These limitations are not merely operational but normative: they reflect a global health order that prioritizes state-centric reporting, emergency response optics, and biomedical metrics over social vulnerability, environmental precarity, and sub-national inequities. Assam thus emerges as a critical case study for rethinking India’s role in shaping a more inclusive and responsive global health architecture.
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| Image credits: @iremseenn on Pinterest |
Floods as a Permanent Emergency
Flooding in Assam is not an episodic disaster but a cyclical condition of life. The annual swelling of the Brahmaputra and Barak rivers displaces millions, destroys crops, contaminates drinking water, and collapses sanitation systems. In 2022 alone, floods affected over 5 million people, creating prolonged humanitarian and health emergencies rather than short-term crises. These floods are increasingly linked to climate change, upstream infrastructural interventions, and altered rainfall patterns, factors that transcend national boundaries and implicate global environmental governance failures.Despite this, global health frameworks continue to treat floods as “natural disasters” rather than as chronic public health determinants. WHO’s emergency response mechanisms are largely reactive, triggered by acute outbreaks rather than slow-onset health degradation caused by displacement, malnutrition, and waterborne diseases. Assam’s floods thus fall into a governance blind spot: too routine to trigger global alarm, yet too severe for local systems to manage alone.
Disease Outbreaks and Structural Vulnerability
Floods in Assam are invariably followed by disease outbreaks. Cholera, acute diarrhoeal disease, Japanese Encephalitis (JE), dengue, and malaria surge during and after flood seasons. Japanese Encephalitis, in particular, has claimed thousands of lives in Assam over the past decades, disproportionately affecting children and economically marginalised communities. These diseases are not merely epidemiological phenomena but indicators of structural neglect, poor housing, inadequate sanitation, limited healthcare access, and under-resourced surveillance systems.WHO’s global health strategies emphasise disease-specific interventions and national reporting obligations under the International Health Regulations (IHR), 2005. However, such frameworks presume a baseline capacity that regions like Assam often lack. Underreporting, delayed detection, and inadequate laboratory infrastructure undermine both domestic response and international coordination. The result is a paradox: global health law exists, but its effectiveness diminishes precisely where vulnerability is highest.
WHO-Centric Governance and Its Structural Limits
The WHO-centric model of global health governance rests on three key assumptions: strong national health systems, effective state coordination, and the political will to prioritise public health. Assam disrupts each of these assumptions. Health is constitutionally a state subject in India, yet international engagement occurs at the national level. This vertical disconnect marginalizes sub-national realities within global health decision-making.Moreover, WHO’s dependence on member state cooperation constrains its capacity to address internal disparities. Health emergencies that do not threaten international spread or global markets often fail to attract sustained attention or funding. Assam’s health crises thus remain domesticated, treated as internal governance failures rather than as manifestations of global systemic inequities. This reveals a deeper flaw in global health governance: its inability to account for internal marginality within sovereign states.
Climate Change, Health, and Global Inaction
Assam’s health challenges cannot be disentangled from climate change. Flood-induced displacement, food insecurity, and disease proliferation are increasingly recognised as climate-health linkages. Yet global climate governance and global health governance operate in silos. While climate negotiations acknowledge “loss and damage,” health impacts remain under-theorised and under-funded within these frameworks. For Assam, this fragmentation has tangible consequences. Climate finance mechanisms rarely translate into strengthened health infrastructure or disease surveillance at the local level. WHO’s climate and health initiatives, though normatively progressive, lack enforceability and dedicated funding. The result is a governance gap where climate vulnerability intensifies health risks without corresponding global accountability.
Human Security and the Ethics of Neglect
From a human security perspective, Assam’s health crises represent a failure to protect basic human dignity. Repeated displacement erodes community resilience, disrupts education, and exacerbates gendered vulnerabilities, particularly for women and children. Yet these human costs are largely absent from global health metrics that prioritise mortality rates and outbreak containment.This ethical blind spot raises questions about the legitimacy of a global health order that tolerates chronic suffering at the margins. If health is a fundamental human right, as recognised under international human rights law, then the persistence of preventable disease and disaster-related morbidity in Assam constitutes a normative failure. WHO-centric governance, constrained by political realities, struggles to translate rights-based rhetoric into enforceable obligations.
India’s Role and Responsibility
As an emerging global power, India occupies a dual position, both as a recipient of global health norms and as a potential norm-shaper. Assam challenges India to reconcile its global ambitions with its domestic responsibilities. A state that seeks leadership in global health diplomacy cannot ignore persistent health inequities within its own borders.India’s engagement with WHO and other multilateral forums must therefore move beyond compliance toward advocacy. By foregrounding sub-national vulnerabilities like those in Assam, India could push for reforms that integrate climate resilience, decentralised health capacity, and community-based surveillance into global health governance. Such leadership would not only enhance India’s credibility but also contribute to a more just and responsive international order.
Rethinking Global Health Governance from the Margins
Assam offers an alternative lens through which to imagine global health governance, one grounded in lived experience rather than abstract universality. This would require a shift from emergency-centric responses to structural prevention, from state-centric reporting to sub-national inclusion, and from biomedical reductionism to social determinants of health.
For WHO, this implies re-evaluating its engagement strategies with federal systems like India’s. Greater collaboration with state governments, civil society, and regional institutions could bridge existing gaps. More fundamentally, it calls for recognising that health governance cannot be effective if it ignores internal hierarchies and regional disparities within states.
Conclusion
Assam’s floods and disease outbreaks illuminate the limits of WHO-centric global health governance in an era of climate instability and fragmented multilateralism. They reveal a global order that is reactive rather than preventive, universal in rhetoric but selective in practice. For populations at the margins, global health remains a distant promise rather than a lived reality.As the world confronts intersecting crises of climate change, pandemics, and institutional decay, regions like Assam must no longer be treated as peripheral. They are, instead, the frontlines where the credibility of global health governance is tested. Whether India chooses to amplify these voices or allow them to remain unheard will shape not only its domestic legitimacy but also its role in the future world order.
About the Author
Tathagata Rajguru is a law student studying at Delhi Metropolitan Education, Guru Gobind Singh Indraprastha University.
This essay is a part of the Spring'26 issue of The India Way—'Breaking Point: India and the Future of World Order'