As coronavirus cases surge in India, healthcare professionals fear conflict-riddled Jammu and Kashmir will become the centre of the deadly pandemic.
Only emerging from a seven-month lockdown in February, its public healthcare system is one of the most unprepared and understaffed in the country.
The union territory has recorded 380 coronavirus cases but this number is thought to be a gross underestimation.
Last week, a reported 5,000 testing kits failed to arrive causing the Kashmir Directorate of Health Services to stop taking samples.
Official sources said there was already a backlog of some 1,300 tests and new patients were arriving all the time.
“In the last 30 years, India prioritised conflict management over upgrading healthcare in Jammu and Kashmir,” explains Khurram Parvez, the programme coordinator of the Jammu Kashmir Coalition of Civil Society.
“Our doctors gained expertise in managing trauma victims but coronavirus is a completely new thing for them. “Jammu and Kashmir is the least prepared region to deal with this virus and it will have devastating effects.”
In 2018, an audit found the doctor to patient ratio in the union territory was one of the lowest in India at 1:3,866.
The national average is 1:2,000, while the World Health Organization recommends a norm of 1:1,000. The study also found less than 50 per cent of nursing positions had been filled.
Ongoing cross-border conflict between India and Pakistan and a continued violent pro-independent insurgency in Jammu and Kashmir has resulted in many healthcare professionals leaving the state for employment elsewhere.
The audit concluded the existing number of healthcare professionals was “barely sufficient to run the health institutions in view of sustained increase of patient flow across the state.”
Now, doctors at SKIMS Medical College Hospital in Srinagar say there are only three staff members treating 96 Covid-19 positive patients. “It is not only against professional ethics but also amounts to gross medical negligence,” read a letter shared with The Telegraph.
On August 5, the Indian Government revoked Jammu and Kashmir’s autonomy, dividing the state into a union territory and placing it under the control of New Delhi.
Residents were placed under a strict curfew until February, causing a bottleneck of essential medical supplies. “Over the years, the infrastructure for healthcare in Kashmir has not improved,” said a doctor at Government Medical College in Srinagar.
“Unlike the other states of India, we are least prepared for coronavirus, we don’t even have a private healthcare system here because conflict didn’t allow corporates to invest here.
“We have brilliant doctors but they are not well equipped, we are in a war with an unseen enemy but without ammunition.”
Jammu and Kashmir is short of 200,000 N95 masks and 10,000 personal protective equipment (PPE) kits. “Doctors treating the non-Covid patients are only given a N95 mask once a week,” said Dr Zainub Nabi, a resident doctor at Shri Maharaja Hari Singh hospital in Srinagar.
Health workers at SKIMS Medical Hospital in Srinagar report skipping their lunch and working for eight hours straight, as they are only being given one PPE outfit per shift.
There are only 215 ventilators for a population of approximately 13 million people and doctors say there have long been supply-chain problems. One senior doctor in Srinagar told The Telegraph it was only a matter of time before his public hospital could not cope. “Our intensive care units are abysmally inadequate if we require ventilation of large numbers of people,” he said, “We can’t handle a flurry of cases of Covid-19.”
Medicines used by Kashmiris to keep respiratory problems in check – like levosalbutamol and ipratropium bromide - are in short supply, as stocks could not be maintained during the seven-month lockdown. Nine out of ten deaths from coronavirus happen in patients with underlying medical conditions, such as respiratory problems, according to an Office for National Statistics study.
“There is a lot of anxiety among the people, we can’t buy medicines here,” said Rukhsar Reyez, a student from Baramulla. During the seven-month lockdown, the internet was also curtailed and only restored in 2G format on January 25. Doctors say the speed of the internet restricts them from keeping up-to-date with the spread of the virus or important medical advice.
“The whole world is battling with an unseen enemy. Unfortunately, we are being undermined by denied access to high-speed internet,” said Dr Iqbal Saleem, a professor of surgery at the Government Medical College in the state capital of Srinagar.
“We have been facing immense difficulty in accessing medical literature and we can’t even do video conferencing with patients to treat them at home in the wake of coronavirus.”
Amnesty International has directed the Indian Government to ‘urgently’ restore full internet access in Jammu and Kashmir. Those who speak out about their concerns risk losing their jobs. Dr Asif Ali Bhat from the SKIMS Medical College had his contract terminated after he spoke publicly about the shortage of masks.
Amnesty International has also reported a surge in intimidation against journalists working in Jammu and Kashmir. The prime minister of Pakistan-administered Kashmir, Raja Farooq Haider Khan, said he was “very much alarmed over how residents on the Indian side would cope”.
“It has been cut off from the outside world, no one can go there, no one can see their plight,” he told the Daily Telegraph. “We are very alarmed. They have been complaining about these medical facilities under the lockdown by the so-called occupying forces. We don't know the situation.”
In addition, cross-border shelling has recommenced this month and residents say this would deter them from seeking medical help if they suspected they had the disease.
“People in my neighborhood prefer home remedies instead of going out to see a doctor. Shells come to kill people without name and address. They kill indiscriminately,” said Ghulam Muhammad Khan, a resident of Reddi village in Kupwara.
Naziya Bashir’s six-year-old son was killed when the Pakistani military shelled her frontier village of Tumna. Unable to flee the hostile fire, because of the coronavirus lockdown, her home was hit directly. “For two hours no-one came to help me and Ziyan died in my arms,” she said. Heartbroken at her loss, Mrs. Bashir concedes living in Jammu and Kashmir during the pandemic resulted in the death of her son.
“Doctors arrived much later than the police and the army soldiers. Until that time my son had silently died in my arms while I was crying for help,” she said.
- A local journalist in Kashmir provided additional reporting for this story but does not want to be named for security reasons.
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