Sudden spike

Decades of low spending on health extracts a price in Gujarat as the crisis deepens.

Migrant labourers clashing with the police in Surat on May 5, demanding to be sent home,

As of May 5, Gujarat’s tally stood at 5,804 COVID-positive patients and 319 deaths. On May 2, the State recorded a sharp spike with 374 new cases in 24 hours. On May 3, there were 28 deaths in a single day. The State’s largest city, Ahmedabad, is a “hotspot as” and the worst affected urban centre in the State with 4,076 cases and 234 deaths as of May 5, according to Gujarat’s Health and Family Welfare Department. Far from flattening, the curve seems to be rising at a rate far above the national average.

Gujarat’s failure in containing the virus exposes some harsh realities on Prime Minister Narendra Modi’s home turf. Why is this supposedly prosperous State hit so hard? Among the factors identified by experts, the most pertinent perhaps is an increased economic and health vulnerability of the population, notwithstanding Gujarat’s claims of a high growth rate. Indira Hirway, director and professor of economics at the Centre for Development Alternatives in Ahmedabad, said: “There is a difference in growth and development. The State places negligible emphasis on social development. The pandemic has proved how unprotected people here are.”

Data published by the Union Health and Family Welfare Ministry in early May calculates Gujarat’s death rate at a frightening 22.6 per cent against the national average of 10.8 per cent. Italy had seen a 26 per cent death rate at the peak of the curve. Gujarat’s fatality rate is at 5.4 per cent against Maharashtra’s 4.2 per cent and Delhi’s 1.6 per cent and the national average (as of early May) of 3.3 per cent.

Ahmedabad Municipal Commissioner Vijay Nehra told media persons that cases were doubling every four days on an average through most of April, a rate at which the State might have ended up with 50,000 cases by May 15. The rate of doubling of cases had been brought down to nine days, but it was still too early to feel relief, he said.

Nehra said the Ahmedabad Municipal Corporation (AMC) was using a “proactive approach” called EPIC, involving “Enhanced Testing, Intensive Surveillance, Proactive Detection and Corona Checkposts”. The city has eight designated COVID hospitals and six quarantine centres. The State has a total of 19 COVID hospitals which have a total capacity of 2,200 beds. The AMC says 31 private hospitals across districts have been recruited for COVID treatment.

Dakxin Chhara, a documentary film-maker based in Ahmedabad, said: “Given the circumstances they are doing what they can, but it is not at all adequate and there is a lot of chaos.” Chhara said his uncle was put in a COVID isolation ward in a hospital even though he tested negative. “It was absolute hell for the family. We did not even know how to contact our uncle as he was being shunted around wards within the civil hospital.”

Gujarat with its several big, medium and small industries is highly globalised and Ahmedabad sees a considerable amount of international travel. In addition to people travelling for business, there is considerable traffic of the Gujarati diaspora visiting the home State; many Gujaratis also take foreign holidays. There is a theory that the L strain of the virus, which is considered very strong, entered the State directly through business travellers from China. The theory has been debunked by a few scientists but is still debated. There is a possibility that travel between Mumbai and Gujarat could have added to the problem.

Hirway, who has written extensively on Gujarat’s development, said there were three main factors for the spread: Ahmedabad’s insufficient and casual attitude towards testing at the start; the city’s congested ghettos; and the high vulnerability of the poorer sections such as the daily-wage migrants. “Gujarat is very different from other States. There is a huge informal workforce that is highly vulnerable with no access to health care. Gujarat is going the wrong way. It may show economic growth but at the cost of other things,” she said.

The red zone in Ahmedabad is within the walled city where the minority Muslim population lives. There are large families packed in small homes, which does not work in favour of distancing norms and lockdown compliance. Statistics show that the largest number of cases are in the central zones of Ahmedabad, where poor people, Muslims and Dalits live.

Sanjeev Kumar, a senior researcher at the Tata Institute of Social Sciences (TISS) who tracks Gujarat’s economic and social development, said that the alarming condition of public health and inadequate spending on the social sector were now extracting a price. Using Government of India data, he said Gujarat had 0.33 hospital beds for every 1,000 of the population against the national average of 0.55. According to the World Health Organisation, India had 0.70 hospital beds per 1,000 of the population in 2011. Gujarat was ranked 17 among the 18 largest States by the Reserve Banks of India in terms of social sector spending. In 1999- 2000, Gujarat was spending 4.39 per cent of its total State expenditure on health, but by 2009-10 this came down to 0.77 per cent, said Sanjeev Kumar.

Gujarat’s low recovery rate of 11 per cent is also a clear reflection of its poor health infrastructure. Once the virus started spreading, managing the crisis was entirely the responsibility of the State. Sanjeev Kumar said that this was where Gujarat fell short.

Plight of the marginalised

Gujarat is also grappling with the migrants issue. Reports say 94 per cent of the workforce falls under the unorganised category. At least half of the migrants are from Uttar Pradesh and Bihar. The lockdown left thousands of them stranded with no resources. Twice in Surat migrants clashed with the police demanding they be sent back home, episodes which highlighted their miserable condition.

Rupesh Solanki, a wholesale fabric dealer, said: “Many are daily-wage earners who work in the hundreds of textile units across Surat district. They live in poor conditions and have barely anything as most earnings go back to the village. It is tragic to see them just sitting hopelessly on the roads.”

The State government has finally made arrangements to send them home. On May 4, 21,500 migrants from Surat were sent home by train. More are expected to get back to their native villages after getting a medical clean chit. Unfortunately, the Railways are charging Rs.700 for each ticket. Nasim Akhtar, a handicraft worker from Bihar who is stuck in Ahmedabad, said: “I have not got my salary and have barely Rs.400 left with me. I could not afford the ticket.”