Executive summary

According to the World Meteorological Organization (WMO), Asia suffered more than 81 climate- and water-related – or hydro-meteorological – disasters in 2022, causing economic damage of more than USD 36 billion (WMO 2022). India ranks as the seventh-most vulnerable country with respect to climate extremes (Germanwatch 2020), with 80 per cent of its population residing in districts that are highly vulnerable to the impacts of extreme hydro-meteorological disasters such as floods, droughts and cyclones (Mohanty and Wadhawan 2021). The occurrence of such disasters can trigger a series of cascading and compounding impacts. Rapid-onset disasters such as floods and cyclones cause substantial physical damage to infrastructure assets, severely impacting critical assets such as road networks, power systems, and healthcare facilities and, therefore, magnifying disaster risks. According to the State Bank of India (SBI) ECOWRAP report (2023), India suffered economic losses of INR 12 trillion due to floods and storms between 1900 and 2023 (State Bank of India 2023). Further, India’s transport and power infrastructure sectors are estimated to suffer an annual loss of INR 1.5 trillion due to extreme weather events such as floods and cyclones (World Bank 2019).

Additionally, like most countries in the Global South, India’s approach to disaster management focuses on response, recovery and relief rather than anticipatory action to reduce future losses (UNDRR 2023). Following the National Disaster Management Act 2005, India’s disaster management plans, policies and guidelines emphasise preparedness and recovery over mitigation and adaptation. Furthermore, existing governance complexities pose challenges in this cross-cutting sector of infrastructure resilience. The development of most critical infrastructure assets falls under the purview of the states, while disaster risk reduction and climate adaptation largely remain a topic managed by national-level policy-makers. This hinders a holistic approach to resilient infrastructure development.

To develop context-specific adaptation solutions, India must identify and quantify the physical risk at a granular level. This calls for comprehensive risk assessment across critical infrastructure sectors, which can generate scientific evidence for administrators, policymakers, and investors to enhance decision-making processes and prioritise adaptation planning. Such a risk assessment will help policymakers prioritise spending on critical assets and streamline the implementation of adaptation measures, thus safeguarding current and future infrastructure investments. To bridge this gap, we have developed a first-of-its-kind, unified, and scalable risk assessment framework for climate-proofing critical infrastructure against extreme floods and cyclones.

Building on the Intergovernmental Panel on Climate Change (IPCC) definition of risk, the framework has been designed to serve a dual purpose: (a) First, it quantifies and maps the risk to critical infrastructure geospatially at the district level. (b) Second, drawing insights from the risk assessment, it identifies risk drivers and proposes context-specific adaptation solutions that can be implemented at varying scales. This is crucial for prioritising infrastructure at risk, streamlining adaptation solutions through a needs-based approach, and minimising redundant investments.

1 Critical infrastructures refer to the physical structures, facilities, networks, and other assets that provide services indispensable to the social and economic functioning of society and are necessary for managing disaster risk (CDRI 2023).

A scientific risk assessment is the first step in climate-proofing. Risk mapping helps strengthen climate resilience by assessing the overall climate change risk at a granular scale. Therefore, the framework serves as a guiding mechanism for selecting the most suitable adaptation measures for sustainable infrastructure development and helps prioritise the implementation of adaptation actions.

This report illustrates a case study on healthcare facilities, which play a pivotal role in safeguarding public health, bolstering economic resilience, and enabling efficient disaster response. India has more than 200,000 healthcare facilities (see Fig ES1). These comprise government facilities (primary, secondary and tertiary healthcare facilities) as well as private ones that are empanelled under government schemes or programmes such as Ayushman Bharat, Pradhan Manti Jan Arogya Yojana (PMJAY), Central Government Health Scheme (CGHS), etc. Therefore, a significant percentage of the Indian population depends on these healthcare facilities, many of which might be facing risks due to extreme weather events or are likely to face them in the foreseeable future.

Figure ES1 India has more than 200,000 healthcare facilities, many of which are at risk due to extreme weather events*

On the other hand, the healthcare sector in India has also witnessed a 14 per cent increase in expenditure over the past year, underscoring the rising importance of public healthcare and social security in ensuring universal health coverage (PIB 2024). This underlines the need for granular risk assessments for healthcare infrastructure, to enable risk-informed investments and context-specific solutions.

Addressing this need, the devised framework for climate-proofing healthcare facilities evaluates multiple indicators to assess each risk component to healthcare facilities and collates the risk score at a district level. In alignment with the IPCC formula, the framework defines risk to critical infrastructure as a function of three variables:

• i. Hazard: The historical or projected occurrence of floods and cyclones in a district;
• ii. Exposure: The density of critical infrastructure assets in the district;
• iii. Vulnerability: The likelihood of critical infrastructure assets within the district to be adversely affected by extreme floods or cyclones.

The risk score, represented on a scale from 0 to 1, is estimated using a composite index-based methodology that combines the scores of each indicator in alignment with the IPCC formula for risk. ES Figure 2 outlines a snapshot of the risk-assessment framework.

ES Figure 2: Framework for climate-proofing healthcare facilities

The proposed framework was further tested through a pilot study in Maharashtra, which ranks third among the Indian states in terms of vulnerability to extreme hydro-meteorological disasters (Mohanty and Wadhawan 2021). The state houses more than 17,000 public healthcare facilities, which might face significant impacts due to the increasing occurrence and intensity of extreme weather events (EWEs) (PMGSY n.d.). This poses a substantial risk to the functioning of healthcare facilities during disasters. Maharashtra also houses the most significant economy out of all the states in India, accounting for 13.3 per cent of the country’s Gross Domestic Product (GDP) (Government of Maharashtra 2023). The Interim Budget 2024–25 has also proposed allocating nearly INR 10,000 crore to improving healthcare facilities in the state. This underscores the need to safeguard the state’s economy and upcoming investments, which must be safeguarded from disaster-induced losses to ensure maximum utilisation (TERI 2024).

Maharashtra showcases exemplary steps to enhance the adaptive capacity of its healthcare system against the growing threats posed by climate change. The state ranks 4th as per Niti Aayog’s Health Index, which assesses the performance of healthcare systems across the country by tracking the improvement in key health outcomes (Niti Aayog 2022). Maharashtra has also submitted a revised version of their State Action Plan on Climate Change and Human Health (SAPCCHH) for 2022-2027, laying out a comprehensive roadmap to tackle climate-induced health risks. Additionally, regional initiatives such as launching the Maharashtra Tertiary Care and Medical Education Sector Development Program in Raigad and Sindhudurg districts aim to strengthen tertiary healthcare services and ensure improved access to quality care (ADB 2023). These initiatives are especially critical as the state faces more frequent and intense extreme weather events, such as heavy rainfall, heatwaves, and cold waves, which heighten the risks of vector-borne diseases. Thus, by prioritising capacity-building in healthcare infrastructure, Maharashtra is equipping its health systems to withstand climate-induced shocks better and continue serving vulnerable communities (ADB 2023).

However, our key findings suggest that further action is necessary to safeguard healthcare facilities in the state, especially to reduce physical risks posed by increased extreme weather events such as floods and cyclones.