An intense heat wave swept across Uttar Pradesh causing an overwhelming number of deaths in many districts including Ballia and Deoria. The rising death toll has once again exposed the inefficiency of the state government in preventing deaths owing to diseases and disasters. Despite the state reeling under scorching heat and loo winds, the government swung into action only after the matter was reported by the media. However, refusing to accept that the deaths have been caused by a severe heat wave, the government once again seems to be in denial mode. A similar strategy was adopted by the state government after the Gorakhpur oxygen tragedy in 2017.
A large number of deaths due to the heat wave were first reported from Ballia, when local journalists sought information about the sudden spike in deaths in the district hospital on June 16. The Chief Medical Superintendent (CMS) of the District Hospital, Dr Diwakar Singh, informed the media that 25 people had died in 24 hours and the cause of the deaths was heat wave-borne diseases. He also said that 60% of the patients who visited the district hospital for treatment suffered heat stroke.
By the time the CMS reported the deaths, a week had passed and about 100 people had died in the district hospital. There was a steep rise in the number of patients admitted to the hospital and the death toll kept climbing. Most of the admitted patients had fever, fatigue, shortness of breath, high blood pressure and other symptoms of heat wave-borne diseases.
Media attention was drawn to Ballia after heatstroke-related deaths in the district hospital. Soon, reports were pouring in from Deoria that 133 people died in the emergency room of Deoraha Baba Medical College between June 11 and June 18. Most of them had breathing problems, fever and vomiting. Many of them died before reaching the hospital.
Dharmendra Pratap Singh, a contracted employee of the Transport Department’s Deoria depot, died in Basti while on duty. Paramhans, the driver of the bus contracted from Deoria depot, died in Salempur. Two other conductors, who were on duty in the scorching heat, fell ill and had to be hospitalised.
ARM of Deoria Depot, O.P. Ojha, confirmed the deaths of the conductor and driver. He also confirmed that two employees fell ill due to heat but asked this reporter to contact the regional manager P.K. Tiwari for information about the cause of illness and death.
Tiwari said that the reason for the deaths was not heatstroke but fever.
When asked whether the drivers and conductors of the transport department were falling sick due to the heat wave, he admitted that 20% of the employees are on leave, whereas in the Gorakhpur region, around 10% are on leave. However, he denied heat being the reason for a large number of employees seeking sick leave. He said that this happens during the wedding season too.
PRD jawan Mahesh Singh, a resident of Akuba village on the Deoria-Salempur road near the Musaila intersection, suffered heatstroke while travelling on his bike. By the time he was taken to the district hospital, he had passed away.
Traffic sub-inspector Vinod Sonkar, a resident of the Rudrapur area of Deoria district, also died while on duty in Ayodhya. News reports cite the reason for his death as heatstroke.
Ramraksha Singh, a farmer of Dumri Khurd village in the Chaurichaura area of Gorakhpur district, died while working in his field. His death has also been described as resulting from heatstroke.
The rising death toll in hospitals across many districts including Deoria and Ballia in the third week of June makes it evident that most of the patients suffered from heatwave-borne diseases, even though the administration may deny it. Statistics also show that as rainfall brought down the temperature, the number of patients admitted to hospitals and deaths also declined. The cases were, therefore, clearly related to a rise in temperature.
Data from Deoria Medical College’s casualty ward reveals that between June 1 and June 18, 133 people were brought dead to the hospital. An analysis of these figures shows that only 30 people died between June 1 and June 10, but 103 people died over the next week. The highest number of fatalities was on June 17, when 30 deaths were reported. In a press conference called by the district CMO, the principal of the Medical College and the chief medical superintendent, it was said that between June 1 and June 18, 53 people who had suffered a heatstroke were admitted, out of which four people died. But these deaths cannot be attributed to heatstroke because the victims’ relatives refused to get the post-mortem done. Therefore, the exact cause of death cannot be ascertained.
According to health officials, 126 people, mostly above 70 years of age, died in the emergency ward of the medical college in June. There have been 24 deaths from respiratory illness, one from acute chronic kidney disease, 13 from stroke/cerebrovascular accident, six from trauma, three from poisoning, one from alcoholic poisoning, 36 from shock with multi-organ failure and four from suspected heat stroke.
As per a report published in Hindustan on June 20, the number of deaths in Ballia district hospital this year is much higher than last year. According to the newspaper, 87 people died in the district hospital in May 2022 and 97 in June 2022, but this year 154 people had already died by June 18, of which 100 fatalities were recorded between June 11 and June 18, indicating an unusual situation. Another report published on June 23 stated that 1,565 people were admitted to the Ballia District Hospital between June 13 and June 23 – of which 160 died.
An increase in the number of cremations during the same period also indicated more fatalities in the third week of June. A large number of dead bodies were cremated on the banks of the Ghaghra river in Barhaj and Bhagalpur of Deoria district, and Gola and Barhalganj of Gorakhpur. According to a Bhagalpur-based journalist, the cremation of dead bodies on the Ghaghra river bank was reminiscent of the COVID-19 pandemic. Another journalist from Ballia also said that the scenes at the district hospital on June 16 to June 18 were horrifying and evoked memories of deaths during the Delta wave of COVID-19 in mid-2021.
यूपी की स्वास्थ्य व्यवस्था और योगी आदित्यनाथ की संवेदनाएं दम तोड़ चुकी हैं!
प्रदेश के सरकारी अस्पतालों से निरंतर आ रही विचलित करने वाली तस्वीरें।
-BHU के सुंदरलाल अस्पताल में OPD के बाहर स्ट्रेचर पर अपनी बारी का इंतजार कर रहे मरीज।
देवरिया जिला अस्पताल में बेड की कमी,बलिया… pic.twitter.com/utFsVQnqPn
— Samajwadi Party (@samajwadiparty) June 20, 2023
UP government denying deaths
The UP government, which had not taken any pre-emptive measures despite the state reeling under scorching heat and hot winds for three weeks before the reports of deaths emerged, suddenly became active once the issue was covered by the media. The government’s first act was to transfer the CMS of Ballia’s District Hospital and rule out heatstroke as the cause of the deaths.
The government then ordered a team of three health officials from Lucknow to visit Ballia and investigate the cause of the deaths. The three-member team included director (communicable diseases) Dr A.K. Singh, joint director (communicable diseases) Dr Mohit and director (medical care) Dr K.N. Tiwari.
The team reached Ballia on June 18 and expressed doubt over the heat wave as the cause of the deaths. The trio said that the district hospital was overwhelmed and five-ten deaths were natural. Mortality rate increases in the summer and a sudden spike in deaths could be a coincidence, they said. The team also expressed apprehensions that contaminated water might also be the culprit. Claiming that two blocks of Ballia-Bansdih and Gadwar have been primarily affected, the team visited a village in the region and checked the water quality. However, a week later, the team reached Lucknow and reported that contaminated water was not the cause of death.
Ballia Nagar MLA and transport minister Daya Shankar Singh issued a statement which plainly said that fatalities increase in the summer.
One may recall that similar statements were made in August 2017 in the wake of the death of children and adult patients due to an oxygen supply shortage at BRD Medical College, Gorakhpur. A team of health officials and experts from Delhi and Lucknow had immediately ruled out deaths due to paucity of oxygen and the then health minister Siddharth Nath Singh made the infamous ‘children die every August’ remark.
Ever since the Gorakhpur oxygen tragedy, the UP government has adopted denial as the primary strategy for health emergencies. It refuses to accept the truth and directs government officials to toe the line.
Under pressure from the government, the health officials started avoiding the media after June 18 onwards. Some officials and ministers even accused the media of spreading fake news. In Deoria, agriculture minister Surya Pratap Shahi expressed his displeasure at the journalists and called the reports of deaths due to the heat wave a lie.
Deoria CMO Dr Rajesh Jha told The Wire, “I am not authorised to speak about the heat wave. Talk to the DM. The situation is improving now. Earlier the situation was ok too.”
The Wire tried to contact the CMO of Ballia but he did not answer phone calls.
State not prepared to deal with heatwave-borne diseases
The government issued an alert at the state level regarding the heat wave on June 19, which was quite late in the day. Since then, coolers and fans have been arranged in hospital wards in many other districts including the Gorakhpur district hospital. On June 19, a new ward of 15 beds was set up in Deoria. On June 21, 18 air coolers were installed in the Gorakhpur district hospital.
These arrangements, made in a rush, indicate that the state government had no prior preparation to deal with the heat wave and despite the temperature touching 40-44°C in most of the districts for three weeks in June, health and other related departments failed to act in time.
In 2021, an action plan was issued by the Union government regarding heatwave-borne diseases. But the Union health ministry also remained apathetic about implementation. The statement issued by Union health minister Mansukh Mandaviya on June 21 after a meeting with ministers and officials of seven heat wave-affected states also shows that the Union and state governments were not serious about implementing the action plan prepared by them.
The release issued regarding the meeting states that the Union health secretary had asked the chief secretaries of the states to act according to the action plan on February 28, but no follow-up was done. When deaths began to be reported from various districts, a series of meetings were hastily arranged in which hollow claims were made about how there was not even a single death due to heat stroke in the entire country.
The National Action Plan on Heat-Related Illness, issued in July 2021, stated that due to climate change, the frequency of heat-wave has increased and the duration of loo winds was also increasing. As a result, heat-related illnesses (HRI) and deaths were also on the rise, it said. The plan noted that between 2015 and 2019, 3,775 people died of HRI.
The National Action Plan states that the primary health centre, community health centre as well as district hospitals should be fully equipped for the treatment of HRI. In addition to essential medicines and equipment, dedicated wards should be set up in these hospitals with air conditioners, air coolers and water coolers.
The plan also contains the SOP for the treatment of heatwave-borne diseases. There is a proforma for the patient’s investigation sheet, which requires information about the symptoms of the patient, the place of illness, the tests conducted, pulse rate, core body temperature, mental sensorium, blood pressure, etc.
As per local reports about the deaths in Ballia, Deoria and other hospitals, there was no preparation based on the action plan. Health and administrative officials had neither conducted inspections nor issued instructions in this regard. After more than 200 deaths in Devraha Baba Medical College, Deoria, on June 19, a 15-bed ward was prepared in a hurry on the third floor of the OPD building. A banner for heatwave prevention was put up at the CMO office.
The state disaster response department was engaged in pre-flood preparations but did not take any action regarding the prevention of heat wave-related cases. After the state government issued an alert on June 19, several departments in the districts were instructed on June 20 to make arrangements for drinking water at intersections, use night shelters as shelter houses, set up free ORS camps, and make public drinking water sources functional.
However, by the time these guidelines were issued, rainfall had already brought the temperatures down in many districts and eased the heat wave. The direct effect was seen in the decrease in the number of patients admitted to hospitals.
Translated from the Hindi original by Naushin Rehman.