Healthcare Access and Rehabilitation Challenges Two Decades Post-Tsunami: A Qualitative Study from South Andaman, India

Background The 2004 Indian Ocean tsunami inflicted catastrophic, cascading health system failures in the geographically vulnerable Andaman and Nicobar Islands, India. Two decades later, this study was undertaken to qualitatively explore the long-term lived experiences of survivors concerning healthcare access, rehabilitation quality, and the subsequent resilience mechanisms that emerged in South Andaman. Methods This research employed a qualitative, phenomenological design using secondary thematic analysis of data from a larger project. Twenty-two tsunami survivors (N = 22), aged 18 years and above, were recruited via purposive and snowball sampling to ensure diversity across gender, location, and socio-economic status. In-depth, semi-structured interviews (IDIs) were conducted between March and August 2024 in Hindi, Bengali, or local dialects until data saturation was achieved. Transcripts were analyzed using Braun and Clarke’s six-phase thematic analysis framework , supported by NVivo software. Methodological rigor was ensured through independent coding and peer-checking. Ethical clearance was obtained from the Institutional Ethics Committee (ANIIMS/IEC/2024/23). Results Four central themes were identified: 1) Catastrophic Systemic Failure and Vulnerability : Characterized by the immediate, total collapse of primary health centers, acute supply chain failure, and disproportionate hardship faced by pregnant women and the elderly. 2) Rehabilitation Gaps and the Psychosocial Void : Highlighting the profound and prolonged absence of formal mental health and physical rehabilitation services, leading to chronic, unaddressed distress. 3) Bureaucratic Hurdles to Equitable Aid : Describing significant delays, corruption, and the loss of essential documents that prevented timely access to medical and financial compensation. 4) The Critical Buffer of Community Solidarity : Demonstrating that local governance and emergent community networks acted as the primary, effective resource for immediate support and long-term emotional resilience. Conclusions Two decades post-tsunami, survivors’ narratives reveal persistent structural weaknesses in disaster health systems in the Andaman Islands. Sustainable recovery requires a paradigm shift towards decentralized, equity-focused healthcare planning , the mandated integration of mental health and psychosocial support (MHPSS) into first response, and the formal empowerment of community-based resilience mechanisms. The study provides critical, long-term evidence for designing resilient health service delivery models in small island developing states (SIDS). Trial registration: Not applicable.