The deaths of more than 100 children due to an outbreak of acute encephalitis syndrome (AES) in Bihar has come under the scanner of the Supreme Court.
The tragedy has sparked national outrage and arrested international headlines. As the death toll passed 150 over the weekend, the Chief Judicial Magistrate of the Muzaffarpur district (where most of the deaths have occurred) ordered that Union Health Minister Dr Harsh Vardhan and Bihar’s state health minister Mangal Pandey be investigated for negligence.
The CJM was responding to a petition by activist Tamanna Hashmi filed on June 17th. Accusing the ministers of negligence, Hashmi sought their investigation under Sections 308, 323 and 504 of the Indian Penal Code, with Section 308, in particular, pertaining to culpable homicide not amounting to murder. Hashmi alleged also that he had received an anonymous threat and filed a complaint with police in Ahiyapur.
“The deaths of children are a direct result of negligence and inaction on the part of the respective state governments of Bihar, Uttar Pradesh and Union of India in handling the epidemical situation which arises every year due to outbreak of AES also called Japanese encephalitis.”
At the national level, the Supreme Court intervened. The apex legal body said “the deaths of children cannot go on in Bihar”, adding that “several issues require answers.” The Court directed the Centre and the state governments in Bihar and Uttar Pradesh to respond within a week of its missive, with a hearing scheduled for ten days following. The Bihar state government is expected to provide a report on “medical facilities, nutrition, sanitation and hygiene conditions.” Officials were also asked about policies implemented to handle the crisis.
The Supreme Court was responding to a petition filed by Manohar Pratap, which asserted that “the deaths of children are a direct result of negligence and inaction on the part of the respective state governments of Bihar, Uttar Pradesh and Union of India in handling the epidemical situation which arises every year due to outbreak of AES also called Japanese encephalitis.”
The plea added that “media reports [show] that there is [an] acute shortage of doctors, medical facilities, intensive care units and other medical equipments in the hospitals in nearby areas and children are dying in hospitals due to lack of required facilities.” Among the steps taken included dispatching medical experts from the Centre to the state and payment of Rs 10 lakh to those who have lost family members to the outbreak (an ex gratia of Rs 400,000 has already been pledged by Bihar Chief Minister Nitish Kumar).
Uttar Pradesh witnessed a spate of child deaths due to encephalitis in 2017, wherein more than 325 children died within the space of a month. Most of the casualties were being treated for encephalitis at the hospital. A shortage of medical oxygen was implicated as the cause of many of the deaths. The tragedy in Bihar and accusations of poor medical infrastructure and lack of equipment echo that event. Indeed, this much was highlighted in a National Human Rights Commission report released last week implicating “deficiencies and inadequacies in the healthcare system” in the tragedies in both Gorakhpur and Muzaffarpur.
For its part, the Uttar Pradesh state government under Chief Minister Yogi Adityanath has claimed the state government has been effective in handling AES. “We started [a] programme ”Dastak” in association with UNICEF to control encephalitis and other vector-borne diseases and we got effective results in controlling encephalitis and AES, but it is continuous…..and it will be started again from July 1,” he said. In 2018 – the year after the Gorakhpur tragedy – Uttar Pradesh registered a drop of more than 66 percent in fourteen of the most-affected districts in the eastern part of the state.
“Action has been pledged by a number of officials, but with the death toll continuing to rise, mounting anger is palpable – manifest in protests against lawmakers, including the Chief Minister. Action is vital, as the missive of the Supreme Court serves to remind us.”
The ongoing controversy over the AES outbreak is casting a spotlight on the inadequate public health infrastructure, both in Bihar and at the national level. As previously reported by Health Issues India, the Muzaffarpur district has a mere eighty doctors to serve every one lakh patients while 79.5 percent of the district’s residents lacking access to a public healthcare facility. Statewide, there is just one doctor for every 17,685.
At the national level, India possesses just one doctor for every 11,082 people in addition to severe shortfalls in terms of public health infrastructure. Inequalities between states in terms of their health indicators jeopardise progress. This results in different states having different capacities in responding to outbreaks such as the AES deaths in Bihar, one of the worst-affected states in terms of public health resources.
Action has been pledged by a number of officials, but with the death toll continuing to rise, mounting anger is palpable – manifest in protests against lawmakers, including the Chief Minister. Action is vital, as the missive of the Supreme Court serves to remind us. Efforts to raise awareness of the disease and risk factors such as the consumption of the lychee fruit implicated in the outbreak are needed. In addition, supervising disease control efforts and vigilance against recurrences in the future will be needed to ensure Bihar is not beset by such catastrophes in the coming years.