In 2023, in a flood-affected village near Meerut, I met Reema, a young mother who had just lost her two-year-old to acute diarrhoea. She remembered the sequence, not the cause: “The water came, and then the fever, and then my child just stopped eating.” A doctor later told her what the case sheet would record. Severe malnutrition was the condition that made the infection fatal.
That is the double blow for children in climate-exposed communities. Floods contaminate water and trigger water-borne disease. Illness then crushes appetite, absorption, and caregiving routines. For the youngest children, it can convert a treatable episode into a death.
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Climate change and diarrhoeal disease
This is not a speculative risk. The World Health Organisation estimates that between 2030 and 2050 climate change could cause about 250,000 additional deaths per year from undernutrition, malaria, diarrhoea, and heat stress. The list matters. Diarrhoea and undernutrition sit in the same sentence for a reason. Heat stress sits there too, because dehydration and water scarcity amplify both disease and malnutrition during extreme heat.
India’s climate exposure is visible in its flood cycles, urban waterlogging, and heatwaves. But the health response still treats these as separate problems, handled by separate departments, in separate files.
NFHS-5 shows malnutrition. It does not explain the triggers.
NFHS-5 reports that 35.5% of children under five are stunted and 19.3% are wasted. These numbers are routinely cited as proof of persistent food and care deficits. They are also evidence of vulnerability. In flood-prone districts, the more precise question is this: what share of wasting and growth faltering is being pushed by repeated diarrhoeal infection after water contamination, rather than only by a lack of food?
That question is not academic. It determines what “nutrition policy” must deliver in a disaster week and the weeks after.
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Poshan Abhiyan cannot work when water is unsafe
India’s nutrition programmes assume continuity: functioning Anganwadis, stable kitchens, predictable supply, children healthy enough to eat. Floods break each link. Kitchens shut or are submerged. Rations spoil. Children fall sick and stop eating. Mothers lose time to caregiving and water collection. In these conditions, food alone does not restore nutrition.
This is why ORS and zinc are not optional. WHO and UNICEF have long recommended oral rehydration salts and zinc supplementation as core diarrhoea management because they reduce severity and duration. India’s own child-health guidance includes zinc for diarrhoea management. In flood-prone blocks, they should be treated as essentials, stocked and replenished like staples.
Disaster management prioritises evacuation. Child health needs prevention.
India’s disaster response remains dominated by evacuation, relief, and compensation. What is missing is a routine, pre-positioned child-health layer that anticipates water-borne outbreaks.
The institutional map already exists. Disease surveillance under the Integrated Disease Surveillance Programme is designed to detect and respond to outbreaks through weekly reporting and rapid response teams. The problem is not absence of a framework. It is the absence of integration at the last mile.
After floods, the practical questions are basic. Where are the mobile clinics under the National Health Mission that reach children in the first 48 hours? Where are the ORS-zinc corners and refill chains that do not collapse when roads do? Where are Anganwadi-level water-quality testing and safe storage protocols that can be activated immediately? Without these, the system responds to illness after it escalates.
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WASH in Anganwadis is climate adaptation, not welfare
The draft climate narrative in India still prefers carbon targets and project announcements. Meanwhile, the most consequential adaptation for children is prosaic: safe water, sanitation, and hygiene in the places where children eat, drink, and recover.
That means treating WASH functionality in every school and Anganwadi as a frontline adaptation metric, not as an infrastructure line item. It means aligning the Ministry of Women and Child Development’s ICDS delivery with the health system’s diarrhoea management protocols, and with drinking-water missions whose stated aim is safe household tap water in rural India. It means acknowledging the sanitation pathway, including faecal contamination, not only the flood image.
Reema’s story should not be used to produce sympathy. It should force administrative clarity. Children will continue to die at the intersection of contaminated water and malnutrition until climate adaptation is defined, in practice, at the level of the Anganwadi floor.
Dr Isha Sharma is Assistant Professor in Economics, School of Social Sciences and Fellow, Centre for Studies in Population and Development (CSPD), Christ (Deemed to be University), Delhi NCR. Khushi Nigam is a researcher based in New Delhi.