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.

‘This is a health and wellbeing crisis’

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.

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.

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.

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.

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.

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.

Climate change is rewriting the boundaries between human spaces and snake habitats. Kerala’s deadly summer of 2026 is the latest — and most visible — chapter in a global crisis hiding in plain sight.

By Dipin Damodharan & Lakshmi Narayanan

The pencil drawing of a crowned king is still on the wall. It sits low — only as high as a small boy could reach. Dikshal was eight years old when he drew it, and eight years old when he died, bitten by a cobra that had slipped into his home in Chirayinkeezhu, Thiruvananthapuram, Kerala, seeking refuge from the punishing April heat. The snake was found later, hiding beneath a sewing machine.

His family had heard about the snakebite deaths spreading across Kerala. They had covered the gaps in their walls with sheets, reasoning that the heat inside would keep snakes away. They had never seen a venomous snake near their home before. When Dikshal woke complaining of a wound, his father Dileep could not make out the bite mark — there was only one puncture, not the two most people expect. The family rushed him to the nearest taluk hospital. Staff, uncertain whether it was a snakebite, did not administer anti-venom. By the time Dikshal reached the Medical College Hospital in Thiruvananthapuram, he had stopped breathing.

He was not alone. On April 18, eight-year-old Aljo from Kodakara in Thrissur district died after being bitten by a common krait while asleep. His brother Anoj was also bitten and remained in treatment. Within days, Kerala had recorded around five snakebite deaths in a single week, prompting widespread alarm. The answer to where all these snakes had suddenly come from, scientists and field workers say, is not sudden at all. Kerala lost 660 people to snakebites over the last decade.

The Physics of a Cold-Blooded Crisis

Snakes are ectotherms — cold-blooded creatures whose body temperature, metabolism, and behaviour are governed entirely by their external environment. Mithun A.S., an experienced snake rescuer who has worked across Kerala, explains it plainly: snakes depend entirely on external sources to maintain their body temperature. When the environment becomes too hot to sustain them, they do not adapt. They move.

“When temperatures cross a threshold, their metabolism accelerates, their need for food increases, and their natural burrows become unbearably hot,” Mithun says. “They have no choice but to come out and find somewhere cooler.”

In a Kerala summer that has broken decade-long heat records, that somewhere is increasingly inside our homes. As cold-blooded animals, snakes cannot regulate their body temperature or sweat, so they come out in search of cooler conditions. This is also the breeding season, which increases the likelihood of human-snake encounters.

What makes this moment particularly dangerous, Mithun notes, is the combination of heat and hunger. As metabolism speeds up, snakes need to feed more frequently. They are not only seeking cool shelter — they are also actively hunting. The two imperatives together drive them deeper into human territory than they would ordinarily venture.

The Microclimate We Built for Them

Krishnan T.J., a SARPA volunteer and snake expert with years of field experience across Kerala, has a precise term for what is happening to our homes. They have become microclimates — islands of thermal relief in an increasingly hostile landscape.

“Our bathrooms, our wells, our shaded corners — these are now the coolest places available to a snake within range,” Krishnan says. “The water sources outside are drying up. The burrows are overheating. The snake is not invading. It is surviving.”

The ecological concept behind this observation is microhabitat compression — as climate change narrows the zones where temperature, moisture, and shelter align, both humans and wildlife converge on the same shrinking refuges. In Kerala’s case, that refuge is often a tiled bathroom floor, the space beneath a bed, or the cool shadow of a sewing machine.

Krishnan points to the role of ornamental plants that climb walls, cracks in compound walls, and gaps in roofing as the entry points snakes most commonly exploit. “People grow decorative creepers along their walls and think nothing of it,” he says. “For a snake, that is a ladder.” The physical infrastructure of the Kerala home — designed for ventilation and shade in a warm climate — has inadvertently become optimal snake habitat.

Breeding Season and the Invisible Danger

Muhammed Anwar, nodal officer for Mission SARPA under Kerala’s Forest Department, adds a dimension that makes the current moment even more acute. April and May are not just the hottest months in Kerala — they are also when the Big Four venomous species hatch.

“The cobra, the krait, the Russell’s viper — this is their breeding season,” Anwar explains. “The hatchlings carry venom as potent as the adults. They are smaller and harder to see. And they are looking for exactly the same cool, damp spaces that the adults are.”

This convergence — record heat, accelerated snake activity, and a new generation of venomous juveniles dispersing across the landscape — is what transformed April 2026 into something beyond a seasonal spike. Anwar is particularly concerned about the structural features of Kerala homes that create easy access. “Ornamental plants climbing walls, gaps in compound walls, cracks where pipes enter — these are the highways,” he says. “And once inside, a snake will settle in the coolest spot it can find. That is often exactly where a child sleeps.”

Anwar has been at the centre of Kerala’s effort to reduce snakebite deaths since the SARPA programme launched in 2020. Chief Minister Pinarayi Vijayan has stated the programme’s goal as bringing snakebite deaths in the state to zero. The infrastructure — over 1,200 trained rescuers, a public app, and rapid response protocols— is among the most developed in India. But Anwar is candid about the limits of even the best response system when the underlying environmental conditions keep worsening.

India’s Hidden Epidemic

What is unfolding in Kerala is a concentrated, visible expression of something far larger across the subcontinent. India had an estimated 1.2 million snakebite deaths between 2000 and 2019 — an average of 58,000 per year. Over a quarter of those deaths were children under 15. Most occurred at home, in rural areas.

India accounts for approximately half of all snakebite-related deaths globally. Every year, an estimated 5.4 million people worldwide are bitten by snakes, resulting in as many as 138,000 deaths and three times as many cases of permanent disability. The World Health Organization classified snakebite as a neglected tropical disease in 2017, with a target to halve deaths by 2030. That target now looks increasingly difficult to meet — not because medicine has failed to advance, but because the climate is accelerating the problem faster than health systems can absorb it.

A landmark study published in PLOS Neglected Tropical Diseases in 2025, conducted by Indian and South Korean scientists, modelled the future distribution of India’s Big Four venomous species under climate change scenarios through 2080. Climate change is anticipated to significantly impact the distribution of snakes, leading to notable shifts in their habitats towards human-dominated landscapes. Under future scenarios, many northern and northeastern states — including parts of Assam, Manipur, and Rajasthan — are projected to show dramatically increased snakebite risk, in regions that currently have minimal suitable snake habitat. The snakebite map of India is being redrawn.

Did You Know? Kerala lost 660 people to snakebites over the last decade. India as a whole records between 46,000 and 58,000 snakebite deaths every year — more than any other country in the world, and roughly half the global total. The WHO has set a target to halve global snakebite deaths by 2030. Climate scientists say rising temperatures will make that target significantly harder to achieve unless the environmental drivers are addressed alongside the medical ones.

A 2025 cross-sectional survey published in Nature Communications found that nearly half of snakebite deaths in India occur outside hospital settings, falling overwhelmingly on rural, low-income households. Dikshal’s father told reporters the family had no safe place to sleep. Kerala declared itself free of extreme poverty in November 2025. The distance between that declaration and a child dying on a floor because his family could not afford a bed illustrates precisely how climate risk compounds existing vulnerability — not abstractly, but fatally.

A Global Pattern

The Kerala deaths of April 2026 are not anomalous. They are, in the language of climate science, a signal. Research published in The Lancet Planetary Health has established a direct correlation between rising temperatures and snakebite incidence. An Oxford University study projects that by 2050, 41% of the global population will be exposed to extreme heat events — with South Asia absorbing the largest share. Similar patterns of snakes moving into urban and peri-urban spaces have been documented in Australia and across sub-Saharan Africa as temperatures rise. According to a Climate Central analysis, in 47 countries, every single day of what scientists classify as “risky heat” was attributable to climate change.

The communities most exposed are precisely those least equipped to respond: rural households with limited access to antivenom, local hospitals uncertain about diagnosis, and families who cannot afford the beds and mosquito nets that would keep a sleeping child above the floor.

The Ecological Argument

There is a dimension of this crisis that public health conversations consistently underweight. Snakes are not the enemy. As Krishnan T.J. puts it: “The snake did not choose to come into your home. Your home became the safest place in its world.”

Snakes play a crucial ecological role by controlling populations of rats and rodents, which spread diseases like leptospirosis and plague and damage crops. The panic-driven killing of non-venomous species disrupts the very ecological balance that keeps those populations in check. Mithun A.S. has watched this cycle play out repeatedly. “Every summer, people kill dozens of harmless snakes out of fear. The rats multiply. The crops suffer. And the venomous snakes, the ones people are actually afraid of, keep coming — because the food is there.”

The WHO’s classification of snakebite as a neglected tropical disease recognised the medical emergency. What remains underrecognised is its ecological dimension — that snakebite mortality is, at least in part, a symptom of ecosystem breakdown driven by rising heat.

What Must Change

Muhammed Anwar’s immediate guidance is practical: maintain clean surroundings, remove woodpiles and debris from around homes, seal wall cracks and pipe gaps, trim ornamental climbing plants, use torches at night, sleep on raised beds with nets properly secured. If a snake is spotted, do not attempt to catch or kill it — call SARPA. If bitten, follow the Do it RIGHT protocol: Reassure, Immobilise, Go to Hospital, Tell the Doctor. Do not waste time on traditional remedies. The first hour is the only variable that can be controlled once a bite has occurred.

But beyond the immediate, Anwar, Krishnan, and Mithun all point to the same deeper truth: the precautions help at the margins. They do not address the driver.

As long as temperatures continue to rise — compressing the thermal refuges available to both humans and reptiles, pushing snakes into spaces that used to be ours alone — the encounters will multiply. Kerala’s SARPA programme is one of the most sophisticated snakebite response systems in India. It cannot outrun the climate.

The snakes entering Kerala’s bedrooms and hiding beneath its sewing machines are not acting out of aggression. They are doing what every living creature does when its habitat becomes uninhabitable. They are looking for somewhere cooler to survive.

So, increasingly, are we.

A new private university focused on wildlife conservation and veterinary sciences is being positioned as an ambitious attempt to reshape how the world trains the next generation of conservation professionals—backed by one of Asia’s most influential business families.

The institution, Vantara University, has been launched in western India by a wildlife initiative founded by Anant Ambani, part of the Reliance group. Framed as an integrated academic ecosystem, the project reflects a growing trend where private capital is stepping into areas traditionally led by public institutions and global nonprofits.

Vantara officially describes the university as the “world’s first integrated global university” dedicated to wildlife conservation and veterinary sciences. While the scale and integration may be distinctive, similar disciplines are already taught across universities worldwide, often through specialised schools, research centres, and veterinary colleges.

The claim, therefore, rests less on the existence of such education and more on the attempt to consolidate it within a single, purpose-built institutional framework.

A Shift Toward Education-Led Conservation

The launch comes at a time when conservation challenges are becoming increasingly complex. Climate change, habitat fragmentation, and the spread of zoonotic diseases are reshaping ecosystems and exposing the limits of traditional conservation models.

There is a growing recognition that protecting biodiversity will require not just field interventions, but a systemic expansion of expertise—from wildlife veterinarians and epidemiologists to policy specialists and conservation planners.

Vantara University aims to respond to this gap by bringing together disciplines such as wildlife medicine, genetics, behavioural sciences, epidemiology, and conservation policy under one academic structure.

Blending Science, Scale, and Philosophy

The university’s vision combines scientific training with a philosophical framing rooted in compassion and stewardship. Its design draws inspiration from historical centres of learning, while positioning itself as a modern, purpose-led institution.

“The future of conservation will depend on how we prepare minds and institutions to serve life with compassion, knowledge, and skill,” Anant Ambani said in a statement.

“Vantara University is shaped by a deeply personal journey of witnessing animals in distress and recognising the need for greater capability in their care… the university seeks to nurture a new generation committed to protecting every life.”

Global Ambitions, Local Foundations

Although based in India, the project is clearly aimed at a global audience.

The university plans to offer undergraduate, postgraduate, and specialised programmes, supported by research infrastructure and international collaborations. It also emphasises action-oriented learning, linking academic work with real-world conservation practices.

This approach reflects a broader shift in higher education, where institutions are increasingly expected to produce not just knowledge, but deployable expertise.

The Rise of Private Influence in Conservation

The initiative also highlights a larger structural shift: the growing role of private capital in shaping conservation agendas.

Historically, conservation has been driven by governments, multilateral agencies, and non-profit organisations. However, large-scale funding gaps and the urgency of environmental crises are opening the door for philanthropic and corporate actors to play a more prominent role.

This raises both opportunities and questions.

Private initiatives can accelerate innovation and investment, but they also bring concerns around governance, accountability, and long-term alignment with public interest.

Questions of Access and Impact

As with many specialised institutions, accessibility will be a critical test.

While the university has announced scholarships aimed at supporting students from diverse backgrounds, the broader question remains: can such models scale inclusively, particularly for communities most directly affected by environmental change?

The effectiveness of the initiative will also depend on its ability to influence policy, contribute to global research, and produce professionals equipped to address complex ecological challenges.

A Changing Conservation Landscape

The launch of Vantara University signals a deeper transition in how conservation is being imagined.

Increasingly, the field is moving beyond isolated interventions toward integrated systems that connect science, education, and practice. In this context, universities are not just centres of learning—they are becoming critical infrastructure in the fight to preserve biodiversity.

Whether this particular model succeeds will depend on execution, collaboration, and its ability to move beyond vision into measurable impact.

But its emergence underscores a central reality:

The future of conservation may depend as much on classrooms and laboratories as it does on forests and protected areas.