At around 2 am on 2 April, 52-year-old Naresh Khatik complained of uneasiness and shortness of breath. His son, Gaurav, said he went to two nearby hospitals to seek treatment for his father, but the hospitals refused to admit him because they said they were not equipped to treat patients showing COVID-19 symptoms. Naresh was a survivor of the world’s worst industrial disaster—the Bhopal gas tragedy of 1984. Ordinarily, Gaurav would have taken his father to the Bhopal Memorial Hospital and Research Centre, a super-speciality hospital that was setup to exclusively cater to survivors of the gas tragedy and their dependents. But on 23 March, the state government had turned the hospital into a facility exclusively dedicated for care to COVID-19 patients.
Around one hour after he first complained of breathlessness, Naresh's family was forced to admit him at the Narmada Trauma Centre, an expensive hospital in a posh residential area. On the night of 5 April, Gaurav said he received a call informing him that his father had tested positive and would be shifted to the All India Institute of Medical Sciences, Bhopal. A little later, the hospital administration invited him to a chamber and accused him of hiding information about his father from them. He said they then told him that his father’s condition was fast deteriorating. “It was around 11 pm. They told me they were unable to save my father,” Gaurav told me. Naresh died that night.
“When my father heard about the coronavirus and the lockdown to crush the spread of virus, he warned me saying gas victims are going to be on high risk, because most of us have breathing problem and are unable to do heavy jobs,” Gaurav said. Naresh Khatik suffered from a weak pulmonary system, and had contracted pneumonia in 2015. He was the first victim of the gas tragedy to die of COVID-19. By 15 April, five more victims of the gas tragedy—Jagannath Maithil, Rajkumar Yadav, Ashfaq Nadvi, Imran Khan and Yunus Khan—had contracted the novel coronavirus and died.
On 15 April, the state government rescinded its order converting the BMHRC into a COVID-19 designated facility. But the infection had already spread in the capital city. Within two weeks, eight more people died, all of them reportedly victims of the 1984 gas leak. According to Mohini Devi, the secretary of the Bhopal Gas Peedit Mahila Udyog Sanghathan, another group that has been working with the gas-tragedy survivors for over three decades, told me that the delay in revoking the 23 March order had resulted in the death of the eight gas victims because they were denied proper treatment at BMHRC. “All those responsible for subjecting the gas victims to unnecessary harassment during the COVID-19 crisis should be taken to task and appropriate compensation should be paid to the gas victims who died due to this criminal neglect,” Devi said.
The deaths seemed to indicate an apathy on the part of the state government towards the gas-tragedy victims, or at least a complete failure to consider predictable consequences of closing the BMHRC’s doors to them. It also demonstrated the poor quality of public healthcare in the state, where patients were forced to choose between public hospitals that were inaccessible and private hospitals that were unaffordable. Most of all, it was a glimpse into the inefficient policies and measures that have marked the state’s poorly planned and ill-thought out response to the pandemic. As Naresh had warned, it showed that hundreds of thousands of survivors of the Bhopal gas tragedy were most vulnerable to the COVID-19 pandemic, and that the state government was ill-equipped to protect them.
The BMHRC works under the Indian Council of Medical Research, which has been India’s nodal agency in framing a response to the pandemic. In 2004, following a Supreme Court directive, the ICMR had also constituted an advisory committee to review the healthcare provided to Bhopal gas tragedy victims. According to the minutes of the advisory committee’s fourteenth meeting, held in June 2016, the BMHRC had 3.76 lakh registered gas victims, and 1.7 lakh survivors who regularly visited the hospital for treatment. In effect, the state government effectively closed the hospital’s door to these survivors, exacerbating a public-health crisis.
The matter had been brought up before the Supreme Court as well by Munni Bi, a 68-year-old gas-tragedy victim, in a writ petition challenging the state government’s decision to exclusively treat coronavirus patients at the BMHRC. Bi was admitted in the intensive care unit when the state made the decision. She was asked to leave the hospital, prompting her to challenge the order in court. But on 7 April, the apex court dismissed the petition, directing Bi to approach the Madhya Pradesh High Court. Two days later, Bi died due to lack of medical attention. “It is highly regrettable that the Supreme Court of India did not find it necessary to intervene in this serious matter and take prompt action to save the gas victims from this avoidable persecution,” Devi said.
“Despite knowing that life expectancy of gas victims are low as compared to others, we are either ill-treated or repeatedly forced to suffer,” Akhil Ahmed, a gas-tragedy victim who visits the BMHRC every week, told me. “This time also, BMHRC was suddenly closed, and we had no information about it. There is no end to our sufferings. Instead of things improving, the situation for the gas victims is deteriorating day by day.”
ND Jayaprakash, a co-convener of the Bhopal Gas Peedith Sangharsh Sahayog Samiti—an organisation that works with survivors of the disaster—accused the ICMR, the BMHRC and the state government of acting with gross indifference and negligence. “The persistent apathy of the ICMR and the government of Madhya Pradesh in monitoring the health status of the Bhopal gas victims is shocking to say the least,” Jayaprakash told me. “They have failed to maintain proper medical records of hospitals and clinics through computerisation and networking, and have failed to supply health booklets to each gas-victim with his or her complete medical record. That proper protocol for treatment of most gas-related ailments has not been evolved even 35 years after the disaster speaks volumes about the apathetic attitude of the concerned authorities in this regard.” He added, “Mere symptomatic treatment, over-medication due to lack of proper monitoring, and dispensing of sub-standard and spurious drugs has resulted in increasing number of renal failures among gas-victims.”
Despite multiple calls, messages and emails to RS Dhaliwal, who is the coordinator of a permanent institute of the ICMR in Bhopal, and Prabha Desikan, the director of the BMHRC, I did not receive a response. Phone calls and messages to Faiz Ahmed Kidwai, the state’s health commissioner, and the chief minister’s office also went unanswered. This story will be updated if and when they respond.
After the state government’s order converting the BMHRC facility, the Bhopal Group for Information and Action—another group that works with the survivors—has moved the Madhya Pradesh High Court to challenge the decision. But while the case was still pending before the high court, the government rescinded its order, after preventing healthcare to survivors who were vulnerable to the pandemic for over twenty days.
Since 15 April, the BMHRC has been treating gas-tragedy victims as well as taking COVID-19 samples for testing, though it is no longer treating patients who have contracted the virus. On 11 May, I visited the hospital and found that there were very few patients. “After it was restarted, the BMHRC is admitting only those gas tragedy card holders who are very critical,” a survivor who visited the hospital for kidney dialysis in early May told me. A senior doctor with the BMHRC told me on the condition of anonymity, “The hospital is only admitting very critical patients to avoid being the worst performer in case the coronavirus crisis deepens.”
As of 25 May, the state government had reported a total of 6,859 positive cases and 300 deaths, including 1,271 confirmed cases and 48 deaths in Bhopal. According to Jayaprakash, at least a dozen of them were victims of the gas tragedy.
Amulya Nidhi, a national co-convenor of the Jan Swasthya Abhiyan—the Indian wing of the People’s Health Movement—said that one of the main problems with the chief minister Shivraj Singh Chouhan’s handling of the pandemic has been the poor rate of testing in the state. As of 25 May, the state had conducted a total of 1,38,584 tests. Despite having a population of more than seven crore, the state has only 13 government testing labs and seven private ones, according to ICMR data. Meanwhile, Maharashtra with over eleven crore residents, has a total of 70 labs—over three times the number in Madhya Pradesh despite having less than double the population—and Kerala, with less than four crore people has 22 labs. Similarly, Karnataka and Gujarat, both with a population of less than seven crore, have 56 and 37 labs, respectively. Delhi, which has less than two crore residents, has 32 labs.
According to SR Azad, a member of the Jan Swasthya Abhiyan’s state core committee for Madhya Pradesh, the state government has done very little to prepare more testing labs in public and private institutions across the state. For instance, the state does not have a single laboratory that conduct CBNAAT testing, which is a polymerase chain-reaction test that was until this pandemic used to identify tuberculosis. “Despite advisory issued by ICMR on 19 April, which we have suggested to the government of Madhya Pradesh, the state is yet to start a single CBNAAT test lab which is faster and cost-effective,” Azad told me.
Another major shortcoming in the state’s handling of the crisis has been a rising number of pending samples yet to be tested for the COVID-19 virus. On 6 May, the Jan Swasthya Abhiyan wrote to the chief secretary of Madhya Pradesh highlighting that there was a mismatch in the total number of tests samples and test results, indicating a backlog. It noted that according to the data released by the state government, as on 1 April, the number of pending samples to be tested stood at 497. The pending samples shot up to 4,501 by 15 April and further rose to 9,021 by 25 April. The press note stated that starting 27 April, the state government stopped providing data on the total number of samples and those awaiting test results.
“The state is not only dealing with backlog of pending samples awaiting results, but rejection of large number of samples has become a major concern,” Nidhi told me. As early as 13 April, Kidwai, the health commissioner, had written to all the district-level officials communicating a message from a virology lab where the state’s COVID-19 samples were sent for testing. Kidwai noted that the virology lab had been forced to reject a lot of the test samples due to a “lack of sufficient documentation.”
Kidwai’s letter suggested towards an inexplicably careless and haphazard handling of the test samples. The letter identified several reasons that forced the virology lab to reject the tests, broadly classified under two categories—errors in the ICMR’s requisition form that has to be submitted with each sample, and problems with the physical tests themselves. For instance, in the first category, Kidwai wrote the errors included, “Category not mentioned,” “More than one category mentioned,” “Incomplete forms/photo copy of forms,” “Not in legible handwriting,” and “Doctor seal sign missing.” In the latter category, Kidwai wrote that there was “Sample leakage,” “Name mismatch,” “Unlabeled sample vials,” and even missing samples.
It was not the first time that these issued had been highlighted. The same unprofessional conduct had been observed and reported by a rapid-response team that visited Indore on 2 April to assess the COVID-19 situation in the district. In response to a report filed by the team, on 11 April, about the worsening conditions in the district, the state’s directorate of health services had told the press, “There were concerns regarding rejection of samples owing to incomplete laboratory form and some instances of non-eligible samples.”
Meanwhile, Nidhi pointed out that the state’s health department still seemed to have continued operating with a certain level of carelessness. Since 18 May, there have been discrepancies in the total the number of tests and daily tests reported by the state government in its daily health bulletins, Nidhi explained. For instance, on 17 May, the state bulletin reported a total of 1,03,898 tests. The next day, the bulletin noted that the state had conducted 1,12,168 tests in total and that it conducted 5,373 tests on that day. However, a comparison of the total number of tests on the two days suggests that 8,270 new tests were conducted. “Where are the missing 2,897 test reports?” Nidhi asked.
For the week preceding 18 May, when this discrepancy was first seen, the number of new tests coincided with the total number of tests reported on each day and its respective previous day. But since then, this discrepancy has continued. On 19 May, the state reported a total of 1,16,473 tests, or 4,305 more tests than the previous day, but only recorded 4,233 new tests—leaving a shortfall of 72 tests. On 20 May, the state reported that it had conducted 4,903 new tests, whereas the total number of tests from the previous day only increased by 4,264—creating an surplus of 639 tests that were unaccounted for. The next day, the state once again reported a shortfall of 420 new tests. Then from 22 to 24 May, it respectively recorded a surplus of 625, 368 and 690 new tests each day. On 25 May, it reported an additional 1,217 tests that were unaccounted for.
As the state government continuously falters in its response to the pandemic, the situation in Madhya Pradesh had become alarming, with the infection having spread to 50 of the state’s 52 districts. As of 25 May, the fatality rate in the state stood at 4.37 percent, significantly higher than the national average of 2.86 percent.
Corrections:
Three Bhopal gas-tragedy victims named in the article—Naresh Khatik, Rajkumar Yadav and Aqueel Ahmad—were incorrectly identified as Narendra Khateek, Ramprakash Yadav and Akhil Ahmed, respectively. Khatik, who is 52 years old, was also incorrectly identified as 60 years old. The opening three paragraphs of the earlier version of this article have been corrected to more accurately reflect these details and the events leading up to Khatik's death.
A previous version of the article also incorrectly stated that five victims of the gas tragedy were frequent visitors of the Bhopal Memorial Hospital and Research Centre, and that the BMHRC had been testing Bhopal gas survivors for COVID-19 since 15 April. All five patients did not regularly visit the hospital, and the hospital began testing samples after it was directed to do so by the Madhya Pradesh High Court, on 21 April.
The Caravan regrets the errors.