Delhi: Inside India’s first heat stroke emergency room

At one of the largest hospitals in the Indian capital, Delhi, a doctor says he has never seen anything like this before.

“This is an unprecedented heatwave. In my 13 years of working here, I don’t recall ever signing a death certificate for heat stroke. This year, I have signed several,” says Ajay Chauhan of Ram Manohar Lohia Hospital (RMLH).

Delhi has been under a prolonged heatwave, with daily temperatures exceeding 40°C (104F) since May, peaking at nearly 50°C. Humidity and hot winds exacerbate the heat, made worse by water shortages and power outages due to soaring demand. And people started dying from the heat in the capital.

Heatstroke, the most serious heat illness, is identified by three key signs: exposure to high heat and humidity, a core body temperature of 40.5°C (105°F) or higher, and mental changes such as mild confusion or altered consciousness. Heat stroke is also a silent killer, and victims can start getting sick hours after exposure to the sun. India’s National Center for Disease Control calls heatstroke a “life-threatening” illness, with a mortality rate of 40 to 64 percent.

Since Dr Chauhan Hospital in Delhi opened a heatstroke clinic in late May, seven people have died from heatstroke and more than 40 have been treated for heat-related illnesses.

The majority were men working outdoors and in small, unregulated factories, in poor conditions and subject to exposure to extreme heat. Of course, the heatwave is not limited to Delhi: dozens of people have died from heat-related illnesses since March, with more than 50 deaths in just three days in early June in the states of Uttar Pradesh and Odisha. .

At the RMLH clinic, perhaps the first of its kind in India, efforts to save heatstroke patients underscore the challenge posed by rapid climate and health emergencies.

A few days ago, a man was transported with a body temperature reaching 42°C (107.7°F). The normal core temperature of a body is 37 to 38°C. He was suffering from heat stroke.

At this temperature, the human body begins to shut down, cells deteriorate, and there is a risk of organ failure. Sweating stops as blood flow to the skin stops, leaving it cold and clammy.

At the clinic, doctors immersed the patient in ice-cold water in a 250-liter ceramic bathtub where the temperature ranged from 0 to 5°C. (The clinic is equipped with two ceramic tanks, a 200 kg ice maker, rectal thermometers, coolers and inflatable tubs.) The patient took approximately 25 minutes to calm down and begin to recover before be transferred to the department for further processing.

“Early cooling saves lives. Every second counts,” says Dr Chauhan. Delay can either prove fatal, leave the patient bleeding, or lead to kidney and liver damage.

It is not difficult to get sick in Delhi. Life is hard. A third of residents live in unsanitary and overcrowded housing. The city’s approximately 6,400 slums, home to more than a million households, lack adequate air conditioning and face seasonal livelihood crises. Men get sick while working outside; women become ill after spending long periods in kitchens equipped with traditional stoves.

Green spaces are rare. At the height of summer, the city turns into a scorching furnace, trapped between the scorching heat above and the burning ground below.

Anjana Kumari, the wife of a daily wage laborer admitted to RHML following heatstroke, told The Indian Express that the only fan in their slum was not working due to a power cut. Her husband, exhausted after working all day Monday, couldn’t sleep and subsequently suffered convulsions, vomiting and diarrhea. She rushed him to the hospital in the night. “The doctors told me he would not be able to walk for some time and would need a lot of care,” Ms Kumari said.

Those who work outside are those who suffer the most. A large majority of respondents in a new Greenpeace survey on the impact of heat on Delhi’s street vendors reported health problems due to the hot weather. Irritability was the most common (73.44%), followed by headaches, dehydration, sunburn, fatigue and muscle cramps. Most have struggled to access medical care due to lack of money.

“The heat is increasing every day. We live under the open sky. What resources can I gather? If possible, there should be trees and plants nearby, so that fresh air keeps blowing and the body gets some relief,” said Guddi, a sugarcane juice seller who uses a grinder manual, to Greenpeace.

“After being exposed to the heat of the sun all day, I don’t want to eat dinner in the evening. All I think about is stretching my legs and going to sleep,” she said.

And all over India, people are getting sick from the heat. A new national survey from the Center for Rapid Insights (CRI) offers surprising insights into how heat waves harm populations and cripple productivity.

It appears that 45% of households contacted said that at least one member had fallen ill due to the heat in the last month.

Of those affected, more than 67% had members of their household sick for more than five days.

This impact has been particularly severe among the poorest. Specifically, 32.5% of households with a motorcycle and 28.2% without a vehicle had members who were sick for more than five days; the figure was lower at 21.8% for car-owning households.

About three-quarters of Indian workers work in jobs exposed to heat, such as construction and mining. This situation worsens during heatwaves because there are fewer safe and productive working hours during the day. A Lancet study reported a potential loss of 167.2 billion work hours in India due to excessive heat in 2021.

“The loss of productivity is staggering,” says Neelanjan Sircar, director of CRI.

Heat waves killed more than 25,000 people between 1992 and 2019, according to official figures. As India does not properly compile mortality data, experts believe the real toll could be much higher.

India’s heat action plans are also not working well, a study reveals. It is telling that 68% of Delhi’s sellers have not even heard of heatwaves, according to the Greenpeace study. It is therefore not surprising that the heat crisis does not figure in political discourse.

“Many view the heatwave as a persistent natural phenomenon, with little expectation of government intervention. This reflects a broader problem of low expectations in India,” says Sircar.

Things look dire in Delhi. In 2022, India experienced 203 heatwave days, the highest on record, with Delhi experiencing around 17. March was India’s hottest month recorded by the meteorological department, while Delhi experienced its second warmest April in 72 years.

“It will get worse. We need to be very careful,” says Dr Chauhan.