By the time 45-year-old Kandi Venkanna was brought to the Government Regional Hospital in Bhadrachalam, the extreme heat had taken a devastating toll on her body.
Venkanna, a daily wage laborer and resident of Subhash Nagar Colony in Bhadrachalam, Bhadradri Kothagudem, Telangana, was working at a construction site in the scorching afternoon sun when he suddenly complained of uneasiness and exhaustion before collapsing at the site. At the hospital, he was immediately taken to the ICU where doctors began treatment. He died within a few minutes.
Earlier that day, Bhadradri Kothagudem had emerged as the hottest district in the state, recording a maximum temperature of 46.3C, according to government weather data.
Doctors say symptoms like fatigue, dizziness and restlessness are becoming common among workers forced to stay outside for long periods of time despite extreme heat conditions.
Across Telangana, temperatures have repeatedly crossed 46C over the past few weeks, with districts in North and East Telangana recording the hottest heat of the season. But beyond India Meteorological Department (IMD) warnings, temperature charts and government advisories, the public health crisis is deepening in construction sites, farms, roadside markets, traffic junctions and congested urban areas, where thousands of people continue to work in the scorching heat – because stopping work is not an option.
By noon in Hyderabad, the heat starts increasing not only from the sky but also from the roads. In the old city, tourists, shoppers, hawkers and travelers move through the crowded streets in the hot sun. Near the entrance to Laad Bazaar, fruit vendor Mohammed Karim, 52, wipes sweat from his forehead before pouring water on a carefully placed pile of Totapuri mangoes on his cart to keep them from drying out in the heat.
Like thousands of street vendors across Hyderabad, Karim spends about 8 to 10 hours outside every day. He says that by afternoon, dizziness, headache and fatigue have become regular. Business slows down as temperatures rise, but leaving early is rarely an option. He asks, “It often seems as if fire is raining from the sky. But if we don’t sit here, how will we earn?”
For thousands of vendors, delivery workers, sanitation workers, traffic police personnel and daily wage labourers, the heat is no longer just inconvenient; Now it is a test of endurance conducted on roads, markets, traffic junctions and construction sites across the city.
Behind these scenes unfolding across Telangana, there is growing concern within the state administration over the rising number of suspicious deaths due to heatstroke.
According to the Revenue (Disaster Management) Department, there have been 19 suspected heatstroke deaths so far during the ongoing summer season in the state, of which only one has been medically confirmed as a heatstroke death. Department secretary Hari Chandana Dasari says all reported cases undergo detailed medical verification before being officially classified as heatstroke deaths.
She explains that district officials regularly send reports to the state government, but official confirmation depends on medical certification establishing heatstroke as the cause of death.
the human blow of an unforgiving heat
However, data collected from District Medical and Health Officers (DMHOs) across Telangana indicates that the number of suspected heat-related deaths may be much higher than the official figures currently reflect. There have been at least 48 suspected heatstroke deaths across the state this summer, data shows, although many of these cases are awaiting medical and forensic confirmation.
In Adilabad district alone, the DMHO said nine deaths are currently being treated as suspected heat-related deaths pending verification. Five such deaths have been reported in neighboring Kumaram Bheem Asifabad district, while 142 patients with suspected heatstroke symptoms have already been treated in outpatient (OP) departments.
13 suspected heatstroke deaths linked to extreme heat conditions have been reported in Mahabubabad and Mulugu districts. Officials said six such deaths have been recorded so far in Peddapalli district. Post-mortem examination has been conducted in four cases and samples have been sent for forensic analysis and the final report is pending.
In Nagarkurnool district, officials reported three suspected heatstroke deaths and said 151 patients with suspected heat-related illnesses were treated in outpatient facilities.
District officials say it often takes a long time to confirm a death from heatstroke as forensic analysis and medical verification can take several weeks. “The reports are sent for forensic investigation and in many cases, confirmation can take up to a month. That’s why these deaths are initially classified as suspicious before they are medically confirmed,” explains a district official.
However, the capital city has not yet officially reported any deaths, confirmed or suspected, due to heatstroke. DMHO of Hyderabad J. Venkat attributes this partly to the comparatively low temperatures in the city compared to many districts in northern and eastern Telangana, which have repeatedly crossed the 46C mark during the current heat wave.
Officials acknowledge another challenge complicating heatstroke reporting this year. After the state government announced an ex-gratia amount of ₹4 lakh for the bereaved families of heatstroke victims, officials say they are receiving claims even in cases where the deaths were due to unrelated medical conditions.
“We have to be extremely careful while certifying these deaths as there is a proper verification mechanism in place,” says an official.
One of the biggest challenges in officially declaring a heatstroke death is the lengthy process of linking the death directly to exposure to extreme heat.
Under the guidelines issued by the National Program on Climate Change and Human Health and followed by Telangana health authorities, a death cannot be immediately classified as a heatstroke death merely because it occurred during the hot season. Doctors and investigators must establish several clinical and environmental factors before certifying heat as the cause of death.
According to the guidelines, for a death to be confirmed as being due to heatstroke, the patient’s body temperature must be recorded at least 40.5C, there must be altered mental status and there must be no alternative definitive diagnosis. Investigators must also establish environmental exposures, including whether the person was working under direct sunlight, engaged in strenuous physical activity or was exposed to heatstroke conditions when symptoms began.
“However, in many cases, patients are brought to the hospital after already attempting to cool their bodies using water or ice, which can lower the recorded body temperature and complicate the diagnosis. Such cases are therefore classified as deaths from suspected heatstroke until further medical confirmation is completed,” says Ravi Babu, district coordinator of health services, Bhadradri Kothagudem.
Apart from the medical examination, the verification process in Telangana also includes administrative examination. A separate ‘three-member committee proforma for sunstroke’ requires certification by a medical officer, police sub-inspector and tehsildar before a death due to heatstroke can be formally processed.
warning map for hot future
The growing concern over heat-related deaths comes even as the Telangana State Heatwave Action Plan 2026 was unveiled earlier this month. The report calls heatwave a ‘silent but deadly risk’ and one of the most serious climate-related public health threats facing the state.
According to the action plan, only 24 out of 612 mandals in Telangana are considered relatively safe from heatwave conditions. The remaining 588 fall under different levels of vulnerability, with six classified as critical, 106 as critical and 189 as semi-critical. The report estimates that approximately 16 million people currently live in severe, critical and semi-critical heatwave areas.
Even Hyderabad, despite not always recording the state’s highest temperatures, has emerged as a significant heat stress zone due to rapid urbanisation.
The report classifies the city as facing moderate heat threat but with a ‘strong urban heat island’ effect due to dense construction, concrete surfaces and heat retention across the city.
The Heatwave Action Plan identifies outdoor workers in the construction, agriculture, sanitation and transportation sectors as among the groups most vulnerable to extreme heat conditions. It also said that more than 31,897 Anganwadi centers and 4,076 mini Anganwadi centers across Telangana remain vulnerable to the heatwave, raising concerns over disruption in nutrition services and maternal and child health service delivery during the extreme heat.
The action plan also includes data on officially recorded heatwave deaths in Telangana over the last seven years. According to this, the state recorded 10 deaths in 2019, six in 2020, three each in 2021 and 2022, six in 2023, 10 in 2024 and eight in 2025.
However, the National Crime Records Bureau (NCRB) report for 2024 paints a completely different picture. According to NCRB data released in May, the state recorded 116 deaths due to heatstroke during 2024 – 98 men and 18 women.
This figure is dramatically higher than the 10 deaths accepted in the Telangana Heatwave Action Plan 2026.
Activists working on heatwave mitigation say Telangana’s latest heatwave action plan is more detailed and comprehensive than the state’s first plan released in 2016. The revised document expands the monitoring mechanism, more clearly identifies district-level vulnerabilities and lays out preparedness measures for departments dealing with health, labour, water supply and disaster management.
The health department has already issued three separate heatwave advisories this summer – in March, April and May – urging citizens to avoid being outside for extended periods during afternoon rush hours, stay hydrated and seek immediate medical help if symptoms of heat-related illness appear.
Director of Public Health B. Ravinder Nayak says, “As part of the preparedness measures, special beds, intravenous (IV) fluids and essential medicines have been arranged in government hospitals to deal with heat-related emergencies. Oral rehydration solution (ORS) sachets have also been distributed through auxiliary nurse midwives, accredited social health workers and Anganwadi workers across Telangana.”
Relief on paper, cracks on the ground
However, questions remain about how consistently many of these measures are being implemented on the ground. The action plan itself directs the Telangana State Disaster Management Authority to regularly monitor and review heat mitigation measures in the districts. But activists say there is little public clarity on how often such reviews are conducted or how effectively local-level interventions work during extreme heat conditions.
One of the simplest yet most important measures recommended under the heatwave response strategy is the provision of accessible drinking water facilities at public places. Across Hyderabad this summer, hundreds of temporary drinking water stalls, known locally as ChalivendramThese are set up by NGOs, private organizations and local communities, often drawing crowds during busy afternoon hours.
But there appear to be shortcomings in the official infrastructure. For example, in Tarnaka, the public drinking water facility operated by the Hyderabad Metropolitan Water Supply and Sewerage Board in a pump house remained closed throughout the day despite rising temperatures, highlighting uneven implementation of basic heat mitigation measures across the city.
The numbers may remain disputed between suspected deaths, confirmed deaths and cases awaiting forensic verification. But across Telangana, the effects of extreme heat are already visible in exhausted workers, deserted afternoon streets and cities that are no longer cool even after sunset.
