Healthy side of Assam

Kokrajhar is one of those places that don’t show up on the radar of middle-class India in normal times. The past few weeks, however, have dramatically changed that. The horrors of violence-wracked Kokrajhar have seeped into our living rooms. Suddenly, this backward district in Assam on the northern bank of the Brahmaputra seems not so far off.

As independent India turns 65, can a site of violence also be a place that sparks hope? The answer is yes. A small group of doctors from Assam and other parts of the country offer an inspirational example of how to turn a humanitarian crisis into an opportunity — they show what young India can do to help those in need. The doctors — who are in their 20s and 30s — are part of a non-profit organisation called “Doctors For You” (DFY). They are working in the relief camps in Kokrajhar and elsewhere, providing much-needed care to pregnant women, young mothers and newborns.
In July, Bodo tribals and Bengali Muslim settlers, including those suspected to be illegal immigrants from Bangladesh, clashed viciously in Kokrajhar and other districts of Assam, leaving a trail of devastation. Over 70 people have died; some four lakh people have lost their homes. Satellite television brought images of death, displacement and disease stalking Kokrajhar — the epicentre of the sectarian violence.
The wrenching visuals from the conflict zone — of thousands of men, women and children squeezed into squalid, overcrowded relief camps, the desperate search for food, clean water, doctors and medicines — have raised once again two uncomfortable and intertwined issues.
The first relates to the complex web of factors behind the clashes. There is a furious and polarising debate on land, identity and the extent to which the flow of illegal immigrants from neighbouring Bangladesh can be held responsible for precipitating the latest disaster. There is no consensus on what should be done to avert such clashes in the future. There is no easy solution either. But it is now painfully clear — if it was not so before — that sweeping the issue of illegal immigration under the carpet does not help.
The second issue is the humanitarian crisis fuelled by the sectarian clashes. This is as important as the debate about the politics behind the clashes because of the magnitude of the human misery and because of the huge gaps in disaster preparedness it has shown up. This is most tellingly illustrated in the state of healthcare. At the time of writing, no epidemic has broken out but tens of thousands continue to live in precarious conditions from the point of view of public health. Over 2.4 lakh people are still reportedly living in relief camps and it is highly unlikely that they will all be able to return to their homes over the next few days, or even weeks. If diseases spread in these camps, it will not matter who is legal and who is illegal. As fresh floods ravage parts of Assam, the state administration faces the twin challenges of natural and man-made disasters. There is a vital need, therefore, to have a road map for emergencies ahead. The fact that such planning is possible and effective is shown by the small example of the DFY team.
The team was heading for Kokrajhar— ironically to conduct the first district-level training of doctors in disaster management — when the violence broke out. The doctors waited in a nearby district, hoping the clashes would end. That did not happen. After consulting one another, they decided that instead of sitting around in their hotel rooms, they would straightaway start helping the survivors of the conflict. This was at a time when ministers in the Assam government were appearing on television news shows and saying doctors were afraid to go the area.
This is not the first time the young doctors are working in an emergency situation. Three years ago, DFY was among the first to send medical teams to flood-ravaged Bihar. One doctor was struck by lightning and died in the middle of relief work. His colleagues were shattered but stayed put. The dedication and the commitment of these young doctors have earned the organisation much international acclaim. In 2010, it received the Saarc award for Outstanding Contribution to Humanitarian Works in the Aftermath of Natural Disasters. Last year, the British Medical Journal chose DFY as the “Best Medical Team in a Crisis Zone”. Set up some five years ago, DFY specialises in medical emergency work and is now supported by the Tata Institute of Social Sciences (TISS). It has offices in Mumbai, Delhi, Patna and Guwahati.
“I am inspired by Medecin Sans Frontieres (MSF). We hope DFY can become an Asian MSF in a few years,” says Dr Ravikant Singh, president. Like MSF, the Nobel Prize-winning international NGO, Singh and his team are buoyed by the idea of working in conflict zones.
“In and around Kokrajhar, things were bad in the initial stage but the government’s response has improved a lot in recent days,” says Dr Mridul Deka, 29, a member of the DFY team. More government doctors have been deployed and women in the relief camps are now getting antenatal check-ups and measles vaccination for children has started.
And yet there are daunting challenges ahead. Many camps are still too crowded. There is a paucity of toilets, heightening the risk of disease. Some camps are more crowded than others and the standards of health, hygiene and sanitation are not uniform. This is worsened because the relief camps are unfortunately segregated along ethnic and religious lines. The divide now runs so deep that even a doctor from one of the ethnic groups does not feel welcome in a relief camp inhabited by another ethnic group.
But there are many takeaways from the work that the small group of DFY doctors are doing in the middle of all this. The key insight is the need for a functioning disaster management plan. There are government agencies which are supposed to do this, and there are policy documents aplenty. But when a crisis strikes, local administrations are usually caught unawares. Many experts have felt over the years that if local doctors and administrators have a fixed drill to follow on a day-to-day basis, and if they have received training in disaster management, it will be much easier for them to contain the kind of situation that flared up in Kokrajhar.

The writer focuses on development issues in India and emerging economies.