Healthcare system collapsing in Kashmir
With communication lines down, residents can’t call ambulances or schedule operations. Now doctors are warning that critical medication is running low in the beleaguered territory.
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5 September 2019
Inhabitants in the disputed Jammu and Kashmir region remain in a state of shock and anger as the military and communications lockdown enters a fourth week, following the Indian government’s unilateral decision to revoke the region’s autonomy. Rights groups are warning that a humanitarian crisis is unfolding in the restive Himalayan territory with reports of mass arrests, night raids, torture and the use of violent force to suppress protests documented in different parts of the state.
The biggest problems facing the local population since Indian forces shut the region down on 5 August have been access to medical care and shortages of lifesaving drugs, leading to fatalities. Reports from different parts of the valley suggest that a major health crisis is unfolding, with patients unable to call for ambulances to get medical care or access hospitals.
Kashmir has been put under an indefinite curfew and communications clampdown after Prime Minister Narendra Modi’s ring-wing government annulled the state’s special status, which gave it a degree of autonomy, and brought the Muslim-majority state directly under federal rule for the first time since 1947.
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As the internet and telephone lines remain cut, patients have been forced to reach the capital Srinagar’s premier hospitals – the Shri Maharaja Hari Singh (SMHS) Hospital and Sher-i-Kashmir Institute of Medical Sciences (SKIMS) – and other primary facilities on their own as they are unable to reach ambulances or medical services. Emergency cases and critically ill patients such as those who require regular dialysis, have undergone operations or are receiving chemotherapy have been the worst affected. In rural areas, basic products such as baby food and sanitary pads are unavailable.
Doctors and other medical staff are finding it difficult to reach hospitals and healthcare centres. The city’s main hospitals have moved staff from general operation theatres to casualty and emergency theatres, resulting in a delay in routine surgeries, which have decreased by almost half. Patients are being sent home early while still in a vulnerable condition after receiving primary treatment.
Emphasising that the Indian government’s lockdown in Kashmir is impeding people’s ability to access urgent medical care, Human Rights Watch (HRW) South Asia director Meenakshi Ganguly said the Indian government’s actions shouldn’t be at the “expense” of Kashmiris’ rights and that the authorities “should take all necessary steps to ensure people are able to obtain healthcare and emergency services”.
Drug distributors and chemists in the valley have raised the alarm that they are running out of medical supplies and unable to place orders to procure essential drugs and medical equipment in the absence of internet and phone services. The state receives more than 90% of its critical medical supplies from India.
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Kashmir Chemist and Distributors Association president Arshad Husain Bhat told The Independent that about 3 000 Srinagar-based distributors are unable to supply drugs to chemists owing to the blockade, saying: “The worst hit are diabetic, haemophilia and hypertensive drugs.”
Panic buying of medicines ahead of the lockdown, with people stockpiling medicines for two to three months, has exacerbated the low supplies. “While the valley has faced troubled times in the past, such as the 2016 unrest, the medicine supply has never been affected so badly. This is a very grave situation,” a doctor told Indian news portal News18.com. Another doctor in a government-run hospital in Srinagar told United States media organisation NPR, “This is one of the harshest restrictions we’ve experienced.”
In a series of tweets, the Jammu and Kashmir administration refuted concerns that there is a shortage of essential medicines or that access to healthcare facilities has been hampered in the valley, terming the assertions “baseless” and adding that health services in the state are functioning “normally”.
Medical journals flag looming crisis
On 17 August, British medical journal The Lancet, in an editorial titled “Fear and uncertainty around Kashmir’s future”, noted that the presence of forces in Kashmir “raises serious concerns for the health, safety and freedoms of the Kashmiri people”.
The independent journal further emphasised that the people of Kashmir need “healing from the deep wounds of this decades-old conflict, not subjugation to further violence and alienation”. It noted that “the protracted exposure to violence” has led to a “formidable mental health crisis” with increased levels of “anxiety, depression and post-traumatic stress disorder”.
The Lancet’s editorial provoked a response from the New Delhi-based Indian Medical Association (IMA), a lobby group made up of medical practitioners, which said the journal had “committed a breach of propriety” by commenting on a political issue and that it had no “locus standi” on this matter. “The Lancet had reacted to an internal administrative decision of the government of India under the garb of concern for the health of Kashmiris,” the letter addressed to the journal’s editor-in-chief noted.
Another United Kingdom-based medical journal, The BMJ, published a similar warning, noting that the military lockdown of Kashmir was hampering people’s rights to healthcare and to life. The 19 August article in The BMJ included the voices of a group of 18 doctors from across India who warned that the “grim” situation had led to a “blatant denial of the right to healthcare”.
The doctors, in their letter to The BMJ, pointed out that people were unable to call an ambulance to take a sick person to hospital. They needed to be taken in a private vehicle if they had access to one. “These vehicles are stopped every few metres by security forces standing at concertina wire barricades to check identity and ask questions.”
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A Kashmiri doctor named Dr Omar Salim, a urologist at Srinagar’s Government Medical College, was arrested by the police after he spoke to the BBC Urdu, warning of critical shortages of lifesaving medicines and deaths in the wake of the prolonged restriction on public movement and the communications blackout in the state.
“This is not a protest, this is a request. Please restore landline and internet connectivity for all hospitals and medical establishments in Jammu and Kashmir,” read the placard being carried by Salim as he spoke with the BBC reporter. “If patients don’t receive dialysis, they will die. If cancer patients don’t receive chemotherapy, they will die. Those patients who can’t be operated on can die,” he told the BBC. The police arrested Salim 10 minutes into the interview for speaking up.
Educational institutions have remained closed since the restrictions were imposed. Public transport and the movement of vehicles is restricted. Public gatherings are banned. Though phone lines have been restored in some areas recently, the restrictions have not been lifted.
An article in The Washington Post reported that state authorities in Kashmir have arrested more than 3 000 people since the crackdown began. A BBC report documented abuse and torture of locals by Indian army personnel. The report said forces raided homes and dragged men into the streets to beat them and give them electric shocks. The report carried photographs showing large welts and other injuries on the men’s bodies, which they said were from the beatings. The Indian army has refuted the allegations.
US and UK lawmakers raise concerns
The situation in Kashmir has drawn concern from several prominent members of the US Congress, who expressed their fears about the deteriorating human rights situation in the valley.
US presidential contender Bernie Sanders recently heavily criticised India’s actions, terming them “unacceptable”, and asserted that the communication blockade prevailing in the state must be lifted immediately. Sanders said the crackdown on dissent in Kashmir “in the name of security” impedes access to medical care.
“Even many respected doctors in India have acknowledged that the Indian government restrictions on travel are threatening the lifesaving care that patients need,” the Democrat senator from Vermont told a recent convention of the Islamic Society of North America in Houston. He added that the US government must support a United Nations-backed peaceful resolution that respects the will of the Kashmiri people.
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A day earlier, US congressman Andy Levin lambasted Delhi’s decision, asserting that Modi had trampled on democratic norms and the fundamental human rights of Kashmiris. US congresswoman Pramila Jayapal, the first and only India-born lawmaker in the US House of Representatives, said she was “deeply troubled” by the arrests of people in Kashmir. Congressman Adam Schiff, chair of the House Intelligence Committee, noted that the situation in Kashmir remained “deeply concerning, with thousands of civilians still detained without charges and with no access to the outside world”.
“Very concerned about the situation in Kashmir, particularly the ongoing communications blackout. Have heard from constituents cut off from their families who are worried about what will happen to them. Despite the blackout, the world is watching,” the Democrat congressman from Virginia, Don Beyer, posted on Twitter.
In response to his tweet, California Democrat Ted Lieu said he had heard from his constituents that they were unable to reach their families in Kashmir. Representative Ilhan Omar, a Minnesota Democrat, said she was “excited to see so many members joining us in calling attention to what is happening in Kashmir. Please continue to call your members and ask them to speak up. We expect openness from India.”
Earlier, the leader of the UK’s opposition Labour Party, Jeremy Corbyn, called for a resolution in Kashmir through relevant UN resolutions. “The situation in Kashmir is deeply disturbing. Human rights abuses taking place are unacceptable,” the Labour leader tweeted.
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Scottish First Minister Nicola Sturgeon also tweeted about her concerns on the situation in Kashmir, stating that her constituents with relatives from Kashmir had spoken to her on the matter. “I share their concern. Human rights and self-determination for Kashmir must be respected.”
Pakistan Prime Minister Imran Khan has continued to ratchet up the rhetoric against the Indian move, asserting that Delhi was planning the “genocide of Muslims in Kashmir”. The cricketer-turned-politician warned the international community that Delhi could launch an attack on Pakistani-held Kashmir in an effort to divert attention from human rights abuses in the portion India controls.
“If the world does nothing to stop the Indian assault on Kashmir and its people, there will be consequences for the whole world as two nuclear-armed states get ever closer to a direct military confrontation,” said Khan in an op-ed for The New York Times published on 30 August.
Khan has regularly drawn parallels between German dictator Adolf Hitler and Modi, and also between the Rashtriya Swayamsevak Sangh, the ideological mentor of the ruling Bharatiya Janata Party, and Hitler’s Nazi Party.
