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EP Investigation: Hidden Epidemic, Tuberculosis Spreads Among Kerala’s Captive Elephants

An EP Investigation into tuberculosis in Kerala’s captive elephants reveals human transmission risks, weak screening systems, and urgent policy gaps.

Lakshmi Narayanan

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Hidden Epidemic: Tuberculosis Spreads Among Kerala’s Captive Elephants
A captive elephant housed in Kerala. The state is home to one of India’s largest populations of captive elephants, many of whom face chronic health risks linked to prolonged captivity and systemic oversight gaps. Image credit: DD/EdPublica

Tuberculosis in Kerala’s captive elephants has become a silent but persistent threat, driven largely by human-to-animal transmission, chronic stress, and systemic failures in veterinary public health. An EdPublica (EP) Investigation reveals how the absence of routine screening, weak governance, and prolonged neglect could turn a preventable disease into a far larger crisis in the years ahead.

By Lakshmi Narayanan | EP Investigation

Tuberculosis is quietly spreading among Kerala’s captive elephants, sustained not by wildlife exposure but by human contact, chronic stress, and systemic neglect. Long treated as a marginal veterinary issue, the disease represents a serious and largely ignored public health and animal welfare crisis—one that experts warn could intensify in the coming years if left unaddressed.

Kerala hosts one of the largest populations of captive Asian elephants in India, housed by temples, private owners, and festival organisers. According to a Forest Department survey concluded in February 2025, the state currently has 389 captive elephants, marking a steady decline from 521 in 2018 and over 700 in 2010, with the majority now owned by private individuals. This sharp reduction over the past decade reflects broader stresses within the captive elephant system, including ageing animals, declining ownership viability, and chronic health concerns.

Within this shrinking population, tuberculosis is neither new nor rare; it is endemic. Historical veterinary records and animal welfare documentation indicate that in earlier years, TB may have contributed to as many as 25 captive elephant deaths annually. Yet in recent times, detailed and transparent reporting on TB-related infections and fatalities has largely disappeared from public view, creating a misleading impression that the risk has diminished when, in reality, surveillance itself has weakened.

This absence of attention does not signal reduced risk. Tuberculosis is a slow, insidious disease that can remain latent or undiagnosed for years. Without mandatory screening or transparent surveillance, infection can circulate undetected within captive elephant populations—allowing animals to suffer prolonged illness and potentially function as silent reservoirs of infection.

Tuberculosis in Kerala's captive elephants: Declining elephant numbers, chronic illness, and gaps in screening reveal a preventable crisis within Kerala’s captive elephant system
Tuberculosis in Kerala’s captive elephants: Declining elephant numbers, chronic illness, and gaps in screening reveal a preventable crisis within Kerala’s captive elephant system

The persistence of tuberculosis among captive elephants is not accidental. It is the result of a convergence of vulnerabilities: constant exposure to infected humans, immune suppression driven by captivity-related stress, and systemic failures in veterinary public health governance. Together, these factors have created ideal conditions for a preventable disease to endure—largely unseen, and largely unchallenged.

The Human–Elephant Interface: A Critical Transmission Pathway

The primary route of TB transmission among Kerala’s captive elephants is reverse zoonosis: the spread of infection from humans to animals. The causative agent, Mycobacterium tuberculosis, is a human-adapted pathogen transmitted through respiratory aerosols. In settings where elephants live and work in close proximity to people, this pathway becomes epidemiologically decisive.

Mahouts and handlers represent the most significant source of chronic exposure. Their daily routines—feeding, bathing, training, and transporting elephants—require prolonged, close physical contact. If a handler carries an active or latent TB infection, the opportunity for transmission to the animal is constant and cumulative.

In addition to handlers, the general public constitutes a secondary but important exposure source. Kerala’s festival culture routinely places elephants amid dense crowds, often for extended periods. These gatherings create intermittent but high-volume opportunities for transmission from undiagnosed or untreated individuals within the broader population. Together, these human reservoirs ensure that captive elephants are rarely insulated from the pathogen. Yet exposure alone does not fully explain disease persistence. The risk of infection is significantly magnified by conditions that undermine the elephants’ immune defenses.

“Tuberculosis in captive elephants is a severe and often underestimated disease. What is seen during post-mortem examinations is extensive, chronic organ damage that reflects prolonged suffering rather than sudden illness. These findings are consistent with long-term exposure to Mycobacterium tuberculosis and delayed detection, Dr. Arun Vishvanathan, a veterinary expert based in Kerala’s Palakkad district, tells EdPublica.

“From a medical and public health perspective, this condition is particularly concerning because it is largely driven by human-to-animal transmission. Elephants living in close, continuous contact with people—especially under stressful captive conditions—experience immune suppression, which allows the infection to progress unchecked. This is not an unavoidable disease; it is a preventable one. Without routine screening of both handlers and elephants, early diagnosis, and strict biosecurity measures, such cases will continue to occur, resulting in needless animal suffering and ongoing public health risk,” Dr. Arun Vishvanathan adds.

Stress, Captivity, and Immune Compromise

Captive environments impose profound physiological and psychological stress on elephants, a species evolved for expansive movement, complex social structures, and environmental autonomy. Confinement to restricted spaces, prolonged chaining, limited exercise, and forced participation in noisy, crowded festivals all contribute to chronic stress.

Scientific evidence across species demonstrates that sustained stress suppresses immune function. In elephants, this immunosuppression reduces resistance to opportunistic infections such as TB and increases the likelihood that latent infections will progress to active disease.

Crowding further compounds the problem. Elephants housed in close quarters or transported frequently between venues are exposed not only to more humans but also to environments conducive to airborne disease transmission. In these conditions, respiratory pathogens can spread efficiently, especially when animals are already physiologically compromised.

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A shrinking captive elephant population and persistent health risks highlight the urgent need for coordinated veterinary and public health oversight.

”Tuberculosis in Kerala’s captive elephants spreads primarily through close, repeated contact with infected humans, and is sustained by conditions that weaken the animals’ natural defenses. Unlike many wildlife diseases, this is not an infection originating in forests—it is largely a human-driven disease cycle. Mahouts and handlers are the most significant transmission source. Daily activities such as feeding, bathing, chaining, and transport require close physical proximity, often for hours at a time. If a handler has active or undiagnosed TB, the elephant is repeatedly exposed to infectious aerosols,” says Manuprasad, an elephant welfare worker from Thrissur.

Festival crowds and tourists create additional exposure. During temple festivals and public events, elephants are surrounded by dense crowds, sometimes for entire days. In these settings, even brief exposure to multiple infected individuals can result in infection.

Systemic Gaps in Veterinary Public Health

Perhaps the most critical vulnerability lies not in biology but in governance. Kerala lacks a standardized, mandatory TB screening programme for captive elephants. As a result, infected animals—many of them asymptomatic—remain undiagnosed for years. This failure in routine surveillance effectively blinds any meaningful public health response and allows elephants to function as silent reservoirs of infection.

Experts warn that tuberculosis in Kerala’s captive elephants could expand if mandatory screening and biosecurity measures are not urgently implemented.

Nutritional inadequacy is another systemic issue. Economic pressures within the temple and festival ecosystem often translate into suboptimal feeding regimes. Poor nutrition weakens immune responses, lowering the infectious dose required for TB to establish and spread.

Compounding these challenges is a widespread lack of awareness among elephant owners and handlers regarding TB transmission and prevention. Clear, enforceable biosecurity protocols—covering quarantine, treatment, and movement restrictions for TB-positive animals—are largely absent or inconsistently applied. Without such measures, even identified cases pose an ongoing risk to other elephants and to humans.

One of several captive elephants in Kerala that died due to illness in recent years, underscoring concerns over veterinary oversight and preventive health systems.
One of several captive elephants in Kerala that died due to illness in recent years, underscoring concerns over veterinary oversight and preventive health systems. Credit: Image provided by Manuprasad

”As an animal rights and welfare activist, I have personally witnessed the post-mortem of an elephant affected by tuberculosis, and it was deeply distressing. The extent of internal damage revealed the severe and prolonged suffering this animal endured—far beyond what most people realize. Seeing such devastation in an animal of immense strength and dignity is heartbreaking,” explains Ambili Purackal, founder of DAYA, a Kerala-based NGO known for its proactive role in the state’s animal rights movement.

What makes this suffering even harder to accept is that it is largely the result of human exposure. Elephants do not face tuberculosis at these levels in the wild; they contract it through forced, prolonged contact with humans under stressful captive conditions that weaken their immunity. This is not just a veterinary concern but a moral one. These elephants are silent victims of preventable disease, and their suffering is a consequence of human neglect and systemic failure,” Ambili Purackal says.

Secondary and Less-Documented Risks

While human-to-elephant transmission remains the dominant concern, other pathways cannot be entirely dismissed. Interactions with domestic livestock or wildlife in shared environments may contribute to transmission chains, though this remains poorly documented in the Indian context. These ancillary risks further underscore the need for comprehensive epidemiological research.

A Convergence of Vulnerabilities

Taken together, the vulnerabilities facing Kerala’s captive elephants form a self-reinforcing cycle. Constant exposure to a human TB reservoir, chronic immune compromise driven by captivity-related stress and poor nutrition, and systemic failures in disease detection and control create ideal conditions for TB persistence.

Breaking this cycle will require a multi-layered public health approach—one that integrates routine screening, improved nutrition, handler health monitoring, and enforceable management protocols. Without such intervention, tuberculosis will remain a silent epidemic, exacting a slow but devastating toll on one of Kerala’s most culturally significant animal populations.

Silence, in this case, is not neutrality—it is risk.

What Needs to Change

Addressing tuberculosis among Kerala’s captive elephants requires coordinated action across animal welfare, public health, and governance. Experts and welfare workers interviewed by EdPublica point to the following urgent priorities:

1. Mandatory TB Screening

·       Routine, standardised tuberculosis testing for all captive elephants

·       Regular TB screening for mahouts, handlers, and caretakers

·       Immediate isolation and treatment protocols for positive cases

2. Handler Health Monitoring

·       Integration of mahout health checks into public TB control programmes

·       Confidential diagnosis and treatment access to reduce stigma and underreporting

3. Improved Living Conditions

·       Reduced chaining and confinement

·       Adequate daily exercise and social interaction

·       Limits on festival exposure, crowd density, and noise-related stress

4. Nutritional Standards

·       Enforced minimum nutrition guidelines

·       Regular veterinary audits to ensure immune-supportive diets

5. Biosecurity and Movement Controls

·       Quarantine protocols for newly acquired or transferred elephants

·       Restrictions on inter-district or inter-state movement of TB-positive animals

6. Transparent Reporting and Oversight

·       Publicly accessible data on TB cases and outcomes

·       Independent audits of temple and private elephant management practices

7. Interdepartmental Coordination

·       Formal collaboration between forest, animal husbandry, and public health departments

·       Recognition of TB in captive elephants as a One Health issue—linking human, animal, and environmental health

Some sources in this investigation have requested anonymity due to professional or personal safety concerns. Their identities are known to EdPublica and their statements have been independently verified.

Earth

The Silent Collapse Beneath Our Feet: India’s Earthworm Crisis

Earthworms – nature’s unseen soil engineers – are vanishing across India. Their decline signals a deeper ecological breakdown, with far-reaching conseque-nces for agriculture, climate resilience, and national food security

Lakshmi Narayanan

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Image: Sippakorn-yamkasikorn/ Pexels

Earthworms are among the most critical yet overlooked “soil engineers” of terrestrial ecosystems. Despite their foundational role, the systematic neglect of soil biodiversity in agricultural policy represents a serious strategic blind spot. Across India, an invisible crisis is unfolding as earthworm populations decline sharply in both agricultural and natural landscapes. This is not merely a biodiversity concern—it is a direct threat to the country’s soil capital and long-term food security.

As foundational organisms, earthworms provide the biological infrastructure necessary for ecological balance. Their disappearance reflects a deeper structural failure in land management systems and calls for a closer examination of their biological and ecological functions.

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Image: Leni/ Pexels

The Foundational Role: How Earthworms Sustain Productivity

In modern agronomy, healthy earthworm populations are a prerequisite for sustainable productivity. These organisms create a living soil architecture that no mechanical intervention can replicate. By processing organic matter, they act as a bridge between decomposing waste and plant-available nutrients, ensuring both chemical fertility and physical stability.

“The decline in earthworm populations reflects a deeper crisis in human–environment interactions,” says Sreelakshmy.M, Assistant Professor, Geography, Nirmala College, Coimbatore, Tamil Nadu. “From a geographical perspective, this issue is not merely biological but spatial and systemic, rooted in the transformation of land, climate, and soil regimes.”

The intensification of agriculture since the Agricultural Revolution has fundamentally altered soil ecosystems. While synthetic fertilizers and pesticides have boosted yields in the short term, they have imposed significant ecological costs. Earthworms, particularly those inhabiting the topsoil, are directly exposed to these chemical inputs. Their decline signals a broader degradation of soil health, as they are key agents of aeration, nutrient cycling, and organic matter decomposition.

When topsoil biodiversity diminishes, the long-term fertility and structural integrity of agricultural landscapes are compromised.

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Equally significant is the rapid transformation of land-use patterns. Urban expansion, infrastructure development, and the spread of impermeable surfaces have led to soil sealing and habitat fragmentation. From a spatial perspective, the conversion of biologically active land into built environments represents a permanent loss of ecological function. Earthworms cannot survive beneath concrete, and with their disappearance, essential soil processes are disrupted.

Core Contributions to Soil Vitality

Earthworms play a central role in maintaining soil health. Their burrowing creates complex underground networks that improve soil structure, enhance aeration, and enable deeper root penetration. These tunnels also stimulate microbial activity, strengthening the soil’s biological ecosystem.

By digesting organic matter, earthworms convert decomposing residues into nutrient-rich castings. These natural fertilizers contain concentrated levels of nitrogen, phosphorus, and potassium—essential elements for plant growth. Through this continuous recycling process, they sustain the nutrient base of agricultural systems.

In addition, earthworms bind soil particles into stable aggregates, improving water infiltration and moisture retention. This reduces surface runoff, protects against erosion, and enhances resilience to extreme weather conditions.

Together, these processes form the backbone of agricultural stability. Yet, modern human-driven pressures are rapidly eroding this biological foundation.

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“Rising global temperatures increase soil heat and accelerate moisture evaporation,” Sreelakshmi explains. “Earthworms depend on a delicate balance of temperature and moisture. When soils dry or overheat, survival becomes difficult, often leading to localized mass mortality.”

This decline illustrates the interconnected nature of environmental stressors—chemical intensification, land-use change, and climate shifts—operating simultaneously across scales.

Analyzing the Drivers of Decline: A Multi-Front Threat

The shift from traditional Indian farming—once characterised by organic inputs, mixed cropping, and minimal disturbance—to intensive industrial agriculture has created increasingly hostile conditions for soil life. The decline of earthworms is driven by multiple, overlapping pressures:

Chemical Toxicity: The extensive use of urea-based fertilizers, pesticides, and fungicides introduces toxic compounds into the soil. Many of these act as neurotoxins, impairing earthworms’ nervous systems and reducing their reproductive capacity.

Nutritional Depletion: Practices such as stubble burning and the removal of crop residues deprive soil organisms of organic matter, their primary food source.

Mechanical Disturbance: Frequent tillage and heavy machinery disrupt soil structure, destroy burrow networks, and cause compaction, limiting oxygen availability.

Habitat Erosion: Deforestation and poor land management accelerate topsoil loss, eliminating the primary habitat where earthworms thrive.

Climate Stress: Rising temperatures, erratic rainfall, droughts, and flooding create unstable and often lethal conditions for moisture-sensitive organisms.

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Image: Edris-Ibraheem/ Pexels

According to Dr. C P Maruthamalai, Assistant Professor, Geology,
Madurai Kamaraj University, the intensive use of chemical inputs significantly disrupts soil ecosystems. Excess nitrogen alters soil chemistry, creating conditions hostile to beneficial organisms. Prolonged exposure reduces earthworm mobility, feeding ability, and reproduction, gradually weakening entire populations.

These stressors are no longer isolated—they form a systemic crisis that is reshaping agricultural landscapes.

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The Domino Effect: Systemic Consequences of Decline

The disappearance of earthworms triggers a cascading “domino effect” across ecological and economic systems, transforming agriculture from a self-sustaining biological model into a fragile, input-dependent system.

Declining Natural Fertility: Reduced decomposition slows nutrient cycling, forcing farmers to rely increasingly on synthetic fertilizers, often leading to rising input costs.

Weakened Soil Structure: Compacted soil restricts root growth and reduces water efficiency, making crops more vulnerable to stress.

Water Instability: Lower infiltration rates increase runoff, contributing to both drought conditions and soil erosion.

Food Security Risks: As soil productivity declines, crop yields become less stable, threatening long-term food systems.

Biodiversity Collapse: Earthworms are central to the soil food web; their disappearance disrupts microorganisms and higher organisms alike, leading to broader ecological breakdown.

This systemic decline underscores the fragility of current agricultural practices.

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Image: Hanielyaks/ Pexels

Rebuilding Soil Health

Addressing this crisis requires a fundamental shift in agricultural thinking—from short-term chemical dependency to long-term ecological restoration. Earthworms must be recognised as key indicators of soil health.

Strategic priorities include:

1. Transitioning to organic and natural farming systems

2. Restoring soil organic matter through compost, green manure, and vermicompost

3. Adopting conservation agriculture and reducing tillage

4. Eliminating stubble burning and promoting residue retention

5. Integrating soil biodiversity into agricultural policy and extension services

Such measures are essential not only for restoring earthworm populations but also for rebuilding resilient farming systems.

An Imperative for the Future

The decline of earthworms is a warning signal of a deeper ecological imbalance within India’s landscapes. Protecting these silent engineers is not simply an environmental concern—it is central to economic stability, agricultural sustainability, and national food security.

A resilient future depends on restoring the biological life of our soils.

Because the future of farming does not begin in laboratories or markets—it begins beneath our feet.

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Climate

The Next Five Years Could Be Earth’s Hottest Yet, WMO Warns

A new WMO forecast warns that Earth could see new global temperature records before 2030, with Arctic warming continuing to outpace the global average.

Joe Jacob

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Global temperature record trends highlighted in a climate change analysis showing rising temperatures worldwide.
Image credit: WMO

Global temperature record levels are likely to be challenged again before the end of this decade, according to a new World Meteorological Organization forecast. Scientists say there is a high chance that one of the next five years will become the warmest ever recorded, as rising greenhouse gas emissions and a possible El Niño event continue to push the planet toward new climate extremes.

The world is heading into another stretch of exceptional heat, with a strong chance that a new global temperature record will be set before the end of the decade.

According to a new assessment from the World Meteorological Organization (WMO), global temperatures are expected to remain at or near record levels between 2026 and 2030, extending a warming trend that has already pushed climate indicators into uncharted territory.

The report paints a picture of a planet that continues to warm despite international efforts to curb greenhouse gas emissions. While the Paris Agreement aims to limit long-term warming to 1.5°C above pre-industrial levels, scientists now estimate there is a 91% chance that at least one of the next five years will temporarily cross that threshold.

Global Temperature Record Could Be Broken Again by 2030

Even more striking, there is a 75% chance that the average temperature across the entire five-year period from 2026 to 2030 will exceed 1.5°C above pre-industrial levels.

The findings do not mean the Paris Agreement has officially failed. The agreement’s temperature targets are measured over decades rather than individual years. Still, climate scientists view the growing frequency of these temporary breaches as a sign of how rapidly the planet is approaching those long-term limits.

The report projects annual global temperatures during 2026–2030 to range between 1.3°C and 1.9°C above the 1850–1900 average. There is also an 86% chance that one of those years will surpass 2024, currently the warmest year ever recorded.

One factor behind the forecast is the likely return of El Niño conditions in the tropical Pacific Ocean.

2027 Could Become the Next Global Temperature Record Year

Dr. Leon Hermanson, lead author of the report, said: “There is an El Niño predicted for the end of 2026, which increases the chances of the following year, 2027, being the next record-breaking year.”

El Niño events typically raise global temperatures by releasing additional heat from the Pacific Ocean into the atmosphere. When combined with the long-term warming caused by greenhouse gas emissions, they can push global temperatures to new highs.

Global Temperature Record Highlights Faster Arctic Warming

While rising temperatures affect every region, the Arctic continues to stand out.

The WMO forecasts that Arctic temperatures during the next five northern hemisphere winters will average about 2.8°C above the 1991–2020 baseline. That is more than three times the projected global average anomaly over the same period.

Scientists have long observed that the Arctic is warming faster than the rest of the world, a phenomenon known as Arctic amplification. The consequences include shrinking sea ice, thawing permafrost and disruptions to weather patterns far beyond the polar region.

The report also points to continued declines in sea ice across parts of the Arctic, particularly in the Barents Sea, Bering Sea and the Sea of Okhotsk.

A Wetter North, A Drier South

The warming climate is also reshaping rainfall patterns.

According to the forecast, northern high-latitude regions are likely to experience wetter-than-average winters over the next five years. Increased rainfall is also expected across parts of the tropics.

At the same time, many subtropical regions are projected to become drier. The Amazon is among the areas where below-average rainfall is considered more likely during the coming years.

Seasonal forecasts for 2026–2030 suggest wetter conditions in the Sahel region of Africa, northern Europe, Alaska and Siberia. Such shifts are consistent with what climate scientists have long expected in a warming world, where a warmer atmosphere holds more moisture and alters long-established rainfall patterns.

Beyond Records

The report is not simply about whether another temperature record will be broken.

For governments, businesses and communities, the findings serve as a reminder that climate change is increasingly shaping everyday realities—from agriculture and water supplies to infrastructure, health and disaster preparedness.

The assessment was produced by the UK Met Office on behalf of the WMO and draws on forecasts from 13 international climate centres. Scientists say confidence in the temperature projections is high because similar forecasting systems have performed well when tested against past climate conditions.

If the projections prove accurate, the second half of this decade could become a defining period in the world’s climate story—not because warming suddenly accelerates, but because the consequences of a steadily warming planet become harder to ignore.

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Climate

‘The story of sea-level rise is not a story about water. It is a story about people’

Prof. Dr. Jemilah Mahmood on why the world is dangerously underestimating a gathering health and justice crisis — and what must change.

Dipin Damodharan

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Image credit: Sunwayuniversity

When the Lancet Commission on Sea-Level Rise, Health and Justice published its landmark report Life at the water’s edge on 8 April 2026, it marked the first major effort to examine rising seas through a health-focused lens. Bringing together 26 international experts, the Commission was convened against a backdrop of accelerating coastal displacement, collapsing freshwater systems, and a growing recognition that the world’s most vulnerable populations are paying the price for a crisis they did not cause.

Among the 26 commissioners is Prof. Dr. Jemilah Mahmood, Executive Director of the Sunway Centre for Planetary Health at Sunway University, Malaysia — one of the region’s leading institutions on planetary and public health. A physician, humanitarian, and policy leader with decades of experience across Asia and beyond, Mahmood has been a consistent voice for justice-centred approaches to climate and health. Dipin Damodharan spoke to her about what the Commission’s findings mean for health systems, governments, and the role of science journalism in turning evidence into action.

Sea-level rise is often discussed as an environmental issue. From a health perspective, how should we understand its real impact on human lives?

The framing of sea-level rise as primarily an environmental issue understates what is actually happening. At its core, this is a health and wellbeing crisis. It is already reshaping how people live in the most fundamental ways: what they eat, whether they can access clean water, how they sustain their livelihoods, and whether they can maintain any meaningful sense of mental stability and security.

The consequences run deeper than just the physical. Rising seas accelerate injury, disease, and displacement, but they also produce profound psychological trauma and the erosion of cultural identity, particularly for communities whose health is inseparable from land, coastlines, and the ocean itself. For many coastal and island populations, this is not simply a question of relocating to higher ground; it is the dismantling of entire ways of life that have sustained people for generations.

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Image: Nici Gottstein /Pexels

What makes sea-level rise especially serious as a health challenge is that it does not operate in isolation. It amplifies the effects of storms, intensifies heat, and deepens socio-economic inequality, meaning that existing health vulnerabilities become far worse rather than simply being joined by a new one.

What are the most immediate and long-term public health risks in vulnerable coastal regions?

The immediate risks are already being lived, not merely anticipated. Coastal flooding and storm surges kill, displace, and destroy the health infrastructure communities need to recover. When salt intrudes into freshwater supplies, the consequences for drinking water and basic hygiene outlast the flood itself by months or years. Blood pressure rise in communities affected by saltwater intrusion is well documented, affecting the highest at risk including pregnant women.

The longer-term risks are in some ways harder to address precisely because they accumulate quietly. Disrupted agriculture and fisheries translate into chronic food and nutrition insecurity, particularly for coastal populations whose diets depend directly on the sea. Permanent displacement strips away not just homes but ancestral land, social cohesion, and the intergenerational ties that underpin community health and resilience.

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And then there is the mental health burden, which too often gets treated as secondary. For Indigenous and island communities, eco-anxiety, grief, and the loss of cultural identity are not soft concerns to be addressed once the physical damage is tallied. They are central to what sea-level rise actually does to human lives.

You describe this as a “justice crisis.” Who bears the greatest burden, and why does sea-level rise disproportionately impact those least responsible for climate change?

The communities bearing the greatest burden are those living in Small Island Developing States, low-lying coastal regions, and Indigenous territories, with concentration in the Western Pacific, where populations have contributed minimally to global emissions. In the worst-case scenarios, up to 410 million people are projected to be living below the high-tide line by 2100.

The injustice is not incidental; it is structural. These communities face displacement from their homes, their cultures, and their livelihoods, along with serious and compounding health consequences, without having meaningfully benefited from the fossil-fuel-driven economic growth that caused the crisis.

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Image: Mumtahina Tanni

It is important to be precise about what justice means in this context. The Lancet Commission is explicit that this is not a conversation about charity or humanitarian generosity. It is about accountability, compensation, and rights. Affected communities are not supplicants waiting for wealthier nations to act out of goodwill; they are rights-holders who must be recognised as such, and crucially, they must have a genuine role in shaping the solutions. That shift in framing — from aid to accountability — is one of the most important things health journalists can help their audiences understand.

Are current health systems adequately prepared to respond to these impacts?

The honest answer is no. Health impacts from sea-level rise remain under-recognised, poorly integrated into national health planning, and largely treated as someone else’s problem. Adaptation efforts, where they exist at all, tend to prioritise physical infrastructure. The health, mental wellbeing, and cultural dimensions are consistently treated as secondary concerns, or rendered invisible entirely.

This is precisely why the Commission was formed. The scale of the challenge is being underestimated, and not just by governments. The financial sector and the international institutions specifically designed to hold the world accountable on climate change have been slow to reckon with what rising seas will actually cost in human health terms.

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What policy interventions should governments prioritise?

The starting point is integration. Sea-level rise and its health consequences need to be written explicitly into national health strategies and climate adaptation plans, backed where possible by legislation and regulation. Voluntary commitments have a poor track record; legal and regulatory frameworks create accountability.

Community-led and Indigenous-informed adaptation must be resourced, not just acknowledged in policy documents. Local knowledge and local priorities are not a soft add-on; they are often the most reliable guide to what will work in a given context.

There also needs to be honest policy provision for the hardest cases: legal, financial, and institutional mechanisms to support protection, compensation, and where it becomes unavoidable, managed retreat from the shoreline. This is politically difficult, but pretending it is not necessary helps no one.

Finally, these policies must be fair across generations. The decisions made now will determine the conditions into which children and those not yet born will arrive. That is not a rhetorical flourish; it is a genuine policy obligation that should shape how governments evaluate every intervention they consider.

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Given the transboundary nature of climate impacts, how important is international collaboration?

It is not just important; it is irreplaceable. Migration driven by displacement, disruptions to global food chains, the spread of infectious disease, the destabilisation of regional economies — these are not problems that stop at a coastline or a customs post. They require regional and global responses to match.

We are having this conversation at a moment when nationalism is rising, when multilateral frameworks are under pressure, and when misinformation and disinformation are actively undermining public understanding of the science and the stakes. That combination is dangerous, and it makes the case for strengthening international cooperation more urgent, not less.

The countries and communities most affected by sea-level rise are largely those least responsible for causing it and least equipped to manage it alone. An international architecture that fails to support them is not just morally inadequate; it is strategically shortsighted, because the consequences of inaction will eventually reach everyone.

I want to leave you with one thought. The story of sea-level rise is not a story about water. It is a story about people: about whose lives are considered expendable, whose knowledge is valued, whose children inherit a liveable world, and whose do not. We have the science. We have the solutions. What we have lacked is the sustained, courageous, human-centred storytelling that turns understanding into action. That is where you come in.

This is the digital version of the interview published in the May–June issue of Education Publica magazine, the print magazine division of EdPublica. The magazine is available on Magzter.

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