Tuesday, 14 April 2020

What should we do?

These are unprecedented times. We are worried, confused and distrustful. The
world is struggling to cope with the COVID 19 pandemic. There is no health system
in the world which can face the wrath of this unseen force. More than 760, 000 are
already infected and about 35, 000 deaths already and the numbers are increasing
day by day. The whole world has come to standstill, economies are crashing, people
losing livelihoods, and in some places, chaos is already setting in. Lots of rumours,
misinformation, fake news, and conspiracy theories, religious and other curses are
making rounds. Mankind is at war with himself. Countries which have far advanced
health systems and resources like the USA, Italy, the UK, and Iran are finding it hard
to provide appropriate treatment to everyone. What should we do in a place where
there is hardly any system and a makeshift administration? In times of such chaos,
you need a leader who people trust and listen to. We don’t have that either.

We need to be realistic. The health infrastructure, number of doctors, nurses and
other allied staff is nil to nothing when we look at the magnitude of this pandemic.
We cannot build hospitals like China did and even if we get some ventilators, there
are no intensive care facilities in most districts and who will operate them when we
do not have any trained nurses or paramedics available. The things are more
complex with COVID 19. Usually first port of call is a doctor or hospital when we
become unwell. Here if you go to the hospital, you can spread it to others including
the healthcare staff. There is no evidence that going to the hospital will help even if
you are tested positive. For those who do become severely unwell and need oxygen
and ventilator support, the prognosis is poor. In our setting, with a dearth of nursing
care, usually, families stay in the hospital, feed, nurse and buy medications from the
market. But here family members are likely to be infected if not symptomatic and if
not already infected, a hospital stay with an unwell patient will infect them. This
raises the question over who will nurse COVID 19 patients as there are not enough
nurses to do that job in Kashmir valley.

The authorities have just focused on testing and tracing people who had travelled
from outside state and this went to the level of propaganda, creating fear and
worsening preexisting stigma. Many people did not come forward with a travel
history and those put in so called quarantine, fled citing justifiable reasons like lack of
basic hygiene and putting dozens of people in the same room that feared likely to get
infected from each other. Even entire extended families of patients who died
because of COVID 19 are being put under alleged quarantine. This is not only
inhumane but hardly based on any scientific facts. Even in such pandemics, people
will need to grieve their dead.

Overall no one seems to be in-charge. One could have thought either director health
services or some other senior specialist from the public health or community
medicine will take the lead. Here we have different officials from the administration
trying to overdo each other without any thought or strategy. Demonizing people,
talking them down and then chasing them like criminals is not going help. There is no
focus on education; information sharing and making sure people don’t get inundated
by rumours through WhatsApp groups only. Can one fight a pandemic using the
decades’ old strategy of managing a political conflict with force and guns? No

What can be done?
It is time to be realistic keeping in view the infrastructure, healthcare staff and
magnitude of the pandemic which is only going to get worse. Everyone cannot be
tested or treated in a hospital. The virus has already spread in the community and
just focusing on anyone with a history of travel is not going to work. About 50 percent
infected do not show any symptoms but are contagious and carry on infecting others.
About 80% only have mild symptoms. So it is the asymptomatic people walking
around you who are spreading it as we speak. Everyone cannot be put in quarantine
or hospital and if we assume only 4 million will get infected out of 8 million; there is
no way of managing this pandemic in the hospital setting. If people are educated
and informed with clear guidelines with sincerity, most can stay home if having mild
to moderate symptoms of cough, fever, malaise and other symptoms. It is ideal to
test people to reduce contact and stress on self isolation in homes, but are there
enough resources to do mass testing.

Training and educating faith healers, peers, imams, and teachers and then using
them to propagate the message at the grass root level. Social distancing and self
isolation is the key to break the chain of spread from one to other. We know the
elderly and those with comorbid medical conditions are vulnerable with bad
prognosis. We have to buy time and protect the vulnerable in a hope that some
treatment or vaccine may be in available in the near future.
The healthcare staff and doctors need personal protective equipment (PPE),
otherwise we many lose may of them to illness and even death and if that happens,
we cannot deal with the pandemic for even few weeks. It is not enough to call them
god or bang plats for them unless there is an investment in healthcare and that
needs to be done now. Just focusing on buying new ventilators would hardly make
any difference if the healthcare staff is not protected in first place. The administration
needs to move on from the attitude of a police state to one of supportive to doctors,
rather than harassing them on the streets and beat them if they try to reach
hospitals.

Finally, people need to take responsibility. In this age, there is no dearth of
information. The internet is only partially restored but enough to know what to do and
what not to do. The infection is spread by droplets- coughing, sneezing, close
contact, hands, and aerosols in closed spaces. The virus lives on surfaces for hours
if touched and retouched. Washing your hands, not spitting in public, covering nose
and mouth when coughing, washing hands regularly, and keeping a distance from
each other is the best solution until we find a treatment. It is time to suspend
mosques, parties, weddings, offices, and any gathering completely. Funerals need to
be managed by professionals in full PPE as the virus is remains alive. These are not
easy times, people may not have food to eat, no jobs and income, so we have a
collective responsibility to look after each other and defeat this monster of a virus. As
Camus writes in his famous book Plague, ‘What’s true of all the evils in the world is
true of plague as well. It helps men to rise above themselves’, and I am sure we will
overcome this current age plague and be human again. Do not rely on hospitals,
doctors, peers, it is your life and only you can protect it for now by staying in your
homes and following the rules.


Saturday, 30 November 2019

Children of Conflict: Millions of Kashmiri Children Growing Up in a Perpetual Siege

LIVING in a conflict zone often confuses one’s existence. The perpetual state of war alters human behaviour, beliefs, and emotions. Growing up in the valley of Kashmir with never ending uncertainties, fear, and insecurity has a deep disturbing effect on the psyche of the local population especially children.
The lockdown in Kashmir has entered its fourth month now with children being the worst victims. About 1.5 million children are cooped up in their homes with parents playing the role of teachers and guards. Rounding up of underage children by the state makes the situation unprecedented. Reportedly, scores of minors have been detained without any legal recourse. With no schools, curfew, and volatile situation, it is not hard to imagine how they cope. No education and no play cannot make any child content with their existence.
Happy childhood is a key to a happy life. There is enough evidence that negative childhood experiences are key to many mental health issues in adulthood. Children look for constant stimulation and activity for engagement, otherwise, they get bored which can lead from minor behavioural problems to severe mood changes. With no schools, the forced holidays have become a burden.
Parents trying to keep children safe often restrict their movement. Children lose the freedom to play, explore and learn from natural surroundings. This is akin to be born in prison where you are caged in a scary basement completely deprived of outdoor play. They cannot even watch their favourite videos and programmes due to continued internet blockade. After being born is conflict, growing up in siege, they live under constant reminder of abnormality without any reasonable explanation as to why they cannot attend school, play or even socialise.
Children have also become victims of state politics to showcase normalcy. Recently the government tried to force them to attend schools and attend examinations. One could argue that their safety and wellbeing is put under risk to score brownies merely by forcing the local population to surrender and humiliation. With mass arrests of people, it is clear that children again bear the burden of not seeing their parents, and are constantly reminded of living in a society which is under collective punishment.
How would a tender fragile mind deal with such severity? Having a role model sans ambiguity in a child’s life is a key to development of the kid as a confident adult with self-esteem. Even a minor parental discord or conflict can ruin a child’s life forever. Now imagine a tender population with lack of direction, clarity, multiple connotations, ongoing reminders of trauma, and unnatural normalcy.
The suffering of children does not stop here. When one is born in such circumstances and grows up in such abnormal surroundings with reminders of pain, barbed wires and locked schools, without any semblance of what normal childhood looks life, the trauma becomes generational. How does generations cope and what becomes of them can ever be underestimated?  There have been numerous research studies and reports, documenting the scale of psychological trauma the population has experienced over the years. The current generation is virtually born in the shadow of the gun and continues to experience the conflict daily.
There is no family in the valley which has remained unaffected. The number of killed is reportedly more than one hundred thousand, many more orphaned, enforced disappearances in thousands, most men and youth having been subjected to some kind of torture, beatings, bullying, and the list goes on. Anyone who makes out of jail will give you a heart-wrenching account of torture from being beaten-up black and blue, paraded naked, cuts, electric shocks, sexual abuse to third-degree torture being used with impunity. Humiliation and denigration go hand in hand in the process.
Psychological issues are bound to creep up with children showing signs of distress- like irritability, behavioural changes, aggression, self-harm, suicidality, and predilection towards illicit drug use. It is hard to fathom how to help them unless the psychological and physical siege is addressed for good. With hardly any access to relaxation, entertainment, and means of education, such problems are bound to become deep-rooted.
There is no access to child counselling or for that matter mental health first aid when required. With a complete ban on internet access and wobbly phone connectivity, professionals willing to intervene are themselves helpless. The dismantling of civil society and voluntary organisations with no local governance catapults the melancholy of these children. I shiver thinking about the children living in hundreds of orphanages across the erstwhile state. The silence of world powers and people who could drive an impactful, sustainable change in the lives of these children, is equally baffling.

Thursday, 14 November 2019

Kashmir- Mental Health Crisis

The lockdown in Kashmir is nearing four months now since the complete annexation and demotion of the Jammu and Kashmir state on 5th August 2019. The entire population is under a physical and mental siege, official and unofficial curfew, with no public transport. There are numerous reports of intensifying health crisis with people finding it hard to reach hospitals more so in emergencies. The entire population remained without any phone connectivity for more than 2 months with people not able to reach their loved ones in and outside the state. Internet access remains suspended. Because of the uncertainty, and not able to know about the wellbeing of old, unwell, and frail, the entire population has been plunged into an anxious state of being. Moreover, the political situation has created a state of despondency, hopelessness, and a sense of grief. There does not seem to be any agency or person to whom people can turn for help or support.
There have been numerous reports in international and local media about the physical health crisis due to the ongoing war-like situation, including deaths of pregnant women, cancer patients, and mostly the undocumented deaths of those not able to reach for help.
When it comes to the mental health of the besieged Kashmiri population and Kashmiris living in India and other countries, it can be summed up as a collective trauma and punishment. A recent review in the Lancet suggests that 1 in 5 people living in conflict zones suffer from mental health problems including depression, anxiety, and Post Traumatic Stress Disorder.
It is known that conflicts involving killings, disappearances, rape, torture, collective punishment, arrests and lack of access to optimum healthcare are fertile grounds for both physical and psychological morbidity and mortality. With 8 million people put under such conditions, it is not hard to fathom the hidden epidemic of mental health problems which the local population is suffering and dealing with in utter silence. Overall, it is very hard to predict the scale of the adverse psychological impact of the lockdown and associated political connotations.
Kashmir was already known for the high prevalence of mental health problems including depression, anxiety, and other stress-related disorders due to the ongoing conflict situation from many decades. One in ten has lost an immediate family member and one third has lost someone in the extended family. These figures are from a decade ago and with the current unprecedented situation when around 8 million people are being put under lockdown, one can argue that entire Kashmiri populace is experiencing some kind of psychological trauma and distress. This is worsened by the mass arrests and alleged torture which is reportedly being broadcasted on loudspeakers in some places. Thousands have been put behind bars, including minors with no legal recourse. This is a perfect breeding ground for the development of many mental disorders.
Not only Kashmiris living in the valley but those living outside India and other countries are equally suffering due to the uncertainty of the situation. A survey revealed that more than 90% of Kashmiri diaspora showing symptoms of anxiety and depression in the first month following the lockdown with predominant symptoms of acute stress, insomnia, and impending doom due to inability in contacting their loved ones.
Children are the most vulnerable group of the population who have been deprived of schools, play, and any sense of normalcy, which is essential for optimal child development. It is a known fact that childhood adversity plays a major role in the development of many psychiatric problems in later life.
A secure, stable and memorable childhood is a key to productive adulthood, to be able to lead a normal life, have families and function as a responsible member of society. With millions of children being brought up in utter confusion, siege, and uncertainty about the safety of their families, is likely to produce a generation of traumatised people like in any war zone. A sense of security is important for children growing up, but if adults are not safe themselves, how can they make sure that children grow up confident and secure. This is likely to lead children to develop behavioural problems, insomnia, irritability, poor academic performance, just to name a few.
There were some reports of a dearth of psychotropic medications but more importantly, it has been the hesitation to seek help or attend consultations with doctors which has made many to relapse in their symptoms. The attendance in the hospitals had sharply declined more so in the first two months and only desperate families would somehow try to bring their patients to the hospital when not able to manage at home. Many vulnerable psychotic patients who usually don’t seek help and roam freely on the streets have been put under risk and some have been admitted to hospital. At times they have been shot dead in the past for wandering in prohibited areas. There are also reports that people with dependence issues are relapsing due to non-availability of drugs or access to treatment. Overall, the silent epidemic of trauma has become a part of daily living in Kashmir.
One wonders how things can change for better unless the political situation improves, and there is some respite for people. Lest the basic human rights are respected and people feel safe, no amount of medication or counselling even if it was available would help. Repeated exposure to trauma, no sense of belonging, and total helplessness do not let patients recover in the best possible settings. To help recover from this psychological trauma and prevent further harm, there is a need for immediate action both politically and on the ground to address basic human rights, recourse to legal help, re-joining families, letting minors go home and finally resolution of the dispute. Doctors and therapists can only then be able to treat people.
The question remains, is anyone listening?

Saturday, 19 October 2019

Kashmir- The curious case of Indian Collective Conscience

Kashmir has been cut off from the rest of the world for more than two months now, with little certainty about what is coming next.  Kashmiris living in and outside the erstwhile state of Jammu and Kashmir remain disconnected with hardly any means to communicate with each other. Just a few days ago some mobile connectivity was restored.  Terrible stories of loss, grief, and mourning are making rounds on social media, few news outlets, and mostly within the minds of Kashmiris.  The days of siege have become another statistic with most losing count.  People are hearing about the deaths and ill-health of their loved ones with little detail or ability to make it to the funeral or the bedside.  No one is talking out about the children stuck in homes, shut schools, and not to mention those beaten, tortured, and incarcerated.  People with chronic and acute diseases are dying undocumented with only God to blame.  The collective punishment of Kashmiris is working.

The perpetual worry about that ‘phone call’ has traumatized so many.  One fears that people are developing traumatic stress even when not physically present in the valley.  Even when people do manage a phone call after begging or borrowing, the harrowing silence on the other side says it all.  Although most people talk about everything being well, the deafening silence you hear even when words are being spoken is unmissable.  How does a nation reconcile and sleep at night with this travesty in their name?  Here a billion or more souls if not always celebrating, are content with what is being done to millions of other human beings in an alleged part of the same country in their name.  Who shares the blame if something wrong is happening?  The home minister of India declared that ‘It is all in your mind’ and everything is ‘normal’ in Kashmir.  You may refuse to agree with him but most of the Indians, educated, illiterate, liberal, religious, atheists, left-wing, right-wing, rich, poor, men, and women are convinced that Kashmiris need disciplining and that this is for their best.  How does one argue with that?
Most Indians are ordinary, hardworking, friendly people, who claim to love animals and would not harm a fly.  How do they reconcile with what their state is doing to fellow human beings?  Indian friends, the close ones, like others, decided to remain silent.  They would not even ask if the family was alright and did we manage to get in touch.  They will bleed for you in case of an accidental injury to you and will remain by your bedside till recovery.  But what is happening here then?  What kind of morality has been created?  Would sympathizing with Kashmiris mean a betrayal of their own country?  What about the claim of belonging to the same country?  Please feel free to ponder. Something has happened.  Somewhere the fear of the other has been used so convincingly that it has managed to break all the bonds, be it of friendship or simply of being human.  After all, India claims to be the propagator of vegetarianism, desperately trying to save cows even if that means ignoring the lynching of fellow citizens while practising ahimsa and non-violence.

Lately, the concept of the ‘nation first’ is doing rounds.  Nothing can be said or written against ‘the nation’. But what makes the nation; the current ruling party and the Prime Minister, the land, or the idea of a map in one’s head?  Or it is the religion of the majority, the conquest of minorities or something else. What about the people who live in that besieged piece of land?  Do they also make the nation?  Maim, punish, and kill people to save the nation from some unknown force.  Does the nation need saving or a self-fulfilling prophecy of destroying the nation is in action?  Treating Kashmiris as an extension of the neighbouring country and punishing them collectively to revenge generational hate for the neighbour only proves Kashmir is not part of the ‘alleged nation’ on whose name all this is being done.
History is a witness that nationhood was used by most tyrants, convincing the majority using fear, prosperity, and superiority as tools to rise to power.  Once in power, unimaginable things were done in the name of the nation, building on the fear of minorities and weaker sections.  Although none of the fascists remained to live their dreams and were victims of their own cruelty, but in the process the death and destruction they managed to offer humankind is unimaginable.  Once they are done with one group, they do have to go after others.  You cannot fathom that a fire set in a neighbour’s backyard will not spread to burn the whole village.  It has already started, people are even being booked for writing open letters, and students are being thrown out of colleges just for some minor criticism of the dear Prime Minister.

The generational trauma, displacement, and human suffering change the course of history both for good and bad.  What is then the solution, dignity in living or living with dignity?  It does not take long to realize that putting others through pain and suffering does not make any nation happy.  You may think that whatever is happening has nothing to do with you, but everything done in your name is your burden.  More so, instead of thinking and questioning, blindly condoning the state action seals the deal.  Some argue that if Kashmiris did not create trouble, in other words, aspire for freedom and demand a referendum as per the promises made to them by all the parties involved, Jammu & Kashmir will still have been a statehood the least. Blaming victims is not a new strategy.  Like Kashmiris have a choice to decide.  They are still to make to the table allegedly meant to decide on their fate. Who does not desire freedom?

Lastly, it is not late to question yourself, if not the state.  Are you sure you know what is being done in your name?  Are you the nation or the next victim of the nation?  If you are the nation, then own it and live with the consequences.  Democracy cannot be imposed, neither can freedom.  Everyone knows it is not about development, freedom of women or education of youth.  Neither is it about terrorism as mostly purported to slander Kashmiris.  There is still time to question the alleged truth unless you have decided to be the hangman in a mask.

https://countercurrents.org/2019/10/kashmir-the-curious-case-of-indian-collective-conscience?fbclid=IwAR1nUEhD6tI51FfbZZMqFbkdzZQSQv1Z2i4U_gFj-4TSjfLYDZUpyaPCwp4

Tuesday, 27 August 2019

Doctors, Veterinarians & Psychiatrists Of India – First Do No Harm


The situation in Kashmir is no mystery these days when it comes to the international media, organisations of repute, and academics.  Kashmir is ‘normal’ when it comes to the Indian government and Indian media houses.  For Kashmiris who live in a total information blackout, day to day survival is the only thing which matters.  Being a psychiatrist who has trained and worked in Kashmir, I cannot stop thinking about the mental anguish, fear and uncertainty which the entire population is facing.  Not able to get through to loved ones locally or from outside the state, just makes the agony worse. I had numerous calls from people around the world, strong men and women, breaking down in tears, experiencing panic attacks and some deciding to go back into the unknown, just to be with the family, no matter what the consequences.  After all, is it not better to share the tears and pain than face the numbness on your own.

With all the major news outlets around the world talking about lack of access to healthcare, baby food and essential medicines, many reputed journals like the Lancet and the British Medical Journal (BMJ) wrote editorials urging and cautioning about the worsening of health of besieged population. Not only the physical health but the ongoing mental trauma people experience made worse by virtually living in an open prison with total information blockade.  As a doctor, I was relieved like many other likeminded professionals who understand the need for professional organisations to raise their voice and at times question politicians, when it comes to the health, safety and wellbeing of people.  Then came the time to face reality, that not all doctors who work under strict professional and moral code, no matter in which country they practice, writing scathing criticism of the Lancet and how dare it take a view on the ongoing suffering of millions of people.  The reality started hitting when in some of the WhatsApp groups; doctors started signing petitions and even planned on trolling the Lancet journal on social media, arguing that it will prevent others from following the Lancet.  The minute I questioned them, asking don’t you need to look at the evidence, the reports of looming health disaster, shortages of medication, the result was not different. National interest comes first; the mood of the nation comes first, no matter if eight million people are caged in their homes not having access to basic amenities necessary to sustain life.

Then came the open letters from Indian Medical Association (IMA), various other doctors organisations and even the Indian Veterinary Association (IVA), not only criticising the Lancet, but at the same time showing complete disregard for human beings and health concerns with total and complete lack of empathy. It would be hard to argue if this is in context of the totalitarian state policies which is taking root in India, racism, communalism or just mob mentality. After all I have trained, worked, debated, and argued with same clinicians for years now and we have always been humans and friends at the end. Did I question myself? Yes, I did. I went back into history, terrified how doctors in Nazi Germany assisted the state in most inhumane experiments and interventions using the same arguments of national interest as my current colleagues from India or Indian origin seem to put forth.   Looking at the letters they wrote to the Lancet journal, one does not have to be an academic or a professional to see that apart from jargon of interfering into the internal matters of a country, there is almost no scientific argument which could put the Lancet’s editorial concerns on the wrong side. 

If this was not enough, a news article published in the daily newspaper The Hindu published on the 22nd August 2019, wherein the current President of the Indian Psychiatric Society (IPS) was planning to protest against the Lancet editorial at the International Conference of World Psychiatric Association in Lisbon. Not only that, he also claimed that IPS has thirty members from Kashmir and the Lancet should have contacted them first, arguing there are hardly any mental health issues and if there are they are due to the inference of a neighbouring country, a favourite of the current political disposition to dismiss any idea about welfare of Kashmiris.  He also questions why the Lancet didn’t publish something when as per him; there was a publication about mental health issues published in 2006. The official letter issued by the President of IPS looks like a dossier from ministry of external affairs talking about Pakistan, terrorism and Osama Bin Laden. In no way does it come across as a letter drafted by a professional body representing highly educated psychiatrists of a country. There is no evidence based argument, no references to any scientific research whatsoever which could have proved the Lancet wrong. The letter talks about coming generations of Indians especially doctors and students carrying an unpleasant memory. What about millions caged at gun point and children staying home trying to avoid the barbed wires?

As a Kashmiri psychiatrist who happens to be a member of IPS as well, I would like to know did IPS at any point try to contact their registered members in Kashmir or did they just splash their names on the letter used to criticise the Lancet. How does a national organisation representing almost all psychiatrists in the country makes videos, issues political statements and politicise about Pakistan, but at no point thinks of questioning the politicians about policies which are putting the physical and mental wellbeing of millions of people at risk. One does not have to be a scientist to understand that putting an entire population in siege, arresting their children, cutting off their all communication links will scar them psychologically forever, more so when the exposure to trauma is more than 70%. One out of ten people have lost a loved one directly to the current conflict and one out of three has lost someone in their extended families.  There are hundreds of publications in peer reviewed journals from local Kashmiri psychiatrists, orthopaedics, surgeons, sociologists, and other specialities talking about the mental and physical morbidity as a direct result of on-going war like situation in Kashmir. This will only get worse and no matter what professional jingoism will say, the reality of mental scarring is real.

Lastly, the members of any organisation have every right to question the decisions made by their representatives, may it be a country or a professional body.  Would the politically minded office bearers of IMA and IPS clarify if they had consulted their members before making sweepings statements, made fun of the scientific premise they claim to follow, shown utter contempt of their terms of reference and more importantly denigrated the pain and suffering of millions of people than becoming their voice. I am sure if there was a responsible body in the country, all these doctors would lose their licences to practice due to probity issues and not adhering to the code of conduct which no doctor should forget. Will the members of IPS ask their president to resign remains to be seen? When the siege is over, I am sure the Kashmiri psychiatrists will have a story to tell and many more scientific papers to write on the very trauma inflicted on them and their loved ones.

Dear Indian Psychiatry Society.... Psychiatry has come a long way from just using chains... !’ , wrote a friend to me who happens to be an Indian psychiatrist as well. 


Thursday, 11 January 2018

SKIMS Conundrum: The theatre of the absurd


Time and again, sensationalism seems to cure the health sector of its ill health. Fake drug scandals, hepatitis C epidemic, and children dying in scores in hospitals are just a few examples of how effectively the health sector is being managed.  Let us not talk about the tortuous queues, lack of beds, poor sanitation, missing lifesaving drugs, corruption and the scarcity of manpower plaguing our hospitals.  With the so called sting operation by a known bigoted news channel, who even accuses the state chief minister of being a separatist, the government suddenly woke up from a deliberate slumber. In a civilised and accountable society, before making allegations of kickbacks on anyone, the news channel would consult their lawyers to check that they have enough proof for what they are about to allege. But ironically, here the government takes the word of the prejudiced news channel and remove the director of the institution from his post without any due process. Surely this is done to create a rhetoric of providing healthcare to people when in actual sense, it hardly matters, as nothing changes for a common man who has to wander from door to door to get any help.

I am not supporting private practice by those doctors who claim a non-practising allowance and it is clearly in breach of their contract. However, when the subject is debated on moral grounds, do we really want to agree that it is in public interest to keep hundreds of sick people waiting on your doorstep and refuse to help them.  I am not trying to say all these doctors are doing it out of goodwill or charity and many may be indulging in wrong practices. More pertinently why do so many people have to beeline the private premises of a doctor at odd hours?  If the government thinks banning private practice is good for the masses, then where are the alternatives? Who would redirect these people to right place at the right time so that they get some relief?  There are more questions here than solutions. This brings us back to the basic question. Do we have adequate doctors and hospitals, and if not, are we utilising the available manpower to the maximum of their capacity and capability? Suspending few doctors or removing SKIMS director hardly makes life easy for someone who needs help here and now.
Time and again, local media and journalists report the failings of health sector, falling on deaf ears. The bottom line is providing safe, accessible, and timely healthcare is not a priority for the government or the bureaucracy.  The people who are supposed to manage our hospitals hardly use them. From health minister to any Babu in the secretariat, a posh private hospital in Delhi is closer than SMHS or SKIMS, paid by the state exchequer and duly referred by the Directorate of health services. This could be for as simple as a fatty liver or a migraine.  If they or their loved ones do come to local hospitals by any chance, the nepotism and VVIP culture makes sure they are received on a red carpet.  This means directors need to more worried about attending the phone calls of their bosses, arrange private rooms, bypass queues, refer them to outside of the state, than look after the departments they are supposed to manage.  Why do we think then SKIMS can be run smoothly or director health services will be confident to stay in his job, if he doesn’t agree with a Babu or attend to their undue demands.  The policy of appeasement is more important that the lack of health policy in the state, which none of the health ministers or health secretaries think is of any importance. 
The institutions of repute like SKIMS ought to be independent if they have to develop and provide services effectively.  By keeping them hostage to the external influence of people who do not know ABC of healthcare or who don’t bother to know, simply means such institutions are doomed.  If the director of SKIMS is powerless, on the mercy of a lay minister or indifferent commissioner, always in need to please people to stay in his job, why are we expecting our institutions to become centres of excellence? I am not suggesting there should be no accountability but surely there should be no political interference. External independent bodies should audit standards of care, corruption and overall performance.  Nowhere in the world, have top institutions excelled when governments and bureaucrats try to micromanage them for paltry gains of power and nepotism.
Let us not forget that doctors and other health professionals work in incredibly difficult and adverse circumstances in the valley. They are often beaten, abused and humiliated. With the ongoing conflict, they have provided services when rest of the populace is trying to keep safe. There are not many incentives for them to be around, but they make sure lives are saved, putting their own lives at risk time and again. Sadly the administration has created a narrative around the failure of the health sector in the valley, which squarely blames an average doctor for all its shortcomings.  For a common man, a doctor is the face of a health institution. If there are no medicines available, people do not blame the administration but the sole doctor on duty in a remote area and at times manhandle him. The local politician once elected does the same and never takes responsibility for the health sector in his constituency. The most they do is to call the BMO, order them rudely to do this and that, if they have to please a yes-man.  This whole scandal is a vicious cycle which only makes sure that health sector becomes a failure no matter what the frontline staff does or doesn’t do. Again, when have people sought better health care from their representatives? Do we ever hear that there was a protest rally to secure better health facilities? The answer is simply, No.
The issue of private practice by doctors working in the Medical Colleges and SKIMS is often used by the politicians to divert the attention from the real issues. Many people believe that banning private practice of such doctors will improve the state of institutions they work for. I am not sure if it is based on mere speculation or some real scientific evidence. Probably if they are fully dedicated to their jobs, it may enhance the academic and research capabilities of such institutions. However, looking at the state of the healthcare, doctor-patient ratio, hospital infrastructure, and the systemic failure of health provision, it is fairly evident that there are more patients in need of help than the government health sector can provide.  Hence we see people beelining the private premises of doctors after travelling hundreds of miles to have few minutes with a doctor. This is an issue of supply and demand and simply banning private practice without providing a real alternative to common people is not going to work.
The best government can do is to come up with a sensible health policy keeping in view the resources, manpower, and demand on health infrastructure. Allowing the health institutions to function and develop without undue political interference will be a good start. Protecting doctors from ill-tempered revenue officials or homicidal police officers when they are working in harsh conditions is not a big ask. The kneejerk reaction to please a bigoted news channel would not save lives but shatter the already low morale of health professionals to rock bottom. I am not suggesting that all doctors are honest and some don’t indulge in malpractice. Such doctors need to be made accountable by lawful means than by acting like a dictatorship.  The new director SKIMS will not come with a magic wand that the attached director didn’t possess. Finally, the government needs to be serious to sort out the mess in health provision than just acting up to shut up a rude malicious news channel. 

Monday, 16 October 2017

Braid chopping- Acceptance and not accusation is the way forward

Kashmiri women, once again, are on the receiving end of the long-standing conflict and war.  Decades of living in fear of losing their loved ones, insecurity, abuse and day to day violation of their dignity have made them no more than scapegoats of the political conundrum.  As per police reports, there have been more than hundred cases of alleged braid chopping.  People more so women are living in perpetual fear of being attacked. Women of any age group are afraid to leave home, are sleeping with multiple layers around their heads and often waking up in panic even by a ticking clock. Vigilante groups have cropped up who are indiscriminately attacking anyone they feel responsible of braid chopping and as a result, many innocents both local and from outside the valley ended up black and blue.  Common people have turned into lynch mobs although the braid chopping incidents are going on without a break and no amount of vigilantism is having any effect.  Many women have reported that men are using braid chopping to make fun of them.  There is nothing funny about it even when joking.  Sadly this is another sad reality of the patriarchal society we live in. 
People are divided as to who is behind all this, with most believing that this sinister game is being played to harass the local population as part of psych-ops.  Some believe that this is due to an epidemic of mental health problems and women who allege braid chopping are doing it to themselves.  Few are blaming the wayward in the neighbourhood trying to have some fun, trying to get a hold on valuables, and what not.  The protest demonstrations by the opposition parties and potential flaring up of the cause make some believe that they may be paying off their agents to become nocturnal barbers.  Last but not the least, the deep mistrust of Indian state and current regime makes them the prime perpetrator of the heinous act for most Kashmiris.  Let us not forget that the rumour mill, fear, and hypervigilance make it impossible to let reason make any sense of the situation.  After months of violent political turmoil, this braid chopping epidemic has diverted the attention of people from the core political issues and impending Article 370 abrogation pending in the courts.
With the top cop of the state openly declares that it is all because of ‘depression and attention seeking’ and proposal to do narco-analysis or lie detector test of the women reporting such trauma, this is no more than treating the victims of this travesty as criminals of the lowest order.  The argument that cases of braid chopping have been reported from Nepal to Delhi and then Kashmir points to hysterical nature of the act, but one could argue that compared to rest of the places, the epidemic number of incidents in Kashmir are beyond reasonable proportions.  Although we may never know for sure what is causing the braid chopping and even if we assume all the cases are because of psychological reasons, how do treating the victims as offenders help the situation.  This is making the state of fear worse leading to further mayhem.  This is no way to reassure the population that the state machinery is there to protect them.  If it is being suggested that this whole menace is a product of fear and heightened response from a subjugated population, no steps are being taken to make them feel safe.  It is hard to think of a person or a political party on any side of the divide who has the power or aura or command to reassure the masses.  The Chief Minister of the state has already lost all credibility and whatever she may say, would probably mean nothing to the general public, but if she had acted sooner, maybe there would have been some impact.  Same is true for the opposition parties and even the Hurriyat camp. This is not the time to play politics or to use the poor victims as a trophy to prove a point.
If the authorities are certain that these incidents are due to psychological reasons or what they call in common language ‘mass hysteria’, would it not have made sense that people were reassured and not threatened further.  With the authorities claiming there is an epidemic of emotional disturbances in the population; one could ask the question, who is responsible for that?  There is no dearth of data suggesting that most of the population have experienced trauma in one way or the other.  Not a single day goes without news of killing in some part of the valley. Hundreds have died in last few years and many more have been brutalised, blinded and maimed. When the whole population is living in an open prison, under the shadow of a gun where life can be taken any minute and no one is sure of the safety of themselves or their loved ones, how does the State expect people not to suffer? Isn’t there an abject hopelessness and lack of certainty in masses with no one knowing what is in store for them?  The occupation not only controls physically but also mentally.
No matter which hand holds the scissors to cut the braid, the ultimate responsibility still lies with the State.  The brutal conflict and draconian laws have over the years made people vulnerable, and it is no surprise we may see them coping by methods which may mean self-harming at times.  But rather than supporting them through their pain and suffering, if the State wants to put them through denigrating lie detector tests, why would they trust the state machinery or police forces for a minute. However, the age-old method of victim shaming and shunning the responsibility is hardly surprising. The victims are traumatised and need support than accusatory fingers.  Again it does not matter who cuts the braid, another person or their own hand, the trauma suffered by the victims is same.  The genius who is proposing the lie detector test needs to understand that if this is happening in a dissociative state, the victim would not remember the event anyway hence there is no scope of lying.
Victims need to be supported, listened to and not interrogated.  The mental health professionals have a duty to educate people, offer training and support to local doctors, community leaders and voluntary workers.  It is not late for the state to own the responsibility, reassure people and give up the accusatory tone and the ridiculous plans to torment the victims by further interrogation.  The culture of fear, suppression, draconian laws, undue use of force, pellet guns etcetera needs to go to prevent such mayhem in future.  Just blaming mental health issues is not good enough when nothing is being done to address the problem.  War zones are ugly places to live in and can bring worst out of people, however, compared to the rest of the world, Kashmiris have proved to be more resilient and not to succumb to the viciousness.
It is prudent that civil society takes charge to ease the suffering.  Community leaders, Imams, and volunteers can play a major role in educating people; control the mobs so that any violence is prevented.  There is no room for vigilantism and lynch mobs to deal with this situation.  The attacks on innocents need to stop as this is not going to end someone’s hair being chopped.  Reassuring masses and controlling the general fear is the solution and not the other way round.

Thursday, 10 August 2017

Mental Healthcare: Time to change

With the President’s assent, The Mental Health Care Bill 2016 became law as the Mental Health Care Act 2017. Under the new law, every person shall have the right to access mental healthcare and treatment from services run or funded by the government. As such, a patient with mental illness will be able to access services and facilities such as: the provision of essential psychotropic medications, free of cost; insurance coverage for mental illness; funding for private consultation if a district mental health service is not available. The law further ensures that treatment and rehabilitation will be available in the least restrictive environment and will respect the rights and dignity of patients, including those from disadvantaged socioeconomic backgrounds. The outcome of these recommendations is that the financial burden, as well as the psychosocial burden, placed upon carers, will be reduced to a large extent.
The bill requires the establishment of central and state mental health authorities. Also, every mental health establishment will have to be registered with the relevant central or state mental health authority. The act provides right to confidentiality to patients suffering from mental disorder. Patients have a right for an advance directive and say in their treatment when they lose the capacity to decide for themselves.
Significantly the new law decriminalised attempted suicide as a criminal act and assumes the act as a result of severe stress and mental disorder. However, this is more as a stop-gap arrangement, by creating a presumption of mental illness in every case of attempted suicide unless proved otherwise. Suicide should be completely decriminalised, without any conditions attached, which would help reduce stigma, create openness and make it easier to seek help.
Overall, the Mental Health Care Act 2017 is a significant improvement over the Mental health Act 1987, bringing about protection and empowerment of persons with mental illness. Effective implementation will require a substantial change in the system currently in place and will need an extensive input of staff and finance. The average number of psychiatrists in India is only 0.2 per 100 000 population, compared with a global average of 1.2 per 100 000 population. Similarly, the figures for psychologists, social workers and nurses working in mental healthcare are 0.03, 0.03 and 0.05 per 100 000 population in India, compared with global averages of 0.60, 0.40 and 2.00 per 100 000, respectively (World Health Organization, 2005).
 With a meagre overall health budget, India spends only 0.06 percent of its health budget on mental healthcare, which is almost nothing compared to even poor nations in the world. This law will only become a success when its financial implications are taken seriously and provided for, or else it may become another tool for corruption and nepotism for many involved in its implementation.  As per a WHO report, most developed nations spend more than four percent of their budgets on mental health research, infrastructure, frameworks and talent pool.
There are certain ambiguities in the new law which question its applicability and meaningfulness for the Indian population. As admission procedures, treatment options and decision-making would become legalised and bureaucratised, certain experts are apprehensive that the bill will likely increase the stigma and hesitation to seek treatment from mental health professionals, due to cultural, educational and social factors, particularly in rural India. But at the same time, the revised legislation could mark a start of a new era for anti-stigma campaigns; it could lead to greater allocation of resources to mental health, and the training and retention of mental health professionals, including psychiatrists, psychiatric nurses and other allied professions. Hence, if appropriately implemented and financed, in addition to improved access to mental health services, the human rights of people who are mentally unwell could be safeguarded to a greater extent by the new act when it comes into power.

Saturday, 8 April 2017

Kashmir Floods-Then and Now

Kashmir valley is famous for its beautiful landscapes; its majestic mountains, rivers that snake through this landscape, lakes which are homes in themselves and the lush green floating paddy fields.  Kashmir is also equally known for its disasters, both natural and man-made.  From the perpetual conflict situation to earthquakes, snowstorms and floods, there are hardly any disasters left, it has not seen.  In the September of 2014 Kashmir valley witnessed the worst ever floods of last 100 years.  The floods were so sudden and severe that for a few days there was no government in power, as everyone including the then Chief Minister of the state was trapped.  All means of communication including the mobile networks went dead.  Even the emergency numbers and wireless system of the security machinery could not stand the assault.  The sudden drowning of the capital city led to the total collapse of the state administration.  It was not that there were not enough warning signs- the incessant rains in upper reaches for days, the hiccups of the meteorological department to offer any proper forecast and advice and finally the failure of the Irrigation and Flood control department to manage the situation, lead to utter devastation.  Even on the day when the Srinagar city lost its defences to the rising waters and the banks of river Jhelum breached, the administration kept reassuring the inhabitants that there was nothing to worry about.  By this time, the south of the valley was already under water for days and it did not take long for north Kashmir to submerge.  The worst hit areas included Srinagar, Anantnag, Kulgam, Pulwama, Shopian and Bandipore in the Kashmir province.  Some areas of the Jammu province were also hit by heavy rains and consequent floods especially Poonch and Rajouri.
Millions of people were trapped, displaced, unsafe, and worst of all at the mercy of the missing administration.  People volunteered, innovated and used whatever means they could, to help and save each other.  Srinagar, a city of million people slipped under water and even those high up in the corridors of power, were not able to get any help.  Many people were rescued by their distant relatives, coming down from far off villages, days after they found themselves trapped under the  rooftops, living on dry rice and whatever they were able to stock, in that moment of  chaos.  Panic gripped the inhabitants of the valley and their relatives and loved ones living outside Kashmir. The situation was made worse by the lack of communication and the abundance of rumours, as there were hardly any credible sources of information.  The water reached up to 18 feet in some areas, flooding the 2nd floors of the houses and drowning and washing away essentials, valuables, cherished memories – anything that stood in its path.
There was social media frenzy, rumours, and a severe criticism of both the state and the central government, for not doing enough to save and help the people in time.  Kashmir being a conflict zone, the outcry was worse.  Even though the Army and National Disaster Rescue Force (NDRF) claimed to be helping people, there was a severe disquiet from various quarters. Allegations of favouritism and selective rescue and relief were hard to ignore.  There was a total lack of coordination between agencies claiming to be working in the rescue operations.  Even the Chief Minister went on record in the Supreme Court that the situation was under control and no further help was required in terms of boats and other essentials.  Obviously, that was a far-fetched claim and people remained trapped for weeks.  The media especially the tabloid news channels went to great lengths making heroes and villains depending on their loyalties, ignoring the actual victims and their suffering.  Sometimes they didn’t even spare people who had just been rescued after days of entrapment and trauma.  Some had lost their loved ones in the flood, but one could see the microphones being thrust into their faces, followed by insensitive questions like ‘How do you feel now?’   
The state government announced estimated loss of Rs1 trillion due to the floods, with housing sector losses of Rs30 000 crore and business losses of Rs70 000 crore.  The death toll after the floods was 280, more than 2500 villages submerged and around 2.53 lakh houses damaged1.  More than 550 000 people were displaced.  People lost everything from businesses, crops, livestock, vehicles, houses and other infrastructures.  The city remained submerged under water for more than 10 days due to the lack of necessary machinery to pump the water out, leading to severe damage to houses and buildings. 
Like other essential services, the health infrastructure totally collapsed with most hospitals remaining submerged under water.  Some hospitals were able to continue minimal services but they were left with no means to transport the sick and the injured.  The inpatients, most of whom were very unwell and some in critical condition were at the mercy of nature had it not been for the local volunteers who along with the on duty medical staff helped the patients to safety.  There was a looming risk of diseases worsened by the lack of clean drinking water, food, essential medicines and cold weather.  The situation became even grimmer when the bodies of dead animals started decomposing in the open and in the water bodies.  Even human bodies surfaced at many places.  The threat of water borne and contagious diseases loomed over the valley, just as the dark clouds continued to do so.  Death, decay and disaster were the only things clearly visible.
A lot has been written about the devastation, failure to manage the disaster and lack of appropriate response once the calamity was over.  Was this tragedy preventable by a proper forecast and warning system?  Was the state’s response and preparedness anywhere near adequate?  What caused such floods and devastation? Many people suggested that the floods were a manmade disaster for various reasons. Had the climate change even taken this picturesque valley into its grips? There are so many questions but hardly any answers.  Even after a year or more since the great flood, there hardly seems any change, reflection or preparedness for future disasters.  People are still living in constant fear and even a day’s rain reminds them that they may have to flee without any official warning.  Finally, the relief and rehabilitation of those worst affected, is still a mystery. When the physical rehabilitation is distant and people are still longing for the safety of their homes, it would be pointless to talk about psychological rehabilitation of the traumatised population.
Despite being prone to extreme weather, rains, floods and earthquakes, Jammu and Kashmir does not have any flood forecasting system or capacity for flood preparedness.  And the facts have not changed since the devastation of 2014.  Although, there was a nominal disaster management cell in the office of divisional commissioner Kashmir, once the floods took over, the cell went underground and has not since made any fresh claims.  The head of the meteorological department was the only source of news and somehow achieved celebrity status but was hardly able to address the worries and anxieties of people.  At times, he was used by the state administration to cover up its failures.
An analysis by the Centre for Science and Environment (CSE) suggests that the climate change and increased carbon emissions are responsible for heavy rainfall in the Himalayan region2.  The situation is worsened in Kashmir due to lack of appropriate drainage system.  If we talk about Srinagar only, the city has expanded beyond reason without any proper planning.  Most of the unplanned construction has taken place around river banks and encroachments are at its peak.  Huge buildings have come up in many flood-prone areas. Even many government offices like the Board of School education, State Hajj House, Police and Hospitals have been constructed in Bemina area of the city.  The area is actually meant to be the flood channel, which is supposed to divert the water in case of flooding in the Jhelum River.  One cannot help but wonder what were the clever city planners thinking, when they approved this land for the construction?   The corruption within the local administration means planning permission is hardly ever a problem and the alleged masterplan for the city has been dumped before it could have taken any practical shape.
As per the CSE ‘In the last 100 years, more than 50 percent of the lakes, ponds and wetlands of Srinagar have been encroached upon for constructing buildings and roads.  The banks of the Jhelum River have been taken over in a similar manner, vastly reducing the river's drainage capacity’.   Another research study undertaken by Directorate of Environment, Ecology and Remote Sensing concluded that, ‘During the past century, deforestation in the Jhelum basin led to excessive siltation in most of the lakes and water bodies of Srinagar and subsequent human greed brought about sustainable reclamation and land-use change in these assets of high ecological value’.  More than 9,119 hectares of open water surface and wetland have disappeared between 1911 and 2014 while only 6,873 hectares were preserved’3.  The encroachments and landfilling is an open secret.
The lakes like Dal, Nagin, Manasbal and Wular stand shrunk, invaded, and turned into a landfill by dumping the rubbish and excreta from the city and adjoining areas.  Mighty buildings, hotels and houses around the officially off-limits land have become part of the city’s identity.  The size of Dal Lake has shrunk from 22 square kilometres (8.5 sq mi) to the present area of 18 square kilometres (6.9 sq mi), and there is a concerning rate of sediment deposition due to catchment area degradation4.   Dal Lake has lost half of its water surface area in last forty years. The adjoining lakes like Gilsar, Khushalsar and Aanchar have all disappeared.  The feeding channels to these small water bodies have turned into landmass through heavy siltation.  Experts like Dr Shakil Romshoo of Kashmir University’s Earth Sciences department had recommended long ago that construction should be totally banned in this ecologically fragile area.  He had also suggested that measures like de-siltation of water bodies and afforestation programmes in catchment areas of the Jhelum should start on a war-footing.  "If the indifference of successive governments and the greed of the society at large has led to the degradation of our water bodies, we, at least, have to think of measures to save them from further degradation before it is too late,"5 But as usual, there are hardly any takers for such advice as the administration is working hand in hand with the land mafia turning the water bodies into a concrete jungle.
The Jhelum River with its origins from the Verinag spring in the Anantnag district passes through various parts of the valley before flowing into Pakistan.  With an increasing population and illegal construction boom encroaching on its banks, the capacity of the Jhelum River to carry usual amounts of water has significantly diminished.  This has meant even one day’s rainfall leads to water logging and potential risk of floods.  The other small rivers, streams and water bodies have suffered a similar fate. Some are at the risk of extinction and many have completely disappeared. 
It is no exaggeration to say that with the global climate change, increased risk of rainfall, lack of adequate drainage channels due to man-made encroachments, disappearing of wetlands and reduced capacity of lakes, Kashmir is at increased risk of flooding again, if necessary steps are not taken sooner.  There is a total lack of planning on the ground and buildings are popping up on any kind of land, from agricultural to forest. Who is responsible? Is it the civil society or the government? Why after so many disasters, nothing seems to change the public attitude or the State’s preparedness? Is the ongoing political conflict shadowing everything else in the state?
With the fragile political situation and the often mistrustful state-centre relationship, nothing much has been achieved as for the prevention and management of such disasters is concerned. Elections were called within few months of the devastating floods which led to regime change in the state.  That did not help matters either, as the administration got drawn into the conducting elections and poor flood victims were left at the mercy of no one.  The state government after preliminary estimates implied lacking enough resources to provide relief and rehabilitation of such enormous scale.  As the winter was approaching there was hardly any plan to house those living in makeshift camps.
There was a flood of non-governmental organisations (NGOs) during the deluge, both local and national. Many Kashmiris living outside India travelled back to help.  People worked hard all over the country to collect money and goods for the flood victims.  Here again, the effort was not organised and many people cried foul for various reasons.  Overall the NGO's were able to support, be it with clothes, medicine, money and other essentials. Many airlines agreed to carry the load free from Delhi and other major cities to Srinagar.  On the other hand, there were complaints that the administration is creating hassles in the process and not letting people work freely.  Obviously, it is hard to ignore the security concerns when it comes to the Kashmir valley.  Although there were many offers of international help, the Government of India did not accept that, claiming that the country was more than capable of dealing with the calamity.  Many in Kashmir felt that keeping away international aid was a step-motherly treatment to the people of Jammu and Kashmir and they were being taught a lesson for political reasons.
Indian Prime Minister Modi visited the valley pledging his support and announcing special assistance of Rs1000 crore for relief and rehabilitation.  He declared the floods as ‘national level disaster’.  On a subsequent visit, Mr Modi announced a relief package of Rs745 crore out of which Rs 570 were earmarked for relief to flood victims and Rs 175 crore for renovation of the six major hospitals. Meanwhile, the state government asked for a relief package of Rs44 000 crores from the centre for rehabilitation of flood affected.  Subsequently, the state officials denied that any money was received from the centre.  It was also alleged that a bill of Rs650 crore was raised against the Jammu and Kashmir State by the NDRF for the relief and rescue work.  Locally with the administration and the revenue department caught up in the election preparation, it was hard for people to even get the estimates of the damages they had suffered.
Despite all these announcements, estimates, packages, the fact remains that people on the ground did not get much relief or help.  Many families spent the last winter with their relatives where possible, some rented on extortionist prices and some suffered badly in open.   When the estimates were finally done, it was equally distressing for people as someone with a 2-3 storey building costing more than Rs 75-100 lakhs or  more, was given a meagre sum of Rs50-70 thousand which was not even enough for demolishing and clearing the site.  People who were considered to have partial damage of their houses were given a paltry sum of Rs 2300, which some felt was an insult to their suffering.  Actually ‘partially damaged’ meant that the house can crumble anytime with minor shakes, that too in this volatile earthquake prone area. Most people chose not to collect the money from the district administration.  Ironically, the second winter has arrived and the relief and rehabilitation has yet to start.  The red tape and bureaucracy of the place did not spare the flood victims and people mostly elected to depend on their own means. With the change in regime and the coalition between PDP and ruling BJP, things did not go any easy.  The State and central governments still seem to be at logger heads when it comes to the rehabilitation of flood affected though the same party (BJP) is in power at both places.
In November 2015, Prime Minister Modi again announced another package of Rs80 000 crore for the state of Jammu and Kashmir. Out of this, Rs2000 crore were earmarked for relief and rehabilitation of the flood affected population.  As the state came under Governor’s rule due to the death of ex-chief minister Mufti Mohammed Sayed, one could guess that whatever plans coalition government had proposed over the months are essentially lost.  It is surprising to know that orders for dredging the Jhelum River had to finally come from the Governor in January 2016 than the two elected Chief Ministers.  It is again announced that some money has been released from the Prime Ministers fund to rehabilitate the flood victims of 2014, but will they actually get it, remains to be seen.  One wonders, isn’t it too little, too late? Kashmir was engulfed by the uprising in 2016 with hardly any government or administration on ground barring the security apparatus busy with killings and blinding people. The great flood of 2014 became a distant memory, though the flood risk is higher than ever keeping in view nothing has changed on ground and Kashmir has received the best snowfall in years which would mean the water bodies will be running high in summer and any climatic change can lead to an unimaginable disaster. The proposed dredging never happened and flood is back like a flashback and it is only April and not September.
The state has yet to put in place the Flood Early Warning System (FEWS) for the Jhelum River.  At least, this could give a timely warning and people can attempt to leave for safety within a reasonable time. But it is hard to understand why there is so much delay even after repeated warnings from the experts.  Coming to the prevention of future floods, nothing solid has been put in place. Writing in the daily Greater Kashmir, Dr Romshoo quotes that when the flood was it its peak, Jhelum was discharging around 120 000 cusecs of water5.  Suggesting using the strategy of Relief, rehabilitation, reconstruction and risk reduction (4Rs) to deal with the disaster, he sounds dismayed that nothing moved beyond political jargon.  It seems that the state government did not use any proper methodology for assessing the damage, and if that was done, the centre will have little excuse in releasing more funds.  Experts have warned that post floods, the state is highly vulnerable for further flooding due to the weaker defences of the river banks, higher underground water levels and reduced water carrying capacity of the Jhelum River and its tributaries.  The current carrying capacity of River Jhelum is around 35 000 cusecs and that of flood channel around 5000 cusecs.  Even if Jhelum is dredged fully, its carrying capacity would not be more than 50 000 cusecs and 10000 cusecs for flood channel. What about if the rain doesn’t stop with water levels cross 120 000 cusecs?
Hence, the risk of impending floods is looming on the population who are still awaiting rehabilitation.  It is worth mentioning that the state of Jammu and Kashmir with its water resources, is a leader in the generation of hydroelectricity, most of which goes to the NHPC limited.  Would it not be reasonable that in return, the State gets some financial assistance from the NHPC to strengthen the rivers and make them more useful to carry the ever increasing load of water?  This may in return help with generating more electricity and revenue.
To conclude climate change, deforestation, encroachments and unplanned construction are continuing at full speed. The rivers have little capacity to carry increased load of water while the risk of incessant rainfall looms over Kashmir more than ever.  The state government is still in slumber and hardly anything has been done to prepare for and prevent further such disasters. With ever increasing political uncertainty in the state, one wonders if there would be any sincere efforts to save the population from further floods, earthquakes and other manmade disasters.  There should be, in place some form of prevention and preservation plan, before it is too late.




Footnotes:
3.      Humayun Rashid and Gowher Naseem, ‘Proceeding of Taal2007’: The 12th World Lake Conference, 653-658.
4.      Dal Lake". International Lake Environment Committee. http://www.ilec.or.jp/database/asi/asi-38.html

SUICIDE AND RESPONSIBLE MEDIA REPORTING: WHAT IS WRONG IN KASHMIR?

Suicide is not new to any society including Kashmir Valley. However, in recent months there has been an escalation both in the number of sui...