Drowning

 

Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid, which can result in death, non-fatal injury (morbidity), or no lasting harm (no morbidity).

In 2021, an estimated 300,000 drowning deaths occurred globally, with children and young people disproportionately affected. Drowning is the fourth leading cause of death among children aged 1–4 years and the third leading cause of death among children aged 5–14 years. Approximately 92% of drowning deaths occur in low- and middle-income countries, where the drowning rate is 3.2 times higher than in high-income countries. The Western Pacific and South-East Asia Regions account for the highest number of drowning deaths globally.

In the Western Pacific Region, more than 84 000 people drowned in 2021—nearly 30% of the world’s drowning deaths. Drowning is the leading cause of death among children aged 5–14 years in the region. The regional drowning death rate stands at 4.3 per 100 000 population, higher than the global average of 3.8 per 100 000. While drowning primarily affects children, the highest rate of drowning deaths in the region occurs among those aged 70 years or older standing at 13.7 deaths per 100 000 population. Men consistently bear a greater burden of drowning than women.

In addition to fatal drowning, many individuals experience non-fatal drowning, resulting in long-term health consequences and a substantial number of hospitalizations annually. Despite its magnitude and preventability, drowning often receives low prioritization in public health agendas—particularly in low- and middle-income countries.

Risk Factors

Drowning is a multifaceted public health issue, shaped by a range of individual, social, and environmental risk factors. Key risk factors include age, sex, poverty and inequality, occupational exposure, climate-related risks, transport on water, and migration and refuge-seeking.

Age. Young children are at particularly high risk of drowning due to their underdeveloped ability to assess danger, as well as a lack of swimming and water safety skills. Risk increases significantly when children are in or near water without active adult supervision. Among older children and adolescents, factors such as growing independence, peer pressure, increased risk-taking behaviours, entry into the workforce, and experimentation with alcohol and drugs further elevate drowning risk. Older adults also face distinct risks, including reduced physical ability, mobility limitations, pre-existing medical conditions, and an associated increased use of medications.

Sex. Globally, the drowning death rate for males is more than twice that of females. Males are generally more likely to engage in high-risk behaviours—such as swimming alone, swimming at night, or in open water—and are less likely to wear lifejackets. Alcohol use is also higher among males during aquatic activities. In addition, men are more frequently employed in work that frequently exposes them to potentially hazardous water, such as fishing, construction, transport and maritime occupations.

Poverty and inequality. Drowning disproportionately affects poor and marginalized populations. The drowning rate in low-income countries is 3.2 times higher than in high-income countries. Regardless of a country’s economic development, drowning often affects the poorest and people with low educational attainment who live in rural settings, especially where people have close daily contact with water for work, transport and agriculture. 

Occupational exposure. Fishers are among the most vulnerable occupational groups due to prolonged exposure to water under hazardous conditions. Long working hours, severe weather, and physically demanding tasks heighten the risk of drowning. Climate change has further aggravated these risks, increasing the frequency and severity of extreme weather events and natural disasters, particularly in low-lying coastal areas and inland fisheries prone to flooding. Small-scale fishers are particularly vulnerable, as many lack access to lifejackets, emergency communication tools, and safety equipment on board.

Climate-related risks. Climate change is significantly increasing the risk of drowning by intensifying extreme weather events such as floods and heatwaves. Globally, floods accounted for 44% of all disasters between 2000 and 2019, with an estimated 75% of flood-related fatalities resulting from drowning. Rising global temperatures also contribute to more frequent heatwaves, prompting people to spend more time in and around water. This greater exposure, combined with increased alcohol consumption on hot days, further elevates drowning risk.

Transport on water. Travelling on water, particularly in volatile weather conditions or without appropriate safety equipment, can increase drowning risk. In many low- and middle-income countries, water transport is significantly less regulated than in high-income countries. As a result, daily commuting often takes place on overcrowded and unsafe vessels, operated by staff who have not been appropriately trained to recognize dangerous conditions or perform high-seas navigation, increasing risk of boat capsize and collision.

Migration and refuge-seeking. An increasing number of people are being displaced from their homes due to conflict, violence, political or economic instability, climate change, and other disasters. Many are forced to migrate through irregular and dangerous routes, which often involve crossing large bodies of water under treacherous conditions. These journeys are frequently undertaken in overcrowded and unsafe vessels, significantly increasing the risk of drowning.

 

The 2014 WHO Global Report on Drowning outlines 10 evidence-based, cost-effective, and scalable actions for drowning prevention, adaptable to local contexts:

1, Install barriers controlling access to water.
2. Provide safe places away from water for pre-school children, with capable child care.
3. Teach school-age children basic swimming, water safety and safe rescue skills.
4. Train bystanders in safe rescue and resuscitation.
5. Strengthen public awareness and highlight the vulnerability of children.
6. Set and enforce safe boating, shipping and ferry regulations.
7. Build resilience and manage flood risks and other hazards locally and nationally.
8. Coordinate drowning prevention efforts with those of other sectors and agencies.
9. Develop a national water safety plan.
10. Address priority research questions with well-designed studies.

A wide range of proven actions can reduce drowning risk across diverse settings. Installing barriers (e.g. covering wells, using doorway barriers and playpens, fencing swimming pools etc.) to control access to water hazards, or removing water hazards entirely greatly reduces water hazard exposure and risk, especially for young children.  Community-based, supervised child care for pre-school children can also reduce drowning risk and has other proven health and development benefits.

Teaching school-age children basic swimming, water safety and safe rescue skills is another approach. But this must be undertaken with an emphasis on safety, and an overall risk management that includes a safety-tested curricula, a safe training area, screening and student selection, and student-instructor ratios established for safety.

Training bystanders in safe rescue and resuscitation is also a vital component of drowning prevention. Survival in drowning incidents often depends on the immediate actions of those nearby. Equipping community members—particularly in high-risk areas—with practical, context-specific training improves the likelihood of effective and timely rescue. It also reduces the risk of harm to would-be rescuers, who may otherwise attempt unsafe interventions.

Effective policies and legislation are also important for drowning prevention. This includes setting and enforcing safety regulations for boating, shipping and ferry operations.  In parallel, building resilience to flooding and other extreme weather events through strengthened  disaster preparedness, land use planning, and early warning systems can prevent drowning during flood disasters.

Developing a national water safety strategy can raise awareness of safety around water, build consensus around solutions, provide strategic direction and a framework to guide multisectoral action and allow for monitoring and evaluation of efforts.

Public awareness and advocacy are essential to mobilizing action. Effectively communicating the human impact of drowning—while highlighting practical, life-saving solutions—can influence policy, empower communities, and drive investment in prevention. Mass media campaigns are particularly powerful in shaping behaviours and increasing public acceptance of safety measures, especially those that protect children.

Finally, accurate and timely data on who is drowning, where, when, and why is essential. Robust data systems enable countries to design targeted, evidence-based interventions that respond to local priorities and reach the most vulnerable populations.

 

 

Since the launch of WHO's Global report on drowning preventing a leading killer in 2014 and the follow-up resource Preventing drowning: an implementation guide in 2017, WHO has been working to scale up advocacy and action for the prevention of drowning.

The Regional Status Report on Drowning in the Western Pacific provides countries with WHO-recommended best practices on drowning prevention interventions and policies, including day care for children, the use of barriers for controlling access to water, public awareness campaigns focused on behaviour change, and policies and legislation on water safety, including regulation of recreational boating and maritime transport.

At a regional level, WHO organizes training programmes and convenes workshops to draw together representatives of governments, NGOs and UN agencies working on drowning prevention.