Drowning Risks and Public Health Vulnerabilities during Urban Floods: Lessons from the Hat Yai Deluge: A Narrative Review

Flooding is among the most prevalent and destructive natural disasters worldwide, and its most catastrophic consequence is the immediate threat to human life through fatal and non-fatal drowning. Urban centers in developing nations face heightened vulnerability because of rapid unregulated urbanization, complex topography, and climate-driven shifts in precipitation. This review examines the November 2025 Hat Yai flood disaster in Songkhla Province, Southern Thailand, as a case study to understand the dynamics, public health burden, and clinical management of flood-induced drowning. Drowning accounted for the majority of immediate flood-related fatalities, driven by flash flooding, delayed evacuation, submerged infrastructure hazards, and vehicle-related submersion. Beyond mortality, non-fatal drowning imposes a substantial public health burden through neurological and pulmonary complications, psychological trauma, and disruption of emergency medical services. Effective clinical management requires a continuum of care spanning pre-hospital airway management, lung-protective mechanical ventilation, empirical antimicrobial therapy for contaminated water aspiration, and targeted temperature management for neuroprotection. Multidisciplinary prevention frameworks that combine early warning systems, community education, the targeted supervision of high-risk populations, and resilient urban infrastructure are essential to reducing future mortality. The Hat Yai deluge underscores the need for a paradigm shift that places drowning prevention and clinical preparedness at the center of urban disaster planning.