The impact of riots on health services receives scant attention, more so when there is a communal angle to it. While the narrative around deaths receives some attention, the deeper insidious effects are glossed over. This will also impact not only the health of the population but also crucial medical responses in a time like the outbreak of the coronavirus pandemic. Here is one such story, although not unique.
After the riots in north-east Delhi, in February, a volunteer called our medical team: “Twenty-two-year-old Noor Jahan (all names have been changed), a pregnant woman, is scared to leave her house. Could you please send a doctor to examine her?” On visiting her, we learnt that the woman had lost all her belongings, including her prescriptions and medications, while fleeing her house in Shiv Vihar as it was being torched.
Seeking refuge with her distant relatives and with her delivery date just a week away, she was gripped by fear and anxiety at the prospects of visiting the Guru Teg Bahadur (GTB) Hospital which was nearby. Anecdotes of the communal hostility her neighbours had faced at this hospital had left her unnerved. She ended up delivering her child at the faraway Sucheta Kriplani hospital, in an unfamiliar environment.
A zone of poor health
North-east Delhi is the most underdeveloped region of Delhi and is marked by all the socio-demographic determinants of poor health outcomes: a significant proportion of the population is from the migrant and minority communities; there are high rates of illiteracy, rampant unemployment and poverty; overcrowding; unsanitary conditions, and a non-existent health-care infrastructure.
Yet, despite the fear, a medical camp in Chand Bagh, set up for a few hours using a mobile van, immediately draws the attention of more than 600 people. While the most common complaints are fever, a runny nose, and body aches, a disconcertingly high proportion of young adults complain of ‘ ghabrahat’ (anxiety). On further questioning, they report poor sleep and appetite, inability to concentrate, and experiencing constant worry, all signs of underlying mental health problems. Further, due to adverse social circumstances, many patients with chronic medical conditions have not been able to visit their doctors. We saw several of these patients who now have a worsening of chronic diseases such as elevated blood pressure and asthma.
Naeem, 25, was in agonising pain. He had a deep cut above his left eyebrow, and was bruised all over after having been beaten up by a mob. Yet, he did not see a doctor. Alarmed by the large number of incarcerations, he had stayed at home. His fears were not unfounded. In the follow-up after the riots, the Delhi Police are estimated to have rounded up over a 1,000 individuals, most of them young Muslim men. Interference of the police in health systems and a lack of patient privacy protection laws have changed the health-seeking behaviour of certain sections of the populace.
Zeeshan, 36, had been admitted to hospital with fractures in both legs and a stab wound in his left arm. After two days of hospitalisation, they wanted to discharge him. His pleas to stay on as his house had been vandalised and his health was poor had to be turned down. The resident doctor had to tell him that despite their understanding of his concerns, he had received all the care needed and that as the hospital was overflowing with patients, beds were needed. Zeeshan had to be told that the hospital could not do anything to help him even if he did not have a safe place to go back to.
During our visits to the riot-affected localities, we noted many burned and looted houses. Even more malicious was that goons had damaged water pipes and looted water purifiers. With open drains and an unplanned sewerage system, there is a real threat of Salmonella bacteria seeding these pipes. Salmonella, the bacteria responsible for typhoid fever, will be hard to eliminate. If not managed properly, people will suffer from recurrent typhoid fevers and diarrhoeal infections, leading to downstream consequences such as child malnutrition and antimicrobial resistance.
Way forward is collaborations
These examples demonstrate how the riots have exposed and deepened chasms in the health systems. A broken health system and a population that has lost trust in health-care providers will amplify the challenges of managing the COVID-19 epidemic in Delhi and worsen all other health-care indicators. Rectifying these shall necessitate a deliberate and comprehensive strategy by the State not only at the infrastructure and policy levels but also at the moral and philosophical levels.
The government must collaborate with local municipal bodies, partners in civil society and members of the local community to devise sustainable solutions. They must build a maternity ward with labour room services so that women do not have to travel to faraway, unfamiliar and hostile hospitals to deliver. A mohalla clinic for primary care is a must in the area as demonstrated by large queues outside the medical camps, which are often organised in an ad hoc manner depending on available resources. Psychologists are needed to provide therapy to the riot-affected children, adults and citizens confined to their houses out of fear. Similarly, physiotherapists should be recruited to prevent long-term physical disability. The sewerage systems should be fixed, water pipes restored and measures such as chlorination for water hygiene instituted at a house-to-house basis.
People should be at the core of health systems and policy design. Systems and policies that drive citizens away from hospitals have to go. An initiative by the Delhi government, in the form of the “Farishte Dille Ke” (The Angels of Delhi), offers hope. Similarly, it ought to set an example for other States by changing health-care privacy laws to protect patients from police interference and also empower them to get medical care.
What is most shocking is the loss of trust in health-care providers on account of the communal underpinnings of the situation. In the short run, the medical community and the government should conduct peace marches in north-east Delhi to assuage fears. In the longer run, just like the “happiness curriculum” in schools, it should start a “humanities curriculum” for medical professionals so that they provide more empathetic and compassionate care.
Anup Agarwal is a medical doctor and