Life in Assam’s Barak Valley: Co-Existing With Floods and Fragile Healthcare

In 2022, the only 150-bed cancer hospital in the valley was forced to administer chemotherapy on the road.

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I have known floods up close and personal — a yearly disaster my community has faced for as long as I can remember. I grew up in Karimganj, one of the districts in the Barak Valley region of southern Assam. During the monsoon season, I remember venturing out of the house wearing huge gumboots. During those months, I stepped out only for emergencies – going to the doctor or getting something from the market. Our schools remained closed for months because people from nearby villages would take refuge in the school buildings as their homes had become uninhabitable because of rising floodwaters.

I still remember my mother’s warnings, “Kichu hole ei jole dactar paoa jabe na” (if anything happens, we won’t find any doctors these in floods), “Oshudh er dokan e jol dhukegeche, osukh hole osudh nei” (pharmacies are flooded, we can’t get any medicine if we fall sick), and “sanp ache jole jash na” (there are snakes in the water, don’t go out!).

Even today, incidents of snake bites, electrocution, drowning, cholera, and malaria are all too common whenever waters rise and life comes to a standstill in the region. What makes all of this far worse, and compounds the distress and vulnerability of the valley’s people, is the fragile healthcare system in the region that, after all these years, is still woefully inadequate and ill-prepared to meet.

Floods have been affecting the people of Assam for decades now and the people of Barak Valley are the ones who are the most affected and vulnerable. 60 people have died and 2.4 million people are displaced or affected by floods in Assam in 2024. More than 386,000 people have been displaced and forced to take shelter in the 515 relief camps set up in schools, colleges, and hospitals in flood-affected districts across the state.

According to reports, my hometown of Karimganj is the worst affected region in Assam with more than 152,000 people affected of which 41,000 are children who have to shoulder the burden of this disaster. There are currently 30 shelters in the Karimaganj district housing almost 9,212 people, yet these numbers do not quite capture the true scale of the disruption and distress that unfolds there every monsoon, year after year.

Public health infrastructure in the Barak Valley region is the most inadequate in Assam. It is also disproportionately burdened with neglected tropical diseases like lymphatic filariasis and giardia intestinalis. Illnesses like acute diphtheria, rabies, diarrhoea, dysentery, enteric fever, malaria and dengue are also common in this region.

Moreover, the rise of Non-Communicable Diseases (NCDs) like diabetes, acute heart diseases, and various types of cancers has further encumbered the already fragile healthcare system of the region. National Health Mission (NHM), Assam reported the rise of water and vector-borne diseases due to floods leading to the absence of clean drinking water and sanitation in the affected areas.

This precarious healthcare system, beleaguered by malnutrition, lack of resources, and high prevalence of diseases, is on the brink of collapse in the best of times and is unsurprisingly overwhelmed whenever there are floods.

In the last census, the estimated population of Barak Valley stood at 4,377,612 and the Silchar Medical College and Hospital (SMCH) located in the Cachar district is the only referral hospital for the entire Barak Valley region. Unfortunately, it does not have something as basic as angioplasty facilities, making it difficult for patients to access necessary emergency care without travelling to big urban centres like Guwahati and Shillong which are a minimum of 8-12 hours away by bus. Yearly floods disrupt even this option as road and rail connectivity is severely impacted, leaving many with urgent need of basic medical attention stranded with nowhere to go.

My father, who is 71 years old, had to be taken for a heart check-up at SMCH earlier this year. This is ordinarily a three-hour bus ride from my hometown. He couldn’t get his check-up done and had to return home after travelling three hours because the whole town was flooded, transportation halted, and there were incidents of landslides. We were compelled to bring him back home without doing his check-up out of fear of becoming stranded.

Flying him to any other city in Upper Assam or Shillong was not possible because the nearest airport located in Kumbirgram is 70 km away and the only road leading to the airport was underwater making it impossible for any kind of transportation to be functional. This is not a one-off incident; people in the region are too used to being cut off from basic healthcare. If this is what my father had to experience, I shudder to think of the plight of those with more urgent and emergency medical needs or even those with limited mobility.

As awful as this was, it is nothing compared to what happened last year.

During the 2022 floods, the only 150-bed cancer hospital in the valley was forced to administer chemotherapy on the road—the only place with minimal water-logging. Medical professionals in life jackets were conducting procedures and transporting patients alongside other essential items to keep the cancer centre running and taking care of patients to the best of their abilities. Similarly, SMCH has experienced power cuts almost every year throughout the monsoon season because of floods, putting the lives of critical care patients at risk.

As a global health professional trained at the University of Oxford and studying health equity, and with my experience growing up in the Barak Valley, I now understand the importance of where and how we live in determining what care we can get and, ultimately, if we survive. How would healthcare experts and the public react if critical procedures like chemotherapy were done on the roads in any other part of the country or the world? This ultimately comes down to the question of who is significant in a country – whose health is considered important and, conversely, where negligence can be normalised.

Medical professionals including community health workers (ASHA workers) are nothing short of heroes in Barak Valley and other neglected regions. In conversation with a few ASHA workers, I have been told that even during floods they continue visiting houses and camps to deliver care. They shoulder the burden of almost the entire healthcare system - from diagnosing malaria to assisting with childbirth, and talking to women and their families about family planning.

Similarly, doctors and other medical professionals in hospitals never stop working, despite power cuts, limited supply of medicines, etc. They persevere under extreme conditions and resource-crunch situations and perhaps the only reason this periodic disaster has not been worse is due to their dedication and untiring commitment.

Although these stories of resilience are inspiring, I strongly believe that our medical professionals and community health workers deserve better – better work conditions, better financial incentives, and most importantly, more respect and recognition. No medical professional should have to take their patients roadside to treat them or deliver babies in make-shift camps. It is not only dehumanising but takes a massive toll on the mental health of these professionals. They deserve better, just as much as their patients deserve better.

I am proud of the resilience of my community – being able to get back on their feet despite decades of facing a never-ending cycle of disasters. But I don’t want to romanticise their struggles – as equal citizens of India, my people deserve as much attention from the state as those in big cities. They deserve to be treated with dignity. Flooding is a yearly event that has unfortunately been normalised by both the government and the people. Political campaigns rarely address flood control measures that parties will implement once elected.

The hardships of monsoon months are so frequent and have been experienced by people for generations that it has become the ‘new normal’. Like any other natural disaster, floods in this region deserve the attention of both the media and our political leadership, yet this has never been the case – and this makes me both immensely sad and angry.

Although the picture looks grim, I still have hope in our government, civil society organisations, and my community – everyone will come together and solve this inter-generational problem in Barak Valley. We have to realise that this is the best gift we can give to our future generations. With all my heart, I hope that controlling floods and building flood-resilient healthcare systems in the Barak Valley region becomes a priority for the government, the people, and civil society organisations. Together, we can alleviate the hardships so many suffer and save countless lives lost each year.

(Shuma Banik is a global health professional and an MSc in International Health and Tropical Medicine from the University of Oxford. She is from Karimganj, Assam, and this article draws on her personal experiences of living and growing up in the Barak valley region.)