In August 2019, community health care worker Noushadbi Mujawar safely evacuated everyone in the village when streets began to flood in Rajapur, a remote village in India. Mujawal, 12 feet tall and 42 years old, remains in the village.
“I moved to a taller building nearby and decided to stay,” said Mujawal, who wanted to help villagers who stayed on their properties as floodwaters rose.
“During the floods, many people stayed home to look after their cattle because there was a lot of risk in evacuating the herds,” she said.
Mujawal is one of India's more than 1 million Accredited Social Health Activists (ASHAs), one for every 1,000 people in villages and towns. ASHA helps provide public health care.
Mujawal has fought to keep people safe as her villages in Maharashtra were hit by deadly floods in 2005, 2019, 2021 and 2024. Every community member spoke to ensure their safety despite the floods claiming many lives.
“This is the most dangerous time, when people are at risk for mental health problems and most never seek treatment because of taboos,” Mujawal said.
Social stigma, cultural barriers and fear of judgment often prevent people from discussing mental health issues and seeking treatment, especially in remote villages where emotional vulnerability is seen as weakness.
Critical job, low salary
ASHA staff are on the front lines as a growing body of research shows that India faces a climate-related mental health crisis. More than 197 million people in India suffer from mental disorders, and a government report states that 50% of those affected by climate floods suffer from post-traumatic stress disorder (PTSD). From 2015 to 2020, flooding alone affected more than 218 million people.
Still, ASHA workers are considered volunteers, and their work, while stressful and dangerous, is necessary and therefore do not receive wages. Instead, they are paid based on the tasks they complete. ASHA leader Netradipa Patil said many ASHAs in Maharashtra work about 10 hours a day and receive an average monthly remuneration of only 3,500-5,500 Indian rupees (40-70 US dollars). Often, payments are delayed for six months or more, forcing many to double as farm workers.
ASHA workers also lack access to the mental health care they need after a critical incident devastates their home or family. ASHA unionized and held nonviolent protests over the years. These have helped improve conditions, but there is still a long way to go.
Need strong social support
During the 2019 floods, Mujawar's neighbor Najuki Mulla, 55, was trapped until volunteers helped her evacuate as floodwaters destroyed her one-room tin house. Mulla lost all her documents and essentials and was huddled in a 10 x 10 feet room in a government school with more than 20 flood victims. A month later, when the floodwaters receded, Mulla was shocked to find her house missing when she returned.
Mujawal discovered that Mulla hardly ate and would sweat excessively. Within days, she found it difficult to breathe and was diagnosed with asthma and clinical depression. She took Mulla to the doctor, who diagnosed her with high blood pressure.
Medications alone are not enough.
“In times like this, what people need is strong social support,” Mujawal said. In order to help his neighbor, Mujawal first asked Mulla to stay with her. She spent hours every day listening to Mulla, who didn't speak at first but started pouring his heart out after a week.
Mujawal counsels her neighbors, arranges medicine and finds ways to help ease the financial burden. She even cooked for Moola and even after she settled back down, she still visited her every day to check on her.
“When people see the community supporting them, they feel unity and strength,” Mujawal said. “Not only do these small gestures help build connections, they also demonstrate ASHA's care and compassion for what we do, which makes it easier for people to trust us.”
Mujawal found that more community members needed support. She began to gather them together and ask them to express their feelings.
“It helps create a connection,” explains Rekha Gawali, an ASHA member from Rajapur.
“Slowly, the experience proved to be a stress-reducing exercise, not just for me but for the 50-plus community members,” Mulla said.
community rehabilitation model
As climate catastrophe spreads, feelings of fear and anxiety become increasingly common, leading to wider mental health challenges.
“Uncertainty about when or how these events will occur is closely related to anxiety,” explains Professor Susan Clayton, chair of the Department of Psychology at the College of Wooster in the US.
Mujawal has increasingly seen climate anxiety in her village, but she has helped build resilience in her community. When another flood hit Rajapur in July 2021, the village was well prepared thanks to ASHA's tireless efforts. Three months before the floods, Mujawal and three other ASHAs met with all the villagers. They listed the most vulnerable groups, developed recovery plans and notified nearby medical centers to prepare. Many people left the village early, taking their valuables with them to avoid at least some damage.
“Because I'm from the same community, people don't think I'm an outsider and believe what I say,” Mujawal said.
Since then, she has helped hundreds of people recover. Over the years, the people she helped started helping others. This began to develop into a community treatment model.
This model is important in India, where the national healthcare infrastructure is saturated and understaffed. The country, with a rural population of 833 million, has 740 public district hospitals to which patients with mental illness are referred.
Mulla experienced another flood in July 2024 and is currently in good condition.
“Given the increasing climate disasters, her troubles should have increased, but doctors reduced the dose she was taking to treat her high blood pressure,” Mujawal said. “That's the power of the community health care model.”
Since then, Mujawal has trained more than 100 ASHAs from nearby flood-affected villages. When these ASHAs organize, they often meet in person and on social media to share best practices. Collectively, these ASHAs are reaching the most remote areas of the country that lack basic healthcare facilities.
growing demand
A major misconception is that only extreme weather events can cause trauma.
“Even incremental changes that cause farm losses to increase year by year can cause a lot of stress,” Mujawal explains.
An October 2023 paper published in the International Journal of Disaster Reduction found that flood-affected adolescents in the southern Indian state of Kerala reported more depression, stress when faced with schooling-related issues and concerns about future floods. and anxiety. They also lack adequate disaster prevention knowledge.
Another paper examining climate anxiety in India, China, Japan and the United States found that climate action can reduce anxiety. Clayton, one of the report's authors, said good social support and connections are one of the best ways to build resilience. Taking any form of climate action is good for mental health, she said, because “it changes people's perceptions from passive victims to empowered people.”
Who will help the helpers?
Mujawal's husband, Javed, 38, was diagnosed with a stomach infection just a month before the 2019 floods and was hospitalized. He recovered slowly, but when he heard that the village was on the verge of flooding, he left the hospital early to help the villagers evacuate.
“He did a great job and had helped move hundreds of people and cattle to safer places,” she recalled. Over the next two months, his health began to deteriorate and he died in November 2019.
She said that while she had been helping others recover, the government had not provided mental health support to help her cope with the devastating loss.
“While we help so many people recover and heal from trauma, no one helps us,” she said.
Still, despite the meager pay and stifling working conditions, she and other ASHA members have no intention of quitting.
“If we stop working, the entire health care system will collapse, affecting millions of poor people. For them, we are the only hope,” Mujawal said.
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