Monsoon 2025 has revealed a grim truth: India’s healthcare system isn’t ready to tackle the intensifying impacts of a warming planet. While healthcare infrastructure faces multiple climate risks, such as extreme heat and droughts, it is the surge in short, intense downpours and flash floods that most disrupt daily operations. In just two months, floodwaters have affected premier healthcare institutions across the country. Hospitals in Delhi saw knee-deep flooding, while pumps had to be deployed to allow citizens hospital access in Chembur during the recent heavy Mumbai rains. Further, rainwater has poured into hospitals across Ajmer, Chennai, Imphal, and Patna in recent weeks.AdvertisementA recent analysis by the Council on Energy, Environment and Water (CEEW) projects that many of India’s 200,000+ healthcare facilities, both public and private, could face heightened climate risks by 2050. This risk is particularly concerning for the 42 per cent of facilities located in urban areas, where extreme rainfall and consequent flooding are expected to intensify.As of 2023, only six of India’s 36 states and union territories had climate-proofing strategies for healthcare infrastructure.Drainage systems in most of the Indian cities still follow outdated Central Public Health and Environmental Engineering Organisation (CPHEEO) design standards, meant for rainfall intensities of 12–20 mm/hour. Today, cities like Delhi, Mumbai and Bengaluru regularly experience 50–100 mm in a single day, overwhelming systems. Urban healthcare systems are tightly linked to power, water, transport, and communications, making them equally vulnerable and disrupting critical services like ambulances, surgeries, trauma care, and diagnostics. Only a fraction of urban healthcare facilities are equipped with flood-resilient design features like elevated utility systems, water-tight doors, or reliable power backup.AdvertisementSome encouraging efforts are underway. As part of the Mumbai Climate Action Plan, the Municipal Corporation of Greater Mumbai has started mapping hospitals located in flood-prone zones to prioritise drainage upgrades and infrastructure retrofits. Thiruvananthapuram and Chennai also show how cities are investing in both hospital-focused upgrades, like Kerala Infrastructure Investment Fund Board’s Rs 90 crores for the redevelopment of the Peroorkada Mental Health Centre with flood-resilient utilities and city-wide stormwater management projects. What India needs now is a systemic, forward-looking strategy to climate-proof urban healthcare infrastructure.3 suggestions for climate-resilient urban health systemsFirst, state health departments must mandate climate‑risk assessments at the district/facility level. A CEEW district-level assessment found that over 40 per cent of India’s districts have healthcare systems that face high to very high climate risk, while about 20 per cent face moderate risk. These assessments should be carried out by hospital management teams in coordination with district disaster management authorities and guided by the National Programme on Climate Change and Human Health (NPCCCH). The aim should be to identify high-risk facilities and integrate resilience retrofits, such as flood barriers, elevated utilities, water-resilient materials, and reconfigured layouts, into ongoing infrastructure planning. A structured Healthcare Facility Climate Resilience Checklist can be used as a standard tool for self-reporting and addressing risks. Just as fire safety clearances are mandatory, hospitals, especially large public and private facilities, should be required to secure periodic climate clearances to continue operations in high-risk zones.Second, urban planning regulations must explicitly include healthcare resilience. This means revising building codes and enforcing them, setting flood-safe location criteria for new healthcare facilities, and mandating resilience audits for existing public and private hospitals, especially those in flood-prone or low-lying zones. State urban development departments, working with municipal corporations, should inform national building codes based on context-specific insights, and enforce the same through local building sanctioning authorities. This approach is already reflected in Surat’s district resilience planning, which embeds flood risk into zoning, base-flood elevation and building regulations.most readThird, a dedicated financing mechanism is central to building climate-resilient health infrastructure. A National Climate-Health Resilience Fund should be established under the 15th Finance Commission’s grants, tied to performance-based grants for states and urban local bodies (ULBs), to drive coordinated action across urban India. Public missions like the Smart Cities Mission, AMRUT, and PM-ABHIM must explicitly earmark resources for climate-proofing public healthcare facilities. Meanwhile, state governments should include climate resilience or climate-proofing as a line item in health and disaster budgets, prioritising high-risk districts. Encouragingly, the 2024 amendment to the National Disaster Management Act mandates urban disaster management authorities in every state. To bring in the private sector, the Ministry of Health and Family Welfare (MoHFW), in coordination with MoEFCC and NITI Aayog, could introduce tax incentives and concessional financing for hospitals that adopt certified climate-resilient infrastructure measures.Anchoring climate-resilient healthcare within India’s National Adaptation Plan and the broader Viksit Bharat agenda can enable states and cities to safeguard essential services. Building health infrastructure resilience isn’t just about protecting buildings when it rains; it’s about ensuring care when people need it most.Shreya Wadhawan is a Programme Associate and Ahana Chatterjee is a Research Analyst at the Council on Energy, Environment and Water (CEEW). Views are personal