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

This study investigates the cascading impacts of recurrent cyclones on the physical and mental health, livelihoods, infrastructure, well-being, and long-term development of communities in the Indian Sundarbans, one of the world's most climate-vulnerable regions. Semi-structured interviews were conducted with community members, frontline public health workers government officials, NGO leaders, mental health counselors, and non-licensed village doctors. We aimed to identify the ecological, geographic, and socioeconomic conditions exacerbating the region's vulnerability to cyclones; examine the intersecting short-term and long-term health, economic, and social impacts; characterize existing response systems; identify structural barriers impeding long-term recovery and development; and propose stakeholder-informed recommendations to strengthen disaster preparedness and promote lasting resilience and recovery. Findings reveal that these communities remain entrapped in a recurring cycle of disaster and inadequate recovery marked by saline water intrusion, collapsed infrastructure, displacement to overcrowded shelters, loss of agricultural land, infectious outbreaks, disruptions to healthcare delivery and child education, life-threatening health emergencies, damage to livelihoods, food insecurity, and rising gender inequity, trauma, and depression. These vulnerabilities and impacts are perpetuated by chronic underinvestment and a lack of responsive policy. Participants called for solutions such as the following: (1) pre-positioning food, water, and medicines to strengthen disaster preparedness; (2) digitizing educational certificates to mitigate school dropout; (3) expanding insurance coverage, compensation schemes, vocational training, and employment opportunities to mitigate income losses; (4) establishing mangrove reforestation programs for livelihood diversification and bolstering natural ecological defense; and (5) increasing investment in resilient infrastructure, especially hospitals, roads, and homes. Policy reforms and tax incentives could mobilize private sector investment. The lived experiences captured in this study illuminate the daily struggle for basic security, income, health, education, and survival in the Indian Sundarbans and the urgent need for policies that uphold health equity and dignity in the face of accelerating climate threats.