Wednesday, September 17, 2008

KOSI CALAMITY-RAVAGED DISTRICTS OF BIHAR

BACKGROUND:

The devastating calamity in the Purnia, Areria, Supaul, Saharsa, Madhepura,
Bhagalpur, Khagaria and Katihar districts of Bihar have led to impacts of an
unprecedented scale and it would, of course, take a long time before some
normalcy returns back to the shattered and endangered lives of the people and
animals. Of particular concern is the serious impacts on the health that has
been caused due to the swelling and spreading Koshi waters, and the grave
concerns that might arise, if adequate preventive and curative measures are not
taken in time.

LACK OF FOOD, NUTRITION AND IMPACT ON HEALTH:

To begin with, before one goes into the medical condition of people, it is
expedient to objectively understand the nutritional impacts that the flooding
of the hundreds of villages has had on the thousands of people. The State
Government having woken up to the reality, realizing the vast scale of the
people marooned, with lands/houses submerged and even villages submerged in the
Koshi waters, very late and initiated half-cooked 'disaster management'
even later, thousands of people remained stranded and starving in the villages.


In the 15-18 days preceding the arrival of the army and navy boats for rescue,
the people had become famished and weak, having exhausted their limited food
stocks. Women, children and elders especially have become quite feeble.
Nutrition being a pre-requisite for good health, this basic requirement was and
is being violated by the State through its inaction.

We are yet to obtain clear break-up details of how much of the Central grant of
food grains has actually been disbursed and has reached the people. Also, how
much grain provision the Bihar Government has made for the affected. Be this
as it may, the ground reality is that at many camps, even a single rice meal
was eagerly awaited, till late. Quite a few people, as we heard, are saturated
of having to consume the same chivda (dried puffed rice), which, in any case,
is not a nourishing and wholesome meal, particularly when consumed as part of
the main meal course, regularly. One witnesses numerous relief camps, where
adequate quantities of food grains have not yet reached. Why is this situation
persisting despite the Centre having announced food grains relief to the tune
of 1.25 lakh tones? Why is not the State Government giving support?

Even now at many relief camps, the same food is routinely served to everyone,
of all ages. There is no consideration of the special dietary requirement of
children, elders or pregnant and lactating women. The National Calamity Relief
Norms also mandates that children, pregnant and lactating women and adolescent
girls must be provided all nutritional support as per the ICDS standards. The
ICDS norms for the calamity affected is only a wish-list , at the most.
Therefore, when, people are coming out from the interiors, they are in a dire
state of under-nutrition and the most necessary task would be to assess their
nutritional requirements at the earliest, preferably at the rescue points and
make available a suitable nutritional-diet response, coupled with medical
attention and care as that person would require. Without assessing and
addressing the nutritional condition, no further medication can happen.
The four hours we spent at Pratapganj rescue point, Saharsa district brought to
us a realization of the inhuman condition in which the rescue was handled. Once
the family, reached the bank either after hours of walk (since water has
receded a little) or through boat, they had to find their own way. Only if a
person, collapsed, he was taken to the Army doctor, only one available. We have
to be after, to ensure treatment was followed up with the referral, relatives
were sent along. ....

The rest of the families were not even properly guided about where to go, even
when tractors, trucks were kept standing in a beeline...it was by chance that
they would know about the free service. What to talk of food to be served,
except a packet they might receive from an NGO (not all did), electrical
suppliers association, present then, they would get noting to satiate hunger.
What to talk of health care? Women were clearly suffering from skin diseases.
When our boat reached Rahta two days ago, on the 12th of September with Ashish
Mandloi from NBA, and Sant and Verma of Shilpi Kendra, there were dead bodies
found and carcasses of cattle strewn all over. There is no arrangement for
taking out dead bodies, which was complained to us by the army officials as
well. We had conveyed this to the District Magistrate, Purnia, on the September
8th night, when a large delegation of ours with IMA doctors, and volunteers
from Orissa, as well our local Committee members and Convener had met the DM.
But assurances of taking care have remained unrealized. There is also no
honest estimate of how many of the dead, actually succumbed due to starvation
or lack of timely medication.

MEDICAL AND HEALTH CONDITION:

The nutritional status after 15-20 days of hunger and severe mal-nourishment is
unrecorded, the medical condition also, in many cases, remains undocumented.
Many people, who are even sick or are suffering various ailments are routinely
and callously sent to camps after the rescue, which is simply unacceptable. It
is needless to over-stress the importance of timely medication and if necessary
prompt hospitalization, after prolonged starvation and neglect.

Take for instance cases of delivery, quite a few of which are taking place at
various camps. There have also been sporadic reports of women having delivered
in boats, during the rescue process. There are hardly any facilities at the
camps for healthy delivery. Says Dr. Verma, a doctor on visit from Madhya
Pradesh, "There is not even a bare minimum table or a secluded hygienic space
for conducting the delivery". Women, also would require some basic materials
like sanitary napkins for better hygiene.

Diarrhea, dysentery and general fever is quite prevalent among many people,
with almost one in two persons suffering from one of these illnesses. Mixed
skin infections; bacterial and fungal infections is also quite rampant with
almost one in five persons suffering from the same. Likewise, skin problems
like ringworm are also quite common among many people, due to spending days in
water and wet clothes. But no camps, as we were told, have any medicine to
treat the ringworm infection. With this, medicinal dearth was normal in all
camps. Even when stocks have appeared since the last few days, skin ointments,
children's medicines in suspensions, effective antibiotics were still absent
and chlorine tablets had arrived, but the general living environment is not
conducive to the health and well-being of the people. Having lived in open
spaces, amidst farms and agricultural lands, many of them are to feel
claustrophobic in the 12'/12' artificial tents erected, in particular at
the 'mega' camps, planned and started being established. The very concept
and structure of a 'mega camp' is ill-conducive to decentralized health
management. Banbanki mega camp is a case in point, where for a 5000 odd
populace, the number of latrines is a paltry 10! There is no alternative to
open defecation in the vicinity of the camp, which would only invite and
aggravate a host of viral infections and other illnesses.


INADEQUATE RESOURCE ALLOCATION BY THE GOVERNMENT OF BIHAR FOR HEALTHCARE:

The Department of Health of the Bihar Government has issued a G.O. dated
03-09-2008 and made an allocation of one crore rupees for the health related
needs for the eight districts of Bihar, with a break-up as mentioned in the
table below. The GO issues a specific mandate that all the amounts must be
spent for flood-relief and not be lying in the banks. However, considering the
population affected (even a conservative estimate is at least 25 lakh people),
this boils down to just Rs. 4/- per person, which is woefully inadequate. The
GO also lays down that the amounts would have to be spend only on the
ear-marked sub-heads, with the sanction of the District Collector, in strict
accordance with the earlier guidelines of the Disaster Management Authority.

1. Saharsa District – 20,00,000
2. Areria - 15,00,000
3. Purnia - 15,00,000
4. Soupoul - 15,00,000
5. Madhepura - 15,00,000
6. Khagaria - 10,00,000
7. Katihar - 5,00,000
8. Baghalpur - 5,00,000

The Guidelines of the Disaster Management Authority do have provisions for
flexibility, use and payment of cash for daily allowance to the affected
persons facing problem of survival at the rate of Rs. 20/- per adult and Rs.
15/- per minor, which does not seem to reach people on the ground.

FAILED DISASTER PREPAREDNESS AND RESPONSE

Considering the magnitude of the disaster, there seems to be very little,
whether in terms of disaster preparedness or disaster response. The National
Disaster Management Act and Policy has comprehensive mandatory provisions,
including that for every national disaster, a Central Ministerial team must
immediately take key decisions on health related aspects, ensure timely and
adequate medication and vaccination reaches all the people and animals in the
affected area, emergency transport, including enough ambulances be made
available, declaring in time any health related or other warning, provision of
special support to the health and well-being of the people and animals in the
calamity-affected area etc. Hardly have any of these measures been implemented
across the affected districts in right earnest.

Though there is always likelihood of an immediate outbreak of an epidemic,
doctors and activists fear that with the unhygienic conditions in the camps and
the hundreds of cattle and countless humans dead bodies yet to be exhumed from
the watery grave, the probability of an epidemic, including cholera cannot be
ruled out. It is immediately essential that the Health and Veterinary
Department work in close co-ordination to wriggle out of any such anticipated
and impending health disaster.

INTERVENTION BY CIVIL SOCIETY GROUPS:

Some of us, teams of activists, doctors and others are involved in relief work
in different villages and districts and are trying to reach out with some
relief materials, where the flood affected; dalits, landless, small
land-holders, fisher folk etc. are residing either in camps or on canals or in
open lands, by the road side. We are also endeavouring for the speedy,
effective and organized planning of different rescue and relief works at relief
camps and elsewhere.

The Indian Medical Association, Purnia has been playing an active role in
providing relief materials, particularly medicines to the flood-affected in the
Purnia district. The IMA doctors had spent for the medicines on their own and
they have also received assistance from the Shashwat Trust in Pune, through us.
Besides, they also have a camp at their office at Purnia, where Out Patient
service and doctoral advice is given every day during the morning hours and
medicines are supplied though the day. They have also let out their space for
relief related work. The IMA, NAPM, NBA and other local groups also had a
dialogue with the Chief Surgeon, who promised to press into service 20
ambulances as well as provide 50, 000 chlorine tablets immediately.

Communications have also been sent to the Chief Minister of Bihar, Shri Nitish
Kumar, Union Railway Minister, Shri Lalu Prasad Yadav and Secretary, Department
of Health, Govt. of Bihar, detailing the health related issues, among others.
There are other such initiatives which are proving to be of help.

Other doctor's teams include those from Pune and the Bihar Jharkhand Sales
Representatives' Union. are A Group of citizens from Bangalore through Mrs.
Jagdale is offering a large stock of ORS and so on and health activists -
volunteers team with Dr. Verma, Dr. Ashish Gupta, Amulya Nidhi, Sant and Ashish
Mandloi and others are in Bihar, taking stock of the macro level situation in
health, including where the Government is providing the service and where
doctors are deployed.

Though activists and NGOs who question all of this are tolerated by the
administration and political establishment in varying levels, their
intervention and suggestions are not very welcome. Local NGOs have also been
questioning the arbitrary ways of the Government in promoting and aiding large
initiatives like those of Baba Ramdev, and negating the role of small community
groups and NGOs, who were the first to respond in the initial stages of the
crisis.

VISIT TO THE CIVIL HOSPITAL IN SAHARSA: AN EYE OPENER ON HEALTH CARE FOR THE
CALAMITY - EFFECTED:

Understanding the vital role that the health department and its officials and
employees has in such a time of calamity, our team, comprising some well-known
activists and doctors also visited the Saharsa Civil Hospital to find out the
special measures for the calamity-affected, the problems that the affected are
facing, the bottlenecks in health care administration as also the
practicalities of state co-ordination with non-governmental organizations.
The day we went, we received information that a day before a child died, whose
mother was in a critical condition. We reached there and saw the Emergency
Ward, along with the Ward for Women and Children, where there was just one
doctor present and no one else. Two nurses were also sitting but were not very
eager to interact with many people. There were a very few flood- affected
people in the Emergency Ward of Saharsa Civil Hospital who had water – borne
diseases. The few who were there managed to reach and stay there with the help
of some of their relatives or from some local people.

The condition of two calamity – affected families reflects the serious lapses
in the administration and delivery of health care services. Not only
insensitivity but also illegal practices have come to the fore. It is necessary
that immediate action is taken against those responsible for the same.

Ruby Yadav, a female patient from a village in submergence reached the Civil
Hospital
, along with her in-laws with a great difficulty. Her father-in-law
Shri Tufaan, despite suffering from Tuberculosis himself, and wading through
very difficult circumstances arranged for Rs. 1000/- for the treatment of his
daughter-in-law, staking his health needs, with an intention that she would get
good treatment and be saved.

But at the hospital, they were forced to spend money on each and every service
and medicine. He had thus spent Rs. 1700 and there was nothing left with him.
Ruby delivered a baby boy. Mother and child were made to lay on the bare floor,
which fact was brought to light by the local media, after which she was given a
bed, but someone again said that they were forced to shell out Rs. 200 for
that. Ruby was bleeding profusely and was clothed in the same soiled clothes
and was writhing in pain. Her pathological tests were conducted by a contracted
lab in the same hospital, after she had to pay Rs. 30 for the same. She was
also asked to purchase all the medicines from outside.
The Medicine centre many times gave no bills and even if they did, there was
neither a date nor name. Every time, the doctor at the hospital used to write a
prescription on a 2"x2" torn piece of paper and they were asked to purchase
the medicines from a private chemist. Ruby's case turned out to be one of
retained placenta, and she was discharged as according to the gynecologist, the
case was a 'difficult' one. But with their house drowned and without a
single penny in hand, Ruby and her father-in-law continued to stay in a corner
in the same hospital, but without any special attention, which Ruby needed.
When we gathered information of this entire incident and went to meet the Civil
Surgeon to hear his version, he along with many doctors, the Regional Director,
Private Secretary of the Health Minister other employees were engaged in a
discussion. We demanded a response. The Civil Surgeon and the Regional Director
confessed that the criminal practices of doctors constraining patients to
purchase medicines from outside, even from the flood – affected, by routinely
writing prescriptions on plain pieces of paper, as against on letter heads or
official bills, are quite rampant and continuing.
Upon request and questioning, Rs. 260 + Rs. 30 (prescription and receipts,
which Tufaan had) was retuned to Tufaan Singh since those were the only bills
he had and the rest of the expenses, we members of different organizations
covered.

In a while, the gynecologist Mrs. Poonam Singh was called in, who explained
that since the case was beyond her capability, she had referred Ruby to the
Patna Medical College and Hospital (PMCH) and that she is helpless now. After a
lot of debate and discussion, it was decided that Ruby would be sent to the
Patna Hospital. We also went to the Hospital and Dr. Sushma Pandey, an
acquaintance of ours, ensured that Ruby was given a bed and since she required
blood, arranged for the same in time. D & E test was performed on her and she
was discharged.

Similar is the story of Pintoo Paswan's young child, Shivnathkumar Paswan's,
hailing from Chattapur, Supaul District, who has been suffering from Meningitis
and has been in a state of unconsciousness for the last few days. Even this
family was forced to expend on the child's medication, which costs were borne
thanks to the help from a local, one Mr. Manjith Singh. In the context of our
visit, there was argument over this case as well. Neither was the money
returned back to them nor did the family receive any assistance from the Rogi
Kalyan Samithi. The family couldn't be traced since then, all that is known
is that they 'went away', no one knows where. On the 7th of September, one
more women Sunita Devi's, succumbed to death due to lack of adequate
treatment.

Yesterday, the death of one more person, Bhumibhai Pal from Bhimnagar village,
Kosi-affected at Saharsa Railway Station shocked us, yet again. His death was a
dire consequence of criminal negligence and untimely discharge given by the
doctors at the Saharsa Hospital. Activists in Saharsa, including the Khadi Gram
Udyog karyakartas sat on a Satyagraha yesterday with the body of the deceased,
before the Hospital, after which an amount of Rs. 15, 000 has been announced
for the next of the kin of the deceased and the same was paid immediately. We
are also demanding an independent inquiry into the incident.

The situation in the Saharsa Hospital which was investigated by in earlier,
only led us to conclude of the dead state of the institution. The affected
patients, although destitute, were asked to purchase medicines which was not
possible for them, who had not a penny. The Rogi Kalyan Samithi Fund is also
not being utilized and made available to those who need it in time. Even a
little complicated case is referred to Patna and the helpless patient and
family is compelled to move out on discharge given and leave for Patna on their
own. This situation is killing patients. We wrote to the Chief Minister and
Health Department immediately calling for justice to Bhumibhai and all other
calamity-affected and hope action would be initiated soon and amends made in
the treatment process on a war-footing.

The health situation related to the Kosi calamity affected is far from
improved. It's especially found that the referral hospitals have no doctors
and staff sensitive, capable and equipped to take care of the affected people.
They claim they are short of good medicines and capable doctors for complicated
cases. We found them to be most callous and inactive.

Activists in Saharsa, including the Khadi Gram Udyog karyakartas sat on a
Satyagraha yesterday with the body of the deceased, before the Hospital, after
which an amount of Rs. 15,000 has been announced for the next of the kin of the
deceased and the same was paid immediately. We are also demanding an
independent inquiry into the incident. The latest information on this front is
that the Civil Surgeon of the Saharsa Hospital has been suspended, following
yesterday's incident and the series of complaints against him, meting out
injustice to needy patients.

We have also heard that the Chief Minister has himself visited Saharsa to
monitor the relief and health care delivery, while the Health Secretary and
Health Department officials are camping there presently. While welcoming this
prompt move of the Chief Minister and the State administration, we hope that
the governmental health machinery would function to its fullest and ensure that
all Kosi calamity-affected, who are in need of medical care and treatment are
provided the same, with quality and sensitivity, at the expense of the State.
We will continue to monitor and participate in the process.

As per the National Disaster Management Act, 2005 and the norms under the
National Disaster Management Authority, National Calamity Fund and National
Calamity Contingency Fund, funds are definitely available for a number of
health related activities, including use of ambulance, even if on rent and the
persons who are so very deprived of food and all facilities and are facing a
serious problem of survival are also entitled to Rs. 20/- ex gratia per person
per day and Rs. 15/- per minor per day. In the case of a person having serious
wounds requiring hospitalization, he or she is entitled to Rs. 7500/- per
person in case of more than one week stay in hospital and Rs. 2500 per person
in the case of less that one week stay in the hospital. Where is this emergency
Fund available? When will it reach the affected? After how many more deaths?
All these are the questions we all who feel accountable to the affected people
will have to answer. The Government too cannot escape its responsibility.

These and other cases only prove that there is no special measure, let alone
sensitivity for the flood – affected people. The poor calamity – affected
are constrained to purchases medicines from outside, just as others have to. A
woman at one of the camps in Raniganj had this to say, "No poor person can go
into any Government Hospital without selling some maize, and since we have no
maize left with us now, we simply cannot think of stepping into a Government
Hospital
". By the ANM merely asking the patients to go to the Hospital, they
are not in a position to.

POST – DISASTER MENTAL HEALTH CONCERNS:

If the physical health needs of the flood-affected are not fully catered to,
can one expect a pro-active psycho social and mental health support system in
place? This, again, is very conspicuous by its absence. Trauma and distress
counseling, which is very much needed in such situations – thousands of
people having lost their family members and relatives – dead, missing or
feared drowned, cattle lost and left out, livestock drowned or fled, lands
submerged, properties – whatever little, flooded, agriculture destroyed,
schools, hospitals, an entire life system delinked from the rest of the world
for weeks, languishing in starvation, neglect and uncertainty - such a huge
trauma, not being addressed is a major health concern.

There are any number of instances where people, particularly women and elders
are mentally distraught having lost their dear ones to the Koshi's waters.
One such women, we encountered on our visits to the camp has been suffering an
intolerable head ache, ever since her son went missing. The camps are direly
falling short of active psycho-social support personnel and persons trained in
counseling, who would be able to listen in patiently to the distressed. There
is also a pressing need for para-medical attendants, including sisters, to
cater to the medical needs.

There are also a few people who have suffered physical injuries due to the
ariel dropping of food packets and relief materials. Paraspati Jadhav of Rahta,
Muraliganj, Kumartanth Thana, suffered a serious injury on his nose due to a 5
kgs food packet falling with great velocity from the aircraft. To add to his
agony, he was misinformed by his fellow-villager that his entire family had
drowned, propelling his blood pressure to 400, making him unconscious. He is
now undergoing treatment at the Purnia Government Hospital for physical injury,
but continues to have a disturbed state of mental health.

FEEDBACK OF HEALTH ACTIVISTS AND DOCTORS:

The team of activists that visited the camps in Banbanki and two each in
Janakinagar and KBC Nehar found the situation abysmal and felt a great need to
revamp and strengthen the health support and medicare systems at the various
camps in Purnia. The situation in the camps in the other districts is not very
different. There is an occasional Primary Health Centre, for instance the one
at Middle School at Mirchaiwadi that is being of some help.

Medical availability and doctoral expertise, is as well, conspicuous by its
absence at the camps. Activists feel the need to have an ambulance in stand-by
at every rescue point and relief camp, at least during these first few weeks of
severity. There are many camps, for instance, the one in Dabeli, where no
medical relief is reaching.

That there is no one from the civil administration at the rescue points is a
recurring complaint, which, though very late in the day must be fixed and
addressed immediately and not be repeated again. There are also feelings that
dalits, Mushahars and labourers are being discriminated against, though the
administration would be loath to acknowledge this, whether in the boat rescue
process or whether with regard to the sensitivity of medical treatment.
In the past few days, our group has taken a new speed and new direction. A
small group with Dr. Verma and Mr. Sant are on the mobile dispensary on the
boat with medicines reaching out to the villages, where the villagers are going
through a difficult life. There are those who cannot leave the village or have
been brought out and went back as there are cattle and some property there or
fear loot. Medical assistance is not reaching them from the State adequately.
We are trying to do our bit. It is this support that is offered by the group on
the boats.

THE WAY FORWARD:

Calling this a national disaster would not solve the crisis even a wee bit. It
is only through proper planning, co-ordination and implementation of all the
norms and guarantees that are on paper, in the areas of health, education,
agriculture, housing, rationing, and livelihood etc. can the State claim to
bring in even an iota of normalcy in the lives of all the millions affected
and displaced b by the Kosi calamity. As mentioned already, some urgent and
effective measures must be immediately taken up on a war – footing to address
the health related concerns. After visiting the affected areas and assessing
the situation on the ground, we make the following suggestions and
recommendations:

PROACTIVE ROLE BY THE HEALTH ADMINISTRATION:

ü An Order must be passed and system put in place by the Health
Department to ensure that the cases are all dealt promptly and effectively with
sensitivity and timely decision, by using amounts from the Rogi Kalyan Samathi
and the Calamity Relief Fund, as also the local Hospital Fund.
ü An investigation must be conducted into the above two cases and all
such instances the doctors and others responsible must be dealt as per law.
Action must be taken against the Civil Surgeon, Saharsa, who is certainly being
criticized by many for his negligence.
ü The Civil Surgeon and Government Health machinery must be directed to
provide free medicines and all support to the affected people, with immediate
effect.
ü All necessary facilities for the calamity affected and ill patients,
including immediate provision of bedding or the patient from one hospital to
another, when necessary, transporting them back to the village or relief camp.
ü NDMA and CRF funds should be immediately available in the hands of all
senior officials, including the Civil Surgeon who can, with minimum procedures
take a decision and ensure timely treatment to the then and there.

FREE AND TIMELY AVAILABILITY OF MEDICINES:

ü An Order must also be passed by the Health Department that very PHC /
Hospital must provide medicines free of cost to the calamity affected, by
purchasing them if necessary, using funds from the Rogi Kalyan Samithi on a
priority basis. Strict action must be taken against doctors who prescribe or
constrain patients and their relatives to purchase medicines from outside.
ü Citing the factual reason that enough medicinal stocks are not
available, even today at many PHCs and hospitals in the flood-affected areas,
the patients are forced to purchase medicines. It must urgently be ensured that
all necessary medicines, including those for infants, children, women and
others general medicines like skin ointments, tonics etc. are made available.
ü Even at Government relief camps, the medicines are not available in
enough quantities. Suspensions, skin ointments and other such medicines
required for children are just not available. The same must be provided.
ü Groups active on the health – related relief work must be consulted
by the Government as to what medicines are not available/needed, detailed
information sought and all such medicines must be made available immediately.
ü Activists and Volunteers must keep a track of what necessary medical
paraphernalia would be required at the camps - particularly emergency
medicines, blood, equipment etc.

TRANSPORT:

ü For all those who are still stranded in the villages, mobile
dispensaries, one in each block, or for a group of blocks, must be immediately
started, also by pressing into service those boats which are not used or used
for a purpose of less utility.
ü Providing ambulances and adequate transport for conveying people
(whether medically or otherwise) from the rescue point to the relief camp.
ü There is presently no transport facility for people who are being
referred to the Civil Hospital either by governmental or non-governmental
doctors or any PHC. Many of them are simply unable to reach the Civil Hospital
or are managing to reach after a great deal of ordeal. The Health Dept. must
ensure that a regular system of brining together all patients (within a block
or a couple of camps) who are referred to the Civil Hospital is put in place
and suitable transport is arranged for them.

HUMAN RESOURCE:

ü The State Health Dept, must by Order, ensure that a team of doctors, by
rotation must camp at the rescue points, until all the rescue operations are
complete and regularly (daily twice) visit every relief camp.
ü Immediately deploying a team of para- medics and nurses at all rescue
and relief camps.
ü A team of doctors and health activists must initiate and maintain a
regular dialogue with the Hospital Superintendents, Health and Veterinary
Departments.
ü A team of experienced doctors drawn from different disciplines advising
the Civil Surgeons at all major hospitals in the 8 districts.
ü Involving people in the medicare processes at the camps and training
them in emergency medical aid, guiding and empowering the local youth and women
in health needs of people at the camps must be initiated.

FOOD AND NUTRITION:

ü Every affected family in any camp, whether Governmental or
non-governmental should be given at least 6 months time-bound temporary coupons
(ration cards) to get his/her due as per the Supreme Court Order i.e. 35 kgs of
food grains per month. This can be through a community, even without going
through the Gram Sabha procedure, in the special situation faced by the region
today.
ü The food grains must be made available to the person with proper
container bags, when ever he or she settles in a temporary or permanent
shelter. The coupon must be valid not just with a specific dealer, but any
where in a Govt. shop, if a decentralized arrangement is worked out.
ü The norms for food to be served in the camps need to be worked out, so
as to ensure that every person mandatory receives 35kgs for consumption.
ü Potable water arrangement should be made at the camps and also in the
villages through hand pumps to be put up at the rate of 1 per 50 families and
otherwise through tankers and pipelines.
ü Ensure Anganwadis are either newly started where there is a need, as
per the Supreme Court Orders or a nearby Anganwadi is upgraded and
operationalized.
ü Volunteers must Follow-up health and nutrition needs, along with the
Right to Food Monitors.
ü Preparing right to information applications and filing them on
different health related issues.
ü Particular attention to the nutrition, health and hygiene of infants.

PREGNANT AND LACTATING WOMEN:

ü Not only are there absolutely nil facilities for pregnant women in the
relief camps, there is also no endeavour to ensure that they are taken to a
Government Hospital or a Private doctor (at state cost). There have been around
15 deliveries at the camp in Banbanki in the last two-three weeks and we have
enough information to conclude that the condition of all them is quite grim. We
have just now received information that some District Magistrates have put
together lists of pregnant women at relief camps, but have not initiated any
supportive measures yet. Lactating women must also be provided adequate
nutrition as per the Supreme Court's Orders.

MENTAL HEALTH:

ü Pyscho-social and rights based counseling, guidance, support and
information to the distressed must be treated as a priority and ensured.

HYGIENE:

ü Proper facility for bathing is a basic pre-requisite for good health
(with a closed space for women). Along with this is required bathing soap and
washing detergent, adequate water, all of which is virtually non-existent. The
State must provide all of this urgently.
ü Knowing fully well that chlorine tablets are a necessary preventive
measure, they were made available quite late and the Government camps have
started using them only no w. These tablets must be made available to all those
families that are staying in non-governmental camps or on canals, in open
lands, by the road side and all those who are firmly staying in the villages.

INFORMATION AND DOCUMENTATION:

ü There is also a need for proper and timely documentation of all these
issues, concerns and subsequent developments at various camps and other parts
of the flood – affected areas.
ü Preparing a comprehensive database of the total number of dead persons
till date – village and district wise, estimates of dead livestock as well,
with reasons of death – drowning, lack of timely treatment, starvation etc.
ü Constant interaction with the people to gather more details about
different sickness and ailments among people.
ü Keep the media informed of the health – related issues.


Amulya Nidhi, Madhuri Variyath, Medha Patkar, Pervin Jehangir,
09905275500 09820619174 9423965153 09820636335

Vijay Bhai, Lokendra, Rajkumar Sinha
09423965153 9430527755 09424385139

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