Environ. Res.: Health 3 (2025) 015007 https://doi.org/10.

1088/2752-5309/ada17d

PAPER

Heatwave induced health vulnerability assessment in Bangladesh

OPEN ACCESS
Maria Mehrin1,∗, Fatema Tuz Zuhra2 and Md Mafizur Rahman3
RECEIVED 1
BUET-Japan Institute of Disaster Prevention and Urban Safety (BUET-JIDPUS), Bangladesh University of Engineering and
6 July 2024
Technology, Dhaka, Bangladesh
REVISED 2
Department of Urban and Regional Planning, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
23 October 2024 3
Department of Civil Engineering, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
∗
ACCEPTED FOR PUBLICATION Author to whom any correspondence should be addressed.
19 December 2024
E-mail: maria@jidpus.buet.ac.bd, zuhratuz108@gmail.com and kaisar@ce.buet.ac.bd
PUBLISHED
10 January 2025
Keywords: adaptive capacity, Bangladesh, heat waves, health, sensitivity, vulnerability

Original content from

this work may be used
under the terms of the Abstract
Creative Commons
Attribution 4.0 licence. Heatwaves emerge as a substantial environmental hazard, posing a severe threat to public health,
Any further distribution especially in the tropical countries of South Asia. Despite Bangladesh’s susceptibility to natural
of this work must
maintain attribution to disasters, including unprecedented temperature surge, heat stress lacks official recognition as a
the author(s) and the title disaster. This study aims to assess the spatial distribution of health vulnerability to heat waves at
of the work, journal
citation and DOI. the district level in Bangladesh. Utilizing a framework incorporating exposure, sensitivity, and
adaptive capacity, the vulnerability index score for each district was computed. The study selected
indicators by first reviewing relevant literature to identify key factors contributing to vulnerability
to heatwaves. The final selection of 14 indicators, three for exposure, seven for sensitivity, and four
for adaptive capacity, was made independently by the authors after consulting with experts and
considering data availability. The entropy weight method, known for its objectivity in
decision-making, was applied to assign weights to each indicator. The results indicated that the
southwestern region and a portion of the northwestern part of Bangladesh are particularly exposed
to heatwaves, with Kurigram identified as the most sensitive to heat. This heightened sensitivity is
driven by a high floating population density, significant engagement in agriculture, and high
population density. The districts most susceptible to heatwaves due to a combination of high
sensitivity and low adaptive capacity include Barisal, Lakshmipur, Kishoreganj, Narayanganj,
Narsingdi, Tangail, Jamalpur, Netrakona, Sherpur, Naogaon, Dinajpur, Kurigram, and Rangpur.
These areas are likely to face the greatest impact from future heatwaves. This research facilitates
strategic resource allocation by by identifying vulnerable districts and offering insights into the
underlying causes, thereby supporting policy development and fostering international
collaboration.

1. Introduction

Heatwaves represent a significant threat as a natural hazard in the context of ongoing climate change [1, 2].
The Sixth Assessment Report of the United Nations Intergovernmental Panel on Climate Change (IPCC)
concluded the rise of the frequency and intensity of heatwaves with certainty and these events are predicted
to occur more frequently in the near future [3]. Simultaneously, the natural climate phenomenon, El Niño,
has the potential to set new temperature records, especially in regions already characterized by above-average
temperatures [4]. Continuous heatwaves undoubtedly pose a threat to sustainable development and human
safety, notably elevating risks of illness and mortality [5]. According to the World Health Organization,
without adaptation to climate change, heat is projected to cause 92 207 additional deaths globally for people
aged 65 and over by 2030. This number is expected to rise to 255 486 by 2050 [6]. The organization reported
an increase in the number of people exposed to heatwaves by approximately 125 million between 2000 and
2016 [7] and up to 2.8 billion people may face exposure to heatwaves by 2090 under a high-warming

© 2025 The Author(s). Published by IOP Publishing Ltd

Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

scenario, as per the analysis by the International Organization for Migration’s Global Data Institute. Notably,
about half of the individuals at risk (up to 1.3 billion) are projected to reside in South Asia.
Bangladesh, a country located in South Asia, experienced some of the warmest temperatures on record in
2023. Between April and July, typically the warmest months, the average temperature is around 28 degrees
Celsius, with highs typically ranging from 30 to 35 or 36 degrees Celsius. However, in 2023, there was a
notable increase in temperatures, often exceeding 35 degrees and occasionally reaching beyond 40 degrees
[8]. The Bangladesh Meteorological Department declared a heatwave following the unprecedented
temperature spike in April 2023 in Dhaka, hitting 40.5 degrees Celsius, the highest recorded in the past
58 years [9]. Moreover, as one of the most densely populated countries actively undergoing significant
developmental activities, this issue is anticipated to worsen over time.
Exposure to heat can lead to a spectrum of health effects, ranging from minor illnesses to heightened
risks of hospitalization and mortality [10]. Although Bangladesh has extensive experience in addressing
cyclones and floods, until now, heat stress has not been adequately considered. Moreover, there is a lack of a
maintained database on heat-related deaths in the country. Responding to heatwave events (HWE) in public
health requires detailed information. This data is essential for the development of effective policies and
programs that specifically address the vulnerability of local populations and communities. The report
‘Climate Change 2022: Impacts, Adaptation, and Vulnerabilities’ under the IPCC highlights the crucial need
for heat health vulnerability assessments to comprehensively understand the risks and impacts of climate
change on human welfare, particularly for impoverished individuals [11]. Furthermore, Sustainable
Development Goal 3 emphasizes the need for increased research and development in health financing, and
the mitigation and management of health risks and vulnerability [12].
Global studies have highlighted that the health vulnerability of heatwaves differs based on variations in
the spatial variability of high temperatures and the social and economic characteristics of populations and
communities. For instance, Zhu et al [13] assessed vulnerability in Guangdong, China by calculating the
multiplicative vulnerability index (VI) and revealed varying levels of vulnerability across districts. Azhar et al
[14] conducted a similar comprehensive assessment of heat vulnerability across India by evaluating
demographic, socioeconomic, and environmental factors contributing to vulnerability at the district level.
The study showed that highly vulnerable districts had more urbanization, higher literacy rates, and better
access to water, sanitation, and household amenities. The factor of urbanization and improved infrastructure
can both mitigate and exacerbate vulnerability depending on the specific socioeconomic and environmental
dynamics [15]. While higher amenity levels can indicate better living conditions, they do not always equate
to lower vulnerability if the underlying economic systems are fragile or if communities are heavily reliant on
climate-sensitive sectors like agriculture [16, 17]. Zhang et al [18] developed a model for China, highlighting
healthcare and living environment factors as the important influencing factors of regional vulnerability.
Soomar and Soomar [19] conducted a literature review to develop and validate a heat vulnerability tool for
Pakistan. In Bangladesh, various studies [20, 21] revolved around the impact of rising temperatures on public
health. Since the public health infrastructure of Bangladesh is already struggling, it is crucial to acknowledge
the following warnings: elements such as population growth, socio-economic circumstances, the capacity of
healthcare systems, urbanization, alterations in land use, and the depletion of freshwater resources can
greatly influence the effects of heat waves [22]. Thus, a dedicated health vulnerability assessment considering
the diversity among regions is essential before delving into discussions regarding the impact of heat wave
change on health. However, only one study [23] investigated the spatial distribution of heatwave vulnerability
in Chattogram City Corporation, the commercial capital of Bangladesh. Given these circumstances, this
study aims to assess the spatial distribution of health vulnerability to heat waves at the district level in
Bangladesh, where the spatially heterogeneous nature of vulnerability is the prime focus. Such a study would
be instrumental in understanding the specific vulnerabilities of different regions within the country and in
formulating targeted strategies to mitigate the impacts of extreme temperatures on public health.

2. Materials and methods

2.1. Study area

The study area of this research is all 64 districts of Bangladesh, covering a total area of 147 570 square
kilometers. Bangladesh is situated in the northeastern region of South Asia, positioned between 20◦ 34′ and
26◦ 38′ north latitude and 88◦ 01′ and 92◦ 41′ east longitude. It shares its borders with India to the
west-north and northeast, Myanmar to the southeast, and the Bay of Bengal to the south [24]. This region is
characterized by dynamic geography, predominantly shaped by riverine features. As a developing country
with a special geographic location and features, Bangladesh is very susceptible to the negative impacts of
climate change. It is located in the subtropical monsoon region with seven distinct zones based on diverse
climatic conditions [25]. According to the study, districts of the southeastern zone, including Cox’s Bazar,

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Bandarban, Rangamati, Khagrachori, Bhola, Patuakhai, Feni, Noakhali, experiences moderate temperatures,
heavy rainfall, and substantial winter dew. The northeastern zone (Moulvibazar, Sylhet, Sunamganj) has a
similar temperate but with higher humidity, frequent fog, and appreciable winter rain. The northern part of
the northern region of the country witnesses extreme temperatures, scorching summers, and very wet rainy
seasons. Similarly, the northwestern zone, consisting of Dinajpur, Bogra, Pabna, and Kushtia districts, has
hot summer temperatures and moderate rainfall. On the other hand, the western zone is the driest and
warmest sub-zone, encompassing the greater Rajshahi districts as well as portions of neighboring districts.
This zone’s climatic traits include very hot summer temperatures and relatively minimal rainfall.
The southwestern Zone includes the districts of Khulna, Jessore, and Faridpur, characterized by relatively
moderate extremes in temperature and rainfall. The climate features hot summer temperatures and fairly
heavy rainfall. Additionally, the south-central zone serves as a transitional area, experiencing abundant
rainfall, moderate temperatures, and vulnerability to severe weather events [26].
Notable variability is observed in demographic and socioeconomic features in different parts of the
country. For instance, according to the 2022 Population and Household Census, the highly dense Dhaka
district in the Dhaka division contrasts with Chittagong Hill Tracts (Rangamati, Bandarban & Khagrachori
districts) in the Chattogram division, where the lowest population density is recorded [27]. Moreover, there
are noticeable regional differences in the distribution of the development budget, suggesting that certain
areas in Bangladesh have experienced more substantial development than others [28]. This underscores the
diverse nature of Bangladesh. The vulnerability to heat waves is contingent not only on spatial meteorological
attributes but also on socio-economic conditions. The unique socio-economic features of the country can
lead to varying levels of vulnerability across different regions. This study is crucial for understanding how 64
districts respond to extreme temperature events, given their existing resilience and susceptible characteristics.

2.2. Vulnerability assessment framework

The vulnerability framework is extensively used in research, particularly in the context of hazards and
disasters induced by climate change. Cutter [29] associated vulnerability to related notions such as
adaptability, susceptibility, marginality, resilience, fragility, and risk. It is described as a state of risk where the
capacity of individuals and locations to respond to environmental hazards and adverse changes is
diminished. Weichselgartner [30] presented vulnerability as an inclusive approach involving natural, social,
and engineering systems and their intricate interconnections. Vulnerability tends to vary spatially; hence, it is
crucial to implement different measures in different locations, considering variations influenced by
circumstances and geographic factors. Identifying regions with sufficient risk and susceptibility to natural
hazards becomes easier through vulnerability assessments [31].
As per the IPCC, vulnerability is characterized as an intricate and multi-dimensional concept that
indicates the extent to which a system is susceptive to climate change or related extreme events. The function
of vulnerability involves both the exposure of a system to climate stressors and its sensitivity to those
stressors, as well as its adaptive capacity or ability to cope with and respond to the impacts [32]. The
framework for assessing vulnerability plays a vital role in the context of climate change by facilitating an
understanding of the varying impacts across different regions, societies, ecosystems, communities, and
sectors.
Since the study emphasized the vulnerability to heat waves which is related to climate change, the IPCC’s
definition of vulnerability is considered. In this study, the framework of vulnerability assessment is implied,
including exposure, sensitivity, and adaptive capacity.
Vulnerability to heat waves depends on two main factors: the level of exposure to heat waves in a
particular area and the socio-economic characteristics of the population living there. Sensitivity and adaptive
capacity, as identified by [13], are two socioeconomic factors. Heat exposure is the level of contact a person
has with an environment where elevated temperatures are present. Personal heat exposure involves
interaction with indoor or outdoor settings, considering factors like air temperature, radiative load,
atmospheric moisture, and air velocity, posing a risk of increased body core temperature or perceived
discomfort [33]. Exposure to local heat waves is a crucial factor for vulnerability. Once the condition of high
temperature is met, the combination of sensitivity and adaptive capacity components further determines the
specific vulnerability level. Sensitivity, as defined by Zhu Q et al and Kuras et al [13, 32], quantifies the extent
to which a system is affected, either positively or negatively, whereas adaptive capacity is a system’s ability to
mitigate potential damages, seize opportunities, or deal with the consequences.

2.3. Data collection

Although the vulnerability frameworks were applied differently in different literature, the main concepts
were similar and equivalent. A set of indicators for each component of the vulnerability framework was
chosen based on previous research [13, 32, 34] and the local context of developing countries. The process was

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Table 1. Selected indicators for vulnerability assessment and their sources.

Source and
Indicator Variable year Derivation procedure Unit

Air temperature • Calculate the average Degrees Celsius (◦ C)

of Air temperature
and relative
humidity for each
month by dividing
the total number by
Relative humidity BMD 2017–21 5 (the number of Percentage
(March–May) years).
Exposure to heat • To get the overall
average for the three
montds, sum the
monthly averages
and divide by 3.
USGS 2022 Derived from the satel-
Land surface temperature (21 April) lite image Degrees Celsius (◦ C)

Population density Pop/sq km

No. of people engaged in
agriculture Number of people
Illiteracy rate Percentage
Percentage of the population
living below the poverty Directly derived from
Sensitivity of heat threshold BBS 2022 the data source Percentage
Floating population Pop/sq km
Female population Pop/sq km
Dependency ratio Percentage

Percentage of green space USGS 2022 Area calculated from

Sq km
Percentage of water bodies (21 April) the satellite image
Adaptive capacity No. of medical facilities Directly derived from
to heat BBS 2022 Number
No. of health professionals the data source

initiated by searching relevant studies to determine the vulnerability to specific hazards. The final selection of
indicators was done independently by authors following a discussion with an expert in the related field and
based on data availability. Fourteen indicators (table 1) were chosen: three for exposure, seven for sensitivity,
and four for adaptive capacity. These indicators accurately represent the vulnerability of the population to
heat waves in diverse regions. They are practical and can be readily applied in real-world scenarios. There are
no constraints in accessing the necessary data for these indicators.
For exposure, the maximum air temperature, relative humidity, and land surface temperature (LST) were
selected. The air temperature is the most direct measurement of heat exposure [35, 36]. However, for the
assessment of heat islands, LST is more suitable because it focuses on the surface level with high spatial
resolution [37]. Moreover, the interaction between land surface characteristics (like vegetation cover, water
bodies, and urbanization) and HWEs is better estimated. This study incorporated both aspects of heat
calculation in order to obtain an inclusive result. Humidity is another important contributor to heat stress as
it exacerbates the effects of heat waves by reducing the body’s ability to cool through sweat evaporation [38].
Different social, economic, and demographic factors are considered to identify the sensitivity of the
population to the heatwave. Besides population density and illiteracy rate, the occupation of the people is an
essential factor. Almost 37% of the population of the country is engaged in the agricultural sector, which is
the largest around the rural area [39]. This category includes day labor, farming, and fishing, which are
mostly outdoor works. Females and populations more than 65 years old and less than 12 years old are
considered another vulnerable group with higher sensitivity [40]; thus, dependency ratio and female
population density have been added. People who are displaced or migrants frequently do not have access to
adequate shelter or treatment, which makes them more susceptible to heat exhaustion. The floating
population represents their group. The population living below the poverty threshold is another significant
factor because poor people lack access to any facilities and have to live a basic lifestyle. Green spaces help
reduce local temperatures through shading and evapotranspiration, acting as natural cooling zones;
waterbodies hold the temperature and reduce stress. Water bodies such as ponds, lakes, rivers, canals, and
reservoirs are considered to influence climates by regulating temperature and humidity levels through

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evaporation, heat convection, which circulates warm and cool air; and solar radiation absorption. These
bodies of water act as natural cooling systems by absorbing solar energy during the day and releasing it at
night, which helps mitigate the effects of extreme heat in urban areas. Additionally, their ability to humidify
the air contributes to moderating microclimates, making them essential features in heat-prone regions [41].
A higher number of medical facilities, along with trained health professionals, ensures a better capacity to
manage and treat heat-related health issues, especially in extreme conditions. Hence, these factors are
included in the adaptive capacity indicator.
Data associated with the selected indicators were collected district-wise from three different sources.
Most of the census data was obtained from the Bangladesh Bureau of Statistics (BBS). Data on maximum air
temperature and relative humidity were collected from the 35 weather stations operated by the Bangladesh
Meteorological Department (BMD) for the months of March to May during the period 2017–21 because
these months are regarded as the warmest months in Bangladesh. Given the study’s focus on assessing the
entire country, the Inverse Distance Weight interpolation technique was employed through ArcGIS to
estimate values for the entire region. Subsequently, the ArcGIS zonal statistics tool was utilized to obtain
district-wise air temperature values. On the other hand, as mentioned earlier, the highest temperature was
recorded on 21 April 2023; satellite images of this particular day were utilized. Lastly, the calculation of land
cover distribution also relied on remotely sensed images acquired from the USGS website. A total of 18
satellite images were acquired from the official USGS website for Landsat 8 (OLI/TIRS) to provide complete
coverage of Bangladesh. Additionally, a key criterion in the image selection process was ensuring a cloud
cover of less than 10% [42]

2.4. Data analysis

2.4.1. Data normalization
To avoid potential issues of using indicators measured in different scales, data was normalized using the
following formula derived from [43].

X − Xmin
X′ = . (1)
Xmax − Xmin

In equation (1), X ′ is the normalized value of indicator X which is obtained by the maximum and
minimum value of each indicator pool.

2.4.2. Determination of weightage for indicators

Indicator weighting is the most sensitive step for index construction. Weighting methods for determining the
importance of criteria can be categorized into three groups: (1) subjective methods, where the experts assign
importance to the criteria; (2) objective methods, where the experts have no role in determining the
importance of the criteria, and (3) combined weighting schemes that integrate elements from both subjective
and objective methods [44]. Due to the varying impacts of different indicators on heat health vulnerability,
this research employed the entropy weight method, an objective method, to accurately reflect the influence of
each indicator, which is widely used in decision-making studies. It is a mathematical approach to objectively
determining the weight of factors, avoiding the biases of human judgment. Entropy weightage assesses the
variability and diversity within the set of criteria. It evaluates the degree of spread or dispersion among the
criteria values [45]. This method is well-accepted for its data-driven, objective nature in measuring the
dispersion value. It is responsible for producing a dependable output in the study of water quality
assessment- [46], different vulnerability assessments for the eco-environment [47], heat, [48, 49], climate
change [26], traffic flow prediction [50]. As opposed to other subjective weighting models (i.e. AHP, FAHP,
SMART) the EWM method holds the advantage of eliminating human biases. The transparency of EWM’s
weight calculation allows for easy explanation and defensibility, distinguishing essential indicators from
peripheral ones which leads to a robust assessment of vulnerability in different regions of Bangladesh.
Criteria with higher variability are considered more important as they contribute more information to
the decision-making process. This technique was executed utilizing RStudio using the following code:

Library (creditmodel)
entropy_weight (dat = name of the dataset),
pos_vars = c(index of positive direction variables),
neg_vars = c(index of negative direction variables) .

According to the analysis, exposure is the largest contributor, followed by adaptive capacity and
sensitivity. Among the indicators, the floating population per sq. km carries the highest weight in the

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Table 2. Weights of indicators for vulnerability assessment index in Bangladesh.

Target layer Component layer Indicator layer

Component Weight Indicator Weight

Air temperature 0.316
Exposure 0.426 Humidity 0.336
Land surface temperature 0.348
Population density 0.1282
Vulnerability to
No. of people engaged in agriculture 0.123
heat waves
Sensitivity 0.240 Illiteracy rate 0.0432
Percentage of the population living 0.076
below the poverty threshold
Floating population per sq km 0.4714
Female population per sq km 0.117
Dependency ratio 0.040
Percentage of green space 0.222
Adaptive capacity 0.334 Percentage of water bodies 0.229
No. of medical facilities 0.135
No. of health professionals 0.413
(Source: Author, 2023).

sensitivity component, indicating its significant influence on the vulnerability assessment. Similarly, the
number of health professionals holds substantial weight within adaptive capacity, emphasizing its critical role
in reducing vulnerability. Other notable indicators include LST, percentage of water bodies, and population
density, which play important roles in determining exposure and sensitivity. In contrast, indicators such as
the illiteracy rate, dependency ratio, and percentage of the population living below the poverty threshold
have lower weights, suggesting their comparatively lesser impact on the overall vulnerability assessment. The
weights of each indicator are shown in table 2.

2.4.3. Calculation of VI
After conceptualizing the vulnerability based on the framework mentioned in section 2.2, an index value for
health vulnerability to heat waves was calculated. The index equation developed by Balica & Wright (2010)
was used in this study [51].

Vulnerability = (Exposure ∗ Sensitivity) /Adaptive Capacity.

The index for each component for each district, including the exposure index (EI), sensitivity index (SI),
and adaptive capacity index (AI), was computed using the following equations to calculate the VI,

∑
n =3
EI = Wei Qei (2)
i =1
∑
n =7
SI = Wsi Qsi (3)
i =1
∑
n =4
AI = Wai Qai (4)
i =1

W e , W s , and W a are the weights corresponding to each influencing factor of the criterion layer. Qi is the
normalized value of the variables under the influencing factors. Finally, the VI using all these components
was calculated using the following equation,

EI ∗ SI
VI = (5)
AI
VIj = Vulnerability index
EIj = Exposure Index

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

SIJ = Sensitivity Index (SI)

AIj = Adaptive Capacity Index.

A higher VI indicates a greater negative impact from heatwaves in a specific district. The Vulnerability
Index for each district was divided into three equal categories using ArcGIS for classification. Subsequently,
the spatial distribution of these vulnerability indices was visualized through a thematic map within ArcGIS.

3. Results

This portion presents the outcomes derived from the methodology outlined in the preceding section. The
index value of each component is categorized into three groups for district-wise comparisons.

3.1. Exposure to heat waves

The analysis of the spatial distribution of exposure to heat waves is the prime component in assessing
heat-health vulnerability. The purpose of this assessment is to comprehend the different heat wave situations
at the district level. Since the three variables considered under this component are associated, they
demonstrate almost equal importance in the assessment of heat exposure.
Compared to the east, the western region of Bangladesh is more exposed to heat waves (figure 1),
specially the southwestern region and a portion of the northwestern part. The hottest air temperatures in the
nation, up to 42.6 ◦ C, are frequently known to be recorded in 2024 (Dhaka Tribune, 2024) in districts like
Rajshahi, Jashore, and Chuadanga, the northwestern part of the country. However, when humidity is taken
into consideration for assessment, the whole south-west region is identified as a heat exposed zone. On the
other hand, due to the geographical features of the northeastern part and the existence of hills, the area has
the least exposure to heat waves.

3.2. Sensitivity of districts to heat waves

The analysis of sensitivity to heat waves within districts is a critical component in understanding the
localized impact of rising temperatures. This assessment aims to evaluate the varying degrees to which
different districts are susceptible to the adverse effects of heat waves. District-wise sensitivity to heat waves is
shown in table 3. In Bangladesh, most districts in the central, northern, and southeastern regions, such as
Dinajpur, Rajshahi, and Rangamati, have high sensitivity, while southwestern coastal areas like Khulna and
Satkhira show relatively lower sensitivity. Among these areas, Kurigram stands out as the most sensitive,
characterized by elevated levels of illiteracy rate, agricultural engagement, and the percentage of population
living below the poverty threshold.
Figure 2 highlights the existence of regional disparity in Bangladesh, demonstrating how sensitive factors
like population density, poverty rate, vulnerable population, and agricultural livelihoods vary significantly
across different districts. Notably, floating population density has the highest influence on the sensitivity
assessment. On the other hand, the dependency ratio has the least influence. Population density and
engagement in agriculture also play substantial roles in influencing this sensitivity. The spatial distribution of
heatwave sensitivity in the country is largely dependent upon all these related criteria. These factors
collectively contribute to an increased risk of both human and economic losses resulting from heat waves.
The claim that northern Bangladesh, influenced by several socio-economic factors, is particularly vulnerable
to extreme heat conditions can be supported by the previous literature. A large rural population heavily
reliant on agriculture faces the risk of crop damage and reduced yields during heatwaves, exacerbating food
insecurity [52]. High poverty levels limit access to essential resources, such as cooling systems and healthcare
[53].

3.3. Adaptive capacity of districts to heat waves

Examining adaptive capacity within districts is crucial for understanding the preparedness and resilience of
specific regions in coping with heat waves. This assessment involves a comprehensive analysis of various
factors, including land cover distribution and healthcare access (figure 4). By scrutinizing these elements, this
analysis seeks to ascertain the district’s ability to effectively adapt and respond to escalating temperatures.
In Bangladesh, most districts show low adaptive capacity to heatwaves (figure 3). However, the big urban
areas, including Dhaka, Rajshahi, and Khulna, demonstrate higher levels of adaptive capacity. Khagrachari,
Sherpur, Barguna, Hobiganj, and Pirojpur (table 3), in particular, stand out as having the least capacity,
primarily due to a scarcity of health professionals within the district. Despite these districts having relatively
higher green spaces compared to other districts in the country, the absence of adequate healthcare facilities
worked here as the most significant factor behind being least adaptive [53, 54].

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Figure 1. Spatial distribution of (a) average air temperature (monthly); (b) land surface temperature; (c) average relative
humidity (monthly); (d) heat exposure in Bangladesh (source: base map courtesy of humanitarian data exchange; distribution
and index generated from author’s analysis, 2023).

3.4. Vulnerability index of districts to heat waves

The evaluation of the VI regarding heat waves at the district level is a crucial attempt. It involves a
comprehensive examination of the varying degrees of impact that heatwaves would cause across different
regions. The vulnerability of our studies was not only dependent on the temperature factor but other
socio-economic and environmental conditions as well. The indicators under heat exposure, including Land
surface temperature, maximum air temperature, and humidity are inherently natural and cannot be directly
controlled. However, the indicators of sensitivity and adaptive capacity can be modified through proactive
measures.

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Table 3. Division wise scenario of heatwave induced vulnerability.

Adaptive capacity Vulnerability

Division District Exposure to heat Sensitivity to heat to heat index

Barisal Barguna High Low Low High

Barisal High High Low High
Bhola High Low Low Moderate
Jhalokati High Low Moderate Low
Patuakhali High High Moderate Moderate
Pirojpur High Moderate Low High

Chittagong Bandarban Moderate Moderate Moderate Low

Brahmanbaria High High Moderate Moderate
Chandpur High Moderate Low Moderate
Chittagong Moderate High Moderate Moderate
Comilla High High Moderate Low
Cox’s Bazar Moderate Low Moderate Low
Feni High Moderate High Low
Khagrachhari Moderate Low Low High
Lakshmipur High High Low High
Noakhali High Moderate High Low
Rangamati Moderate Low Moderate Low

Dhaka Dhaka High High High Low

Faridpur High Low Low Low
Gazipur Moderate Moderate Low High
Gopalganj High Low Low Moderate
Kishoreganj Moderate High Low High
Madaripur High Low Low Moderate
Manikganj Moderate Moderate Low High
Munshiganj Moderate Low Low Moderate
Narayanganj Moderate High Low High
Narsingdi Moderate High Low High
Rajbari Moderate Moderate Low High
Shariatpur High Low Low Moderate
Tangail Moderate High Low Moderate

Khulna Bagerhat High Low Moderate Low

Chuadanga High Low High Low
Jessore High Moderate Low High
Jhenaidah Moderate Low Low High
Khulna High Moderate Moderate Low
Kushtia Moderate Low Low Low
Magura Moderate Moderate Low Moderate
Meherpur High Low Low Moderate
Narail High Low Low High
Satkhira High Low Low Moderate

Mymensingh Jamalpur Moderate High Low Moderate

Mymensingh Moderate High Moderate Low
Netrakona Low High Low High
Sherpur Low High Low High

Rajshahi Bogura Moderate Moderate High Low

Chapainawabganj High Moderate Low High
Joypurhat Moderate Low Low Moderate
Naogaon High High Low Moderate
Natore High Moderate Low Moderate
Pabna High High Moderate Low
Rajshahi High Moderate High Low
Sirajganj High High High Low
(Continued.)

Though district-wise sensitivity and adaptive capacity have been discussed in the previous sections, the
vulnerability has to be assessed in a combined way. The districts that have high sensitivity to heat waves while
having low adaptive capacity would be affected the most by heat waves. These districts are- Barisal,

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Table 3. (Continued.)

Adaptive capacity Vulnerability

Division District Exposure to heat Sensitivity to heat to heat index

Rangpur Dinajpur Moderate High Low Moderate

Gaibandha Moderate Moderate Low High
Kurigram Moderate High Low High
Lalmonirhat Moderate Moderate Low High
Nilphamari Moderate Moderate Low High
Panchagarh Moderate Moderate Low Moderate
Rangpur Moderate High Low Moderate
Thakurgaon Moderate Moderate Low Low

Sylhet Habiganj Moderate Low Low High

Moulvibazar Low Low Low Low
Sunamganj Low Moderate Low Low
Sylhet Low Low Low Low
Source: Author, 2023.

Lakshmipur, Kishoreganj, Narayanganj, Narsingdi, Tangail, Jamalpur, Netrakona, Sherpur, Naogaon,

Dinajpur, Kurigram, Rangpur. Moreover, among them, Barisal, Lakshmipur, and Naogaon can be identified
as the most vulnerable since they have high exposure accompanied by higher sensitivity and lower adaptive
capacity. On the other hand, Chuadanga has lower sensitivity and higher adaptability; hence, despite being
highly exposed to heat, this district has less vulnerability. Based on the index value, the most vulnerable
districts are Khagrachhari,Sherpur, Lakshmipur, Barguna, Habiganj, Pirojpur,Narayanganj, Gaibandha,
Manikganj, Netrakona, Jessore, Rajbari, Lalmonirhat, JhenaidahThe results derived from the VI, calculated
using equation (iv), illustrated that heatwave-induced vulnerability cannot be seen as a problem of one
particular zone of the country. The vulnerable districts are spread across the country (figure 5).
The findings of this study are also consistent with the study of Rahman et al (2024) [55], where the result
showed that Rajshahi experienced the most mild heatwaves, followed by Chuadanga, Ishurdi, and Jessore
[52]. Patuakhali exhibited the highest increase in heatwave days, while Chuadanga showed the largest
decrease.
Several other studies can be mentioned that hold conformity with the findings. Buzási [56] in the study
for assessing the heatwave vulnerability of Budapest’s 23 districts using a weighted indicator method with
socio-economic variables and LST, found differences in sensitivity and adaptive capacity between districts,
with downtown areas showing lower vulnerability. Applying LST as a weighting factor significantly altered
the vulnerability distribution.
Wang et al in their study of HWE assessment found that cities with extremely hot weather are more likely
to adapt to the heatwave and have less sensitivity [57]. The results indicated that not all the cities with hot
weather would suffer more from the HWEs, as they may have been adapted to such weather conditions and
then less sensitivity to the HWEs, while those cities with relatively cold weather were more sensitive to
HWEs. Similarly, in our studies, districts like Barguna and Chuadanga turned out to be less vulnerable,
despite experiencing a surge of temperature during peak months [58].

4. Discussion

Research on the evaluation of vulnerability to climate-related hazards has been carried out extensively in
developed countries across many academic fields [13, 19, 34]. This study attempts to present a visual and
conceptual representation of heat wave-induced health vulnerability throughout the country. The
multisource socio-economic and spatial data used in this study has greater replicability in many other
countries, especially developing ones. The health vulnerability to heat waves comes with distinct regional
variations.
The result of heat exposure can be compared to different studies conducted worldwide. In their study of
heat vulnerability in four Indian cities [59], the researchers found that Kolkata and Angul, which are located
on the western side of Bangladesh, were more vulnerable to heat. These regions are especially vulnerable to
the heat threat because of their similar geographic and climatic characteristics. A similar study of climate
vulnerability assessment in British Colombia [60] found that significant spatial disparities exist within the
study area, in terms of health conditions and population demographics. This variance further impacts the
final index of vulnerability.

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Figure 2. Spatial distribution of (a) population density; (b) female population density; (c) floating population density; (d)
number of people engaged in agricultural activities; (e) illiteracy rate; (f) percentage of people living below poverty threshold; (g)
dependency ration; (h) sensitivity index in Bangladesh (source: base map courtesy of humanitarian data exchange; distribution
and index generated from author’s analysis, 2023).

The findings show that Khagrachhari,Sherpur, Lakshmipur, Barguna, Habiganj, Pirojpur, Narayanganj,
Gaibandha, Manikganj, Netrakona, Jessore, Rajbari, Lalmonirhat, Jhenaidah are the most vulnerable districts
of heatwave. The research findings indicate that districts attributed to different geographical locations pose
the most threat due to the heatwave attack. Hence, the other socio-economic factors play a vital role here.
According to the climate project led by Choi et al [51], regions such as Lalmonirhat and Gaibandha in
western Bangladesh exhibit extreme levels of wet-bulb temperature, a critical metric for assessing humid heat
stress.
The study explores socio-economic factors contributing to health vulnerability, revealing that the
northern areas of the country are particularly highly sensitive and least adaptive to heat waves. The northern

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Figure 2. (Continued.)

regions of Bangladesh are generally situated far away from the sea influence and predominantly inland. Also,
the topography of this area is characterized by low hills and plains. Northern areas are also often
characterized by agricultural practices, which makes the fields more exposed to the sun during the dry
season. The lack of significant elevation creates less relief from the heat, and consequently the area experience
higher temperatures. The combined adaptive capacity and sensitivity in the northern area is also
comparatively lower, which makes the final VI high. Moreover, the northern areas are designated as the most
economically disadvantaged in the country, which results in increased vulnerability compared to other
districts. These impoverished regions exhibit lower adaptive capacities. For example, our research reveals that
Kurigram has the lowest adaptive capacity, aligning with the findings of social surveys conducted in
Bangladesh [61]. Globally conducted studies also indicate a lag in the human development index in the

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Figure 3. Spatial distribution of adaptive capacity (source: base map courtesy of humanitarian data exchange; index generated
from author’s analysis, 2023).

northern regions of the country. The Kurigram district in the north reports 54% extreme poverty [62, 63],
along with challenges such as insufficient infrastructure development and connectivity issues [64]. The
findings can also be validated by exploring other existing literature and supporting evidence.
Barguna, Pirojpur, and Lakshmipur are part of the coastal belt where climate change-induced heatwaves,
combined with high humidity, deteriorate the stress on vulnerable populations [22, 65]. Additionally, by
lowering agricultural production and water supplies, other factors, including saline intrusion and frequent
natural catastrophes (such as landslides and floods), exacerbate the socioeconomic status of the population
[66]. The Khagrachhari district is known for its natural beauty, cultural diversity, and adventure
opportunities, which have led to a surge in tourist interest [67]. In recent years, tourism in this district has
expanded significantly, driven by improvements in infrastructure, obtained by deforestation and the loss of
green cover, which previously acted as natural cooling mechanisms [16, 68]. The hill tracts, including
Khagrachhari, are sensitive ecosystems. Clearing forests for tourism-related activities disrupts local
ecosystems and reduces the land’s ability to absorb heat. On the other hand, Gaibandha, Lalmonirhat,
Sherpur, Netrakona, Manikganj, and Rajbari are located in the Northern and Central Plains where extreme
weather variations are common phenomena [69]. These districts are often prone to droughts during the
prolonged dry season. The heavy reliance on traditional rain-fed agriculture in these districts contributes to
land degradation, which can reduce the soil’s moisture retention ability and increase temperatures [70].
Irrigation practices may also alter local humidity levels, making the area more prone to heatwaves. Overuse
of groundwater and soil erosion from intensive farming can lead to dry, barren land, which further absorbs
heat and creates a local feedback loop where temperatures rise [71]. Many of these districts, particularly
Gaibandha, Netrakona, Lalmonirhat, Sherpur, and Narail, have high poverty rates, which constrain their
degree of adaptability to extreme heat [63]. People in rural areas often have limited access to healthcare,
cooling technologies, or infrastructure that can mitigate the impacts of heat waves. Manikganj, Rajbari,
Jessore, and Jhenaidah, being semi-urban or rural districts, often lack the necessary infrastructure, such as
adequate healthcare services, shaded public spaces, or cooling centers, that can protect vulnerable
populations during extreme heat events. Districts like Sherpur and Lalmonirhat have seen deforestation and
land use changes [72], like Khagrachhari, contributing to higher surface temperatures [73]. The loss of
vegetation reduces the natural cooling effects provided by forests and increases the vulnerability of these
regions to heatwaves. The process can be described as a circle of vulnerability, where each factor impacts
another [74]. The river-dependent districts like Rajbari, Gaibandha, and Manikganj are prone to water
scarcity during prolonged heatwaves, leading to decreased access to drinking water and irrigation. Because of

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Figure 4. Spatial distribution of (a) number of medical professionals; (b) number of medical facilities; (c) wetland area; (d) green
area in Bangladesh (source: base map courtesy of humanitarian data exchange; distribution generated from author’s analysis,
2023).

the rising rates of poverty and health concerns, susceptibility increases. The rural communities in these
districts do not have proper access to early warning systems or public awareness campaigns about heatwaves
[75]. This lack of preparedness can lead to delayed responses to heat-related illnesses, making the districts
more vulnerable. Overall, these districts face a combination of geographic, environmental, agricultural,
socio-economic, and infrastructural challenges that intensify their vulnerability to heat waves.

14
Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Figure 5. Vulnerability assessment to heat waves for districts in Bangladesh (source: base map courtesy of humanitarian data
exchange; Index generated from author’s analysis, 2023).

5. Conclusions

With 2023 marking another record-breaking year in terms of temperature in Bangladesh as well as in Europe,
the effects of climate change are becoming more apparent in worldwide communities. The study serves as a
valuable contribution to the decision-making processes of urban planners and civil engineers aiming to create
heat-resistant localities. In the face of the anticipated increase in the frequency and intensity of heat waves
globally, particularly in the 21st century, the research recommends allocating resources to high-vulnerability
areas. Local governments are urged to develop comprehensive adaptation strategies to enhance adaptive
capacities to heat waves, with a particular focus on the identified vulnerable districts. The suggested
measures include the implementation of early warning systems, public awareness campaigns, targeted
support for vulnerable populations, and initiatives to increase the availability of water bodies. The outcomes
can be leveraged in international collaborations, particularly considering Bangladesh’s status as a country
adversely impacted by climate change. These recommendations aim to guide effective efforts in combating
heat vulnerability and fostering sustainable urban development. For the optimum allocation of resources, the
annual budget distribution of the country can consider the factors to combat climate change issues at the
root level. However, there are some limitations which can be addressed in future studies. The inadequate
number of weather stations in the country leads to challenges in accurately representing temperature
variations. Bangladesh has diverse climatic zones, and temperature patterns can vary significantly between
urban, rural, coastal, and hilly areas [52, 73]. When interpolating temperature data from a few stations to
larger areas, assumptions are often made about the uniformity of temperature gradients. Thus, the study may
have errors in representing local conditions, particularly in areas with complex topography. Moreover, the
study has only considered the LST of one day (the warmest day considered in the capital of the country)
which is a limitation as it does not account for temporal variations in temperature. While the study
effectively utilizes quantitative data to analyze vulnerability, it may benefit from qualitative insights, such as
local perceptions of vulnerability, which could enrich the findings. There is scope to work on the future
prediction of vulnerability, which is essential for understanding and informing adaptive strategies.

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Environ. Res.: Health 3 (2025) 015007 M Mehrin et al

Data availability statement

The data cannot be made publicly available upon publication because they are owned by a third party and
the terms of use prevent public distribution. The data that support the findings of this study are available
upon reasonable request from the authors.

Conflict of interest

The authors declare no conflicts of interest. Authors did not have any personal circumstances or interest that
may be perceived as inappropriately influencing the representation or interpretation of reported research
results.

Funding

This research received no external funding.

Informed consent statement

Since the research dealt with no human subjects or experimental animals, Informed Consent Statement is
not applicable

ORCID iDs

Maria Mehrin  https://orcid.org/0009-0005-8119-1148

Fatema Tuz Zuhra  https://orcid.org/0009-0004-2893-1066

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