans

Study design and recruitment

We employed a qualitative methodology using semi‑structured interviews to explore participants’ perspectives, experiences, and recommendations regarding cyclone impacts, vulnerabilities, existing resources, and policy and investment gaps in accordance with the research aims. Reflexive thematic analysis, incorporating deductive and inductive approaches, was used to identify recurring themes from the data [36, 37].

Interviews were conducted with a diverse cohort of stakeholders to understand a broad spectrum of perspectives, including community members (farmers, drivers, non‑licensed village doctors, shopkeepers, and women), frontline public health workers (e.g., Accredited Social Health Activists, or ASHAs; Anganwadi Workers, or AWWs); elected local government officials (Gram Panchayat Pradhan; Deputy Gram Panchayat Pradhan); appointed local government officials (public health nursing officers, block‑level epidemiologist); mental health counselors; senior leadership from a locally embedded NGO; and a professor of disaster management from a flood‑prone adjacent state (Table 1). Purposive and convenience sampling were employed to deliberately recruit individuals with direct experience living through and responding to cyclones. Recruitment was limited to Kultali and Gosaba, two vulnerable blocks, where the locally embedded NGO had strong community ties. These sites were also prioritized for their repeated exposure to severe cyclones.

Data collection

A semi‑structured interview guide was developed and iteratively refined with input from faculty experts in climate change, public health, qualitative research, and the challenges in the Sundarbans (PN, GB, MS) (Appendix A). Questions were informed from a literature review on climate‑related health impacts, sociodemographic and structural vulnerabilities, and disaster recovery strategies among cyclone‑vulnerable regions globally, as well as the study team’s conceptual framework on cyclone‑related health impacts in the Sundarbans. The draft guide was piloted with two stakeholders, and feedback was incorporated to improve alignment with the study’s research questions (Table 1).

Interviews focused on five a priori domains: (1) the ecological, geographic, and socioeconomic conditions predisposing the region to repeated cyclone impacts; (2) the immediate and long‑term health, economic, infrastructural, and social impacts of cyclones; (3) existing response and recovery systems and capabilities; (4) structural barriers that hinder effective response and long‑term recovery; and (5) community‑led solutions for strengthening disaster response and recovery. Data collection was continued until thematic saturation was reached, defined as the point at which no new substantive concepts emerged in subsequent interviews. This determination was made in consultation with study team members experienced in qualitative research (PN, GB, MS). All interviews were audio‑recorded via Zoom, transcribed via Sonix (Sonix, San Francisco, CA), verified for accuracy against audio recordings, and anonymized. Anonymized transcripts were uploaded to Dedoose (Dedoose, Manhattan Beach, CA) for coding and analysis. This study was approved by the Institutional Review Board of the University of California, Berkeley.

Qualitative analysis

The analytic process proceeded via three stages: (1) initial deductive coding using initial a priori codes; (2) inductive development of new codes, themes, and subthemes that expanded and categorized the a priori domains; and (3) comparative analysis of thematic patterns and differences across stakeholders.

To ensure reliability and consistency, two coders (GB, PN) practiced applying an initial set of a priori codes and independently coded two transcripts in consultation with MS. This process enabled resolution of early discrepancies and calibration of an aligned, preliminary coding method. Thereafter, following frameworks by Kiger et al. [41], PN and GB manually reviewed and independently coded each transcript, meeting to discuss emerging concepts, inductively refine the codebook, and jointly formalize interrelated themes and subthemes [36]. Thereafter, a comparative analysis was conducted systematically. PN manually reviewed all excerpts and transferred each quotation into a master analytic spreadsheet per corresponding themes and subthemes. This chart served as the foundation for data synthesis and informed the organization of the thematic results after consensus was obtained with the study team. Reflexivity was prioritized throughout data collection, coding, and synthesis [42].

Interview background

We conducted a total of 33 key informant interviews (KIIs) with diverse stakeholders, each lasting 15 to 65 minutes. All interviews were conducted with the aid of an English–Bengali translator and held at community spaces (e.g., schools, hospitals, Integrated Child Development Services (ICDS) centers, NGO offices, etc.). Interviews included (11) adult community members (drivers, farmers, shopkeeper, homemakers, members of Women’s SHG, and non‑licensed village doctors); (7) frontline public health workers (ASHAs and AWWs); (3) elected local government officials (Gram Panchayat Pradhan); (4) appointed government officials; (2) mental health counselors; (1) professor of disaster management from a flood‑prone adjacent state; and (5) senior leaders at a locally embedded NGO. Twenty participants (60.6%) were women—in part because all ground‑level public health workers in the region are women. All participants had direct experience leading and/or coordinating cyclone response; and all participants except the NGO leaders, one mental health counselor, and the professor of disaster management were residents of cyclone‑affected communities in Kultali and Gosaba.

Reflexive thematic analysis combined deductive and inductive approaches. We organized findings around five a priori domains, each aligned with the study’s core research questions: (1) the ecological, geographic, and socioeconomic conditions predisposing the region to repeated cyclone impacts; (2) the immediate and long‑term health, economic, infrastructural, and social impacts of cyclones; (3) existing response and recovery systems and capabilities; (4) structural barriers that hinder effective response and long‑term recovery; and (5) community‑led solutions for strengthening disaster response and recovery.

1.1 Ecological and geographic vulnerabilities in the sundarbans

According to ASHAs and officials, the Sundarbans face rising sea levels, increasing temperatures, and more frequent, intense cyclones. Several community members described witnessing between four and seven flooding events annually, with at least six major storms causing significant harm in recent years. Gosaba and Kultali were identified by counselors as especially vulnerable blocks (Figure 1). Flanked by rivers on both sides, study participants reported that villages in these areas experienced disproportionately high rates of mental illness and suicide, driven by the repeated infrastructural damage and annual economic losses.

Figure 1

1.2 Socioeconomic precarity and healthcare workforce shortages

A significant portion of families in the Sundarbans rely on jobs in farming, fishing, driving, and honey collection, all climate‑sensitive livelihoods disrupted for months to years after cyclonic events due to flooding, saline water intrusion, and infrastructural damage to roads and boats. Gram Panchayat officials highlight the lack of alternative livelihoods as a key barrier to recovery, leaving communities without income for months each year: “Most of the people here are fishermen or farmers—they need alternative sources of income. There are no industries. If some industries or other income‑generating programs were introduced, it would help a lot. Right now, there are no other options besides farming and fishing.” (Deputy Gram Panchayat Pradhan)

While we could not quantitatively verify the figures, one official estimated, “Out of 25,000 people in the block, about 17,500 are farmers. If you count families, that’s about 5,000 to 5,500 farming families. Only one percent is servicemen, and the rest are primarily fishermen or others in informal work.” (Deputy Gram Panchayat Pradhan)

These workforce shortages extended into the health system. Participants repeatedly emphasized the scarcity of qualified healthcare providers across the Sundarbans. In Kultali, one mental health counselor reported being the sole provider for 36,000 children, adolescents, and adults and caring for 400 people per month. “In this locality, there are adolescent‑friendly health clinics, but no doctors are available—only nursing staff. To access a trained counselor or psychologist, there is only one for the entire block. I am posted here, and once a month a psychiatrist visits. Medicines are available, but not at the grassroots level. If anyone wants counseling, support, or medication, they have to come to the rural hospital.” (Mental Health Counselor for Children, Adolescents, and Adults) This absence of health professionals was attributed to reluctance to work in remote, cyclone‑prone regions.

2.1 Displacement and shelter crisis

During each cyclone, alerts issued by the Meteorological Department were relayed through Gram Panchayat officials and ASHAs. ASHAs then mobilized families to shelters via coordinated WhatsApp messaging and house‑to‑house visits, playing a key role in preparing families to gather legal documents, medicines, and dry food, and in supporting evacuation or shelter‑in‑place strategies for those unable or unwilling to leave.

For many residents, displacement has become a recurring and exhausting reality. As one shopkeeper from Gosaba reflected: “I’ve seen this happen many times—our house gets swept away by rising river water. We have to take shelter in nearby relief centers, where we cook and survive with the supplies provided by the government. During those times, we live entirely in those shelters.” (Shopkeeper)

A non‑licensed village doctor shared a similar experience: “Most of the time, our houses are swept away during floods. Whenever that happens, we have to leave and shift to another place. There have been several times when our homes were submerged by river water, and we had to rebuild new houses elsewhere.” (Non‑Licensed Village Doctor)

Gram Panchayat officials recalled the immense logistical challenges evacuating families to cyclone centers. “The wind speed was 250 to 300 kilometers per hour. Saline water flooded the whole village…. Out of 7,500 families in this village, 5,500 were devastated…We tried to evacuate everyone to safe spaces and arrange food, shelter—everything. We coordinated with other departments who provided tarpaulin, food, and medicine.” (Deputy Gram Panchayat Pradhan)

Despite these efforts, NGO leadership emphasized that evacuation and mass displacement were severely constrained by an insufficient number of shelters across the Sundarbans. Consequently, thousands of families were mobilized but forced to share overcrowded, unsanitary spaces that posed direct health risks, including heightened risk of diarrheal illness, poor menstrual hygiene management, and child trafficking.

2.2 Infrastructural damage

ASHA workers described how major cyclones such as Aila (2009) and Amphan (2020) caused extensive, large‑scale infrastructural destruction, while smaller, recurring storms perpetuated infrastructural vulnerabilities.

Most homes were constructed from mud, asbestos, or tin and collapsed in the face of high winds and flooding. Rebuilding was described as a repetitive and futile cycle, with homes frequently destroyed and repaired, only to collapse in the next storm. One ASHA recounted her colleague’s reaction: “She was really frightened because her house is a concrete house, but the roof is just metal. During Amphan, it was blown away. Suddenly there was no roof, and rain was coming in. She said, ‘We’ll all die.’” (ASHA Worker)

Several ASHAs reiterated that paved roads broke down quickly under floodwaters, turning to thick mud and cutting off access to health services and relief efforts. NGO leaders reported that entire villages in Kultali lost electricity for up to three weeks after Amphan, leaving communities unable to power lights, charge phones, or communicate externally. “Amphan had devastating effects across the entire area. For around two weeks—nearly 20 days—there was no electricity and no communication. Every place was in darkness.” (NGO Leader)

2.3 Disruptions to livelihoods

NGO leaders reported that the flooding of agricultural lands, fishponds, and livestock was among the most destabilizing impacts. Salination could render soil infertile for months to years. Given that most households rely on cultivation for income, the loss of crops, fishponds, and cattle could trigger acute financial and food insecurity. As one elected official described: “Almost all the men in our village are either fishermen or farmers. They’ve lost everything—their land has become infertile, and even the fish are gone. People are starving. They have no food, no water, no shelter. We’re searching for help from outside. If we get support during that time, it will make a huge difference.” (Gram Panchayat Pradhan)

Another ASHA described watching her pond, once a key source of livelihood, deteriorate: “Behind my house there are two big ponds with Hilsa fish—they’re very expensive. I could sell them in Calcutta for thousands of rupees. But there was no help to preserve them. They died. The Gram Panchayat couldn’t do anything.” AWWs in Gosaba also emphasized how families, facing mounting out‑of‑pocket expenses, resorted to high‑interest loans, some reportedly as high as ₹70,000.

2.4 Disruptions to education

AWWs, ASHAs, and mental health counselors consistently emphasized that recurring cyclones are a major cause of prolonged school closures that pose serious developmental, emotional, and safety risks for children. In 2024, flooding from recurring storms destroyed classrooms. Electrical systems failed, furniture was soaked, and windows were shattered. Beyond infrastructural damage, schools were repurposed as temporary shelters for displaced families or remained closed due to teacher shortages. As one ASHA explained: “If ten teachers are needed, there may be only one. So how can they manage? Even after Class 10, there’s nothing in the school. For more than six months, children were going to school only to collect dry rations—rice, potatoes—not for education. Their attendance was marked, but there was no teaching. They just took the rations and came back home.” (ASHA Worker) Without access to education for extended periods, school closures increased children’s risk of permanent dropout.

As one participant shared, “During Cyclone Amphan, we distributed dry rations and nutritional supplements directly in the field, especially for children. But I noticed that their education was severely impacted by the disaster. Due to the lockdown and the cyclone, their schooling suffered even more. They were stuck at home most of the time and became increasingly dependent on smartphones.” (NGO Leader)

One prominent barrier to continued education was the loss of essential documents. Flooding risked destroying educational certificates, preventing children from re‑enrolling in school.

2.5 Health impacts and disruption to health services

The health consequences of these experiences were wide‑ranging. These impacts precipitated outbreaks of infectious diseases, disrupted treatment for chronic conditions such as hypertension and diabetes, exacerbated malnutrition, and had lasting impacts on mental health.

One epidemiologist reported that overflowing latrines and contaminated water supplies led to spikes in diarrhea, urinary tract infections, malaria, dengue, drowning, and even death in the days following storms. Impassable roads disrupted access to antenatal care, contributing to anxiety among pregnant women who feared complications during delivery, according to a mental health counselor. People living with HIV (PLHIV) faced treatment disruptions and avoided shelters out of fear that public knowledge of their diagnosis could lead to discrimination or exclusion from cyclone shelters and essential resources. ASHAs reported rashes among infants, children, and parents from prolonged saltwater exposure, disrupted immunization schedules due to displacement, and gaps in malnutrition surveillance among families forced to migrate.

For many families, seeking care was simply not an option. Cyclones rendered existing health services inaccessible as fragile roads collapsed under flooding and a shortage of boats further isolated entire communities in Gosaba, Kultali, and surrounding blocks from hospitals for days to weeks. In the absence of formal care, families relied on non‑licensed village doctors with limited capacity to manage complex or emergency needs. “During Amphan, their house structures were so poor that they were totally devastated. They had no house at all. Can you imagine their situation? They were suffering from HIV and getting ART from the government hospital. But during Amphan, they couldn’t go to the hospital to access ART. And then what solution did we have for that? Mentally, they were totally depressed from the start.” (Physician and NGO Leader)

One elected official explained, “If something happens in the evening or at night, there’s nowhere nearby we can go for help. This is a mostly waterlogged area, and if someone is bitten by a snake or has a critical condition like a stroke, we have to travel to the nearest hospital—about 40 kilometers away—and even cross a river to get there.” (Deputy Gram Panchayat Pradhan)

Another official with expertise in vector‑borne disease control emphasized the compounding health risks: “During storms, people suffer from severe diarrhea and mosquito‑borne diseases like dengue and malaria. The roads become flooded, making it very difficult to take patients to the hospital, and boats are often unavailable because of high water levels. Pregnant women suffer the most, and nearby unlicensed doctors provide only initial support. Healthcare professionals and government doctors are unable to reach us.” (Appointed Government Official)

Two non‑licensed village doctors echoed these barriers.

“The main problem we face is the poor condition of the roads. Most of the time, we have to travel by boat, but there are not enough boats in our area. To reach the hospital in Gosaba, we have to make a very long journey, which often makes it impossible for the sick or those needing treatment to get proper access.” (Non‑Licensed Village Doctor)

“We face a lack of proper medicine, and those with serious health issues suffer the most. Many times we have to travel long distances to reach the hospital in an emergency. During that journey, people often die on the way, and families lose their loved ones.” (Non‑Licensed Village Doctor)

2.6 Malnutrition

Participants reported that malnutrition among children was a longstanding public health crisis in the Sundarbans, and cyclones further disrupted already fragile systems. AWWs, responsible for providing one reliable meal a day to children under age five, described how their place of work—ICDS centers—was frequently repurposed as emergency shelters following cyclones. As a result, children lost access to meals, and mothers lost access to nutrition counseling and lactation support for weeks to months.

As one AWW explained: “Kids come here for nutrition…. The government made this scheme [ICDS] for that. So my job is to make sure they get the correct nutrition. I tried to save the food—I put it on the top shelf so the rice and food wouldn’t get ruined. But after the flooding, others had nowhere to go, so they came and stored their things there. My job was definitely hampered—I couldn’t give the children the nutrition they needed.” (AWW)

Several AWWs observed increased desperation among children in shelters due to food insecurity: “They’re already not eating properly. Many are malnourished. During Amphan and other cyclones, they end up in flood centers, struggling for food. The children start pushing, jumping over each other. That desperation turns into aggression. And still, they don’t have the nutrition or strength to cope. We’re trying our best to hold things together, but we don’t know how long we can.” (AWW)

Disruptions in household income and school meal programs exacerbated pre‑existing food insecurity.

2.7 Mental health

Frontline ASHAs and AWWs underscored that when these disruptions stretched over weeks and months, they were closely associated with long‑term mental health consequences. One mental health counselor echoed this sentiment, describing a steady intensification of distress, with rising rates of trauma, depression, post‑traumatic stress disorder (PTSD), and even suicide. She emphasized that children and wives exhibited signs of loneliness, depression, trauma, and even suicidal ideation, exacerbated by instability and trauma.

“We often see mental health issues—depression, PTSD, and severe emotional stress—after every cyclone. Suicidal tendencies are very high here, and it’s clearly linked to climate change. It’s a serious issue. We’re working on it, and so is the government, but the impact is severe and deeply connected to climate‑related events.” (Mental Health Counselor)

“There’s hardly any cultivation now because of water scarcity, so there’s no income. As a result, [men and] elders are migrating for work, while the younger generation and the wives are left behind. They have no one to talk to, and many are experiencing suicidal thoughts.” (Mental Health Counselor)

AWWs also emphasized the emotional toll on children, noting that signs of trauma were visible and profound:

“What I’ve noticed is that children go very quiet after these atrocities. We try to help them through drawing and toys, so that at least some happiness returns… [but] If you’re a kid and suddenly your parents are picking you up and running to a flood shelter in the middle of extreme rain and a cyclone, how would you feel? Terrified, right? That’s how it is for them. This fear runs so deep that it brings silence to their lives again and again. Sadness settles in, and happiness fades away.” (AWW)

2.8 Vulnerable populations

Participants described how several populations—including farmers, women (including pregnant women), girls, PLHIV, and children—were especially vulnerable to these health, economic, and social impacts (Table 2). Farmers faced loss of land, livestock, and food security, leading to debt, migration, and mental distress. Women contended with reproductive health challenges, gender‑based violence, and severe mental health harms. Pregnant women struggled to access antenatal care, placing themselves and their unborn children at risk. Children were vulnerable to abuse, school dropout, and increased phone and social media use. This was identified as a risk factor for trafficking, as predators would solicit children through social media platforms. PLHIV faced treatment disruptions and social exclusion.

3.1 Mangroves: natural ecological buffer

Participants emphasized that the Sundarbans’ growing ecological fragility aggravated these impacts. Coastal mangrove forests serve as critical ecological buffers. With upward‑growing root systems that stabilize the soil, mangroves serve as natural barriers against storm surges and saline water intrusion. Yet participants reported that these ecosystems are rapidly degrading due to erosion and environmental pressures, leaving communities increasingly vulnerable to flooding. “Since birth, I’ve witnessed many cyclones and natural calamities. Amphan was one of the worst. Our main protection comes from the trees—the mangroves. They protect us. The mangrove is like our mother. Without it, we would drown.” (Gram Panchayat Pradhan)

They emphasized, “If a wave like a tsunami comes, it will destroy everything—our concrete barriers, our big houses—everything. But what we can do is try to protect ourselves. We must start afforestation. We must save the trees. That may help nature protect us in return.” (Gram Panchayat Pradhan)

There was a recognition of the importance of ecological protection across the community:

“India is a land of huge population. So we are the reason for global warming, you know. And all these things. We are the cutting trees, destroying forests. Everything is happening and it is increasing day by day.” (NGO Leader)

3.2 Asha workers and anganwadi workers: frontline responders and community health members

ASHA workers emerged as the critical link between communities and government systems throughout disaster response and recovery. ASHAs described being mobilized by Gram Panchayat officials in the wake of flooding to conduct real‑time monitoring of disaster conditions. They described going out into the community to capture and send live updates, including photos of flooding and damaged infrastructure. They also described monitoring supplies, conducting needs assessments, and reporting gaps to authorities. “Our duty is to take pictures and report how many people have been moved to the shelter, where they are, and what the situation is…. Every hour or two, we must report on the number of people relocated, the electricity status, whether the generator is working, and more. During cyclones, we are expected to handle everything, but we’re not given enough resources.” (ASHA Worker).

In Gosaba, ASHA workers opened their own homes to neighbors, providing food, safety, and guidance. “One hundred and fifty people stayed in my house during the flood. My house is large, elevated, and doesn’t flood easily, so everyone comes here. I prepare potatoes, pumpkins, and other vegetables in advance because I know my neighbors will seek shelter with me. But I end up doing all the running around—cooking, helping—while others feel helpless. Even though this house has issues with the roof and feels unsafe, people still come here, because there’s nowhere else to go.” (ASHA Worker)

Despite these burdens, ASHA workers embraced their role out of a sense of duty. “It’s our job. We are very pro‑India—patriotic by nature. My job is to help people, and I’m doing that. I’m an ASHA worker, so I do what I’m supposed to do. From newborns to the elderly, whoever needs support, I provide it. (ASHA Worker)

Yet their testimonies reflected physical strain, emotional burnout, and lack of investment that may threaten the sustainability of this workforce. ASHA workers’ decision to open their homes during cyclones also highlighted the absence of institutional support: “I brought people into my home out of a sense of humanity—but even it wasn’t easy. They used my toilet, my bathroom, and my bedroom. It became overwhelming. I couldn’t even keep my toilet clean, and I couldn’t express my frustration because I knew they were in need. I was torn—yes, I wanted to help, but there were limits.” (ASHA Worker)

AWWs echoed overwhelming workloads, lack of recognition, and unpaid labor that extended beyond their official duties. “As an ICDS worker, my job is to provide proper nutrition to children, educate them, and counsel adolescent girls. But in reality, I end up doing far more than what my role requires.” (AWW) AWW workers also described using their own funding to support others. “Sometimes I don’t even receive my full salary, because part of it goes toward feeding and educating the children who come to me for support.” (AWW)

3.3 Early warning and cyclone centers infrastructure

Participants praised the reliability of the Sundarbans’ early warning systems as a central strength of the region’s response system, which has improved significantly since cyclone Aila. Cyclone centers were also broadly recognized as vital lifelines, offering shelter, food, water, medicine, and other essentials during cyclones. These multi‑story structures are financially self‑sustaining, serving as venues for weddings, ceremonies, and community gatherings during non‑disaster periods to generate revenue for maintenance and disaster preparedness. One ASHA explained: “The cyclone center is a two‑ or three‑story building. On the ground floor, people keep their cattle—cows, goats, even roosters. The upper floors have separate spaces for women, men, and children. They provide everything needed—medicines, sanitary napkins, whatever is necessary. They take care of all of it.” (ASHA Worker)

However, existing centers were overcrowded, lacked privacy, and posed safety risks for women and girls. Participants echoed incidences of gender‑based violence and challenges managing their reproductive health. In Kultali, there are 7 cyclone centers for 229,053 people; in Gosaba, there are 10 cyclone centers for 246,598 people, according to NGO leadership with access to government reporting [43, 44]. One ASHA reported: “One center is supposed to support 5,000 people, but in reality, it’s serving around 12,000. We’re seeing many cases of depression. People are deeply distressed—they say they’re depressed because they can’t care for their families or their children. They cry and ask, ‘What will happen to us?’ They are saying we are in depression.” (ASHA Worker)

3.4 Gram panchayat‑level services

Gram Panchayat officials described prioritizing post‑disaster distribution of food, medicine, water, and essential supplies and highlighted the state’s deployment of mobile water trucks capable of producing up to 35 pouches of clean water per minute. These were distributed through local networks. To mitigate sanitation risks, local authorities installed temporary pit latrines and coordinated the delivery of antidiarrheal and antibiotic medications to cyclone centers. Officials acknowledged that such latrines were not ideal but prevented open defecation and contamination of public water sources, such as ponds. Despite these efforts, community members reported that services were often delayed or insufficient.

3.5 NGO‑based services

NGO leaders view their role as strategic safety nets addressing service gaps for vulnerable populations. They described support they offered during a cyclone, “We provided awareness about the present situation and weather to help reduce their panic. They were panicking, so we provided accurate information and knowledge to help them stay calm and take logical action…. Thereafter, provide information about where they can access government services—such as housing, shelter, treatment—and where free camps and health checkups are being conducted.” (NGO Leader)

NGOs also supported training of ASHAs and AWWs on birth preparedness during disasters and advised pregnant women to keep phones charged, maintain contact with block authorities, and utilize emergency transport services if delivery becomes imminent during flooding.

To ensure continuity of ART during storms, one participant shared: “We support people living with HIV by making sure they can access medications and nutritional support…. We used to work with people living with HIV, and during Cyclone Amphan we distributed dry rations and nutritional supplements directly in the field…. We also advocated to the government so ART could be made available at local health centers. Otherwise, they would have to travel to the district hospital, which becomes impossible during flooding.” (Physician and NGO Leader)

NGO leadership also attempted offering phone‑based counseling on menstrual hygiene and infection prevention to adolescents during disasters. “Since our workers couldn’t always reach them because of waterlogging, we educated them by phone on how to manage their hygiene during the disaster.” (NGO Leader)

Lastly, NGO leadership emphasized subsidizing funding for home repairs and proactively checking on community safety. “Our fieldworkers visit people in their homes and follow up with phone calls. During COVID and Amphan, when phone lines didn’t work and we couldn’t reach many people, we went directly into the field to check whether they were in a safe space.” (NGO Leader)

5.1 Immediate preparedness measures

One respondent recommended urgent, low‑cost interventions that could be implemented immediately to strengthen disaster preparedness. Communities should be pre‑equipped with chlorine tablets, clean water, and dry food, as government relief often arrives only after several days. Schools could establish systems to back up or digitize students’ essential documents to prevent permanent loss during disasters. For farmers, secure seed storage is critical, since cultivation is not possible for months following a cyclone. Additionally, at least one mental health counselor should be stationed at each PHC, where none are currently posted.

5.2 Community capacity building: training and education

NGO leaders and government officials emphasized that lasting resilience requires infrastructure, policy, and financing. Yet their responses also highlighted a critical need to equip communities with knowledge, habits, and skills to adapt to a changing climate. They outlined the importance of training community members to proactively safeguard essential documents before cyclones; fostering environmental awareness from an early age, much like basic hygiene or safety habits. ASHAs also identified drowning as a major risk during floods and called for survival training and swimming instruction. Dedicated environmental education at a young age was highlighted as a way to engage the community.

5.3 Policy recommendations to invest in livelihoods and simultaneously promote cyclone resilience

Across interviews, the need for a more cyclone‑resilient economy emerged as one of the community’s most pressing priorities. Given that most families currently rely on cyclone‑sensitive livelihoods, stakeholders emphasized that protecting existing livelihoods must be a core component of disaster response policy. Participants called for insurance coverage, compensation schemes, and infrastructural safeguards to help communities—especially farmers, drivers, and fishermen—recover from recurrent economic losses. “When fishermen go out to sea and their launches, ferries, or trawlers are damaged by cyclones, they should be covered by insurance. But beyond insurance, livelihoods must be fundamentally protected through policy. It’s not just about compensating loss—it’s about ensuring sustainable, long‑term security. These protections must be established and maintained by the government.” (Professor of Disaster Management)

At the same time, Gram Panchayat officials, NGO leaders, ASHAs, and AWWs recognized the region’s overreliance on cyclone‑vulnerable occupations and called for investments in livelihood diversification. Participants proposed expanding employment programs, industry activity, and vocational training to provide families with stable, sustainable livelihoods. “People here are always in search of livelihoods. Once their basic livelihood needs are met, then they can devote their minds and energy to other aspects of life. Here, our people are still struggling for the minimum: toilets, roads, school buildings. That’s why our priorities are different.” (Professor of Disaster Management)

In discussions with Gram Panchayat officials, who spoke passionately about the protective value of mangroves, nature‑based livelihood strategies emerged as potential solutions to the region’s overlapping economic and ecological challenges. One recommendation was the development of mangrove reforestation programs that would provide temporary or long‑term employment while simultaneously fortifying the Sundarbans’ most vital natural defense against flooding and salinization. Two officials emphasized:

To scale such initiatives, a disaster management expert recommended a series of policy reforms to mobilize private sector investment in the Sundarbans. Chief among these was amending India’s Corporate Social Responsibility (CSR) law, which currently limits companies to spending CSR within a 10‑kilometer radius of their operations. “Under current rules, private companies must spend 2% of their annual profits on social development. However, there’s a loophole in the policy. CSR funds must be spent within a 10‑kilometer radius of where the company operates. For example, if a company is located in Kolkata, it won’t typically sponsor a program in the Sundarbans, which is 50–60 kilometers away. That’s because it falls outside the official 10‑kilometer zone. This restriction prevents companies from supporting critical work in more remote, underserved areas. That loophole in the CSR policy needs to be removed.” (Professor of Disaster Management)

The expert also called for the creation of targeted climate financing policies with explicit tax incentives to encourage private sector investment in environmental and disaster resilience projects, such as mangrove reforestation and climate resilient infrastructure. “There’s also no targeted policy or tax incentive specifically aimed at environmental or climate‑related initiatives. That needs to change.” (Professor of Disaster Management)

From this perspective, effective policy reforms could catalyze private sector contributions to climate resilience, enabling initiatives that are both environmentally sustainable and economically empowering for vulnerable communities in the Sundarbans.

When these ideas were shared and tested with other community stakeholders—including ASHAs, AWWs, and NGO stakeholders—there was broad agreement that private sector investment and policy reforms were essential to developing and scaling climate‑resilient livelihood programs. However, participants equally stressed that sustainable development cannot depend solely on external actors and that local governance bodies had to be empowered to lead effectively.

5.4 Long‑term infrastructural and health investments

Participants identified several investment priorities to reduce vulnerability, sustain health and education access, and foster long‑term recovery and development. These included constructing hospitals in the Sundarbans to address the absence of nearby medical care; renovating old ponds to restore their fertility for fishing and irrigation, thereby supporting livelihoods; strengthening and expanding roadways, which would prevent disruptions to health services, schools, and markets during floods; replacing mud‑based homes with concrete structures to prevent the collapse of homes, displacement, and damage during storms; building concrete‑based barrages along coastlines to prevent saltwater intrusion and protect village perimeters; and establishing mental health centers to provide trauma care after disasters.

As one driver reflected, “I fear that one day, during a cyclone, our village might no longer be livable. My hope is that we’ll have proper medical facilities, safe shelters for flood‑affected people, clean water, enough medicine, and protection for our children’s future.” (Driver)

Farmers and a disaster management expert echoed this call for investment in secure shelter and healthcare access:

NGO stakeholders emphasized that Gram Panchayat officials should be equipped to drive climate resilience by integrating localized Sustainable Development Goal (SDG) indicators into the Gram Panchayat Development Plans to ensure disaster preparedness and long‑term recovery are embedded into local planning and budget allocation.