The projected 15,800 additional heat-related deaths in India highlight the severe impact of El Niño on vulnerable populations, particularly outdoor workers, older adults, and those without access to cooling systems. The Global South, including regions like the Sahel, Southeast Asia, and Brazil, is expected to bear the brunt of the global toll due to high baseline heat exposure and limited resources for adaptation. Without timely interventions, the health risks associated with extreme heat could escalate, disproportionately affecting lower-income communities and exacerbating existing inequalities.