Safer summers on the Caspian: how Iran prevents drowning deaths through community action

Two decades of education and prevention programmes have shifted attitudes to water safety and reduced deaths from drowning

Stretched along 273 km of Iran’s northwestern coastline, Guilan province is a popular destination for summer swimming. Millions of Iranians visit for holidays and long weekends. But the Caspian Sea develops strong rip currents, and together with the many lakes, dams and other waterways across the province, more than 100 lives are lost to drowning in Guilan each year.

According to drowning registry data compiled by the Trauma Institute at Guilan University of Medical Sciences (GUMS), younger people are particularly at risk, especially boys and young men. This is attributed to over-confidence in swimming skills and a lack of risk awareness.

During holiday periods, the population of Guilan can double. With half the population comprised of tourists, organizations responsible for preventing drowning face significant challenges in disseminating their messages.

Since 2005, the Ministry of the Interior, in collaboration with GUMS and the Ministry of Health and Medical Education, has led partnership efforts to improve education on water safety and established a range of drowning prevention initiatives.

They found one of the most effective ways to reach local communities was to use existing health and education networks.

“The Islamic Republic of Iran’s health care delivery system is well positioned to support drowning prevention strategies relating to education,” says Dr Ali Davoudi-Kiakalayeh, a founding member of the Trauma Institute at GUMS and head of the Centre of Excellence for Drowning Prevention.

There are health care workers, known as Behvarz, in almost every area of rural Iran. Based in local clinics, they make home visits to the population in their service areas.

“We can use their expertise to educate clients about drowning risk factors, and to educate high-risk populations about basic resuscitation techniques,” Dr Davoudi-Kiakalayeh explains. “Such programmes are inexpensive and easily organised.”

For students, swim skill training is now provided during school hours and throughout the summer. Coastal summer lifeguard patrols have been expanded and a new lifejacket loan system ensures no one misses out on safety equipment due to socioeconomic status.

On local television, Darya, a government-funded show, shares water safety messages for children and their parents through its summer broadcasts. Public health teams also promote these messages on local television news, helping to highlight the importance of drowning prevention.

Public health researchers continue to interrogate the data and work with stakeholders to ensure interventions are relevant and effective.

For a qualitative report published in 2023, researchers spoke to medics, community leaders, lifeguards and the families of drowning victims in Guilan, to better understand the area’s risk factors and beliefs and attitudes towards drowning. The reporters then sought their views on how to prevent and respond to drowning incidents.

Between 2006 and 2018 there was a significant decrease in the number of drowning deaths in Guilan province. Dr Davoudi-Kiakalayeh hopes that the lessons learned can help shape new drowning prevention programmes along the Iranian coastline. 

‘We have a shared sense of purpose’: working together to improve riverside safety in Iraq

Multiagency collaboration and community engagement in Iraq reduce the number of lives lost due to drowning

The Tigris and Euphrates rivers are part of daily life in Iraq. They are used for leisure and commuting, and large groups gather along the riverbanks for holidays, festivals and family outings. Tragically, during these busy times, people sometimes drown.

Since 2021, the Ministry of Health and Ministry of the Interior have worked in partnership with a range of agencies to create a shared plan to reduce fatal drownings in rivers and other open water bodies through improved emergency response.

Activities include first aid training, emergency treatment protocols for health workers and a community first aid responder programme to qualify new first aid trainers with the Civil Defence. Joint rescue exercises improve teams’ readiness and ensure everyone understands their role in an emergency.

“Working together has its challenges but there is a strong spirit of collaboration,” says Dr Mahmod Aziz, Head of Disaster Management at the Ministry of Health. “Every agency brings its own expertise, and with a shared sense of purpose, clear communication, regular training and joint protocols you can achieve your goals. We have also found that creating a centralized system for sharing data and best practices improves coordination and effectiveness.”

As well as emergency response, the partnership has designed activities focused on improving community safety around water. Clear signage carries emergency phone numbers and warns of hazards along approaches to rivers, river police patrol near bridges and water bodies and local volunteers are taught first aid skills.

For prevention work to make an impact, Dr Aziz emphasizes the importance of engaging with communities and increasing their water safety knowledge.

“Outreach helps us to build relationships with communities and understand their needs,” he says. “We focus on education and awareness because informed people are more likely to take safety seriously. Sharing success stories also inspires others to take action in their communities.”

Dr Aziz has already learned of a community member who attended a water safety meeting to learn about drowning risks and prevention strategies saving a child who fell into a river during a family outing. Their quick response and first aid skills made a crucial difference.

Since the collaboration began, improved emergency response and safety awareness have helped reduce the number of drowning incidents.

“This reflects the hard work and combined efforts of everyone involved. It shows that pooling our expertise and resources leads to greater impact,” says Dr Aziz. “While we celebrate this progress, we plan to build on it by expanding community programmes and using new technologies for better data collection and analysis.”

From risk to regulation: advancing waterside safety through legislation in Pakistan

In 2020, Islamabad’s Waterside Safety Bill strengthened the legal frameworks that protect people from drowning

In Pakistan, drowning is the fifth leading cause of accidental death, with young people at highest risk.

Recognizing that existing safety standards around canals, dams, lakes and rivers were ineffective at preventing these tragedies, in 2020 the Ministry of Interior enacted the Waterside Safety Act in Islamabad’s Capital Territory to reduce waterside injuries.

The Act provided a new regulatory framework of safety standards to make the capital’s watersides safer for both recreation and travel. The Act formed the Waterside Safety Authority, mandated to enforce a range of water safety measures in Islamabad. They include conducting local risk assessments and implementing interventions – installing clear and impactful warning signs, installing and maintaining barriers to control access to water and establishing lifeguard services and supervision patrols – at high-risk locations.

The legislation is enforced by regular compliance inspections and an investigation process that follows up on complaints when hazards remain unaddressed. If failures are not addressed, fines and other penalties are issued. Waterside safety officers are also responsible for reporting drowning incidents, ensuring the impact of interventions can be measured and improved.

The Act recommends involving a range of organizations to strengthen impact and encourages cooperation with meteorological and health sectors, disaster management authorities, local governments and Rescue 1122 (the national emergency service).

As well as protecting Islamabad, the Act provides Pakistan’s other federal states with a model to develop or review their own water safety legislation. Since 2022, other provinces have started to adopt similar safety measures.

The Act marks an important milestone, and the commitments it enshrines can be added to by amendments and new regulations as needed. Safety on transport vessels is just one of the areas that have been expanded since 2020. 

Raising awareness about the dangers of swimming in Morocco’s reservoirs

An innovative travelling campaign cuts the number of deaths by drowning

For decades, Morocco has been implementing an ambitious dam construction programme to improve water security. There are now more than 150 operational dams, and new projects are underway, At the same time, more and more people are swimming in dam reservoirs to escape the summer heat. And as the number of swimmers increase, so too does the risk of drowning.

To address the challenges, an innovative campaign was launched to help communities better understand the risks of swimming and learn what to do in case of emergencies. The Bouregreg and Chaouia Hydraulic Basin Agency (ABHBC), responsible for managing water resources in a densely populated region in western Morocco, organized a traveling caravan to raise community awareness of the dangers of swimming in dam reservoirs and ways to mitigate them. The initiative was carried out in collaboration with educational and civic partners, the national gendarmerie, civil protection services and local authorities.

In 2017, under the slogan "Vacations are for relaxing, not for tragedies", the first caravan visited villages and markets near the El Malleh and Sidi Mohammed Ben Abdellah dams. At each stop the team broadcast prevention messages through loudspeakers, highlighting the dangers of swimming and reminding people of the prohibitions in place. They conducted practical demonstrations of rescue and resuscitation techniques with the support of civil protection services and distributed leaflets and displayed informational posters along the caravan's route. As a result, no drownings were reported at the 2 dams throughout the year.

Buoyed by this success, in 2018 the caravan restarted, with a stronger focus on schools. Activities were scheduled to avoid disrupting exam periods. Messages directly reached more than 15 000 students, with an estimated indirect reach of around 75 000 people when students shared the advice with their families. The initiative also expanded into other media, partnering with national radio and television stations and creating educational cartoons to engage young audiences.

“The feedback from communities has been very positive,” explained ABHBC. “Residents became aware of the dangers posed by the deep waters of dams which may appear calm but are very hazardous. The resuscitation and rescue demonstrations were particularly well-appreciated.”

In response to this feedback, the agency is now considering extending the campaigns annually and covering more locations. 

Safer shorelines: Tunisia moves to protect beachgoers

A multisectoral programme to improve the safety of public beaches allows holidaymakers to enjoy their summer vacations free of danger

Tunisia’s Ministry of Health, Ministry of the Interior (through the National Office of Civil Protection), local authorities and tourism businesses have united to create the Safe Summer Vacation programme.

As summer – and the holiday season – approaches, many Tunisians and foreign visitors travel to the coast where public beaches can get very busy. And as the numbers of people along the coast increases, so too does the possibility that accidents might occur.

Each year, from June to mid-September, the programme’ s multisectoral plan keeps swimmers safe through 4 key activities: advising on hazardous water conditions, supervising swimming areas, employing lifeguards and ensuring lifesaving equipment is available at high-risk locations.

The first step is to educate vacationers on choosing the right beach for swimming.

Each year the Ministry of Health publishes lists, for the public and relevant authorities, of beaches that are unsuitable for swimming. The lists incorporate information from laboratory testing for water-based pollution and pathogens, meaning beachgoers are protected not only from getting caught up in dangerous currents but from other risks too.

Taking the lead on drowning prevention, Civil Protection officers maintain advisory flags that indicate whether a beach has lifeguards and if conditions are safe to swim. These change according to the weather. Supervisors are assigned to watch over beaches 7 days a week. They are responsible for regulating boat and leisure craft activity to further protect swimmers, designating safe passages for watercraft and keeping swimmers closer to shore with floating barriers. They also ensure that lifesaving equipment, including assistance boats, marine bikes, ambulances and rescue and resuscitation kits are available throughout the season.

In peak season, Civil Protection officers select, train and supervise lifeguards for more than 200 beach units, working closely with municipalities which help to supply recruits and fund salaries. Lifeguards then patrol licensed public beaches, including on public holidays and formal vacation days.

One of the challenges the programme has faced is recruiting enough people to meet its ambition of fielding more than 2000 lifeguards annually. Opportunities exist for lifeguard employment within the hotels and tourism sector but most lifeguards are young people and students attracted by the better pay offered by hotels.

Programme partners are working hard to publicize lifeguarding opportunities and highlight the positive impact new recruits can make by saving people from drowning. The statistics from recent years are an example of this impact – between 2021–2023 beach patrol teams rescued around 400 people from the sea each year.

Collaborating to improve drowning data in Saudi Arabia

Concerted efforts underpin advances in drowning prevention

A lack of baseline data was the greatest challenge when Saudia Arabia introduced its first national drowning prevention policy in 2021, as there was no central reporting system.

“We had mortality data, but we needed to know more,” explains Dr Yasir AlMuzaini, Head of Injury Prevention at the Saudi Public Health Authority (PHA). “To design effective interventions, you need to understand your country’s unique risk factors. Data is so powerful because it tells the story. Who’s getting into danger? Who isn’t? And why?”

To this end, the Saudi Public Health Authority created the Drowning Incident Notification System (DINS) in partnership with the Saudi Red Crescent, Civil Defence, Ministry of Health and Border Guards. Using a paper questionnaire first, and then a digital app-based form, first responders were asked to capture data at the drowning scene, which was fed back to the PHA for analysis. Using a phone, tablet or computer, demographics, time of day, location, water body type, signage, rescue equipment and other risk factors were recorded.

“One of the system’s strengths is that each organization can access their own data,” says Dr Yasir. “We also use their feedback from quarterly meetings to make improvements, like adding dropdown options for new risk factors that they’re reporting. Anything we can do to simplify and speed up the process will increase uptake of the system.”

A significant improvement has been the new dashboard, which pulls all the data into graphics and charts. At a glance, users can see the trends, seasons, demographics and locations that raise drowning risks.

“We have a much better picture of risk factors, and the evidence to convince decision-makers of the changes needed,” says Dr Yasir. “We noticed that many people who drowned lacked swimming skills. So now we’re working with the Ministry of Education to teach this in schools. There are so many decisions like this that we’ve influenced because we have a better view of the problem.”

DINS is a temporary step, while a fully-fledged injury surveillance system is developed. But despite this, the partners believe it’s a persuasive test case for digital innovation to address other public health challenges.

“When agencies collaborate on a public health initiative, it reflects the seriousness of the issue – and the need for a unified response,” Dr Yasir adds. “This collaboration shows the importance of patience, time and concerted effort. It represents a significant leap forward in the country’s approach to public health surveillance and drowning prevention.”

“I would encourage anyone to make a start, even with a simple paper form. We started from zero 2 years ago, and already we have a great focus. If you want to create effective, rapid interventions, you have to have good data.”