Muslim patients suffer as Hindu doctors fear for their safety

A LETTER OF CONCERN: REGARDING THE HEALTH SITUATION IN THE RELIEF CAMPS OF AHMEDABAD

Gujarat has been engulfed by unprecedented violence since February 27, 2002 following the Godhra train massacre. Systematic and gruesome attacks have been unleashed against local communities. Hundreds have lost their lives and and even larger numbers have been injured. Over a lakh of people continue to live in refugee camps.

We, a team of health professionals from Christian Medical College and Hospital, Vellore, India undertook medical relief in the refugee camps of Ahmedabad, Gujarat between May 28-June 4 in response to the request of a group of Non Governmental Organizations.

Our primary objective was to provide medical services to refugees in the relief camps of Dariakhan Ghummat, Shahalam and the Vatwa Dargah camp No. 2 located in various parts of Ahmedabad, Gujarat, India. The first two camps are the largest among the 35-40 camps in the city. On the basis of our initial experiences in providing medical care, our team also undertook an assessment of the public health situation in these three camps. We have been disturbed and concerned by what we have seen and experienced. We have attempted to summarise our observations and concerns.

In the three camps thousands of people are crowded together. Two of the camps are situated in burial grounds and one in a school. People are exposed to heat and rain with minimum shelter. A large number of people have to share a few toilets. Food rations are minimal. People huddle together with a few belongings without privacy or protection. Recreation facilities are non-existent. In this physical condition, families are struggling to cope with loss of family members, homes and livelihood in an atmosphere of extreme mistrust, physical and emotional insecurity. This is the scenario three months after the camps came into being.

These conditions do not meet the basic living standards and are inimical to health.

In this context the community members and non-governmental organisations through their own efforts and resources have played an outstanding role in ensuring that minimum services and relief are available in the face of extreme odds. However their efforts are overstretched.

Camp inmates have not been provided adequate facilities and guaranteed security in the relief camps. No comprehensive rehabilitation package is in place for the refugees. There is therefore a crisis of confidence in the state.

These camps should not be closed down in view of threat to life and property that still continues in the original localities. The facilities in the camps must be upgraded so that they meet minimum standards required for healthy living.

OBSERVATIONS

SHELTER

Ø When the violence erupted, the riot victims fled to mosques, dargahs and burial grounds for refuge. These have been spontaneously been converted into relief camps.

Ø There is extreme overcrowding.

Ø In two of three camps people were housed in makeshift shelters consisting of shamianas (cloth erected on poles as roof and cloth as floor).

Ø Families have been staying in these camps for over three months and despite this length of time a more physically secure structure has not been erected.

Ø The shelters do not protect the people from the intense heat of summer. We observed numerous cases of heat related skin conditions and heat exhaustion.

Ø The monsoons, which are imminent, will flood these camps and make them inhospitable, exposing people to cold and constant damp.

WATER AND SANITATION

Ø Water supply in the camps has been met by the Municipal Corporation. There are few
water points as compared to the international standard of one water point for 250 people1. Chlorination of drinking water has been ensured. The drinking water source has been segregated from the toilets.

Ø Toilet facilities in all the camps are inadequate for the population served (1:70 to 1:370 people). They are not easily accessible and are poorly maintained. The International Humanitarian charter prescribes one toilet for 20 people within one minute’s walk1.

Ø There is a potential threat of outbreaks of acute gastroenteritis and other water borne diseases with the coming of the monsoon. Currently sporadic cases of gastroenteritis and viral hepatitis are being reported.

MEDICAL SERVICES

Ø The lack of adequate and coordinated medical facilities has been and continues to be a major problem.

Ø While the bigger camps have managed to organize at least skeletal outpatient and referral systems, the smaller camps have little or no facilities.

Ø Whatever facilities are in place here are due to efforts of the local communities and various non- governmental organizations.

Ø People in the camps are reluctant to access public and private hospitals in view of the perceived discrimination.

Ø Post-traumatic stress disorder and other psychiatric problems related to the extreme physical violence, sexual abuse, loss to life and property are widespread among men, women and children. There has been no provision for specialized counseling and psychological support required to manage these problems. The persisting physical and emotional insecurity has prevented any improvement of these problems.

Ø Patients with chronic diseases such as tuberculosis, hypertension, diabetes, ischaemic heart disease, seizure disorder and psychiatric disorders are unable to continue their regular medical care.

Ø Special needs of women and children have not been addressed adequately

FOOD

Ø The food supplies provided by the government do not meet optimal dietary requirements. The camp organizers have to purchase extra supplies to meet the shortfall.

Ø Only two meals per day are provided to the camp inmates. People frequently complain of hunger.

Ø The food provided falls short in taste and dietary quality in relation to proteins, vitamins and mineral requirements.

Ø Pregnant women and children are nutritionally vulnerable, and no extra provision has been made for them. We have seen several cases of anemia and malnutrition.

We recommend:

Ø That the current camp shelters be upgraded to more secure and protective structures. This is urgently required in view of the continuing physical insecurity outside the camps and the imminent arrival of the monsoons.

Ø The provision of coordinated, comprehensive and acceptable medical care at the camps with adequate referral services. Sensitive counselling and psychological support to the survivors of sexual assault, physical violence, and traumatized and bereaved children by trained health professionals is urgently required.

Ø The quality of diet provided at the camps be improved. Balanced diet should be provided for everyone. Pregnant women, lactating mothers and children require special attention.

Ø An increase in the number toilets and in the quality of their maintenance.

Ø A comprehensive and innovative rehabilitation programme, keeping in mind the physical mental, and social aspects of health. The NGO’s and the local communities do not have adequate resources for this. It is the responsibility of the State to carry out this work.

An independent assessment [refer to the MFC report2] of the health situation in the relief camps of Gujarat between April 15th and 29th, demonstrated an identical health scenario. Over the last month, there is no evidence of any improvement in the poor living conditions and inadequate health care provision. In this context, urgent intervention on the part of national and international agencies is required. We strongly urge you to respond to this humanitarian crisis and provide all possible assistance.

References

1. Humanitarian charter and Minimum standards in Disaster Response. www.sphereproject.org/handbook

2. Carnage in Gujarat: A Public Health Crisis.Report of the Investigation by Medico Friend Circle. May,2002. www.mfcindia.org