Community health care worker Noushadbi Mujawar safely evacuated everyone from Rajapur, an isolated village in India, as its streets began flooding in August 2019. Mujawar, 42, remained in the village herself even as floodwaters rose 12 feet above her house.

“I moved to a nearby taller building and decided to stay,” said Mujawar, who wanted to help those villagers who stayed with their property as the floodwaters rose.

“Many people stay in their homes during floods to care for their cattle, as evacuating them involves significant risks,” she said.

Mujawar is one of over a million accredited social health activists, known as ASHAs, in India, one for every 1,000 people in villages and towns. ASHAs help make public health care accessible.

Mujawar has tried to keep people safe during deadly floods that inundated her village in Maharashtra state in 2005, 2019, 2021, and 2024. She makes it a point to talk to every community member during any disaster to ensure their safety even as flooding deprives many of electricity, food supplies, and essentials.

“This is the most dangerous moment when people are at risk of mental health issues, and most of them never seek treatment because of the taboo,” Mujawar 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 a weakness.

Critical work, low pay

ASHA workers are on the front lines of what a growing body of research indicates is India’s climate-linked mental health crisis. Over 197 million people in India suffer from mental disorders, and a government report points out that 50% of the climate flood-affected population suffers from post-traumatic stress disorder, or PTSD. Floods alone affected more than 218 million people from 2015 to 2020.

Still, ASHA workers are considered volunteers and are not paid a salary for their stressful and dangerous but necessary work. Instead, they are given an honorarium based on tasks completed. ASHA leader Netradipa Patil said many ASHAs in Maharashtra work around 10 hours daily and average a monthly honorarium of just 3500-5500 Indian rupees ($40-70). Often, payments are delayed for six months or more, forcing many to double as farmworkers. 

ASHA workers also lack access to the mental health care they themselves need after a major event devastates their own homes or families. Over the years, ASHAs have unionized and staged nonviolent protests. These have helped make conditions better but there is still a long way to go.

A need for strong social support

During the 2019 floods, Mujawar’s neighbor, Najuki Mulla, 55, was stranded until volunteers helped evacuate her as floods destroyed her one-room tin house. Mulla lost all her documents and essentials and was cramped with over 20 flood victims in a 10-by-10-foot room at a public school. A month later, when the floodwater receded, Mulla returned to find her house gone, leaving her in shock.

Mujawar found that Mulla barely ate and would sweat excessively. Within a few days, she was finding it difficult to breathe and was diagnosed with asthma as well as clinical depression. She took Mulla to a doctor, who diagnosed hypertension.

Medicines alone were not enough.

“During such times, what people need is strong social support,” Mujawar said. To help her neighbor, Mujawar first asked Mulla to stay with her. She spent several hours a day listening to Mulla, who at first did not speak a word but after a week started pouring her heart out.

Mujawar counseled her neighbor, arranged medicines, and found ways to help ease the financial burden. She even cooked food for Mulla and kept checking up on her with daily visits even after she was settled again.

“When people see their community supporting them, they feel a sense of unity and strength,” Mujawar said. “These small gestures not only help build a bond but also show the care and compassion that ASHAs bring to their work, which makes it easier for people to trust us.”

Mujawar found that many more community members needed support. She started bringing them together and asking them to express their feelings.

“This helped create a bond,” explains Rekha Gawali, an ASHA from Rajapur.

“Slowly, such experiences proved to be a de-stressing exercise not just for me but for over 50 community members,” Mulla said.

Community model of healing 

As climate disasters proliferate, feelings of fear and anxiety are becoming more common, contributing to broader mental health challenges.

“The uncertainty of when or how these events might occur is strongly associated with anxiety,” explained professor Susan Clayton, chair of psychology at the College of Wooster in the United States.

Mujawar increasingly sees climate anxiety in her village but she has helped the community build resilience. When another flood hit Rajapur in July 2021, the village was well-prepared thanks to consistent efforts by ASHAs. Three months before the floods, Mujawar and three other ASHAs met with all the villagers. They listed the most vulnerable people, prepared a rehabilitation plan, and informed nearby health care centers to be ready. Many people left the village in advance, taking their valuables, preventing at least some losses.

“Since I am from the same community, people don’t consider me an outsider and trust what I say,” Mujawar said.

Since then she has since helped hundreds of people recover. Over the years, those she assisted have begun to help others. This started blossoming into a community model of healing.

This model is important in India, where the national health care infrastructure is oversaturated and understaffed. For its rural population of 833 million, the country has 740 public district hospitals, where patients are referred for mental health ailments. 

Mulla faced another flood in July 2024 and is doing well.

“Looking at the rising climate disasters, her troubles should have increased,” Mujawar said, “but the doctor reduced her dosage for hypertension. This is the power of a community health care model.”

Since then, Mujawar has trained over 100 ASHAs from the nearby flood-affected villages. As these ASHAs are organized, they often meet both in person and on social media to share best practices. Collectively, these ASHAs are reaching the remotest parts of the country that lack essential health care facilities.

Growing need

A major misconception is that only extreme weather events cause trauma.

“Even gradual changes that lead to increasing farm losses every year can cause a lot of stress,” Mujawar explains.

An October 2023 paper published in the International Journal of Disaster Risk Reduction found that adolescents affected by floods in the south Indian state of Kerala showed more depression, stress, and anxiety while facing problems related to schooling and worry about future floods. They also lacked adequate knowledge about disaster preparedness.

Another paper examining climate anxiety in India, China, Japan, and the United States found that anxiety lessened with climate action. Clayton, one of its authors, said good social support and connection are among the best ways to build resilience. She said that taking any form of climate action can benefit mental health as “it changes the perception from being a passive victim to somebody with agency.”

Who helps the helpers?

Mujawar’s husband, Javed, 38, was diagnosed with a stomach infection just a month before the flood in 2019 and was hospitalized. He was recovering slowly but left the hospital early to help villagers evacuate when he heard the village was on the brink of flooding.

“He was doing all right and had helped hundreds of people and cattle move to safer places,” she recalls. In the next two months, his health started deteriorating, and he died in November 2019. “My husband kept working ‘til his last breath,” she said.

She said the government provided no mental health support to help her deal with this crushing loss even as she kept helping others to recover.

“While we help so many people recover and heal from the trauma, no one helps us,” she said.

Still, she and other ASHAs have no intention of quitting, despite the poor pay and stifling working conditions.

“If we stop working, the entire health care system will collapse, impacting millions of poor. For them, we are the only hope,” Mujawar says.