Table 1
Characteristics of study participants (n = 33).
| Gender | Value* |
|---|---|
| Female | 20 (60.6%) |
| Male | 13 (39.4%) |
| Current Residence, n (%) | |
| Kultali | 7 (21.2%) |
| Gosaba | 19 (57.6%) |
| Kolkata, West Bengal | 7 (21.2%) |
| Occupation and Role, n (%) | |
| Locally Embedded NGO Leadership | 5 (15.2%) |
| Mental Health Professionals | 2 (6.1%) |
| Academic Professor of Disaster Management | 1 (3%) |
| Elected Government Official | 3 (9.1%) |
| Appointed Government Official | 4 (12.12%) |
| Accredited Social Health Activists (ASHA Worker)** | 3 (9.1%) |
| Anganwadi Worker (AWW)*** | 4 (12.12%) |
| Community Members | 11 (33.33%) |
| Driver | 2 (6.1%) |
| Farmer | 2 (6.1%) |
| Shopkeeper | 1 (3%) |
| Homemaker | 2 (6.1%) |
| Women’s Self‑Help Group (SHG) Member**** | 2 (6.1%) |
| Non‑Licensed Village Doctor | 2 (6.1%) |
[i] *Data are expressed as number (%), unless noted.
[ii] **Accredited Social Health Activists (ASHA Worker): female community health worker under India’s National Health Mission who serves as the critical link between rural households and health services. Selected from within the community, ASHAs support maternal and child care, facilitate sanitation and nutrition programs, assist with immunizations, promote basic health education, and contribute to health data and local planning [38].
[iii] ***Anganwadi Worker (AWW): female community health worker at Integrated Child Development Service (ICDS) centers, a national program providing supplementary nutrition, preschool education, nutrition and health education, immunizations, health check‑ups, and referrals to support children under six and their mothers with the goal of reducing child malnutrition, illness, and school dropout [39].
[iv] ****Women’s Self‑Help Group (SHG) Member: A member of a 12–18‑person women‑only collective that meets monthly to discuss finances, pool savings, access bank loans, and provide small loans to support other women’s needs and promote self‑reliance. SHGs are linked to the Anandadhara scheme of the Government of West Bengal [40].
Figure 1
Map of South 24 Parganas showing Gosaba and Kultali, Sundarbans, West Bengal, India.
Source: Tanvir Anjum Adib / Wikimedia Commons, CC BY‑SA 4.0.
Figure 2
Conceptual model of cascading infrastructural, health, and economic impacts of recurrent cyclones in the Sundarbans.
Table 2
Stakeholder‑identified vulnerable populations, risk factors, and impacts.
| POPULATION | RISK FACTORS AND IMPACTS | EXEMPLARY QUOTES |
|---|---|---|
| Farmers | Economic Devastation: Farmers experienced extensive loss of fertile farmland, livestock, and income—leading to prolonged economic insecurity, significant loan burdens, and migration. Food Insecurity and Government Dependence: Farmers were dependent on prolonged government rations, leading to sustained food insecurity. Mental Health Strain: Prolonged economic hardship contributed to widespread emotional distress and increased risk of depression and suicide. | “In our farming, we face a lot of challenges, such as flooding. All our fields are waterlogged.” (Farmer) “They lost their jobs, their cultivated lands—everything was destroyed. The level of destruction here is worse than in other areas. All the houses were gone after the dam broke. Many cattle, cows, dogs, and other animals drowned.” (ASHA Worker) “Most of the ponds became unusable, and the agricultural land remained uncultivable for 2 to 3 years after the saline water intrusion. The land became infertile. As a result, people lost their jobs, their livelihoods—everything. The Panchayat provided food rations so they could survive, and many became migrant laborers, leaving the area in search of work. The rations are still being provided to some families, but the quantity has decreased. Initially, the support was significant, but now it has been reduced.” (ASHA Worker) |
| Women and Girls | Trafficking and Gender‑Based Violence: Women faced disproportionately higher rates of trafficking and gender‑based violence during and after displacement. Reproductive Health Challenges: After evacuation to cyclone centers, women were unable to maintain adequate menstrual hygiene due to limited space, lack of privacy, and insufficient access to sanitary products and clean water. | “When people leave their homes and take shelter in common spaces, those places often become unsafe—especially for women and girls. Sometimes, trafficking even happens from within these shelters. Also, because the area is flooded, there are serious challenges related to hygiene, particularly menstrual hygiene for girls.” (NGO Leader) “Menstrual health and hygiene are severely affected. First, there’s the issue of supply—where will they get sanitary products? Even if they manage to get them, there’s the problem of disposal. Sometimes adolescents end up wearing the same pad for an entire day or longer, which increases the risk of infection. On top of that, shelter homes are often overcrowded and lack proper sanitation or washroom facilities, making it even harder to maintain hygienic practices.” (NGO Leader) “In cyclone shelters, there are often no separate spaces for men and women—everyone is lying together on the floor. In many cases, there are no separate toilets either. Because of menstrual taboos and the lack of privacy, women feel extremely uncomfortable and uncertain about how to manage their menstrual health and hygiene while surrounded by so many men.” (NGO Leader) “Child marriage and drowning are major issues here, along with mental health challenges. Human trafficking is also a serious problem. But above all, gender‑based violence is something I deal with every single day.” (Mental Health Counselor) “Many girls couldn’t access sanitary napkins. Those using cloth often didn’t dry it properly, leading to a number of reproductive tract infections.” (NGO Leader) |
| Pregnant Women | Antenatal Care Disruptions: Antenatal care was interrupted during cyclones due to flooded roads, damaged infrastructure, and overwhelmed health centers. Pregnant women were often unable to attend regular check‑ups or receive necessary supplements and services. Delivery During Disasters: Pregnant women who went into labor during evacuation or while staying in shelters had decreased access to skilled attendants or proper delivery facilities. Anxiety and Worry: Pregnant women experienced heightened fear and uncertainty about their ability to reach health facilities during emergencies. Participants noted that many expressed deep concern for their unborn children and for surviving the pregnancy under such conditions. | “It’s a terrifying experience—especially for women in their third trimester or nearing their delivery date. That’s when it’s crucial to monitor vitals like blood pressure, blood sugar, hemoglobin, and weight. It’s a very vulnerable time. We often get calls from the field saying, ‘We’re not getting these services—what should we do?’ This lack of access causes significant mental stress for pregnant women. And we know that stress during pregnancy can affect the entire delivery process. So yes, they become extremely anxious because of these gaps in care.” (NGO Leader) “For women whose delivery dates are approaching, we advise them to keep their phones charged so they can contact the ambulance or rescue services if needed. There’s a facility called the water ambulance, which is used for emergencies—especially for pregnant women who need to be transported for delivery. We’ve also spoken with the block authorities to ensure they can help mothers access this service when required.” (NGO Leader) |
| People living with HIV (PLHIV) | Intergenerational Stigma and Social Exclusion: PLHIV, often men and migrant laborers, faced significant shame and stigma if their diagnosis became known within the community. Discrimination in Shared Spaces: Individuals with HIV were at‑risk of exclusion from shared community resources such as flood shelters, evacuation centers, and places of worship. Treatment Disruption: Cyclones and displacement disrupted access to essential medications like ART. Food Insecurity: PLHIV experienced unmet nutritional needs during cyclones, compounding their health risks. Mental Health Distress: These challenges contributed to PLHIV experiencing panic, anxiety, and depression. Widowhood and Family Strain: In many families, the death of male PLHIV left women widowed, creating economic and emotional hardship. | “They (PLHIV) had to travel to the hospital to get their antiretroviral therapy, but due to lack of transportation and limited financial resources, they were very panicked. They kept asking, ‘Will we get the medicine? Will we be able to travel to the hospital? What will we eat?’ They had seven days of rations—but what after that? That uncertainty haunted them the most. Some had built small kitchen gardens, but those were destroyed too. Everything was severely damaged. It deeply impacted their mental health, because these were things they had cared for over time—their home, no matter how small, their garden, their daily routine. And then, in a single day, everything was gone. That sense of panic came from the sudden disruption of what little stability they had.” (NGO Leader) “They isolate themselves from their peers. And if the villagers find out about a family’s HIV status, even today, they face discrimination. They’re often restricted from using shared resources like the village well or from worshipping in common community spaces.” (NGO Leader) “They were hesitant to go to community shelters because they feared discrimination. Sharing space with others who didn’t know about their HIV status felt risky—if people found out, they might not be allowed to stay. Since the shelter is a community resource, and these same communities often restrict PLHIV from using local ponds or worshipping at temples or mosques, there’s a real fear they would also be excluded from the shelter itself.” (NGO Leader) |
| Children | Educational Disruption and Dropout: Prolonged school closures following cyclones left children without access to education for extended periods, increasing the risk of permanent dropout. Flooding also risked destroying essential educational certificates, preventing children from re‑enrolling in school. Exposure to Abuse, Trafficking, and Neglect: With parents migrating to other cities for work, children were often left neglected. Unattended children—especially girls—faced higher risks of sexual exploitation, trafficking. Early Risky Behaviors: Children were also more likely to engage in early substance use, risky sexual activity, and excessive social media use—a risk factor for trafficking—as coping mechanisms or due to lack of oversight. Mental Health and Nutritional Risks: Children exhibited signs of loneliness, depression, trauma, and even suicidal ideation, exacerbated by instability and trauma. Disruptions in household income and school meal programs exacerbated pre‑existing food insecurity. | “What I’ve noticed is that many of the children have become extremely quiet and withdrawn after experiencing these disasters—what we call natural disasters…. They’re unable to express themselves. A kind of fearfulness is setting in. To help, my peers and I try to engage them through drawing and toys—anything that might bring a little happiness into their lives, to help break the silence.” (AWW) “After the disaster, [children] eventually dropped out. We’ve also seen other serious concerns—like adolescents, around 17 or 18 years old, turning to substance use.” (NGO Leader) “[Through social media, traffickers] say, ‘Come with us—we’ll give you a good job and pay you well.’ So people go. But when they arrive, they’re given some kind of medicine or drug, and then they’re trafficked to places like Delhi or Mumbai.” (ASHA Worker) “Officially, [parents] don’t say they’re selling their children. They say, ‘I’m marrying off my daughter’ or ‘You can adopt my child.’ But in reality, they ask for money—10,000 rupees, one lakh—and give the child away. Legally, exchanging money for adoption is illegal in India, but it still happens. So yes, they do sell their children, either through early marriage or so‑called adoption.” (ASHA Worker) “Social media addiction is another major issue. Since no one is there to listen to them—parents are often absent or unavailable—children are given smartphones. They’re lonely and nobody is there to listen to them.” (Mental Health Counselor) |