climate change - Urban SHADE

Urban SHADE work on The Naked Scientist

Urban SHADE work on The Naked Scientist Urban SHADE’s Principal Investigator Dr Rachel Tolhurst spoke to the podcasting platform, The Naked Scientist about the effects of El Niño on the health of those living in low-and-middle-income countries. She highlighted the particular issues faced by those living in urban informal settlements. She discussed the link between climate change and access to healthcare, maternal and child health, increase in food and water borne diseases and vector borne diseases, food security among other issues. Urban SHADE project works in 11 informal settlements in Sierra Leone, India, and Kenya. You can listen to the podcast on this link- A super El Nino is on the way. What should we expect?

Events, Uncategorized

Stakeholders unite to protect communities during extreme weather

Stakeholders unite to protect communities during extreme weather events Freetown, Sierra Leone The Sierra Leone team of the Urban SHADE consortium conducted several workshops between May and June with various stakeholders, including state bodies, to roll out the project’s interventions. Government authorities participated actively in these workshops and are keen to see the interventions through. Urban SHADE focuses on improving health system delivery during extreme weather events in informal settlements. The intervention pilot brought disaster management authorities together with relevant health departments to build sustainable plans for health system preparedness in informal settlements. The workshops also helped formalise partnerships with stakeholders and clarify roles and responsibilities for all actors before, during, and after extreme weather events. The authorities involved in disaster management, early warning, and local administration include: • Sierra Leone Meteorological Agency (SL-MET) • National Disaster Management Agency (NDMA) • National Fire Force (NFF) • Freetown City Council (FCC) The health authorities included: • Ministry of Health, Climate Change Unit and the Health Education Department • National Public Health Agency (NPHA) • District Health Management Team (DHMT) Some of the key activities planned during the workshops for health-related outputs include: • Co-Developing a response checklist for health professionals • Co-Developing a disaster response plan for frontline workers • Preparing IEC materials and infographics to raise awareness of health and climate emergency response. These are mainly pictorial and produced in English, and will be validated by the community and subject experts, with a plan for distribution across public health units and other community channels • Co-creating a communication plan for early warning messages that uses existing channels (CDMC WhatsApp group, megaphones, door-to-door outreach, visual alerts, and so on) The Urban SHADE consortium thanks all the state actors for their active cooperation.

Blog, Uncategorized

Heat stress worsens chronic health conditions, residents of informal settlements hit hardest

Heat stress worsens chronic health conditions, residents of informal settlements hit hardest Climate change is increasing the frequency, intensity and duration of heat extremes worldwide. In India, the average maximum temperature increased by ~0.5°C by 2000, and by ~1.0°C by 2020, as per a study published recently. Heat extremes put more individuals, communities and health systems at risk of illness, and death. People with pre-existing chronic illnesses such as diabetes, hypertension, renal disease among others are more vulnerable to heat-related illnesses. Extreme heat is known to exacerbate health risks of those living with chronic diseases and can trigger hospital visits and mortality risk as the body struggles to regulate itself under heat stress. Urban SHADE’s Hemanth Chandu and Pavani Pendyala recently wrote an article about informal settlements residents who live with chronic diseases. Urban SHADE’s Menaka Rao spoke to Dr Vivekanada Jha, executive director at The George Institute for Global Health, India, and a nephrologist and public health researcher. He is Professor, Faculty of Medicine, Imperial College London, and the past President of the International Society of Nephrology. A prolific writer and editor, Dr Jha has worked with many global organisations including the World Health Organisation to develop clinical practice guidelines and advocacy papers. His research interests include understanding the health and societal impact of kidney diseases around the world and the development of affordable, scalable and sustainable primary and secondary prevention tools. Here are the excerpts of the interview: Menaka: How does extreme heat affect persons with chronic diseases such as hypertension, diabetes? In your clinical experience, what changes have you seen among those living with chronic health conditions , especially among poor patients and those living in informal settlements? Dr Jha: Heat affects both basic biology and the response of the body to external stimuli for people with chronic diseases including hypertension, diabetes, cardiovascular disease, kidney disease, etc. As temperatures go up, we sweat more. While the sweating is perceptible when humidity is high, it is not perceptible when the heat is dry. Sweating leads to a loss of water and salt from the body, reducing the total water and salt concentration. This can lead to a reduction in blood pressure. We have seen in clinics that people with well-controlled hypertension suddenly experience low blood pressure during extreme heat. They become giddy and weak. So during the summer months, we have to reduce the number of blood pressure medicines then, especially diuretics, which have the property of increasing urine flow, further worsening fluid and salt loss. We also have to warn our patients to check their blood pressure more frequently and pay attention to how they are feeling. Many people with diabetes require insulin, which is taken in the subcutaneous region. During the heat, the body does not absorb insulin well from that site, leading to uncontrolled blood sugar levels, even if it had been previously controlled. The build up of sugar concentration in the blood leads to spillage in the urine, which draws more water with it, causing dehydration. We ask patients to avoid injecting on the limbs before physical activity in heat. The abdomen is more predictable. They should also monitor blood sugars more frequently during heat waves, especially after meals. Insulin is a protein that denatures in hot weather. It should therefore be stored in a fridge. Many in informal settlements don’t have access to a fridge. Practical solutions include using insulated pouches with ice bags or clay pot coolers. The effects of heat on kidney function have been extensively studied. When people lose salt and water through sweat, the blood flow to the kidneys decreases, and the kidneys lose some function. Let’s say a manual worker works in extreme heat from morning to evening. By evening, their kidney function becomes lower than normal. The kidney function may recover after the worker returns home and has water for the day, but repeated insults to the organ can result in long-term irreversible injury, which can progress to kidney failure. This has been well documented in many geographies around the world, including rural agricultural communities, outdoor workers such as construction workers, people who work in salt pans, and others. A population that is overlooked is women in informal settlements who have to cook indoors using coal or wood-fired stoves and therefore are exposed to high heat for prolonged periods. The body’s homeostatic mechanisms, which help us adapt to changes in our external environment, such as high heat, are impaired in those with chronic diseases like hypertension and diabetes. A younger person without any of these diseases, for example, will respond much more resiliently to heat stress. Menaka: What is the kind of advice for people with chronic diseases? Dr Jha: We warn our patients with hypertension that their blood pressure may go down during summer and that they should be mindful of any new symptoms that they develop. For example, if they start feeling giddiness or weakness, they should either check their blood pressure wherever they are or come to the clinic, where it can be checked. In that situation, we may need to reduce the number of blood pressure medications. Similarly, when the summer season ends, their need for blood pressure drugs may increase again. People with diabetes who are taking insulin, we have to advise them to keep their insulin in a cold environment, in a fridge, etc. We also tell them that when they are taking insulin, they should make sure they don’t inject it into the same site of the skin every day, especially over the limbs before physical activity. Finally they need to increase the frequency of blood sugar monitoring especially after meals. For people with kidney disease, we tell them to drink extra water and take salt when they step out. Not just one single one-litre bottle, as it’s not sufficient. We also ask them to try to avoid going out during the peak summer hours, so they go out early in the morning. For example, we tell farmers to try to

Blog, Uncategorized

Extreme Heat Imperils Chronic Disease Patients In Informal Settlements

Extreme Heat Imperils Chronic Disease Patients In Informal Settlements Lack of ventilation, cooling methods and increased susceptibility to heat makes every summer dangerous for those living with chronic disease in India’s urban slums and settlements Hemanth Chandu, Pavani Pendyala Vijayawada and Guntur, Andhra Pradesh: Within hours of sunrise, the two-room flats in the government-constructed apartment in New Rajarajeshwari Peta in Vijayawada feels like a pot on a stove. By 11 a.m., Vidya (name changed) sits outside her home with her neighbours under the shade of a tree. The women chat and laugh, relieved to escape the summer heat inside the house. Vidya who is in her late 30s lives on the ground floor or a four-storey building, in a resettlement colony constructed more than a decade ago for low income families. “Ee vadagaalpula valla intlo baaga aaviri vachesthundi. With these hot winds, heat builds up in the house like steam. I find it difficult to breathe sometimes,” she said. But for Vidya, it is more than just physical discomfort. She is diabetic and feels her condition worsen during the summer. Extreme heat is known to exacerbate health risks of those living with chronic diseases. About 57% of Indian districts, home to 76% of the country’s population, are at high to very high heat risk, a 2025 study by Council on Energy, Environment and Water (CEEW) showed. Andhra Pradesh is among the most heat-prone states. A study done by the India Meteorological Department’s scientists published this year shows that the average maximum temperature across India increased by ~0.5°C by 2000, and by ~1.0°C by 2020. Northwestern and central India and the coast of Andhra Pradesh experienced the most significant increase. Between 1981 and 2000, these regions experienced an average of 2.5 to 5.5 heatwave days per year. However, over the two decades between 2001-2020, the frequency of heatwaves has increased with 3.5-8.5 days per year, particularly in northern, western, south-central, central-east, and peninsular India. IMD has forecast heatwave to severe heatwave conditions in 17 states and Union territories, including parts of Andhra Pradesh such as Vijayawada and Guntur. ISignal reached out to the Union and state health ministries for comment. We will update this story when we receive a response. How heat affects those with comorbidities “The body’s homeostatic mechanism, meaning how we adapt to any change in our external environment, such as high heat, becomes impaired in those with chronic diseases like hypertension, diabetes, renal disease, among others,” said Vivekanand Jha, executive director at The George Institute for Global Health, India, and a nephrologist and public health researcher. For blood pressure patients, excessive sweating can lead to a drop in blood pressure. “We have seen in clinics that people with well-controlled hypertension suddenly experience low blood pressure during extreme heat. They become giddy and weak. And when we measure their blood pressure, it is low. So, during the summer months, we have to reduce the number of blood pressure medicines, especially diuretics, which increase the urine flow, increasing loss of fluid,” Jha added. Diabetics are at greater risk for heat-related illnesses because of their impaired capacity to dissipate heat, and this can have important consequences on cardiovascular regulation and glycemic control. For insulin-dependent diabetics, during extreme heat, the body is unable to absorb insulin, resulting in uncontrolled sugar levels. “Insulin needs refrigeration at 4 degrees Celsius. Many in informal settlements don’t have access to a fridge, so obviously they don’t have access to effective insulin.,” Jha explained. In renal disease, the loss of salt and water due to excess heat can result in loss of kidney function. “Let’s say a manual worker goes out to work in extreme heat from morning to evening,” he continued. “By evening, their kidney function becomes lower than normal. The kidney function may recover after the worker returns home and has water for the day, but repeated insults to the organ can result in long-term injury, resulting in chronic kidney disease which can progress to kidney failure.” Gig and platform workers without access to toilets avoid drinking water, which ends up impacting their kidneys, as ISignal reported in April 2026. Extreme weather can also trigger hospital visits and mortality risk as the body struggles to regulate itself under heat stress. For Vidya and other residents of informal settlements, who are already more vulnerable to the effects of climate change, the additional burden of having a chronic health condition poses further risk. Mounting health problems A couple years ago, Vidya used to run a food cart cooking and selling breakfast items such as dosa and idli, when she met with an accident. Hot oil spilt on her leg, and refused to heal for a long time. She finally had to go to a private hospital in the city where the doctors had to remove one of her toes. The surgery cost her Rs 1.2 lakh, which she borrowed from an informal lender for 10% interest per month. She continues to have a persistent wound. “Everyday I put on the glove and do the dressing of this wound myself,” she said. She was first diagnosed with diabetes when she was pregnant with her second child more than a decade ago. She goes to the primary health centre (PHC) near her house every month, where her blood sugar levels are checked and she gets her medicines. The PHC staff with whom around 200 diabetics are registered informed us that the blood sugar levels among the diabetics rises above their usual levels during summer. “I follow everything the doctor says. I take the medicine and follow the diet. But my sugar levels are often not in control,” she said. Because of her uncontrolled diabetes and the persistent wound on her leg, Vidya had to give up working outside home. Vidit Panchal, a public health physician who has worked in several parts of rural India, and with poor and tribal populations, said more evidence needs to be generated related to effects of extreme heat among people living in informal settlements. “There is not much primary evidence from different parts of India on how heat is impacting health outcomes of people

Events, Uncategorized

Consulting with stakeholders in Freetown

Consulting with stakeholders in Freetown Starting this February, the Urban SHADE team in Sierra Leone conducted meetings with various stakeholders to discuss the interventions of the project. The Urban SHADE Sierra Leone partners include Sierra Leone Urban Research Centre (SLURC), Institute of Gender and Children’s Health Research (IGCHR) and The Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOSAPAH). The teams engaged with institutions mostly government-based that work directly with climate risk management, disaster preparedness and health systems in Sierra Leone at national and city-level. The Urban SHADE team presented the findings of the project on how extreme weather affects people living in informal settlements, particularly their health. The Urban SHADE team will co-design interventions with communities and stakeholders to find interventions that are practical, scalable and sustainable. The organisations the team met are: Sierra Leone Meteorological Agency (SL MET), National Disaster Management Agency (NDMA), Ministry of Health, National Public Health Agency (NPHA), District Health Management Team (DHMT), Freetown City Council (FCC), National Early warning and Response Mechanism Coordinating Centre (NEWRMC) and National Fire Force (NFF). While the Urban SHADE team appealed to the stakeholders for their support in further activities, it also became increasingly clear that effective responses to climate-related health challenges require strong coordinated multi-sector collaboration. The Urban SHADE team is gearing up to form a Stakeholder Working Group which will include representatives of these stakeholders and will aim to coordinate effectively in the future. The Urban SHADE team will share these research findings and proposed interventions with the three communities (Susan’s Bay, CKG, Moyiba) and seek suggestions from the community as well, and representatives and leaders from these communities will also be part of the Stakeholder Working Group. The Urban SHADE team will have workshops with the Stakeholder Working Group where the interventions can be co-designed, and particular roles and responsibilities of different stakeholders during extreme weather events (extreme rainfall and extreme heat) can be clarified. The team is currently in the process of formalising partnerships with these stakeholders through Memoranda of Understanding (MoUs).

Events

Community meetings in Kenya on proposed interventions

Consulting the community on proposed interventions in Kenya The Kenya team of Urban SHADE project is having community meetings explaining the findings, and talking about possible interventions. The intervention proposed for all three communities– Tudor Moroto and Matopeni in Mombasa and Mibuyu Saba in Kilifi is co-designing training modules and protocols for health workers and community health workers with the health department on flood and extreme heat management. One of the additional proposed interventions for Mombasa’s Tudor Moroto is the establishment of a community resilience hub which is intended to serve both as a community health facility, as well as a community centre. The proposition is that this hub can help increase access to healthcare during extreme weather events as well as become a hub for community meetings, support community activities and interventions and also serve as a rescue centre during disasters. The Urban SHADE team had several meetings with the community members starting with the local administration and village elders in February to get their buy-in on the interventions and support in mobilizing and organizing the community meetings. In the community meeting at Simitini village in Tudor Moroto, there was a discussion on the access road to the identified building for the resilience hub. The access road is currently narrow, and rudimentary. The access road to this building also becomes too muddy after the rains. The community members said that if they have the right material, such as cement, they can fortify the access road. They were unsure about involving the government as there were worries that the government could ask people to move out of their homes, without compensating them. On developing modules for health workers to tackle health-related issues of flood and heat, the community members from all three settlements said that they would like community members to be also involved in the training workshops and other activites related to disaster management, and health-related interventions. The Urban SHADE team will discuss this further in stakeholders meetings which are underway.

Musings, Uncategorized

The Combermere nalla

The Combermere naala Inayat Singh Kakar The Combermere naala is one of the five natural streams that flow down central part of Shimla city. These streams are natural drainage channels that carry excess water down the mountainsides. The Combermere naala originates mid-way on the Jakhu hill, making its way down the hillside to form the Eastern boundary of our field site, Krishna Nagar and ends at Lal Pani where taxi drivers use the water to wash their vehicles. Old pictures of Shimla city show the naala flowing down pristine hillsides. Now when you hear the gushing of the water, you see a channel choked with garbage. The water tumbles over the garbage, desperately makes its way down, slowly changing its path as it cuts through the hillside. As the naala reaches Krishnanagar it becomes even more choked with garbage. Krishnanagar’s residents whose houses are constructed along the naala describe it as a health and safety hazard. In the summer, the wet garbage cooks in the harsh sun and becomes a swampy breeding ground for flies and mosquitoes. In the rains, the water thunders down the hillside, gushing so loud that it keeps nearby residents awake from the anxiety of flooding. Ramu, whose house is built right next to the naala says that he is afraid it will one day sweep his house down with it. He says that infrastructure built by the Municipality has created choke points in the path of the naala, instead of towards the end of its course at Lal Pani (near where the 2023 landslide took place) where it could be cleaned regularly. Right now, the choke points which are inaccessible to human beings. The naala is built in a way that it gets obstructed, and damages the hillside where Krishnanagar is located, increasing risk of landslides. With a sigh, Ramu says that the story of the naala is emblematic of a cruel irony faced by the residents of Krishnanagar, home to the majority of city’s sanitation workforce.

Musings

Nowhere to go

Nowhere to go Dr. Abu Conteh It’s 12pm on a bright beautiful Monday morning, and the sun is beginning to get ahead of me. I am visiting the Soja town section of the Moyiba community to talk to Sia, whose house was recently destroyed by a mudslide. Moyiba is one of the most deprived informal settlements in Freetown, which is also exposed to multiple hazards including mudslides. Sia is a single mother of three who makes a living from stone mining. As I ascend the over 600-meter-high hill, I couldn’t help but wonder how women in this rugged part of the community deal with climate hazards and access healthcare. In the past years, women in this section of the community have had to deliver babies by the side of the road as they couldn’t make it to the only government health clinic in time about 3 kilometers away. Transportation here is a challenge, as motor bike riders complain of rugged roads. As I arrive at Sia’s home, she greets me warmly and offers me a seat in her delipidated single bedroom mud house that was destroyed by a huge boulder (in 2025). The house is now a relic of the original two-bedroom house built by her husband who died two years ago. “The destruction of the house has changed my life so badly”, she said. She recounted her daily horrors of having to live in a leaking house or rebuilding it withher meagre income. “I can barely feed by children, let alone rebuild this house.” As I looked around, I could see that most houses here are built with mud bricks, which makesthem vulnerable to extreme weather events such as flooding and mudslide. Sia recounts she is not the only woman affected. ‘‘Last year, one woman lost two children because of a mudslide,” she said. While she feels the community is not safe, she is worried about having to leave a whole life behind that she has built for over a decade. ‘‘I have nowhere to go. We are not offered any help by the ‘’big ones.’ No one has helped me since my house got destroyed,” she said.

Musings, Uncategorized

Bahari

Bahari Bessie Sarowiwa She’s big, she’s blue, she’s bold. She’s Bahari. For many years Bahari gave life to many and offered refuge to many more in Tudor Moroto, like a mother. She’s watched us grow up and was always there when we needed her. We played with her when we were kids and learned to swim in her cool waters. She gave us a place to relax when the heat was unbearable. She provided food for us when our parents came back with nothing. She liked having us around and never complained. But not anymore. She has changed. She doesn’t seem happy these days and the glow that she once had is no longer there. The beautiful blue she once had is now more of a blue green. And the cool breeze she would give us when heat was unbearable is now just hot air and a stench. The food she shared with us has dwindled and it appears that all the fishermen catch now are plastic bags and used diapers. The places we would go to play with her are now places we warn visitors about because they never know what they may step on. All the people that relied on her for their basic needs are now struggling to even get through the day. It breaks my heart. How did we end up here? Bahari, did we do this to you? That’s what everyone is saying. That our actions are what made you this angry. We cut down the trees that fed you and kept you clean to build houses. You were nice to us but instead we paid you back with food and sewer waste. You’re now threatening to leave us. Please don’t give up on us, Bahari. We’re trying to do better. We’re learning from our mistakes. It might be a little late but it’s the least we can do.

Musings

Battered and bent, but still standing

Battered and bent, but still standing Desta Ali Down the long, steep, steps of Susan’s Bay stands a tall, green five-storey building. It looks weathered and worn, but it stands stubbornly and quietly. During the day it is virtually empty, but I’m sure it houses more than hundred people at night. There is a lot of cracks in its concrete; its roof is made of rusted metal sheets. The building tells a story of time. Every time I look at it, I hear it say, “I have survived many floods, yet I am still standing. I am a survivor.” It almost makes me fall in love with it, because it reminds me of myself, standing tall in the midst of trials, keeping my head high, and trying very hard not to crumble. The glasses on the windows are broken, yet the bars are still holding on, almost as if fighting hard to maintain security. The top floor of the building is unpainted. That means it has been added recently to create more space for more people. The bottom floor is incomplete and wrapped with tarps and more rusted metal sheets. It was possibly built as a garage but is now being used as an accommodation for a desperate family. This tells a story of greed, because someone has decided that making money from rent is more important than the safety of people. I admire the building for all it has gone through and all that happens within its walls. But I also feel sorrow and dread. I know it’s only a matter of time before it crumbles. The land it is built on is a coastal land and not meant for buildings. I am sure its foundations were not made to carry that much weight. I always ponder how many more floods can it survive? How much more erosion can its foundations take? My only hope is that when that day arrives, it will happen during the day, when no one is home.