WHEN Cyclone Remal tore through Bangladesh’s southern coast in May 2024, it displaced around 800,000 people in a single night. In the weeks that followed, the crisis did not end with the wind and water. It shifted shape. Across coastal areas, thousands fell ill from contaminated water and mosquito-borne infections. Months later, health workers in Banshkhali and Kutubdia — two upazilas in Cox’s Bazar and Chattogram that repeatedly absorb the force of tidal surges — began reporting something less visible but equally alarming: rising anxiety, depression and long-term respiratory illness among communities still trying to recover.
This is not an exception. It is becoming the pattern of life along Bangladesh’s 711-kilometre coastline, where an estimated 36 million people live barely one to three metres above sea level. Climate change here is no longer a distant projection. It is a present-tense public health emergency unfolding in real time.
The scale of the crisis is now being documented with growing clarity. Recent surveys in coastal Bangladesh show that floods, cyclones and sea-level rise are directly linked to respiratory illnesses, mosquito-borne diseases and worsening mental health. In one study across Banshkhali and Kutubdia, more than half of respondents reported climate-related psychological distress. Another multi-district survey in the southeast found similar patterns, with over 50 per cent of participants acknowledging that their mental health had deteriorated due to climate stress.
These findings are not isolated. After Cyclone Amphan in 2020, more than half of surveyed adults showed moderate to severe psychological symptoms, and a significant proportion reported suicidal thoughts. Bangladesh’s record dengue outbreak in 2023 — over 321,000 cases and 1,700 deaths — further exposed how climate conditions are expanding mosquito habitats and intensifying disease cycles. Meanwhile, salinity intrusion into drinking water has pushed sodium intake in some coastal regions to nearly three times the WHO-recommended limit, contributing to hypertension, pregnancy complications and cardiovascular disease.
What emerges is not a collection of separate health issues, but a single, escalating pattern: climate stress is being absorbed directly into the human body.
One of the least discussed dimensions of this crisis is also one of the most consequential — the gender gap in climate awareness and survival. In coastal communities, men are more likely to access information about climate risks, largely because their work keeps them outdoors and connected to visible environmental changes. Women, by contrast, are often confined by mobility restrictions and limited access to information channels, including community meetings and timely alerts.
This gap is not abstract. It has life-or-death consequences. When warnings do not reach women in time, evacuation decisions are delayed, children are left unprotected, and household preparedness collapses. In climate emergencies, information is not just awareness — it is survival infrastructure.
The burden does not end there. Salinity intrusion also disproportionately affects women’s health, particularly during pregnancy. Studies have linked high sodium levels in drinking water to increased rates of hypertension and pre-eclampsia in coastal districts, with risks rising sharply in dry seasons. Climate change, in this sense, is not gender-neutral. It is actively reshaping inequality through health.
Yet even as the health burden grows, the system meant to absorb it is under severe strain. Bangladesh has made historic progress in reducing cyclone-related deaths through early warning systems and disaster preparedness. But climate-related illness is a different challenge — slower, continuous and far more difficult to contain.
In coastal areas, access to healthcare remains limited. One study found that a significant portion of residents still rely on indigenous or informal treatment systems, not out of preference but because formal healthcare facilities are too distant, too expensive, or too overwhelmed. Many communities remain unaware of basic national health policies that are meant to serve them. When the formal system is invisible in everyday life, vulnerability becomes routine.
At the same time, hospitals across the country continue to struggle with climate-linked disease surges. The 2023 dengue crisis exposed how quickly the system can be overwhelmed when environmental conditions intensify disease transmission at scale.
The World Health Organisation has already warned that Bangladesh’s response to climate-sensitive health risks must become stronger, better coordinated, and adequately financed. But the warning itself points to a deeper issue: the gap between climate reality and institutional readiness is still widening.
The consequences extend beyond public health. Climate vulnerability increasingly shapes economic vulnerability. As global financing institutions tie concessional loans and climate funds to measurable resilience outcomes, Bangladesh’s exposure to climate-related health burdens weakens its credibility as a stable and efficient investment destination. For an economy dependent on manufacturing and exports, especially in coastal and peri-urban zones, unreliable health systems and recurring environmental shocks translate into real economic risk.
The logic of response, however, is already clear.
Bangladesh’s climate-health crisis is not only about adaptation — it is about prioritisation. Mental health cannot remain peripheral when more than half of coastal residents report psychological distress. Gender-sensitive communication must become standard practice, not an afterthought. Health infrastructure in coastal zones must be redesigned to remain functional during floods and cyclones, not fail precisely when demand peaks.
Equally important is the need to decentralise knowledge. Communities already understand the changing climate intimately through lived experience. That knowledge is often more immediate than formal models suggest. The challenge is not to replace it, but to integrate it into policy design.
Finally, climate health must be treated as a core public investment issue. Prevention — through infrastructure, communication, and water safety — is significantly cheaper and more effective than responding repeatedly to large-scale outbreaks and disasters after they occur.
Bangladesh has earned global recognition for how it has reduced cyclone mortality over the past decades. That achievement was not accidental; it came from sustained investment in early warning systems, community preparedness and institutional coordination.
The question now is whether the same seriousness can be applied to the slow, unfolding crisis of climate-related disease and mental health. Cyclones may arrive once or twice a year. Climate stress, however, does not leave. It accumulates quietly, in bodies, homes and systems already under pressure.
The coastline is not only sinking under rising seas. It is carrying a growing health burden that is already reshaping everyday life. The next challenge is whether policy can rise fast enough to meet it.
Jannatul Ferdos is a lecturer at the Hamdard University Bangladesh. Dr Kazi Md Barkat Ali is a professor at the University of Chittagong.
