This article was originally published in 101 Reporter under Creative Common license. Read the original article.

By Parsa Tariq

Pampore, Jammu and Kashmir: By the time the afternoon sun settles over Pampore's orchards, some workers head home early; others retreat into the shade before returning to the fields. The situation is new for everyone as Kashmir’s summers are turning increasingly intense.

On June 19, 2025, Srinagar recorded 35.2°C, its hottest June day in 20 years and seven degrees above the seasonal average, according to the India Meteorological Department. Just over two weeks later, on July 5, the city touched 37.4°C — its highest July temperature in more than 70 years.

Showkat Ahmad, an orchard worker in his late forties from Samboora village in Pampore, spends long hours outdoors during harvest season. One afternoon, after hours in the heat, he grew dizzy. "I thought I hadn't eaten enough that morning," he said. "I went home thinking some rest would make it better." When the dizziness continued into the next day, he went to a nearby health centre and was treated for dehydration and weakness — oral rehydration salts, medication, two days off work. Heat was never mentioned.

His experience captures a larger problem: heat illness rarely announces itself. It looks like dozens of everyday complaints.

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Quiet Heat

For 22-year-old Ayaan Ahmad of Namblabal (name changed on request), the symptoms were more dramatic. "It was extremely hot," he recalled. "As soon as I reached home from college, I felt breathless. When I stood up, I became dizzy. Suddenly everything went blank. I couldn't see anything. I started shivering and my heartbeat became very fast." Friends rushed him to the Government Hospital in Pampore, where doctors found his oxygen saturation slightly low and his heartbeat unusually fast. He was given two injections and a sublingual medicine; an ECG later came back normal. "Later, the doctor told me it had happened because of the heat," he said.

Zareefa Begum, 60 (name changed), spends most afternoons tending vegetables behind her home. She dismissed her own symptoms. "My daughter keeps telling me, 'Drink enough water, it's because of the heat,'" she said. "I tell her I'm simply getting older. Every summer feels harder with age. Heat is just an excuse." She has never sought care for the headaches and exhaustion that recur every summer, chalking them up to age.

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Dr. Altaf Shah, Senior Medical Officer at District Hospital Pulwama, said the hospital has treated about a dozen heat-related cases this summer — but in Kashmir, heat usually acts as an aggravating factor rather than a standalone diagnosis. "Symptoms are frequently overshadowed by illnesses such as dehydration, fever, headache or general exhaustion," he said. "Diagnosis depends on a strong history of heat exposure and clinical assessment." Signs commonly overlooked, he added, include low blood pressure, a burning sensation in the eyes and face, neck pain, dry mouth and reduced urine output — symptoms easily pinned on other illnesses if recent heat exposure isn't considered. He could not point to a specific case where heat illness was first diagnosed as something else and later reclassified; more often, he said, heat worsens existing conditions or blurs into routine complaints.

Dr. Prashanth N Srinivas, a public health physician and Senior Fellow at the Institute of Public Health, Bengaluru, agreed the clinical picture is easy to miss. "The clinical picture of heat illness overlaps with many common conditions, and frontline records usually capture only the immediate complaint," he said. "Doctors rarely record heat as the environmental trigger, which is why the true burden often remains invisible." Early signs — fatigue, dizziness, cramps, nausea, weakness — are the easiest to overlook; if the condition progresses to heatstroke, patients may develop confusion, altered behavior or collapse, often without obvious fever. In older adults or those with heart, kidney or respiratory disease, heat tends to trigger existing conditions rather than present on its own; even younger patients may simply collapse, obscuring the heat exposure underneath.

That gap shows up in the records themselves. District Hospital Pulwama keeps no separate OPD register for heat-related illness — patients are logged under their presenting diagnosis, not heat exposure, making the true caseload impossible to determine. Dr. Srinivas said heat-related deaths are undercounted for the same reason: the final medical event — cardiac, respiratory — gets recorded, not heat's role in triggering it. Without reliable local data, he said, health systems struggle to plan cooling measures, staffing, supplies or early warning systems.

The Adaptation Lag

Dr. Srinivas frames this as a lag in adaptation. "People and health systems in places like Kashmir have long adapted to mild summers," he said. "As temperatures rise, recognizing heat illness becomes harder because it has never been high on the list of clinical or public suspicion." Housing, clothing, work routines and infrastructure were all built for a cooler climate, he said — rising temperatures are now testing those systems as much as human physiology.

Training frontline health workers to recognize and manage heat illness is a standard component of India's Heat Action Plans, though assessments consistently find clinical and institutional readiness among the weakest parts of implementation. In Pulwama, Dr. Shah said there is currently no dedicated Heat Action Plan for Pampore or the district — heat-related illness is still considered relatively uncommon, and patients are managed through routine outpatient services. Those most at risk, he said, are roadside vendors and others who spend long hours outdoors with little protection from direct sun. Kashmir remains milder than much of India, but he expects rising urbanization and environmental degradation to push heat-related risk higher in the years ahead.

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