As of January 2026, Indore, the country's cleanest city, is swamped with the news of an Indore Public Health emergency after the massive contamination of water across the city in the Bhagirathpura area. The epidemic of acute gastroenteritis has caused several deaths, including among infants and elderly people, and has impacted thousands of households. While immediate concern has been the lack of life (in terms of mortalities) and the quality of infrastructure, the mental health of affected families, which is less visible and has a longer-lasting effect, remains unaddressed for the most part. This policy brief focuses on the failure of urban water governance leading to the outbreak and the psychological trauma caused by such preventable deaths and intervention for combined public health and mental health responses.

A Crisis in India’s Cleanest City

With multiple wins, Indore has consistently occupied the first position under India's cleanliness surveillance initiative of the Swachh Survekshan awards, and this has created a public sense of good urban governance. However, the contamination crisis in Bhagirathpura reflects some critical poles beneath matrices of sanitation at the surface. More than 2,000 residents reported symptoms of serious vomiting and diarrhoea (more than 150 were hospitalised). Official numbers confirm at least seven to 10 deaths, including that of a six-month-old baby, exacerbated by the lethal effects of systemic neglect.

Scale of the Outbreak and Human Cost

The emergence of waterborne disease was too much for local healthcare facilities to handle within days. Families told entire households sick at the same time, leaving caregivers to make impossible choices between seeking medical help and caring for other members of the sickened family. For the families who lost babies and old people, the shock was added to by the knowledge that the deaths were preventable. Such experiences are remarkably linked with complicated grief, guilt, and prolonged psychological distress.

 Infrastructure Lapses and Governance Failure

Investigations by the Indore Municipal Corporation showed a drinking water pipeline had broken just below the toilet from a police checkpoint. The lack of requirement for any septic or safety tank, therefore, permitted raw sewage to seep into the water supply. Internal records have revealed further that the tender process for a fresh supply line, conducted in the month of August 2024 under the AMRUT scheme, deteriorated further and stayed stalled for more than a year because of the delays in funding. Emergency repairs only started once people had died, indicating a trend of reactive instead of preventative government.

Mental Health Impact: Invisible Scars on Families

While the physical effects faded away for many of the survivors, the psychological effects are still with them. Parents who lost babies report post-traumatic stress symptoms of intrusive recollections and fear of water consumption. Elderly caregivers who experienced the loss of spouses or dependent ones are at increased risk of suffering from depression and social withdrawal. In low-income urban communities, the consequences of such trauma are not usually addressed through formal mental health services, so the chances of severe impairment in the long-term.

Bhagirathpura Families

Interviews shared by the local media show that families living in Bhagirathpura are still using water supplied by bottles or water tankers months into the outbreak, indicating an erosion of trust in public utilities at a very deep level. For bereaved families, the impact of dealing with municipal systems are reminders of institutional failure everywhere. The lack of psychological counselling or grief support from the community is a further contributing factor that fuels the damage inflicted by the outbreak.

Government and Legal Response

The Madhya Pradesh High Court issued an order in which it asked the authorities to make immediate arrangements for the supply of clean water and free medical treatment. The state government had declared ex gratia compensation of one lakh for the family of the dead. Administrative action, which involved firing a PHE sub-engineer and suspending top officials, and a high-level inquiry. While these steps address accountability, there is no explicit mention of mental health rehabilitation of the affected families.

Policy Gaps and Structural Lessons

Weaknesses in systemic monitoring of urban water safety, defined as a home, system, or framework within which urban water quality requirements are represented by data and infrastructure, and accountability flows, as the Indore crisis reveals. Crucially, disaster response frameworks continue to be narrowly focused on physical health outcomes, thereby willfully ignoring the psychological aftermath of preventable public health disasters. Without institutionalised mental health support, these affected populations are left to cope with years of trauma.

Intergenerational Trauma and the Loss of Trust

Beyond immediate grief and concern, the Indore water contamination crisis has the potential for long-lasting, intergenerational psychological impacts. Families that lost infants or elders also frequently describe a feeling of betrayal, which they have felt for public institutions ever since, especially that of municipal water authorities and the structure of ‘real' power. This is not just an erosion of trust on an emotional level, but also has practical consequences. Parents report an ongoing issue of fear surrounding tasks as simple as making infant formula and cooking food, or allowing children to drink tap water. Such high-level hypervigilance is consistent with trauma-related stress responses. Invisible Scars: The Mental Health Toll on Families Who Lost Elders and Infants to Preventable Diarrhoea, which could affect how future generations come to view the public services and state responsibility.

Gendered Burden of Psychological Distress

The mental health burden of the outbreak has been disproportionately borne in households. Women (especially mothers and daughters-in-law) have a disproportionate emotional workload of being primary caregivers for both infants and elderly family members. In the situation of death, they often feel compounded guilt and feelings that they did not do a good job in their caring role, despite structural causes beyond their control. This gendered pattern of distress captures a larger pattern of inequities in unpaid care work and points to the need of gender sensitive mental health interventions in cases of public health crises.

Urban Inequality and Differential Exposure to Risk

The outbreak in Bhagirathpura highlights the way in which discrimination in cities increases vulnerability to the problems in health and wounding of the psyche. Lower-income neighbourhoods are more likely to only have access to municipal water supplies, no access to private healthcare, and live in densely-populated housing where disease spreads quickly. When contamination occurs, these communities are exposed to both greater exposure and fewer coping resources. The psychological effect of preventable deaths is therefore inextricable from the questions of spatial injustice and unequal planning in the city.

Silence Around Mental Health in Disaster Governance

Despite increased awareness about mental health as a public health priority, there is nothing but an overwhelmingly biomedical and infrastructural approach to the incorporation of mental health in disaster response frameworks in India. Official responses focus on water testing, fixing the pipelines, and amounts of money paid as compensation, and psychological rehabilitation is not talked about as much in public briefings or court orders. This silence reinforces stigma surrounding mental health, as well as saying that emotional suffering is secondary to physical recovery. The embedded indicators of mental health within disaster assessment would be a very significant step towards holistic governance.

Long-Term Economic Consequences of Psychological Trauma

Untreated psychological distress also has economic costs, beyond the cost to an individual in personal suffering. Caregivers who are depressed, anxious, or suffer from prolonged grief will often lose work time, may need to incur higher healthcare costs, and withdraw from socialisation. In communities where there were already incomes that previously had wedges, all the worst of these consequences can exacerbate a cycle of impoverishment. We must see mental health support as an economic investment, not an addition to welfare for which no one really has the budget after a public health failure to take place.

Rebuilding Public Confidence Through Transparent Communication

In reacting to a preventable disaster, restoring trust is something more than fixing some infrastructure. Transparent communication to inform the public and others through communication about failure, accountability measures, and, in the future, safeguards remains central to psychological recovery. In the absence of clear and empathetic communication, there are still rumours and fear instead, which prolongs distress. Evidence from disaster psychology suggests that acknowledging harm to people in a timely way and being seen to be fixing their problems can go a long way towards relieving the impact of long-term trauma on affected populations.

Policy Recommendations

Policy responses will need to incorporate the issue of mental health in public health disaster management. This includes mandatory psychological first aid to affected families, long-term counselling services, transparent communication for restoring trust, and proactive infrastructure audits. Compensation mechanisms should include mental health rehabilitation as well as financial relief.

The Indian crisis of water contamination in other cities is not only a failure of infrastructure but a failure to protect human dignity. The infant and elderly being taken away by preventable diarrhoea leaves a psychological scar, with no statistics. The treatment of these invisible scars demands a move away from the reactive approach to governance and towards a preventive approach that is people-centric and views mental health as an integral part of public health.

References

• World Health Organisation (2017) Guidelines on Sanitation and Health.
• UNICEF (2022) Water, Sanitation and Hygiene and Mental Health.
• National Institute of Mental Health and Neurosciences (2021) Disaster Mental Health in India.
• Ministry of Housing and Urban Affairs (2024) AMRUT Mission Guidelines.

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