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Kashmir communications blackout is putting patients at risk, doctors warn

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5204 (Published 19 August 2019) Cite this as: BMJ 2019;366:l5204

Rapid Response:

Re: Kashmir communications blackout is putting patients at risk, doctors warn

Dear Editors,

On behalf of the British Kashmiri Medical Association (BKMA), we commend the BMJ on raising concerns about the health and humanitarian crisis in Kashmir due to continued communication blockade, since 5th August 2019. We, the British healthcare professionals of Kashmiri origin are directly affected by this ongoing conflict. There is no access to internet, mobile telephones, and there is an ongoing restriction on the movement of people. Patients needing dialysis, chemotherapy, emergency surgeries, and pregnant women are unable to get timely treatment due to unavailability of transport, ambulance services, shortage of medical staff, and dwindling supplies of life-saving medications1.

The lockdown has entered the third month and ground reports suggest that the situation to access to healthcare continues to worsen.2-4 Scheduled cancer surgeries are being cancelled and people have no means to call an ambulance.4 It has become extremely difficult for doctors to seek urgent advice, liaise with others, or refer to other specialties. Junior doctors have to physically travel between hospitals in hostile conditions to seek such advice while compromising their own safety. Due to lack of internet, clinicians have no access to clinical guidelines, evidence base, and insurance details of patients which makes the delivery of healthcare extremely difficult.

Nearly 8 million people caught up in this blockade are being denied the fundamental right to healthcare. Numerous reports in international media have alleged several deaths due to exacerbation of chronic illnesses which could have been prevented if people were able to access urgent medical care5. Estimates suggest 20% (1.6 million patients) of the population that suffers from a chronic disease is at risk of poor outcomes due to the current situation6. There are widespread reports of blindness and physical injury due to the use of pellet guns 7-8. In addition to the obvious physical element, the psychological scarring of the population is unimaginable.9-10

The preventable healthcare disaster and communication blockade in Kashmir is affecting day to day functioning of Kashmiri diaspora and many have reported symptoms of severe anxiety11. With the situation becoming grave without any respite for over nine weeks now, Kashmiris residing in the United Kingdom are struggling to make contact with their families and have little knowledge about their safety and wellbeing. There is no clarity on how long this blackout is going to continue. We are concerned that many Kashmiris living around the world could end up having acute mental health crises as a direct consequence of the current situation.

We finish with the hope that the global medical fraternity and global organizations seek immediate relief for the besieged population, stress on the international agencies to support local healthcare system in Kashmir and also send fact finding teams to review the Kashmir Medical Disaster.

Lastly, as Kashmiri doctors, directly affected by the ongoing situation, we would like to thank the editorial team of the BMJ for the timely news article.

Yours sincerely

Dr Farooq A Wandroo President BKMA
Dr Mudasir Firdosi Vice-President BKMA
Dr Afifa Qazi General Secretary BKMA

References:

1. BBC New. Inside Kashmir's lockdown: 'Even I will pick up a gun'. https://www.bbc.co.uk/news/world-asia-india-49294301

2. Samaan Lateef. Kashmir crisis: Hospitals turning patients away as doctors fear ‘impending tragedy’. https://www.independent.co.uk/news/world/asia/kashmir-crisis-hospital-vi...

3. R. Prasad. In a letter, doctors urge government to allow patients in Kashmir to access health care. https://www.thehindu.com/news/national/other-states/in-letter-in-bmj-doc...

4. Aakash Hassan. Kashmir Dispatch 11 | Valley Running Out of Medicines With No Fresh Supply Coming, Say Doctors. https://www.news18.com/news/india/kashmir-dispatch-11-valley-running-out...

5. Sameer Yasir and Jeffrey Gettleman. In Kashmir, a Race Against Death, With No Way to Call a Doctor. https://www.nytimes.com/2019/10/07/world/asia/kashmir-doctors-phone.html
Dated: October 7, 2019. Date Accessed October 08, 2019.

6. World Health Organisation- Noncommunicable Diseases ( NCD) Country Profiles, 2018. https://www.who.int/nmh/countries/2018/ind_en.pdf?ua=1 Date accessed September 9, 2019

7. Muddasir Ali, Majid Maqbool. Lockdown hits access to healthcare in besieged Kashmir. https://www.thenewhumanitarian.org/news/2019/09/19/Kashmir-lockdown-heal...

8. Office of the United Nations High Commissioner for Human Rights. Update of the Situation of Human Rights in Indian-Administered Kashmir and Pakistan-Administered Kashmir from May 2018 to April 2019. https://www.ohchr.org/Documents/Countries/IN/KashmirUpdateReport_8July20...

9. de Jong K, Ford N, Kam Sv, et al. Conflict in the Indian Kashmir Valley I: exposure to violence. Confl Health. 2008;2:10. Published 2008 Oct 14. doi:10.1186/1752-1505-2-10

10. Kashmir: Violence and mental health. https://www.msf.org/kashmir-violence-and-mental-health Report14 December 2006. Accessed online dated: 09/20/2019.

11. A. Qazi, M. Firdosi, F. Jan, A. Majeed. Psychological burden of the Kashmir Conflict on Kashmiris living abroad: damage caused from a distance. EPA 2020 Secretariat

Competing interests: No competing interests

12 October 2019
Afifa Qazi
General Secratary
Dr Farooq A Wandroo President BKMA, Dr Mudasir Firdosi Vice-President BKMA, Dr Afifa Qazi General Secretary BKMA
The British Kasmiri Medical Association ( BKMA)
London, United Kingdom