Securitising Health: India silences frontline health workers in Kashmir amid COVID-19

Medical staff wearing protective gear walk inside a disinfecting tunnel before entering a hospital in Srinagar on 2 April. Several doctors said that the government’s response to COVID-19 was being seriously weakened by the silencing of doctors and the securitisation of the management of the contagion. TAUSEEF MUSTAFA / AFP / Getty Images
24 April, 2020

“It has been observed that some of the Government servants are publically criticizing the efforts of the administration to combat the Pandemic of COVID-19,” read a circular issued by the Jammu and Kashmir directorate of health services, on 1 April. It continued, “Hence forth strict action will be initiated against such elements, who resort to such uncalled for reporting to the media.”

The circular threatened prosecution under the Epidemic Diseases Act, 1897, which could carry sentences of imprisonment for over six months. The gag order was aimed at the frontline health workers in Jammu and Kashmir who were increasingly vocal about the lack of essential equipment. The gagging of health professionals not only endangers their lives, but also weakens the state’s ability to understand the crisis and control it efficiently. While intolerance to criticism has been visible in several states across the country during the pandemic, Kashmir’s history endows it with a more severe meaning. The Kashmiri public, which has been in a complicated, often hostile relationship with state machinery, might also begin to lose faith in the state’s attempts to combat COVID-19 if these continue to be marked by hostility towards health workers.

Despite its small size and relative isolation from mainland India, Kashmir had one of the most severe outbreaks of COVID-19 in the country. As of 12 April, Jammu and Kashmir had the highest number of COVID-19 infected people per 1000. According to the website of the union ministry of health, on 24 April, the number of positive cases stood at 427, including 5 deaths. The number of people enlisted for observation has surpassed sixty four thousand.

“The order was dictatorial and authoritarian in nature and is aimed to suppress genuine concerns of healthcare workers to hide their own shortcomings,” a doctor from the Sher-i-Kashmir Institute of Medical Sciences, who wished to remain anonymous, said. Several doctors told us that the government’s response to the contagion was being seriously weakened by the silencing of doctors, adding that medical professionals were increasingly given a smaller part in advisory roles and decision-making to deal with COVID-19 in Kashmir. The administration also did not grant doctors the option of speaking at daily press-briefings about the crisis by the administration. “During the swine flu epidemic, it was director health services and the director of SKIMS who used to issue press briefings,” Mohammad Yousuf Tak, the convener of the JK Doctors Coordination Committee, said. “And common people had more faith on them in comparison to current bureaucratic briefings.”

Since 18 March, when the first case of COVID-19 was reported in Kashmir, doctors began posting on social media that the state’s health system lacked the equipment to deal with a largescale health crisis. “What we are mostly concerned about is the shortage of medical supplies and essential equipment,” a young doctor at Shri Maharaja Hari Singh hospital, who wished to remain anonymous, told me. “We are provided with PPE kits”—personnel protective equipment—“in very limited quantities; sometime almost negligible,” he added. A report in the Economic Times said that over fifty healthcare workers, including doctors and nurses, were either quarantined or isolated after they had come into direct contact with COVID-19 positive patients in Jammu and Kashmir.

There has been a historic lack of medical infrastructure in the region, where the Indian government’s concerns over security have arguably often outweighed its concerns over public welfare. The doctor-patient ratio in Jammu and Kashmir stands at one doctor for 3,866 patients as against the World Health Organisation’s recommendation of one doctor per 1000 patients. Hospitals in Kashmir are equipped with a mere 93 ventilators for a population of around eight million. Jammu and Kashmir is facing a deficit of around two thousand nurses in different hospitals and health centers.

Kashmir was one of the first states to begin isolating and tracing people with a travel history. On 19 March, district administrations aided by Jammu and Kashmir Police sealed roads and ordered the closure of public places including educational and religious places. A strict vigil was kept on roads with dozens of violators booked under law or brutally beaten by the police.

After the 1 April circular, several doctors were made to delete social-media posts that spoke of the lack of supplies. On 2 April, Dr AG Ahangar, the director of SKIMS, called for a meeting of the hospital’s doctors and other staff. He threatened action against them if they leaked any information to the media or made public comments on the hospital’s efforts to fight COVID-19. Many doctors and other health workers, from SKIMS and other hospitals, who spoke to us for this report did not want to be named, fearing “disciplinary action” by authorities.

On 21 April, Dr Asif Ali Bhat, a junior resident at SKIMS, was terminated for demanding PPE. “Every doctor has a right to have standard PPE when he is treating patients and asking for such a thing is neither unethical nor illegal,” Mir Samiullah, a senior consultant at Star Hospital, Sanat Nagar, said. He added that the termination was “an attempt to intimidate doctors for asking genuine demands.” On 22 April, doctors at SKIMS held a silent protest against Bhat’s termination.

“The lack of proper security gear pushes us to formulate a duty schedule where each doctor is put in a quarantine after performing their duties, and this certainly depletes the health staff,” Dr Owais Dar, the general secretary of Doctors Association of Kashmir, said. According to Dar, the ban on speaking to the media has stopped doctors from communicating important information. “We can mitigate this pandemic only if we inform the masses. The administration is trying to muzzle our voices and genuine demands but that won’t stop us from raising our voices,” Dar added.

“Kashmir is not new to this and in fact the pandemic is being treated as a law and order situation [rather] than a serious health issue,” a psychiatrist from Srinagar’s Psychiatric Diseases Hospital, who wished to remain anonymous, told me. The approach of the authorities in dealing with the public during the pandemic has often been excessive and unwarranted. Reports have pointed to numerous instances where the police attacked sanitation workers in several parts of Kashmir despite them carrying valid ID cards. On 14 April, workers of Srinagar Municipal Corporation went on strike to protest the police violence against them. Junaid Mattu, the mayor of Srinagar, wrote a letter to the prime minister Narendra Modi, and BVR Subrahmanyam, the chief secretary of the region, for action against the police involved in these attacks.

Doctors, too, have been on the receiving end of police violence in Kashmir. In Bandipora district’s Hajin block, doctors alleged that Shabaz Mirza, the deputy commissioner of police for the district, was hostile to them over the phone. They later went on strike, demanding that an investigation into the behaviour of the district administration be undertaken by higher authorities. They also demanded the immediate suspension of Mirza.

Other doctors also complained of police harassment amid the lockdown in Kashmir. Dr Khawar Khan, a resident doctor at SMHS, tweeted, “It is extremely cumbersome to explain to personnel of JKP every morning that we are on emergency duty. Our I-Cards are not being accepted as curfew passes and we are being asked to provide separate pass for the vehicles/cars we are plying in. The issue must be solved at earliest.”

 In some cases, police blockades have also obstructed doctors’ work. On 14 April, the Srinagar administration set up permanent wall-to-wall barricading on a main road between the localities of Natipora and Nowgam. This blocked the movement of essential services and emergency vehicles. “Sealing of red zones must ensure provision for exit (albeit manned) for medical emergencies,” Parvaiz Koul, a physician who works at SKIMS, tweeted. He continued, “Erecting irremovable barricades makes it impossible. What about a heart attack, a delivery or a surgical abdomen? Containment is necessary, curfew without exit is not.” On 15 April, the district administration allowed passage for emergency services such as ambulances and fire tenders, and also designated alternate routes for the movement of essential services.

Mudasir Firdosi, a health advocate, wrote in the daily Greater Kashmir, “The administration needs to move on from the attitude of a police state to one of supportive to doctors, rather than harassing them.”

The bureaucratisation of crisis management in Kashmir has also at times led to a worsening in the lack of equipment in hospitals. On 30 March, Athrout, an NGO that works with marginalised communities in Kashmir, started a crowd-funding drive and soon managed to supply SMHS hospital with six ventilators. However, on 9 April, the ventilators were returned to the NGO, without any explanation from the hospital authorities.

“It was illogical to return ventilators to the NGO at time when we needed them most,” a senior resident doctor at SMHS, who wished to remain anonymous, said. “This is a pandemic; every support should be acknowledged and appreciated. But Kashmir is a different story.” The doctor continued, “By accepting help from the NGO, the hospital thought this would give people and healthcare workers another excuse to criticize them. They are not ready for that.” On 11 April, the Jammu and Kashmir High Court directed the secretary of the department of health and medical education to ascertain why the donation was rejected. On 14 April, Athrout also acquired 10,000 PPE kits, which it plans to distribute to frontline health workers in the valley.

A doctor from Khyber Medical Institute Srinagar, who wanted to remain anonymous said, “Preparedness is essential for fighting COVID-19 pandemic. However, we are weak in that.” He paused before adding, “Only Allah can save us now.”