A few weeks ago in Brisbane, there was widespread nervous anticipation with all of us glued to the news awaiting the arrival of Cyclone Alfred. There was an anxious camaraderie between colleagues at my medical surgery, and a clearing of decks and yards by neighbours, as the cyclone’s arrival was delayed several times. Supermarket shelves were once again cleared of stock, echoing the bad old days of the pandemic, with toilet paper once more in high demand.
I pulled the pin on work when Alfred’s arrival became imminent and waited at home with my family, our emergency plans in place. When Alfred reached the suburbs, the streets were soon awash, with trees felled by wind and power cut to 300,000 homes. We got off lightly — no power and no internet for two days. Others waited a week or more for power to be restored, while many lost their homes and personal possessions.
It was back to business as usual the following week. I returned to work while updates on the news declared that the worst of Cyclone Alfred was now over, with clean-up efforts to begin. The heart-wrenching images of whole towns inundated and homes rendered uninhabitable quickly faded from screens, while the real disaster unfolded in the worst-hit suburbs and towns along the east coast.
Natural disasters are increasing in frequency and severity, with flooding now the second most deadly weather event after heatwaves in Australia. A review of global research indicates that mortality rates rise by up to 50 per cent in the year after a flood. There is often a heavy focus on the immediate impacts of disasters, but it is in the weeks, months and years following an event that the scale of the impact becomes clear — and many of these are health-related. Disasters are now considered a social determinant of health, with the most vulnerable disproportionately affected.
Jess (not her real name) moved to a small regional town in New South Wales a year ago, as the cost of housing was significantly lower than in Brisbane. Now in her fifties, Jess is divorced and has one adult daughter. Moving somewhere rural was an opportunity to start afresh, but she had difficulty finding a local GP, so opted to continue seeing me for most of her health needs using telehealth and two face-to-face visits annually. It is far from ideal, as she has diabetes, hypertension, high cholesterol and chronic pain following a back injury many years ago. I suspect Jess is also depressed and anxious, but she denies this and has declined further assessment. She rang me for her routine prescriptions after losing everything in the flash flood that followed Cyclone Alfred. Her small fibro cottage was not insured as the cost was prohibitive, leaving her homeless with few personal possessions and none of her medications. She managed to rescue her aged cat, something she was grateful for.
Her scenario is not uncommon, and it offers a glimpse into the long-term health effects of disasters. Immediately after a cyclone or flood, deaths and injuries can occur from drowning, falls, or being struck by debris. However, just as significant is the impact of disrupted care for pre-existing chronic health issues due to damaged health infrastructure, loss of routine medications, and reduced preventative healthcare.
Jess’s diabetic control was already challenging prior to Cyclone Alfred, but with no housing, an uncertain future, and the stress of losing everything she owned, her diabetes management was not her first priority. Studies show that, following disasters, there is an increased prevalence of diabetes, as well as a 40 per cent rise in mortality among those with existing diabetes.
'Within a week or two, Cyclone Alfred became history, another natural disaster to add to the rising tally of climate-related events. But its long-term impacts will continue indefinitely in the worst-hit communities. The cumulative health effects of these increasingly frequent disasters will expose the fragility of a health system already under strain.'
Doctors for the Environment Australia has produced a report outlining not only how cyclones and floods harm health, but also the financial cost of extreme weather and the impact on the provision of healthcare. Between 2005 and 2022, disaster relief and recovery cost the Australian Government $23.99 billion. By 2050, the direct economic cost of extreme weather is expected to reach $35.24 billion per year. Healthcare costs will continue to rise significantly due to the increasing physical and mental health impacts of severe floods and storms.
Reporting on disasters tends to emphasise the resilience of local communities. In the immediate aftermath, there are heart-warming examples of people helping clean up flood-ravaged homes and delivering meals to those affected. However, the mental health effects of losing everything can be lasting, with significant psychological distress often emerging months or even years after the initial event. An analysis of Australian communities affected by bushfires found a 14 per cent prevalence of psychological distress up to four years later.
What is most alarming in the data relating to the economic and health costs of natural disasters is the prediction that extreme weather events — floods, storms, heatwaves, droughts and bushfires — will become more severe and frequent as climate change accelerates. The escalating cost of rebuilding and repairing infrastructure is already a major burden on taxpayers and local communities, with insurance costs so prohibitive that coverage is no longer an option in many high-risk regions.
Our health system is already under significant stress, with many, like Jess, struggling to access a GP for routine needs. It is well recognised that continuity of care for chronic health issues is severely disrupted during disasters, with long-term impacts on mortality and morbidity still difficult to assess. The floods in Lismore highlighted the challenge of maintaining healthcare when medical centres and pharmacies were wiped out in the city centre. One year on, medical services were still not fully functioning. They had to be completely rebuilt, yet were deemed ineligible for emergency funding by the state government. Temporary services were set up, but limited resources meant many locals had to travel to nearby towns or went without the care they required.
.png)
Healthcare is fundamental to any community — a basic human right — and being unable to access medications, routine health checks and preventative care has significant long-term consequences. It is an impact of climate change that is too often overlooked, despite its enormous implications for morbidity, mortality and economic cost.
I sent Jess her prescriptions electronically and arranged another telehealth appointment for follow-up. She had been monitoring her own blood pressure at home regularly, but her blood pressure monitor was lost in the floods. Her routine blood tests were due, but became a low priority once she had nowhere to live. The local café where she worked remains closed for an indefinite period, leaving her with no income. Jess has a daughter in Brisbane, and will likely move back at least temporarily while she makes plans for a future that looks increasingly bleak.
Within a week or two, Cyclone Alfred became history, another natural disaster to add to the rising tally of climate-related events. But its long-term impacts will continue indefinitely in the worst-hit communities. The cumulative health effects of these increasingly frequent disasters will expose the fragility of a health system already under strain.
I have been back in my consulting room for a few weeks, the power restored and infrastructure intact. Many others have not been so fortunate, with serious and ongoing health impacts only just beginning and resources to address them scarce. We are treading water, with a finger in the hole in the dike. But this time, it may not be enough.
Jo Skinner is a Brisbane-based GP, women’s fiction author, freelance health writer and distance runner.
Main image: A resident walks on a flooded Edmonstone Street in the suburb of Newmarket on March 09, 2025 in Brisbane, Australia. Australia's east coast is experiencing severe weather as ex-Tropical Cyclone Alfred moves south. While downgraded from cyclone status, the weather system continues to bring damaging winds, heavy rainfall, and flash flooding, particularly in the Gold Coast and northern NSW regions. Authorities have issued severe weather warnings, and coastal areas remain at risk of significant erosion and hazardous surf conditions. Residents are urged to stay updated on local warnings, avoid floodwaters, and prepare for ongoing disruptions. (Photo by Albert Perez/Getty Images)