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Purpose - Mombasa City in Kenya is one of the most vulnerable towns to flood risk due to its low-lying coastal location. Those at the highest risk in the city are households living in the flood-prone informal settlements. However, little is known about the perception of these vulnerable households to the flood risks and its health impacts, which is important for developing effective long-term adaptation strategies. The purpose of this paper is to examine the general perception of the residents regarding flood risks, its impact on their health and their adaptation strategies.

Design/methodology/approach - This study surveyed 390 randomly selected households in three informal settlements in the city of Mombasa using a semi-structured questionnaire. This was supplemented with six focus group discussions (FDGs) and six key informant interviews (KIIs).

Findings - The majority of respondent households perceive future flooding as high risk or severe with high negative health impact. Despite this, many do not evacuate their homes because they do not have alternative places to move to. Flooding was indicated to have had a negative physical and mental health impact on members of households. Although majority of households had taken some adaptation measures, most of these were short term, mainly due to financial constraints, lack of knowledge and government support. Perception of flood risk and gender were found to have a strong influence on taking long-term adaptation measures at the household level.

Practical implications - Reducing flood risk and averting its health consequences in flood-prone informal settlements require empowering and supporting those living in these areas with ability to initiate long-term adaptation measures and creating awareness about future risks.

Originality/value - This study provides evidence about how residents of flood-prone informal settlements perceive flood risk and how the exposures to perennial flooding impact their health. The paper augments existing knowledge of flood risk in poor urban neighborhoods of developing countries.