Countries all across the world felt the tremors of the COVID-19 pandemic at different frequencies and at different points in time. Different, too, were their receptiveness to the lessons the outbreak taught.
Unlike many of its similarly rich and relatively developed peers, India failed to grow from its experience with the outbreak – to catastrophic consequences.
When the virus first arrived on India’s shores, the central government responded carelessly, declaring a sudden lockdown that left millions of migrant workers trapped, broke and hungry, in the capital. Ultimately, the decree wasn’t enough to completely avert an outbreak. During India’s first wave, they counted some 8 million confirmed infections and hundreds of thousands of deaths. In the battle to keep the virus at bay, 747 doctors had died.
A year since and catastrophe has reared its head once again. Even though the virus is nowhere near eradicated – and despite the emergence of more transmissible variants – India’s leadership seems to have settled on complacency. Massive election rallies and religious festivals, all packed with people, take place all across the country.
Meanwhile, case counts continue to climb, overwhelming hospitals, doctors, and the country’s supply of oxygen. Even after draining their savings to pay for medical treatment, every day, thousands of families bid farewell to loved ones who succumb to the disease, forced to hold their send-off rituals on sidewalks or riverbanks. During the second wave, around 20 doctors die daily, further emptying out an already-sparse healthcare industry.
According to Stener Ekern, associate professor at the Norwegian Centre for Human Rights, the virus laid bare and magnified gaps in the system that were already there. “All across the world, the pandemic did not really create new problems, it just highlighted the existing ones.”
Looking at India, Miloon Kothari, former United Nations Special Rapporteur on adequate housing, could only agree: “India was already grappling with many human rights issues before the epidemic hit, and the system had started to weaken even before the BJP [Bharatiya Janata Party, currently in power in the country] government came into power.”
The COVID-19 pandemic has exposed and magnified critical weaknesses in India’s healthcare system, and the country’s catastrophic second wave is but the logical, painful conclusion of years of state neglect. Amid a critical shortage of medical supplies, medicines, oxygen, and hospital beds, thousands of patients are left to die without receiving even just a bit of medical care.
A long time coming
India’s medical infrastructure has been under stress since long before the pandemic. Even after becoming the fifth-largest GDP contributor in the world, the South Asian superpower still lacked a system that could respond to crises with a human rights-centered approach.
In 2018, The Lancet, a top medical journal, published the Healthcare Access and Quality Index. Out of 195 countries evaluated, the Index ranked India 145th in terms of quality and accessibility to healthcare. It fared slightly worse than fellow South Asian nation Bangladesh (133rd), and lagged far behind Sri Lanka (71st) and China (48th).
The same Index pointed out that while its neighbors Pakistan and Sri Lanka counted 98 and 100 physicians per 100,000 people in 2017, respectively, India only had 85.7. In terms of facilities, Pakistan and Sri Lanka had 63 and 415 available beds per 100,000 patients, while India only had 53.
India’s lack of oxygen amid its second COVID-19 wave is not something unexpected, too. In 2017, 30 children died at a hospital in Uttar Pradesh due to the same critical shortage.
By 2020, two years since the Index was published in The Lancet, the Human Development Report ranked India 155th out of 167 countries in terms of available beds. Though the Index and the Report aren’t directly comparable with each other, it seemed clear that healthcare India was deteriorating.
Much of why the country’s healthcare system is so weak can be attributed to poor state support. Currently, the government spends only 1.26 percent of its GDP on public healthcare. The USA and Brazil, both also severely ravaged by COVID-19, allocate 9 percent and 18 percent of their GDP, respectively. Even other countries in the region have better funding, with Pakistan and Bangladesh both channeling 3 percent of their GDP into healthcare.
The National Health Policy passed in 2017, only recommends to bump expenditure up to 2.5 percent, and only by 2025.
As a result, regular citizens have had to pick up the very costly slack. Owing to an over-dependence on private entities, out-of-pocket expenditure in India is among the highest in the world. In 2019, there were 25,778 public hospitals in India, dwarfed by the 43,487 private health facilities.
In the same year, more than 373 million people were below the poverty line, according to UN estimates. To make things worse, unemployment has also worsened, jumping from 4.9 percent in 2013 to 11 percent in 2021. For millions upon millions of people, the country’s expensive healthcare remains comfortably out of reach.
Despite the threat of the pandemic, farmers from across the country continue to protest against the three controversial farm laws, passed in late 2020. The laws show how India’s government has used the pandemic as cover to further restrict civic space in the country, side-stepping proper legislative procedures and clamping down on dissent.
Broken bridges
“Nationalism primarily affects the flow of information,” says Ekern of the Norwegian Centre for Human Rights. “The more nationalist you are, the more concerned you are with the exterior images. Therefore, it becomes vital for governments of countries to restore their image.” For him, this fixation on external image has only served to worsen India’s problems.
With its national politics so firmly rooted in religion and identity, cracks started forming in India’s society. Amid the pandemic, and under the BJP, these cracks have started to become fissures.
According to Ekern, the current atmosphere in India looks very different, something he’s never witnessed before, not even in the previous strict regimes, and not even under emergencies. “Over the last few years, India has become less democratic. The country which was earlier regarded as much more relaxed and diverse is now trying to project unitary and narrow image,” he says.
As a natural result of this rigidity and forced uniformity, human rights in the country have taken a blow. “Human rights are a matter of balance,” Ekern explains. “Balance of individual and collective rights and freedom unites a nation. Why else would one like to sacrifice one’s freedom to save someone unknown, sitting in some other part of the country?”
Coupled with the “dismantling of independent institutions and a weak mainstream media” in the country, Kothari, the former Special Rapporteur, says that the ultimate result is a shrinking civic space. “Both the activists and the people [have become] wary of challenging the state.”
The state has pushed the country’s civic and legal spaces into lethargy, which it then takes advantage of. Just during the pandemic, the government has passed 11 ordinances, none of which went through consultations, often leap-frogging legislative opposition. The three controversial farm laws were a product of this legal side-stepping. Until now, despite the threat of India’s second wave, massive peasant protests against these laws are ongoing.
The basic rights in a democracy, including the right to correct information, freedom of speech, and press freedom, have also been dealt a serious blow. In response to calls for help online, the ruling powers send out threats of arrest and seizure, trying to scare its people into silence.
Even local governments, it seems, don’t have the standing to point out flaws in the country’s COVID-19 response. When the state government of Delhi, for instance, cried out for help regarding its short supply of essential medical equipment and drugs, Solicitor General Tushar Mehta told them to “not be a cry baby.”
Information has also been under the tight supervision of the government. Many critics have pointed out that even as India’s official numbers show a worrying swell in cases, they still do not accurately reflect the devastation on the ground, raising the possibilities of underreported data.
The country’s unreliable tallies are only made worse by its adversarial relation with the free press. From 2016 to 2021, India dropped nearly 10 places on the World Press Freedom Index, falling from 133rd to 142nd. Moreover, rather than solve its crisis on the ground, the state instead chose to arrange meetings with its diplomats, asking them to help counter the narrative in international media about India’s failure.
“The leader of a country has to build bridges and relations with the independent institutions. Those bridges are broken,” says Kothari. With more and more centralization of power and decisions, “How can an individual institution run the country?” ●
Monika is an independent journalist based in New Delhi.
