By the time 45-year-old Kandi Venkanna was brought to the Government Area Hospital in Bhadrachalam, the brutal summer heat had already taken a devastating toll on his body.

Venkanna, a daily wage labourer and resident of Subash Nagar Colony in Bhadrachalam of Telangana’s Bhadradri Kothagudem, had been working at a construction site under the relentless afternoon sun when he suddenly complained of uneasiness and exhaustion before collapsing at the site. At the hospital, he was immediately wheeled into the ICU where doctors began treatment. Within minutes, he died.

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 such as exhaustion, dizziness and uneasiness are becoming increasingly common among labourers forced to spend long hours outdoors despite extreme heat conditions.

Across Telangana, temperatures have repeatedly crossed 46C over the past few weeks, with districts in north and eastern Telangana recording some of the harshest heat conditions this season. But beyond India Meteorological Department (IMD) warnings, temperature charts and government advisories lies a deepening public health crisis unfolding across construction sites, farms, roadside markets, traffic junctions and overcrowded urban neighbourhoods where thousands continue working in oppressive heat — because stopping work is simply not an option.

By early afternoon in Hyderabad, the heat rises not just from the sky but from the roads themselves. In Old City, tourists, shoppers, hawkers and commuters continue moving through the crowded lanes under the punishing sun. Near the entrance of Laad Bazaar, 52-year-old fruit vendor Mohammed Kareem wipes sweat from his forehead before pouring water over a carefully arranged stack of Totapuri mangoes on his cart to keep them from shrivelling in the heat.

Like thousands of street vendors across Hyderabad, Kareem spends nearly 8 to 10 hours every day outdoors. By late afternoon, he says dizziness, headaches and exhaustion have become routine. Business slows as temperatures rise, but leaving early is rarely an option. “It often feels like fire is raining from the skies. But if we don’t sit here, how will we earn,” he asks.

For thousands of vendors, delivery workers, sanitation staff, traffic police personnel and daily wage labourers, summer is no longer merely uncomfortable; it is now a test of endurance played out on roads, markets, traffic junctions and construction sites across the city.

Behind these scenes unfolding across Telangana lies a growing concern within the State administration over the rising number of suspected heatstroke deaths.

According to the Revenue (Disaster Management) Department, the State has so far reported 19 suspected heatstroke deaths during the ongoing summer season, of which only one has been medically confirmed as a heatstroke fatality. Department Secretary Hari Chandana Dasari says all reported cases undergo detailed medical verification before being officially categorised as heatstroke deaths.

District authorities regularly send reports to the State government, but official confirmation depends on accompanying medical certification establishing heatstroke as the cause of death, she explains.

Human toll of an unforgiving summer

However, data gathered from District Medical and Health Officers (DMHOs) across Telangana indicates that the number of suspected heat-related deaths may be significantly higher than the official figures presently reflect. The data shows at least 48 suspected heatstroke deaths have been reported across the State this summer, though 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 fatalities pending verification. Neighbouring Kumaram Bheem Asifabad district has reported five such deaths while 142 patients with suspected heatstroke symptoms have already been treated in outpatient (OP) departments.

Mahabubabad and Mulugu districts have each reported 13 suspected heatstroke deaths linked to extreme heat conditions. In Peddapalli district, authorities said six such deaths had been recorded so far. Post-mortem examinations have been conducted in four cases with samples sent for forensic analysis and final reports pending.

In Nagarkurnool district, officials reported three suspected heatstroke deaths and said 151 patients with suspected heat-related illnesses were treated at outpatient facilities.

District officials say confirming a heatstroke death often takes considerable time since forensic analysis and medical verification can take several weeks. “The reports are sent for forensic examination and in many cases, the confirmation may take up to a month. That is why these deaths are initially categorised as suspected before they are medically confirmed,” a district official points out.

The capital city, however, has not officially reported any confirmed or suspected heatstroke deaths so far. Hyderabad DMHO J. Venkati attributes this partly to comparatively lower temperatures in the city than several northern and eastern Telangana districts that have repeatedly breached the 46C-mark during the current heatwave spell.

Officials acknowledge another challenge complicating heatstroke reporting this year. Following the State government’s announcement of ₹4 lakh ex-gratia for bereaved families of confirmed heatstroke victims, authorities say they have also been receiving claims in cases where deaths were caused by unrelated medical conditions.

“We have to be extremely careful while certifying these deaths because there is a proper verification mechanism in place,” an official says.

One of the biggest challenges in officially declaring a heatstroke death is the lengthy process involved in medically linking a fatality directly to extreme heat exposure.

Under guidelines issued by the National Programme on Climate Change and Human Health and followed by Telangana Health authorities, a death cannot immediately be classified as a confirmed heatstroke fatality merely because it occurred during hot weather. Doctors and investigators are required to establish multiple clinical and environmental factors before certifying heat as the cause of death.

As per the guidelines, for a death to be confirmed as heatstroke-related, the patient must have recorded an ante-mortem core body temperature of at least 40.5C, altered mental status and no alternate definite diagnosis. Investigators must also establish environmental exposure, including whether the individual was working under direct sunlight, engaged in vigorous physical activity or exposed to heatwave conditions when symptoms began.

“In many cases, however, patients are brought to the hospital after attempts have already been made to cool their bodies using water or ice, which can reduce recorded body temperature and complicate diagnosis. Such cases are therefore categorised as suspected heatstroke deaths until further medical confirmation is completed,” says Ravi Babu, District Coordinator of Health Services, Bhadradri Kothagudem.

Apart from medical investigation, Telangana’s verification process also involves administrative scrutiny. A separate ‘Three Member Committee Proforma for Sunstroke’ requires certification by a medical officer, sub-inspector of police and tahsildar before a heatstroke death is formally processed.

Warning map for a hotter 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 describes heatwaves as 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 of Telangana’s 612 mandals are considered relatively safe from heatwave conditions. The remaining 588 fall under varying levels of vulnerability, including six categorised as severe, 106 as critical and 189 as semi-critical. The report estimates that nearly 1.6 crore people currently live in severe, critical and semi-critical heatwave zones.

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 categorises the city as facing moderate heatwave risk but with a ‘strong urban heat island’ effect caused by dense construction, concrete surfaces and heat retention across the city.

The Heatwave Action Plan identifies outdoor workers in construction, agriculture, sanitation and transport sectors among the groups most vulnerable to extreme heat conditions. It also notes that over 31,897 Anganwadi centres and 4,076 mini Anganwadi centres across Telangana remain vulnerable to heatwaves, raising concerns over disruptions to nutrition services and maternal and child healthcare delivery during peak summer.

The action plan also contains data on officially recorded heatwave deaths in Telangana over the past seven years. According to it, the State recorded 10 heatstroke deaths in 2019, six in 2020, three each in 2021 and 2022, six in 2023, 10 in 2024 and eight deaths in 2025.

However, the National Crime Records Bureau (NCRB) report for 2024 presents a sharply different picture. According to NCRB data released in May, the State recorded 116 heatstroke deaths during 2024 — 98 men and 18 women.

This figure is dramatically higher than the 10 deaths acknowledged 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 monitoring mechanisms, identifies district-level vulnerabilities more clearly 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 prolonged outdoor exposure during peak afternoon hours, stay hydrated and immediately seek medical attention if symptoms of heat-related illness appear.

“As part of the preparedness measures, special beds, intravenous (IV) fluids and essential medicines have been arranged across government hospitals to handle heat-related emergencies. Oral Rehydration Solution (ORS) sachets have also been distributed through Auxiliary Nurse Midwives, Accredited Social Health Activists and Anganwadi workers across Telangana,” says Director of Public Health B. Ravinder Nayak.

Relief on paper, gaps on the ground

However, questions remain over how consistently many of these measures are being implemented on ground. The action plan itself directs the Telangana State Disaster Management Authority to regularly monitor and review heat mitigation measures across districts. But activists say there is little public clarity on how frequently such reviews are conducted or how effectively local-level interventions function during peak summer conditions.

One of the simplest yet most critical measures recommended under the heatwave response strategy is the provision of accessible drinking water facilities in public spaces. Across Hyderabad this summer, hundreds of temporary drinking water stalls, locally known as chalivendrams, have been set up by NGOs, private organisations and local communities, often drawing crowds during peak afternoon hours.

But gaps in official infrastructure remain visible. In Tarnaka, for instance, a public drinking water facility operated by the Hyderabad Metropolitan Water Supply and Sewerage Board at a pump house remained locked through the day despite soaring temperatures, highlighting the uneven implementation of basic heat mitigation measures across the city.

The numbers may continue to remain disputed between suspected deaths, confirmed fatalities 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 no longer cool even after sunset.