Mumbai coastline crisis: Urban flooding is a public health issue
The coastal city of Mumbai is in crisis. There’s plastic in its ocean and its beaches. The fisher communities living along its coastline are losing access to fishing commons and livelihoods. Private vehicles and mass transit systems like buses jostle for space on narrow roads, ensuring longer hours for commuters travelling the length of the city. Urban flooding, related to as much to monsoon as to the high tide, is a leading cause of a host of health conditions. In a multi-part series, Hindustan Times asks you to take a clear, hard look at the unfolding crisis and our role in it
In the past decade, 14-year-old Gausuddin Sayyed has visited the local homeopathic practitioner’s clinic at least five times every year. Each time, his complaints were similar: wheezing, choked nasal passage and cough. The healer would give him medicine for allergic bronchitis. Sayyed would complete the course over three to six days depending on the severity of the bout. He would get better. Then it was time for treatment again.
The teenager lives in Cheetah Camp near Chembur with his younger brother, Moinuddin (12), mother, Rehmat (32) and father Farid (40). Their two-room house is located on the edge of the Vashi creek and floods often: not just every monsoon, but even during a particularly high tide. After the water recedes, the walls grow a layer of green fungus or mold which gets darker in colour each passing day.
Gausuddin and Moinuddin would wait till the mold thickened before scraping it off their walls. Soon after the cleaning exercise, Sayyed’s bout of respiratory discomfort would flare-up.
“The fungus and the dampness triggered his allergies according to the doctor,” said Rehmat, who works as a community volunteer for the Tata Institute of Social Sciences (TISS).
From dampness to air
Fungi needs nutrients like carbohydrates, proteins and lipids to thrive and they find these nutrients easily on plants, walls, and wood among other surfaces. Fungal growth also requires moisture. Add to that improper or poor ventilation — like where Gausuddin lives —and the perennial nature of his ill-health becomes explicable.
Molds are a common type of fungi that spread rapidly on damp surfaces and release tiny spores into the air which can be inhaled easily. Dust mites and several fungi produce allergens associated with asthma and many fungi produce toxins and irritants that may affect respiratory health, a document by the World Health Organization (WHO) pointed out.
“The indoor concentrations of some of these organisms and agents are known or suspected to be elevated in damp indoor environments and may affect the health of people living or working there. In particular, it has been suggested that dust mites and fungi, both of which favour damp environments, play a major role,” the document on indoor air quality, dampness and mold, stated.
“Molds are common in our environment, but it’s the proximity, exposure and sensitivity to the molds that impact people,” said Rahul Phadtare, Gausuddin’s homoeopathic doctor, who advised the Sayyeds to move out of their home.
“But where could we go? This has been our home for the past 14 years,” Rehmat said.
Living with wetness
For the Sayyeds, the problem of mold is connected to a bigger issue: urban flooding.
Every monsoon, a large part of the M East ward — home to over 800,000 residents who comprise over 40% of the city’s slum population — gets flooded. The ward is close to Vashi creek, but several homes of the Cheetah Camp settlement, one of the main localities here (and where the Sayyeds stay), have been built over the creek by filling it up with debris. Environmentalists point out that the natural depth of the creek has reduced on account of this.
The creek and a warren of nullahs that run through the ward serve an important function by allowing surface run-off of the water during high tide or in the monsoon. However, an ineffective sewage system and an ineffectual garbage disposal and collection mechanism mean that the nullahs are choked with waste.
Nowhere to go, the water often spills into homes. “The water level rises above my waist level during heavy rainfall,” Rehmat said.
Such flooding events pose a major risk to public health, medical experts said.
“When flooding occurs, all sorts of organisms — bacteria, viruses, fungi — enter people’s homes, putting them at the risk of severe infections,” said Dr Nerges Mistry, director of Mumbai-based Foundation for Medical Research (FMR) which conducts advanced laboratory research in the field of neurology, immunology and microbiology. “Children, senior citizens and people with co-morbid conditions are the most vulnerable,” she added.
Flooding events in Mumbai are not new. On July 26, 2005, Mumbai experienced a cloudburst with 944 mm of rain in a span of 24 hours. According to an affidavit filed by the BMC in the Bombay high court, 546 people had died during the flood due to drowning and other related accidents. However, many more are believed to have died days after the flood due to flood-related illnesses and diseases.
On 29 August 2017, the city experienced another devastating flooding event with 330 mm of rainfall reported within 12 hours killing nearly 20 people. Low-lying areas suffered the worst impact of the flooding, as water entered people’s homes, damaging property.
This is only going to keep happening. Changing climatic conditions, pollution and coastal erosion exacerbate these events. A recent report by the Intergovernmental Panel on Climate Change (IPCC) has warned that 12 Indian cities close to the coastline, Mumbai included, could be about three feet underwater by the end of this century, due to rising sea levels.
The crisis, as we now understand it, is not the event itself or even its repetitiveness. The often invisible and unseen after-effects — like Gausuddin’s allergic bronchitis — are part of the unfolding catastrophe.
An observational study
In 2005, soon after the city was hit by floods, doctors at the civic-run KEM Hospital noticed an increase in the number of women requiring hospitalisation due to worsened asthma. Curious, the hospital’s health survey unit including resident doctors and volunteers visited the patients’ homes to investigate the possible environmental triggers.
The KEM researchers used a steel tube to trap air from the patients’ homes and sent it for testing to the microbiology department. The findings showed severe mold infestations in their houses, which were located in areas that were severely affected during the floods.
“We found two common types of fungi, aspergillosis and candida, during the onsite monitoring,” said Dr Amita Athavale, head of the pulmonary medicine department, KEM Hospital. Since the women spent more time in their homes, the KEM doctors believe that they had increased exposure to the molds, and that, in turn, caused their asthma to flare.
Dr Rakesh Kumar, the former director of the National Environmental Engineering Research Institute (NEERI) said that floods can be linked to many public health hazards. Mold and other fungi are only one category.
“Floods expose people to contaminated sewage water leading to gastrointestinal and diarrheal diseases, cause spurt of vector-borne diseases, and put people at the risk of bacterial infections like leptospirosis that is spread through the urine of rats, dogs and other animals,” he said.
Since 2015, leptospirosis has killed 70 people under treatment in the civic-run hospitals in Mumbai. This is the highest death toll among monsoon-related diseases. For instance, in the same time period, malaria had killed 38 people, dengue 55 and Hepatitis A and E, 10. (See chart)
Phadtare, the homeopathic practitioner who had treated Gausuddin since his childhood initially referred him to bigger civic hospitals assuming that his respiratory illness was triggered by an underlying condition. However, chest scans and other tests were always inconclusive.
“He would feel healthier when he stayed with his grandmother in a nearby building. That’s when I could link his bouts to the mold infestation in his house,” he said.
In Gausuddin’s case, as his home was perpetually prone to flooding, his allergies were triggered through the year — which explains why he had to visit the local healer so often.
Early this year, the Sayyeds borrowed ₹2.5 lakh to increase the height of the flooring of their house and put tiles on half of the walls so that the floodwater does not dampen them. “So far, we have not had any flooding this year. Hopefully, my son’s allergies will reduce now,” said Rehmat.
The BMC has undertaken a series of flooding mitigation measures over the past few years which includes de-silting and upgrading the stormwater drains, widening and deepening drains and water channels, hiring de-watering pumps in low-lying areas among other things. But a public health perspective would force us to rethink our approach to urban planning all together.
“We need pre-emptive actions. And as we anticipate more such emergencies, we need to strengthen our public health infrastructure to cope,” Mistry of FMR said.
“With the climate crisis, the intensity of rainfall is going up each year,” said urban planner and Mumbai-based architect Rahul Kadri. “Where will the water go if we have blocked all the estuaries and narrowed the mouth of rivers? It is going to fill up the city,” he said.
Rivers swell during the monsoon and they need space to flow. “The more we block, the more the rivers will swell and cause flooding,” Kadri said.
The three things for us to tackle
Dr Nerges Mistry,, director, Foundation for Medical Research (FMR)
“When flooding occurs, all sorts of organisms — bacteria, viruses, fungi — enter people’s homes, putting them at the risk of severe infections. Children, senior citizens and people with co-morbid conditions are the most vulnerable,”
Suresh Kakani, additional municipal commissioner (health)
“When we look at strengthening existing peripheral hospitals or creating more health care facilities, urban flooding and its threats are discussed vigorously. The development plan of the civic body includes the health department at all stages of planning, mainly when it comes to reserving plots for public use and developing future public health infrastructure,”