There were warnings for days, but no one really predicted the devastation that would tear through Central Texas over the 4th of July weekend in 2025. “We did have some rain alerts,” says Rosanna Robero, a Development Officer at Frontera Healthcare Network. “But we get so many alerts like that, we just kind of blew them off.”
Though they were used to occasional severe weather, people never thought to prepare for apocalyptic levels of water. So they went to bed on the night of July 3 listening to pounding rain and clapping thunder, thinking it was a storm like any other. But they woke to a world that was irreversibly altered.
By the morning of July 4, Tropical Storm Barry and Hurricane Flossie had combined to release the equivalent of four months’ worth of rainfall in just four hours across several counties in Central Texas. The Guadalupe River had risen 26 feet in 45 minutes. People living in RVs and trailers along the riverbanks were swept away. And—in a tragedy that would capture the nation’s attention—fast-rising floodwaters had torn through Camp Mystic, an all-girls summer camp, drowning some of the sleeping campers. In the end, at least 137 people died in what became the deadliest inland flood in the U.S. in 50 years—many of them children.
To the Rescue
In the first 72 or so hours, the first responders to the disaster were locals—volunteer firefighters, EMTs, those affected by flooding themselves, and neighbors and friends of those affected. Borrowing boats and cars, the residents engaged in painful, painstaking search-and-rescue efforts, diving into floodwaters in search of the young girls’ bodies and belongings.
International Medical Corps, whose emergency response work in the US dates to Hurricane Katrina in 2005, immediately reached out to health clinics in Texas to offer support—but were asked to hold off. “In the beginning, the community was very wary of having outsiders descend on these small towns, which were dealing with unimaginable grief,” says Shira Goldstein, International Medical Corps’ Head of Programs for US & Territories. “They were asking for people to give them some time and space—and so we respected that.”
The organization that found itself on the frontlines of the disaster was therefore not a seasoned emergency responder, but rather a local network of federally qualified healthcare centers (FQHCs) called Frontera, whose mission is to provide quality, affordable healthcare to residents of six rural and under-resourced counties in Central Texas. When the floods hit, Frontera staff members were unexpectedly forced into a massive, urgent coordinating role for the affected region—a role for which they had no experience.
“We were going out and trying to reach people, but we were very reactive and scattered in our efforts. We were also short-staffed, because we had our clinical operations that we needed to keep up and running,” says Robero. “But now we had the new addition of needing to respond to this emergency out in the field—going door to door and visiting the hotels and shelters that were housing displaced people.”
“Frontera stepped up in an incredible way to fill impossible shoes,” says Goldstein. “But at the two-week mark, they started to feel very overwhelmed.” At that point, Frontera requested outside support, and International Medical Corps, in partnership with Americares, was able to mobilize 15 mental health professionals to Central Texas within 24 hours.
Over the following weeks, International Medical Corps conducted more than 1,300 wellness checks and community-outreach engagements in group and individual settings across 17 sites. Our team also distributed more than 2,500 items to first responders and affected community members, including hygiene kits, wound-care kits, hygiene products and other essential items. But it was their mental health-related work that would leave the greatest legacy.
The Silent Emergency
While reports around the flood’s catastrophic physical effects made national headlines—the deaths, the houses swept away, the infrastructure destroyed—a more invisible and pervasive emergency was taking hold. “What has really lingered is the post-traumatic stress,” says Robero. “Sometimes mental health impacts take months to catch up because people are in such survival mode at first.”
In a place like rural Texas, mental health remains a largely taboo topic. But the devastation and grief proved to be unprecedented for many in the community, which saw an increase in substance abuse and domestic violence in the aftermath of the floods. Still, International Medical Corps staff knew they could not come into these rural, closed-off communities aggressively pushing mental health interventions.
“This involved gaining trust, really focusing on what it means to help a community come to terms with the impacts of this disaster—and it was very heavy,” remembers Goldstein. “It was a unique response in terms of what the community needed, and in terms of what we were able to provide. We haven’t really seen, at least in the US, a response that was so emotionally charged, due both to the nature of who the victims were and to what the community had to do to rally around this tragedy.”
It took more than two months to find the body of the last girl who had been missing and, according to Goldstein, “The community was sort of held in a point of stasis until they could find her.”
Through mobile teams that would set up outside churches and in school parking lots, International Medical Corps intentionally took time to gain the community’s trust. We also stationed another team down by the river next to Camp Mystic, setting up a volunteer hub for the people from all over Texas and beyond who had showed up to help.
While serving lunch to the volunteers, International Medical Corps staff would give people the opportunity to share their feelings, so “if someone needed a more in-depth conversation or referral to additional mental health resources, we were able to do that in a way that felt like a lot less intrusive and clinical,” says Erica Tavares, International Medical Corps’ Senior Director of US Programs.
Sometimes our response was just wellness checks—handing somebody a bottle of water, getting somebody something to eat, sitting with them and just chatting. Other times, asking 'How are you doing?' would evoke a response where people were moved to tears. We were there to let them know that they were not alone.
–International Medical Corps Volunteer Stephanie Barnard
Goldstein recalls one volunteer who stood out to her: an ex-Marine who had traveled from the East Coast to assist in the search-and-rescue efforts. He arrived 24 hours after the flooding and spent every day for four straight weeks diving into the river in search of bodies and belongings. He would come into the volunteer hub, load up his lunch plate and retreat to the sides to silently stare off into space, while others debriefed and socialized. One day, Goldstein sat down next to the man and asked him how he was doing.
He began recounting, with what Goldstein describes as a sort of disassociation, the horrors that he had witnessed in the flood’s immediate aftermath, and how they were now down to finding jewelry and other artifacts of people still missing, using them to piece together evidence to find bodies. He eventually shared how isolated he felt—but quickly acknowledged that other people had it far worse than him. When Goldstein reminded him, “Even if someone has it worse, it doesn’t mean that you’re not going through something that’s also incredibly difficult and that you don’t have a right to grieve,” he broke down crying.
“I felt like I was really there for him when he needed it, in a way that I don’t think he would have let himself do if I hadn’t been willing to just sit for hours and listen to him,” says Goldstein. “Moments like that that really made me feel like a slow and steady approach is also really important at times.”
Robero calls the increase in mental health support in the community one of the “silver linings” of the flood. Frontera had spent years working to break down barriers to mental health services in a community of “proud and stubborn” Texans who “do not want to be a burden on anyone.” In the aftermath of the disaster—as well as today, one year later—Frontera seeks to remind Texans that “It’s okay to not be okay.”
One Year Later
On the eve of the disaster’s one-year anniversary, Central Texan communities are still struggling to rebuild. Though what happened at Camp Mystic and the riverfront were “undeniably intense” and headline-worthy, Goldstein points to the underrepresented stories of those in the surrounding counties who were also severely affected. “You weren’t hearing about that, because it wasn’t as dramatic,” says Goldstein.
Many people are still living in homes that are deteriorating and incredibly unsafe, or are still living with family members and friends because their homes remain uninhabitable. Black mold is a pervasive problem in homes where water was not properly cleared out, and Frontera’s patients are increasingly presenting with lung issues as a result. And in a region where the economy largely depends on livestock and wine production, property damage caused by the floods has decimated many people’s livelihoods.
But there have been positive outcomes as well—namely, International Medical Corps’ work to help build out Frontera’s community health worker program. During Goldstein’s first three days in Texas in July 2025, she sat with the leadership team of Frontera to help map out what an emergency response could look like, as the organization had never done one before. She raised the option of going mobile—thinking beyond the fixed walls of their health centers.
“Most of the people Frontera serves are incredibly poor, and many of them are elderly and have existing chronic illnesses,” she says. “And their ability to travel into a fixed site during an emergency decreases, especially given road closures and all the other challenges they could be facing.”
Today, Frontera has a mobile unit staffed by community health workers. Since the flooding, International Medical Corps has paid a portion of the health workers’ salaries, helping to ensure that constant follow up within the community helps to connect people with health services. “Now they’re able to go out into the community to provide care for any host of reasons, including during emergencies,” says Tavares. “So, that has also been part of the legacy that we’ve left.”
Robero underscores this impact. She recalls how, in January, when she and the rest of the Frontera team were preparing for an ice storm, they put into practice what International Medical Corps had taught them. “I remember sitting at the leadership table with our CEO and several other members of our leadership team, and we were able to take what we had learned from International Medical Corps,” says Robero. She says their staff meetings were much shorter—not because they had less to say, but because they were more organized and efficient, and because everyone knew their role and scope of work. In the end, the ice storm passed with little damage—but Frontera was able to prepare for the worst.
The “Canary in the Coal Mine”
Though flood-affected communities in Central Texas are on the road to recovery, the big-picture reckoning remains painful. Goldstein estimates that 90% of the deaths from the flooding were preventable, due to inadequacies in planning, systems and resources.
“It wasn’t one point of failure, it was multiple—and the community will be forever changed as a result,” says Goldstein. “When you have that many young children die in the blink of an eye, that’s not something you really get over.”
Robero believes that every breakdown in the community’s response can be tracked back to communication—not being able to get in touch with staff members, not being able to check in on patients and the failure of general emergency response communications throughout the counties. “One thing that I would recommend to other FQHCs is to make sure that you have good relationships in place before a disaster, because that’s not really a muscle that you can develop in the moment,” says Robero. “Do the work now to connect with your county and city officials, so that when a disaster strikes, you’re collaborating and leveraging your resources, and everyone’s working together toward the same common goal.”
This unfortunately is a story that could play out in communities across the country. Robero calls Central Texas “the canary in the coalmine.” There were 29,000 emergencies in the US last year alone, and only 60 of them were declared federal disasters.
“You have this toxic mix happening, where you’ve got an increase in the scale, severity and frequency of disasters, but you also have a decrease in funding for emergency and healthcare services from a variety of levels, and you have hospital closures happening, so primary healthcare and emergency healthcare is moving further and further away,” explains Tavares. “That means that you’re going to have disasters happen without the resources to take care of them, which means that primary health clinics, particularly in rural areas, must be more flexible and able to pivot to support emergency responses in times of disaster.”
And Still, We Rise
Increasingly, community health workers are going to be forced into emergency response roles, as they were in Central Texas. They will need the skills to take care of themselves and their neighbors. The good news in all of this is that people do want to help.
Time and time again, in disasters across the globe and right here at home, the common refrain from survivors and emergency responders is how, in the very worst of times, people do show up with the best of themselves. Goldstein says the Texas floods are a clear example of this, with Texans arriving from all over the state ready to do whatever was needed to help—mucking houses, handing out gloves, clearing debris and so forth. People also found opportunities to get together and play music, socialize, feed each other and find moments of joy.
“Literally, hell or high water be damned, they were going to come together, they were going to meet up and they were going to support each other,” says Goldstein. “I think that was also really incredible to see.”
Robero underscores how amazing it was to see her community pull together and work around the clock to clean up, rebuild and help people get back up on their feet. “It all made me feel so much more compassionate for others,” she says, “And realize that material things just don’t matter—the most important thing is having those you love.”
A remote part of the country on a long road to recovery can provide us with a salient reminder: slow down, look closer. There’s wisdom to be gleaned here. Media moves fast, events are easy to forget, but it is important to remember that a passing headline can represent an irreversible tear in someone’s universe. Life can change in an instant. Healing takes time.
As systems continue to fail and disasters continue to strike, we as humans struggling to survive on a precarious planet will increasingly have to rely on our shared humanity. But we can still count on this time-tested truth: people do show up for each other. They will always show up for each other.
“So, the best we can do,” says Tavares, “is help them be ready to do that.”
International Medical Corps has been active in the US & Territories since 2005, initially responding to devastation caused by Hurricane Katrina in New Orleans. Today, we collaborate with national, state and local partners to support emergency responses, identify gaps in the health system and support community-driven solutions to challenges brought on by natural disasters, public health crises and outbreaks of disease, helping to increase access to healthcare in underserved communities. Find out more about our US programs.