More than 70 children have lost their lives in a tragic incident of medical mismanagement in Baba Raghav Das (BRD) Medical College Hospital in Gorakhpur, Uttar Pradesh (UP) in the past week. The numbers have risen in the past few days and they continue to rise, with some media outlets reported that the number as on Monday, 14 August, could be as high as 79.

Most deaths were reported from the neonatal and encephalitis wards.

The deaths were reportedly caused due to non-payment of outstanding accumulated dues worth Rs 68 lakh that the hospital owed to Pushpa Sales, the sole supplier of liquid oxygen to the hospital.

The private company wrote to the hospital repeatedly warning that supply of oxygen could be disrupted if dues were not cleared. The same was also publicised by local media outlets days before the deaths began.

College officials said they had forwarded requests regarding the same to the government but received no response (the college has a history of being severely underfunded).

“I wrote at least three letters,” BRD Medical College principal Rajeev Misra told television reporters on Saturday, adding that he had even flagged the issue in video conference discussions.

After the state-run hospital failed to repay its dues, the oxygen supplier cut off the supply.

A partial repayment of Rs 22 lakh was done only on Friday, 11 August, one full day after the tragedy began, one full day when 23 children lost their lives.

30 kids died in hospital without oxygen. This is not a tragedy. It's a massacre. Is this what 70 years of freedom means for our children?

— Kailash Satyarthi (@k_satyarthi) August 11, 2017

The tragedy has ignited outrage across the country and abroad. Nobel Peace laureate Kailash Satyarthi termed the tragedy a “massacre”. It has also evoked a political firestorm over allegations of administrative mismanagement and Gorakhpur being UP Chief Minister Yogi Adityanath’s constituency for almost 20 years.

Response of BRD Hospital and the government

BRD’s Chief Medical Superintendent Dr RS Shukla denied the deaths had been caused by a lack of oxygen supplies when asked by Reuters.

The hospital, in a statement, said there had been a “drop in pressure in the supply of liquid oxygen” on Thursday, but added cylinders were procured from various other suppliers.

The state government too initially declined media reports saying the deaths were due to lack of oxygen supply. District Magistrate Rajeev Rautela told the media that the deaths were not due to cutting off of oxygen supply but were “due to different medical reasons”.

UP’s Health Minister Siddharth Nath Singh outright denied the deaths were due to shortage of bottled oxygen. Singh also stated that encephalitis had been prevalent in the area for a long time and there is a history of casualties increasing this time of the year.

The state government suspended the head of BRD Medical College, Rajeev Misra, late on Saturday and ordered an investigation into contracts to supply oxygen.

CM Yogi Adityanath and Union Health Minister JP Nadda reached BRD Hospital in #Gorakhpur pic.twitter.com/W9XT28GAOl

— ANI UP (@ANINewsUP) August 13, 2017

Chief Minister Yogi Adityanath blamed the medical college’s principal, officials and the oxygen supplier. On Saturday evening he said that it will be “despicable if the deaths turned out to be caused due to oxygen shortage”.

According to a report by Hindustan Times, on August 9, Adityanath had reviewed the arrangements in the hospital during his two-day visit to Gorakhpur but the officers did not tell him about the impending oxygen crisis due to non-payment of the bills.

On Sunday, Adityanath visited Gorakhpur, which has been his constituency for five terms. Accompanying him was Union Health Minister JP Nadda, who promised the full cooperation of the centre in resolving the crisis. The Chief Minister promised a full-fledged inquiry into the tragedy and promised “stringent action” against the guilty.

“We have formed a high-powered committee under the state chief secretary to probe the reason of the deaths of children in the BRD Medical College and the supply of oxygen. Stringent action will be taken against the guilty, whether in Gorakhpur or elsewhere,” Adityanath said.

PM is constantly monitoring the situation in Gorakhpur. He is in constant touch with authorities from the Central & UP Governments.

— PMO India (@PMOIndia) August 12, 2017

MoS Health Anupriya Patel & the Union Health Secretary will take stock of the situation from Gorakhpur.

— PMO India (@PMOIndia) August 12, 2017

The Prime Minister’s Office (PMO) on Saturday said that Prime Minister Narendra Modi is constantly monitoring the situation in Gorakhpur and is in touch with central and state authorities.

The union government has also announced the setting up of a regional medical centre at a cost of Rs 85 crore in Gorakhpur for research into children’s diseases.

Response of Opposition

The death of the 70+ children ignited a political firestorm due to indications that the deaths could have been avoided had the government helped BRD Hospital repay its dues and allegations of medical and administrative mismanagement and negligence.

Talking to media, Congress leader Ghulam Nabi Azad said, “The administration was notified of the lack of oxygen. Local media reports also hinted at the possibility of a large tragedy in the hospital. It is shocking that nothing was done about it. Suspending the Principal after this and announcing an enquiry into the matter is just an eyewash. There should be an all-party probe into this; the matter should not be submerged at any cost.”

Azad also demanded the resignation of state Health Minister Siddharth Nath Singh immediately.

The Samajwadi Party also held protests on the issue.

The government was criticised for focussing state funds and government attention on things like as rolling out ambulances for cows, increasing security for cows and making Aadhaar mandatory for availing ambulances.

Have been receiving complaints against him ( Rajiv Mishra, suspended Principal). His work was disorganized, substandard: KK Gupta #Gorakhpur pic.twitter.com/uJgXyylI5n

— ANI UP (@ANINewsUP) August 13, 2017

BSP chief Mayawati also attacked the state government saying that BRD College Principal Rajeev Mishra has been made a “scapegoat” after he was suspended.

“By making the college principal a scapegoat, the state government is trying to absolve itself of all responsibility,” Mayawati said.

She also termed as “irresponsible” Uttar Pradesh Health Minister Siddharth Nath Singh’s remarks that “many children die” in the month of August every year at the Gorakhpur-based state-run hospital.

Dr. Kafeel Khan removed as the Nodal Officer for the Department of Pediatrics of Baba Raghav Das Medical College, #Gorakhpur.

— ANI UP (@ANINewsUP) August 13, 2017

There was also widespread outrage over the removal of Dr Kafil Khan, who became a hero on social media after he reportedly spent from his own pocket to arrange three oxygen cylinders at BRD Medical College on Thursday night when the supply of liquid oxygen stopped. Dr Khan was abruptly removed from the post of nodal officer for the encephalitis ward.

Confirming his removal from the post, Dr Khan told The Times of India, “It’s a smear campaign against me. I was only trying to help the children. I did everything from getting in touch with oxygen firms to ensuring prompt help to patients.”

Public healthcare in Gorakhpur is in shambles

The medical college in question has a history of being woefully underfunded; since February, the hospital staff has not even been paid. In April, the college had requested Rs 37 crore in funds from the state government, which forwarded the request to the centre. The hospital is still waiting for the funds.

Gorakhpur’s healthcare has a reputation of being in shambles. Encephalitis, in particular, has plagued Gorakhpur for years, something its five-time MP Yogi Adityanath has highlighted in the past. 70% of encephalitis-hit children in Gorakhpur are malnourished and doctors and activists have warned against the region’s dismal public health system for a long time now.

But conditions remain dire. Government data shows 62 out of 1,000 children born in Gorakhpur die before turning one. Against this, 48 out of 1,000 die in UP and 40 out of 1,000 in India. In fact, if Gorakhpur were a country, it would have been among 20 nations with the highest infant mortality rate (IMR) in the world.

Public healthcare in India is in shambles

In an unrelated event in Nagpur on Sunday, Union Surface Transport and Shipping Minister Nitin Gadkari admitted that it is difficult to provide modern and timely healthcare to all at government facilities and, as such, attempts should be made to involve private and social institutions into the running of healthcare centres with government incentives like provision of land.

“Due to various factors such as non-availability of expert doctors, skilled manpower, lack of funds and ticklish rules and regulations, it doesn’t become possible to provide professional healthcare to patients at government health facilities,” Gadkari was quoted by The Indian Express as saying.

Gadkari is right: India’s public healthcare system is a disgrace and among the worst in the world. And the pathetic state of healthcare is not unique to Gorakhpur; it is a feature of all UP and most of India. And activists and analysts and experts have been screaming for healthcare reform for years. And yet, despite all the warnings, despite all the preventable deaths, healthcare in India remains in shambles.

Nearly one million Indians die every year due to inadequate healthcare facilities and close to 700 million citizens have no access to specialist care.

If the government were to increase government spending on healthcare from the current below-1.5% levels to UN-recommended 2.5%-levels, it would improve health conditions of millions of Indians.

Only last week, the Economic Survey told Parliament that India was in desperate need of universal healthcare. If India is serious about its goals to become a superpower and to ensure the best facilities for all its people, it cannot be done without ensuring healthcare for all citizens.

The question is, do governments (at UP, the centre and the other states) need another Gorakhpur tragedy to occur before being forced to take action?