Drowning is a significant public health issue globally as it is a leading cause of accidental death.
The World Congress on Drowning in Amsterdam in 2002 defined it as “a process resulting in primary respiratory impairment from submersion in a liquid medium”.
It is implicit in the definition that a liquid-air interface is present at the entrance to a victim’s airway, which prevents the individual from breathing oxygen.
Its occurrence is usually silent and rapid.
The typical image of a victim helplessly gasping and struggling in the water is not often reported.
The more ominous scenario is a motionless individual floating in the water or quietly disappearing beneath the water surface.
In Malaysia
The Housing and Local Government Deputy Minister informed the South-East Asian Nations Drowning Prevention Capacity Building Workshop held in Penang in 2023 that there were 1,340 deaths due to drowning from 2018 to 2022 in Malaysia.
This works out to an average of 268 deaths annually, or about one death every 33 hours.
However, there is no data on near misses, i.e. those who almost drowned, but were saved.
The Fire and Rescue Department recorded 619 emergency calls involving child and teenage drowning incidents between 2021 and April 2025.
There were 139 incidents in 2023, 122 in 2024, 108 in 2025, and 38 in the first quarter of this year.
Rivers and irrigation canals accounted for 364 cases (58.8% of total); beaches 150 cases (24.2%); waterfalls and rapids 50 cases; lakes and former mining pools 44 cases, and 11 cases involved drains.
Teenagers aged between 13 and 18 years accounted for 334 cases (54% of total), followed by children aged seven to 12 years with 218 cases (35%).
Risk factors
The risk factors of drowning usually vary with the person’s age. They include:
Young children are at a high risk of drowning because of underdeveloped ability to assess risk, and deficient swimming and water safety skills.
The risk increases when children interact with water without active adult supervision.
According to the World Health Organization (WHO), the age incidence of drowning victims in Malaysia in 2022 was 5% for newborns up to six-year-olds, 29% in seven- to 19-year-olds, 42% in 20- to 39-year-olds, 16% in 40- to 59-year-olds, and 8% in those aged 60 and above.
The death rate among males is higher than females.
According to WHO, the male and female incidences of drowning in Malaysia is 81% and 19% respectively.
Males are also more likely to be hospitalised than females for non-fatal drowning incidents.
The difference is attributed to increased exposure to water and riskier behaviour like swimming alone, illicit drugs and/or alcohol consumption before aquatic activities.
Climate change is causing more extreme weather like floods and heatwaves.
Drowning accounts for three-quarters of deaths in flood disasters.
Drowning risks due to floods are high where early warning systems and flood mitigation infrastructure are underdeveloped.
Heatwaves increase the risk of drowning as more people seek water for heat relief and often spend longer periods of time in and on the water.
Fishermen have a substantially higher risk of drowning.
The United Nations Food and Agriculture Organization (FAO) estimates that more than 32,000 fishermen die annually around the world.
Climate change has aggravated the conditions under which most fishermen work, with extreme weather and natural disasters more common and destructive.
Travelling on water, especially in dangerous weather conditions and/or without appropriate safety equipment, can increase drowning risk.
This is especially so on overcrowded and unsafe vessels, operated by personnel untrained to recognise hazardous conditions or perform high-seas navigation.
Drowning affects the poor and marginalised disproportionately.
The daily exposure to water in low- and middle-income countries increases the risk of drowning.
Many displaced people or those migrating because of conflict or instability resort to irregular channels for migration that are very hazardous.
These channels include those across large expanses of water in treacherous conditions, often in overcrowded, unsafe vessels without safety equipment and/or operated by untrained personnel.
When you drown
A drowning victim faces immediate threats to life, i.e. effects on the central nervous and cardiovascular systems.
Thus, the most critical actions in the immediate management of drowning victims include prompt correction of low levels of oxygen in the blood (hypoxaemia) and excessive acid in the body fluids (acidosis).
The degree of central nervous system injury depends on the severity and duration of hypoxaemia.
Survivors may have neurological complications as the long-term effects of cerebral hypoxia (lack of oxygen) can be devastating.
The key predictor of outcome in a drowning victim is the submersion/drowning time.
The prognosis is poor when the incident is unwitnessed, there is delay in cardiopulmonary resuscitation (CPR) or the victim enters a coma.
Cardiac arrest can lead to a high death rate or severe neurological complications.
The prognosis is best when there is early rescue, brief symptoms, and normal or improving examination findings.
Prevention
Water safety awareness is critical to reducing drowning incidents.
There are several preventive and safety measures that can be taken by individuals, the public and the authorities.
They include:
- Never swimming alone – always have supervision or a trained lifeguard present
- Teaching children basic swimming and water safety skills
- Learning CPR – immediate action can save the lives of drowning victims
- Providing lifesaving courses for children, adults and staff at schools and workplaces like hotels etc
- Controlling access to water hazards with barriers at swimming pools, rivers, lakes, mining pools, wells etc
- Ensuring water facility safety compliance, including having trained staff on duty.
According to the WHO, the implementation at community level of three interventions will save many lives.
These interventions are:
- Provision of day-care, basic swimming and water safety skills
- Safe rescue training, and
- Resuscitation training.
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Sadly, the WHO noted that Malaysia has no national drowning prevention strategy and the raising of awareness is limited.
The WHO stated:
“A WHO investment case modelling investment in drowning prevention between now and 2050 shows scaling up just two interventions to be cost-saving.
“Through investing in day-care programmes for pre-school children and teaching children basic swim skills, 774,000 fewer children would drown between now and 2050.
“Furthermore, another 178,000 children would avoid severe, life-limiting injuries due to non- fatal drowning over the same period.
“Scaling these two interventions is projected to result in savings of over US$400bil (RM1,637bil) – a return of nine times the value of the cost of scaling up the interventions.
“Effective policies and legislation are also important for drowning prevention.
“Setting and enforcing safe boating, shipping and ferry regulations are vital to improving safety on the water and preventing drowning.
“Building resilience to flooding and managing flood risks through better disaster preparedness planning, land use planning and early warning systems can prevent drowning during flood disasters.
“Developing a national water safety strategy can provide strategic direction and a framework to guide multisectoral action and allow for monitoring and evaluation of efforts.”
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
