The first big storm of the monsoon season has receded, leaving fatalities, damaged houses, and ruined livelihoods across South Asia.

More than 670 deaths have been reported thus far, and millions have been displaced or significantly affected. Many are still missing, including children.

Dr. Ravikant Singh, founder of the nonprofit Doctors for You, recalls making his way to a village in Bihar, one of the poorest states in India. A baby who had been delivered that morning had spent hours still attached to the placenta – there was simply no one available to care for mother and child.

Throughout the region, houses and even entire villages have been submerged. “Even in higher-up places, many villages in Bangladesh are underwater,” said Iftikher Mahmood, founder of the HOPE Foundation for Women and Children of Bangladesh.

For people living in affected areas in India, Nepal, Bangladesh, and Pakistan, the difficulties have just begun.

Immediate dangers

It’s the start of monsoon season, a yearly seasonal change that causes the majority of South Asia’s rainfall to occur over just three months in the summertime. A new storm arriving Thursday is expected to blanket 90% of India with rainfall – which could, in turn, cause additional flooding, rising rivers, and landslides.

Each major storm can have devastating effects that continue for months or even years after the initial burst of rain and flooding – long after the news cycle has forgotten it.

More immediately, many people in flood-affected areas, particularly in India, are still cut off from most contact with the outside world, making it difficult to deliver aid.

Food supplies have been damaged and water in flood-affected areas has been contaminated with sewage and other unsanitary material. That means many people are currently going without food, clean water, or access to medicines. If they get sick or are already dealing with chronic conditions, there’s no one to care for them.

Organizations like the HOPE Foundation’s field hospital, Mountain Heart Nepal, and Doctors for You have responded by setting up medical camps in flood-affected regions, making their way to isolated villages to treat patients, and providing everything from clean water to soap to people living in overcrowded facilities and makeshift shelters.

They’re already treating injuries and snakebites, along with diarrhea and skin diseases – both complications from contact with contaminated water.

Looking ahead

They’re also gearing up to address the serious, often deadly diseases that can follow a storm or flood. Cholera, which spreads rapidly when people drink water contaminated by the disease, is a visceral fear.

“After the flooding…we saw lots of standing water,” said Dr. Aban Gautam, president of the aid group Mountain Heart Nepal. Standing water attracts mosquitoes, greatly increasing the potential for malaria, dengue, and other vector-borne diseases.

Crowded conditions in shelters and camps can cause respiratory diseases like pneumonia to spread quickly. And people with chronic conditions like diabetes and hypertension are less likely to have access to the vital medications needed to manage their conditions.

All of these are compounded by malnutrition, already a risk for the largely poor population affected by the storm. “Since they belong to low socioeconomic groups, they are vulnerable,” Dr. Gautam said.

He explained that many of the people affected are subsistence farmers and members of lower castes. (Indian society is stratified into strict layers determined by status and occupation. Members of some low castes, as well as those outside the caste system, have famously been called “untouchables.”)

In Nepal, Dr. Gautam said, people are slowly returning to their homes. “People are starting to rebuild,” he said. But that doesn’t mean that life will return to normal anytime soon.

For one thing, the threat of disease won’t disappear. Dr. Gautam is concerned that he’ll see outbreaks of cholera, diarrhea, and vector-borne diseases in Nepal in the coming weeks.

Economic impacts

But in addition, monsoon season has a profound impact on South Asia’s agriculture and, by extension, its economy. “Such a large number of people are so dependent on this intensively seasonal rainfall,” said Sunil Amrith, a professor of South Asian studies at Harvard University.

“If the monsoons are late, or if they fall short of normal expectations, or they are in excess, they can ruin a harvest, and in a predominantly rural country, that really matters.”

Many of the people in this region are rural farmers for whom a bad harvest is devastating. “The whole family depends on income from livestock and from farming,” Dr. Gautam said. In the wake of the storm, livestock have been drowned and paddy fields destroyed.

Highlighting the situation

Direct Relief has responded by providing requested medical supplies and an emergency cash grant, helping aid organizations in the region set up medical camps, travel to flood-affected areas to provide services, and distribute urgently needed medical supplies.

The organization has aided in other disasters in the region, including Cyclone Fani, which hit northeastern India earlier this year, as well as heavy floods in Nepal in 2017 and in Kerala, India in 2018.

Dr. Singh explained that frequent disasters cause “donor fatigue,” in which people are less likely to help out when faced with repeated requests for donation.

To compound matters, Dr. Singh said, “the local media is not giving much attention, or maybe they don’t want to highlight the situation on the ground.”

There may be an explanation for the relative lack of media coverage in the region and elsewhere. “In some sense, I suppose, one might call it an ordinary disaster,” said Amrith. “It’s almost as if these things are expected in South Asia, under the radar.”

“A force that governs the world”

And the future may be more volatile – in part because of climate change. “The monsoon has become more prone to extremes,” Amrith said. Both the where and when have become less predictable: monsoon rains have been falling in unexpected places, and heavy rains are interspersed with longer dry periods.

Amrith said that monsoon seasons have always had a profound – and variable effect – on South Asian economic and cultural life. “The monsoon is portrayed as a force that governs the world” even in centuries-old literature.

“But they really are changing,” he added. “They’re becoming much more unpredictable and much more dangerous.”