{"id":20072804,"date":"2021-05-20T12:30:00","date_gmt":"2021-05-20T07:00:00","guid":{"rendered":"https:\/\/www.thethirdpole.net\/?p=72804"},"modified":"2021-05-20T19:38:22","modified_gmt":"2021-05-20T14:08:22","slug":"covid-19-engulfs-unprepared-himalayas","status":"publish","type":"post","link":"https:\/\/dialogue.earth\/en\/justice\/covid-19-engulfs-unprepared-himalayas\/","title":{"rendered":"Latest Covid-19 wave engulfs unprepared Himalayas"},"content":{"rendered":"\n

The recent spike in Covid-19 cases in South and Central Asia has shone a harsh light on the lack of medical infrastructure for mountain communities. Tens of thousands of people in the Hindu Kush Himalayan region have been displaced in the name of development, but they have not benefitted. Infrastructure is costlier to build in the mountains, which is why healthcare infrastructure – in particular – should have been a priority. Unfortunately, the 250 million people living in these areas are poorer than their counterparts at lower altitudes. This means that their concerns are often ignored in policymaking. Few recent events have exposed this neglect as much as the Covid-19 pandemic.<\/p>\n\n\n\n

Covid-19 threat in South and Central Asia<\/span>

India remains the global epicentre of the current Covid-19 wave. Limited testing facilities, especially in remote areas, mean that official data remains at best only indicative. The government of India is facing particular criticism for possibly suppressing numbers<\/a> \u2013 both of infections and deaths \u2013 but this is the only data available.<\/p>

By the end of the second week of May, over 25 million Indians had been infected with Covid-19 since the start of the pandemic; around 275,000 people had died. Over 18% of those tested were Covid-positive, many with the more transmissible variant of the virus, B.1.617. In Nepal, national positivity rates last week crossed 40%, prompting fears of mass deaths and hospitalisations if new infections are not curbed. In Pakistan, where daily deaths have been at a record high, cases fell in the second week of May though there are fears of a situation like India\u2019s arising. Officials are still apprehensive about the spread of infections following the Eid festival, when families visit one another and large gatherings take place. In Central Asia, though Covid-19 infections have remained comparatively low, the economic impact on mountain communities has been devastating due to restrictions on tourism.<\/p><\/div><\/div><\/div>\n\n\n\n

Premature declaration in Gilgit-Baltistan<\/h2>\n\n\n\n

In March 2021, officials<\/a> in Gilgit-Baltistan (GB) said the region was free of Covid-19 but feared a surge of the virus once tourists returned. Given the abysmal rate of testing, it is impossible to be sure of the situation. On 14 May, the Pakistani government reported 273 tests had been conducted in the region in the previous 24 hours.<\/p>\n\n\n\n

That rate has remained low throughout the pandemic. This is despite a study<\/a> conducted after the first wave in GB in 2020 said: \u201c[The] mountain community in Pakistan is not isolated from the impact of Covid\u201019 pandemic\u2026 The aftermaths of this pandemic are likely to be severe unless mountain\u2010specific policies and responses for the mitigation of Covid\u201019 impact and the revitalisation of mountain economy are developed.\u201d<\/p>\n\n\n\n

Little has been done to improve this. Given the shortage of basic infrastructure it is hard to upscale. In all of GB, there are 21 medical facilities with 126 beds<\/a>. There are three labs testing for Covid-19 in the region. The government has pledged to provide 10 additional ventilators<\/a>, which would take the number in the province up to 26.<\/p>\n\n\n\n

According to a 2017 study by Amimah Fatima Asif, a medical officer at the district headquarter hospital in Skardu, the doctor to population ratio in GB is 1:4100, whereas the national statistic is 1:1206. Doctors are rarely available, there is a serious shortage of trained laboratory and operation theatre technicians and trained nursing staff, and no basic medicines are procurable, she wrote.<\/p>\n\n\n\n

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In the near-absence of government-run facilities, local volunteers and community leaders have become active. \u201cIn the first and second waves of the pandemic, our youth and volunteers remained vigilant to enforce the SOPs (standard operating procedures) in the villages by rendering round-the-clock duties,\u201d said Muhammad Ayub, a community leader in Yasin valley of GB. They distribute essentials, fumigate homes and cars driving up from the plains, make and distribute masks and sanitisers, and check if tourists have negative Covid-19 test results.<\/p>\n\n\n\n

\u201cWe used to make arrangements for the isolation of suspected passengers coming from cities,\u201d said another volunteer, Muhammad Alam in Thoi village of Yasin valley. \u201cWe provided one spray machine to every union council of Yasin valley besides masks and sanitisers,\u201d said Javed Iqbal, a member of local NGO Yasin Mahraka. \u201cOur female volunteers are also active.\u201d<\/p>\n\n\n\n

Kashmir shows disconnect between government and reality<\/h2>\n\n\n\n

Community management of the Covid-19 pandemic is as important as medical and administrative measures, India\u2019s central minister Jitendra Singh said on 14 May. He was speaking to his constituents in Udhampur in the Himalayan region of Jammu and Kashmir.<\/p>\n\n\n\n

At a time when Covid-19 patients are dying due to a lack of oxygen and ventilators all over the region, Singh wanted<\/a> community leaders to ensure no-one hoards oxygen cylinders at home. When residents pointed out there were not enough technicians to operate the few ventilators available, he said he had proposed a \u201cshort duration programme\u201d to train more people. With India\u2019s Covid-19 vaccination drive slowed down by the lack of vaccines, the minister was urged to speed up the process. His only response was that it was his \u201ctop priority\u201d. The abysmal condition of hospitals in Jammu<\/a> was ignored.<\/p>\n\n\n\n

Jammu and Kashmir\u2019s jails \u2013 overcrowded in response to a decades-long separatist movement \u2013 have turned into Covid-19 hotspots. On 12 May, a dissident leader Mohammad Ashraf Sehrai died<\/a> in a hospital in Jammu after catching the virus in Udhampur jail. The administration\u2019s response was to tighten curfew all over the Kashmir valley. Speaking in private, doctors in Srinagar complained that lorries containing oxygen cylinders were being held up by security forces.<\/p>\n\n\n\n

The numbers are staggering. On 15 May, Jammu and Kashmir recorded<\/a> 4,788 new Covid-19 cases in 24 hours, taking the tally of infected persons to 211,742. The official death toll rose to 2,672; of these, 60 had died the previous day.<\/p>\n\n\n\n

Lockdowns in mountain communities are ineffective<\/h2>\n\n\n\n

The disconnect between the government and the people all over the Himalayas has become stark in the current Covid-19 wave. Across the region, the authorities\u2019 default option has been to impose lockdowns with varying degrees of severity. They ignore the hardship this forces on people dependent on lorries carrying food, fuel and other necessities up the mountain roads. Worse, these methods are likely ineffective in controlling the spread of the virus. People live in close proximity, and they depend on social networks for their daily needs. With no alternative arrangements provided by governments, people are more likely to break the rules if the alternative option is to starve.<\/p>\n\n\n\n

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There are no isolation facilities and no basic public healthcare, let alone specialised treatment, in many mountainous areas. Instead, those falling ill are told to isolate themselves at home. A majority of people in the Himalayas live in one or two-room cottages, with very little ventilation so that the homes can be kept warm in winter. How can the infected isolate themselves in such homes? There is no answer from any central or state government.<\/p>\n\n\n\n

This basic neglect of marginalised communities has been part and parcel of India\u2019s pandemic response, even during the first wave of Covid-19. Even more problematically, frontline healthcare workers have received little support, and have borne the brunt of the work in dealing with the pandemic.<\/p>\n\n\n\n

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More hearses for Himachal<\/h2>\n\n\n\n

In the Indian state of Himachal Pradesh, the official Covid-19 death toll stood at 2,185 on 14 May. The number of people infected is now 157,862, with 56 deaths on 14 May.<\/p>\n\n\n\n

The state government took two major decisions<\/a> in the same week. It decided to buy more hearses to address the current shortage, and ordered the forest department to provide wood for cremations, free of cost. These ghoulish decisions came after an uproar when dead bodies were discovered floating in the Ganga<\/a> in the neighbouring state of Uttar Pradesh. At the same time, the Himachal Pradesh government\u2019s lockdown order left loopholes for virus transmission: weddings can still be held with gatherings of up to 20 people, and construction work can still go on. It has been the same, or worse, in all the Indian Himalayan states.<\/p>\n\n\n\n

As elsewhere in India, the judiciary has been forced to step in. The Himachal High Court has ordered<\/a> the government to \u201censure equitable access to testing, medicine and hospital beds across the state\u201d. There is no sign that the order is being followed.<\/p>\n\n\n\n

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During the first wave in 2020, voluntary organisations in the remote district of Lahaul and Spiti had done yeoman service to keep the virus away. \u201cBut this time, the wave is too strong,\u201d said a resident who did not want to be identified. \u201cWe\u2019re getting no help from the government. We cannot do everything ourselves.\u201d<\/p>\n\n\n\n

Kumbh Mela devastates Uttarakhand<\/h2>\n\n\n\n

Uttarakhand has become the Covid-19 epicentre of the Himalayas. The government permitted, and even encouraged, the Kumbh Mela which brought millions of Hindu pilgrims to the holy city of Haridwar from February to April, despite warnings from public health experts.<\/p>\n\n\n\n

From the start of the pandemic to the end of March 2021, there had been 42,541 cases in the state\u2019s nine mountain districts. Between 1 April and 8 May, this number<\/a> reached 88,875.<\/p>\n\n\n\n

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The impact of the Kumbh Mela is clear, especially since many residents of the high-elevation districts had travelled to Haridwar for the holy dip in the Ganga. AK Dhwani, a schoolteacher in Tairia village near Corbett National Park, confirmed this, saying: \u201cMany residents fell ill after returning from the Kumbh Mela. The situation worsened because many joined large wedding celebrations.\u201d Residents of two villages in Betalghat block of Nainital district had gone together to the Kumbh festival. In both villages, half the residents (116 people) are now Covid-positive.<\/p>\n\n\n\n

Testing and vaccination nearly impossible in the mountains<\/h2>\n\n\n\n

Locals dispute the official numbers. Many Covid-19 patients have not informed the authorities \u2013 they have self-medicated at home and stayed put. The few testing centres at high altitudes are either closed or crowded \u2013 most people fear catching the infection if they go to these centres. And then it takes up to a week to get the result. This means the infection spreads before the result arrives and the patient is isolated.<\/p>\n\n\n\n

If that is the state of testing, the state of vaccination is worse. You must get online to book a vaccination slot: not an easy job in a region where mountains impact on wi-fi signals. As it is, India has too few vaccines<\/a>.<\/p>\n\n\n\n

No facilities for treatment at high altitudes<\/h2>\n\n\n\n

Even in normal circumstances, residents would go to the foothills for decent medical care. They would travel to either the state capital, Dehradun, or to Haldwani in the eastern part of the state. This is still what is happening. Doctors and paramedics working in high-altitude health centres confirmed that if they find a Covid-19 patient who needs institutional treatment, they send the patient to Dehradun or Haldwani. \u201cWe don\u2019t have the facilities to treat them,\u201d said one doctor who did not want to be identified for fear of losing his job.<\/p>\n\n\n\n

What if someone needed an oxygen cylinder at home? \u201cWe don\u2019t have oxygen cylinders for homes,\u201d the doctor replied. \u201cWe don\u2019t have the two nurses who are supposed to work here. They were told to work in Haridwar during the Kumbh Mela. They are still there.\u201d<\/p>\n\n\n\n

For residents of remote villages near the Tibet border, going to hospital can mean a drive of up to a day over rough roads. In the current circumstances, even this cannot guarantee treatment. Medical facilities in and around Dehradun have proved inadequate; the situation is worse in Haldwani. Oxygen cylinders and medicines are being sold on the black market at highly inflated rates. This has led to the same desperate pleas for help on social media that are seen all over India. Doctors at Haldwani\u2019s Sushila Tiwari Hospital say they almost ran out of oxygen more than once in late April and early May, a critical issue for patients for whom oxygen can be the difference between life and death.<\/p>\n\n\n\n

The state government has announced that it will install oxygen plants in hospitals and health centres in high-altitude districts. No work has started yet. The lone ray of hope in the state is a move by the disaster management department to work with residents to set up Covid-19 inspection committees that can monitor home isolation.<\/p>\n\n\n\n

No infrastructure, no governance in Nepal<\/h2>\n\n\n\n

Covid-19 cases at the Everest base camp<\/a> make global news, but citizens afflicted by the pandemic are interested only in news of hospital beds with oxygen. These are a rare commodity even in the capital Kathmandu. Villagers depend on primary health centres which have no oxygen cylinders, no doctors, and no testing facilities.<\/p>\n\n\n\n

On 23 April, a few days before Nepal\u2019s Prime Minister KP Oli lost a trust vote in Parliament, the Federation of Community Forests Users group<\/a> took a major step forward. The group decided to hand over 1,400 offices across the country for quarantine of Covid-19 patients. The federation has over 22,000 forest users\u2019 groups spread across Nepal.<\/p>\n\n\n\n

Smaller efforts are starting. In Lalitpur in the Kathmandu valley, local NGO Chayasa Manka Khala has set up an isolation space in a community centre, with four beds with oxygen. \u201cIf our community members fall sick and we don\u2019t get beds in hospitals, where shall we go? We have started this initiative before it is too late,\u201d said<\/a> Shyam Byanjankar, president of the NGO.<\/p>\n\n\n\n

Bhutan stays safe, but for how long?<\/h2>\n\n\n\n

Bhutan remains an outlier in the Himalayan region for a variety of reasons. First and foremost of these is its health infrastructure. Bhutan spends the most in the region, as a proportion of its GDP, on healthcare. It also has a per capita GDP of over USD 3,000, higher by almost a third than Pakistan, India, Nepal or Bangladesh. With a strong public healthcare infrastructure and a small population, Bhutan managed to vaccinate its population at a higher rate<\/a> than any other country in the world when it received vaccines from India.<\/p>\n\n\n\n

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