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Promoting Projects and Practices in Community Health in India

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Street scene in India, August 2020. © UNICEF/Vinay Panjwani

One of the most populated countries in the world, India has been facing problems with regard to well-being of its citizens while sustaining their developmental needs. The need for better health facilities, and developing antidotes for new kinds of pathogens and viruses have made the task more challenging. The respective governments, pharma companies, and testing labs are trying to develop safe trial mechanisms and developing safeguards for protecting the lives of vulnerable sections of society. Within India, the community health programme involves the non-governmental sector, healthcare professionals, economics aspects and social interaction through people and voluntary workers. While the health ecosystem exists, the problem has been finance, support and critical knowledge repository. India did well to address issues such as polio vaccination and creating community awareness for regular medication against tuberculosis. There is a mounting impact of chronic diseases in economic and social sectors, need for quality health services in the wake of changing demographics, and increasing life expectancy have made matters more complex.

In terms of understanding the requirements for building better resilient and health-conscious societies, it is important that the vaccines, lifesaving drugs, and medicines should be developed with certain generalised regulations which can improve the health of the society and address problems faced by people living across regions. While India is a subcontinent comprising of all geographical features, it is also a cauldron of different ethnic communities, and physical features which provides exceptional opportunities for testing and developing medicines which can cater to different physical and pathological profiles of people. Within India, one can find people with different levels of immunity. As the eating and food habits have been different, there is higher incidence of diabetes, hyper tension and cardio diseases in a cross-section of people. It has also been seen that people who are above 40-70 years of age have been more vulnerable to pandemics, and other communicable diseases. A sizeable mortality profile of people suggests that.

In this context it becomes very important that medicines which should be developed should have a better shelf life and give results which can be corroborated with testing facility, with a cross-section of people. The results have usually varied with regard to people with different eating habits and also nutrition factor. Pandemics such as COVID-19 have brought to the fore that India has better resistance mechanisms which has helped in relatively less mortality rate when these people have been infected with COVID-19. The duration of sickness because of COVID -19 has varied from five days to more than three weeks. In such certain times, it has been found that because of lack of any effective medicine or any sure shot diagnostic mechanisms the treatment has prolonged and the recovery has been slow. In terms of legal and other regulatory mechanisms, it has been found that most of the clinical trials which are done in India enroll the vulnerable  and poor people and human trials are conducted. There is a grey area of medical compensation and addressing post-tests complications from legal point of view.

For India it has become imperative to develop projects and conduct feasibility studies through government mechanisms rather than through medical companies. While projects have been undertaken to study different kind of diseases that school children and adults will be facing in the next two decades, it has been found that most of the complications will be related to teeth, eyesight, anxiety and mental well-being. However, in the case of pandemics and community health programmes it has been encouraging signs that initiatives such as creating awareness with regard to AIDS, mental well-being, depression and anxiety disorders have been fruitful and rewarding with institutionalising counselling and telephone helplines. Most of the programs have been done and supported by NGOs as well as a few voluntary organisations.

The projects and programmes which can be initiated in India should address core issues. Firstly, the incidence of non-curable diseases, depression, immunity disorders, other issues related to community transmission, and the development of proper safeguards and awareness with regard to pandemics and life-threatening diseases. Secondly, the COVID-19 has opened a Pandora’s box with regard to the incidence of diseases which impact community, and thereby also affect government health budget. Lastly, it is necessary that India will have to create medical soldiers and inform voluntary workers so that the community transmission and community health well-being should be addressed on a priority level.

As the COVID vaccine is in different trial stages, many countries are looking for testing facility in India and also conduct human trials, as legal structure in medicinal trials is still in infancy. India needs to address the issue of IPR on developing vaccines and medical history should be addressed jointly as it has been found that many western countries have been purchasing medical history of the patients living in developing Asia, providing vaccines through great testing mechanisms and subsequently using copyright laws to deny cheap medicines to the larger community.

 In this regard it is important that India should conduct research on immunity vectors of its population and develop generic drugs which can help in protecting communities from most transmissions. It is also pertinent to note that in terms of the temperature variance across India it provides unique testing opportunities in different conditions. However, there is a need for a holistic approach and therefore it is important that training and sensitisation of the personnel working in this field is of paramount importance. Initiatives related to preventive and therapeutic services is critical. Also, looking for quick alternatives would save the lives of personnel.

Just like any emergency, there is a need for rapid action medical force which can provide immediate assistance and better cognitive abilities track critical illnesses and the reasons thereof. It has been seen in the case of midwifery and associated postnatal diseases that it has worked wonders with a better equipped and knowledgeable person existing in each society for better assistance and awareness.

The critical importance of voluntary workers is that with sufficient technical assistance (which might come from government and state units) gives them confidence and also strengthens their application of knowledge for better informed public health practices and policies. Technical assistance and quick action through centralised control centre has to create the first line of defence in case of a pandemic. 

The institutes which have been working in this field are Public Health Foundation of India, Indian Institutes of Public Health and All India Institute of Hygiene & Public Health, which have been disseminating information through online workshops, seminars, and social media. They have created affiliates and sister agencies working in the field all across India. Networking of public health institutions in medical education need to address issues such as environmental health and countering new kind of diseases which are dominating.

This clearly highlights the fact there is a need for understanding pandemics, developing awareness among communities about public health, and stress on hygienic environment, conducting long term  research on emerging diseases and promoting research in tropical medicine.

India need to allocate separate fund for public health initiatives and promote exchange of medical workers with third world countries for better understanding the nuances of medical and health research. In fact, in most of the think tank meetings, public health and awareness is not listed as topics whenever Track II dialogues are held. There is also a need for better practices in public health, education, and developing health demonstration projects, barefoot nurses and doctors, strengthening an eco-system of education, training, and scholarship. Developing traditional medicine and making it easily accessible should be the bulwark against diseases. Restructuring Community Medicine/ Preventive and Social Medicine colleges which impart this kind of education in developing countries is required as the number is relatively less. Across developing world scholarship in community medicine and hospital administration is low and needs structural financial support. The data collection and diagnostics apparatus need micro management to create better response chain. COVID-19 has provided the reason for public health to be taken as a national initiative.

Pankaj Jha is faculty with Jindal School of International Affairs, O P Jindal Global University, Sonepat. He can be reached at pankajstrategic[at]gmail.com

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South Asia

Did India invade Kashmir?

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Friday prayers in Srinagar, Jammu and Kashmir. © John Isaac

Pakistan has decided to observe 27th October as Black Day. This was the day when, according to India’s version, it invaded the disputed Jammu and Kashmir State.  India says that Pakistan had earlier entered a lashkar (irregular forces) into Kashmir on 22nd October. But, it is eerie that India never approached the International Court of Justice, as pointed out by Josef Korbel  (the author of the Danger in Kashmir), or the  United Nations (under Chapter VII of the UN Charter) to get Pakistan declared an aggressor. It approached the UN under Chapter VI of the UN charter (mediation). India’s invasion of Kashmir is based on myths .

Myths

India claims that ‘Maharaja Hari Singh signed the treaty of accession with the Indian Dominion on October 26, 1947’. As such, India was justified in marching invading Srinagar. . As for the ‘accession instrument’ argument, curious readers may refer to Alastair Lamb’s ‘Incomplete Partition, Kashmir – A disputed legacy 1846-1990’, and ‘Birth of a Tragedy’.

On the question of who the ‘aggressor’ was, the factual position is that India marched its troops into Kashmir without Maharajah’s permission – a blatant act of aggression (Alastair Lamb, ‘Incomplete Partition , Chapter VI: The Accession Crisis. Lamb concludes: ‘According to Wolpert, VP Menon returned to Delhi from Srinagar on the morning of October 26 with no signed Instrument of Accession. Only after the Indian troops had started landing at Srinagar airfield on the morning of October 27 did VP Menon and MC Mahajan set out from Delhi from Jammu. The Instrument of Accession, according to Wolpert, was only signed by Maharaja Sir Hari Singh [if signed at all] after Indian troops had assumed control of the Jammu and Kashmir State’s summer capital, Srinagar.

Lamb regards the so-called Instrument of Accession, ‘signed’ by the maharajah of Kashmir on October 26, 1947, as fraudulent. He argues that the maharajah was travelling by road to Jammu (a distance of over 350 km). How could he sign the instrument while being on the run for the safety of his life? There is no evidence of any contact between him and the Indian emissaries on October 26, 1947. Lamb points out Indian troops had already arrived at and secured Srinagar airfield during the middle of October 1947. On October 26, 1947, a further airlift of thousands of Indian troops to Kashmir took place.

The UN outlawed the ‘accession’; the accession resolution, passed by the occupied Kashmir’s ‘constituent assembly’ is void. Aware of India’s intention to get the ‘Instrument of Accession’ rubber-stamped by the puppet assembly, the Security Council passed two resolutions, Security Council’s Resolution No 9 of March 30, 1951, and confirmatory Resolution No 122 of March 24, 1957, to forestall the ‘foreseeable accession’. It is eerie to note that the ‘Instrument of Accession’ is not registered with the United Nations. India took the Kashmir issue to the UN in 1948 under article 35 of Chapter VI which outlines the means for a peaceful settlement of disputes on Jammu and Kashmir State, not under Chapter VII dubbing Pakistan as ‘aggressor’. India knew at heart that she herself was an aggressor.

In his books, based on Nehru’s declassified papers, speeches and correspondence, Avtar Singh Bhasin debunked Nehru’s perfidious failure to hold a plebiscite. In Chapter 5 titled Kashmir, India’s Constitution and Nehru’s Vacillation (pages 51-64) of his book India and Pakistan: Neighbours at Odd he makes a startling revelation. Nehru discarded Maharajah’s and Kashmir assembly’s ‘accession’; in a letter dated October 31, 1947, addressed to the disputed state’s prime minister, he shrugged off ‘accession’. He said in the letter, ‘after consideration of the problem, we are inclined to think that it [plebiscite] should be held under United Nations’ auspices’ (p. 28 ibid..). He reiterated in New Delhi on November 3, 1951, that ‘we have made it perfectly clear before the Security Council that the Kashmir Constituent Assembly does not [insofar] as we are concerned come in the way of a decision by the Security Council, or the United Nations’(SWJ: Volume 4: page 292, Bhasin p.228). Again, at a press conference on June 11, 1951, he was asked if the proposed the constituent assembly of Kashmir ‘decides in favourof acceding to Pakistan, what will be the position?’ he reiterated, ‘We have made it perfectly clear that the Constituent Assembly of Kashmir was not meant to decide finally any such question, and it is not in the way of any decision which may ultimately flow from the Security Council proceedings’. He re-emphasised his view once again at a press conference in New Delhi on November 3, 1951. He said ‘we have made it perfectly clear before the Security Council that the Kashmir Constituent Assembly does not [insofar as] we are concerned come in the way of a decision by the Security Council or the United Nations’. Bhasin points out, ‘at a press conference on July 24, 1952, when asked what the necessity of plebiscite was now that he had got [accession by] the Constituent Assembly, he replied “Maybe theoretically you may be right. But we have given them assurance and we stand by it. Bhasin points out Nehru made a ‘tactical error’, one ‘of committing himself to the UN’.Accession documents are un-registered with the UN.

Concluding remarks

India’s prime minister Modi cartographically annexed the disputed state, spurning the UN resolutions and the Simla Accord. Let India know that a state that flouts international treaties is a rogue state: pacta sunt servanda, treaties are to be observed and are binding on parties. Mushtaqur Rehman elaborated why Kashmir is the most dangerous place in the world (Divided Kashmir: Old Problems, New Opportunities for India, Pakistan and the Kashmiri People, 1996, pp. 162-163).No talks, no mediation. That is an open invitation to war, perhaps a nuclear Armageddon.

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Bangladesh violence exposes veneer of Indo-Bangladesh bonhomie

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image source: Focus Bangla /dhakatribune.com

Protests in Chittagong, Comilla and elsewhere left 10 dead, besides loss of property. The protests were sparked over an allegation of desecration of the Holy Quran in a temple. The Holy  Quran was found resting on the thigh of a Hanuman statue in a Durga Puja pandal near a pond in Comilla called Nanua Dighi. A raft of issues from water disputes to religious tension mask mistrust in the relationship. Let us look at some of them. Broken promises indicate that India looks to its own interest.

CAA/NRC

India’s Citizenship Act and the national Register of Citizenship  does not confer citizenship on the Bengali immigrants at par with non-muslim refugees. In one of his speeches, India’s minister Amit Shah even called Bangladesh immigrants “termites”. The BJP leaders quote from Sheikh Mujibur Rehman’s book to say that Mujib, as an East Pakistani national, wanted to annex Assam into East Pakistan (Bangladesh). Bharatiya Janata Party MLA from Telangana T. Raja Singh Lodh demanded `Illegal Bangladeshi settlers and Rohingya should be shot if they do not return to their countries like gentlemen’. He made the statement in the context of the Supreme Court-monitored exercise to identify genuine Indian nationals living in Assam. A legislator from Goshamahal in Hyderabad, in similar vein, roared in a video message on a social networking site: “If these people, illegal Bangladeshis and Rohingya, don’t go back with ‘sharafat’ (like gentlemen) then there is a need to talk to them in their own language. They should be shot. Only then India will be safe. Such illegal settlers were “shot and driven out” from some other countries.

YS Chowdary of the Telugu Desam Party Said illegal immigrants from Bangladesh had settled in Assam as part of a “conspiracy to destroy India”. It is the responsibility of the government to send them back to Bangladesh, he added.

 “Shoot on sight”

Indian Border Security force has orders to “shoot on sight” if any Bangladeshi citizen living near the  4,096 kilometer (2,545 mile)alluvial/shifting border,   happens to cross over. Regarding border killings, Brad Adams, Executive Director of the Asia Department of Human Right Watch state that, “Routinely shooting poor, unarmed villagers is not how the world’s largest democracy should behave” (Adams, Brad  “India’s shoot-to-kill policy on the Bangladesh border” The Guardian. London). According to a report published by Human rights organisations, around 1,000 Bangladeshi civilians have been killed by Indian Border Security Force (BSF) in a period of 10 years (from 2001 to 2010). The report also states that Indian paramilitary forces routinely threaten, abuse arbitrarily detain and torture local Bangladeshi civilians living along the border and Bangladeshi border guards usually don’t help the Bangladeshi civilians. Odhikar, a Bangladesh-based human right organization, allege that acts of rape and looting have also been perpetrated by BSF at the border areas.

Bangladesh Border Guards hate the BSF so much that a soldier, accompanying his commander for a flag meeting with DG was shot dead.

Onion export banned

India suddenly stopped exporting onions to Bangladesh. While addressing India-Bangladesh Business Forum, in Delhi, Bangladesh PM Sheikh Hasina expressed grief on the onion crisis in her country. She taunted that she asked her cook not to use onions in her food. Hasina said, ‘We are facing crisis on the onion issue. I don’t know why you have banned onion export. Maine cook ko bol diya ab se khana mein pyaaz bandh kardo.” Indian Government had banned export of Onions on September 29 (Times of India ).

India is the biggest supplier of onions to Bangladesh, which buys a yearly average of more than 350,000 tons. India abruptly slapped a ban on onion exports to Bangladesh. Following the export ban, onion prices in Bangladesh jumped by more than 50 per cent, prompting the government to procure supplies from elsewhere.

Vaccine export contract cancelled

India backed out of its agreement (December) with Bangladesh to supply 30 million doses of AstraZeneca vaccine, developed by Oxford University in cooperation with the Pune-based Serum Institute of India. The Institute announced that India had barred Serum from selling doses on the private market until everyone in India had received the vaccine.

Later, Salman F. Rahman, a Cabinet minister and co-founder of the Beximco Group, a Bangladeshi conglomerate, took over the responsibility to distribute three million doses of the AstraZeneca vaccine in Bangladesh.

Concluding remarks

The ruling Awami League itself is mired in charges of corruption and nepotism. Its army chief also is being besmeared. It cracked down hard on its opponents  with the army chief’s help. The persecution of Muslims in India and laws like the citizenship Amendment Act and the National Register of Citizenship turned Bangladesh into a simmering cauldron of resentment.Demand for expelling all Bangladeshis from various Indian states is gaining momentum. The onslaught against Bangladeshi Muslims in India is part of Hindutva (perverted Hindu nationalism) frenzy to harass Muslim community.

Bangladesh is tight-rope balancing China and India. Many cabinet ministers think that Bangladesh’s future lies with stronger rapport with China. During her visit to China, Bangladesh’s Prime Minister discussed a broad spectrum of issues and signed several memorandum of understanding. They cover the power sector, riverine matters including Brahmaputra River, commercial loans and formation of various working groups. Bangladesh has also accepted the Belt and Road Initiative.

Bangladesh has contracted Chinese in a proposed $300 million project downstream of Teesta River.  Turkey also is improving relations with BD.

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Changing complexion of “militancy” in the occupied Kashmir

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Women walking past Indian security forces in Srinagar, summer capital of the Indian state of Jammu and Kashmir. Nimisha Jaiswal/IRIN

Two teachers, Supinder Kaur and Deepak Chand, were shot dead in Srinagar on October7, 2021.The Resistance front owned the killing. The name implies that this organisation like the Jammu and Kashmir Liberation front does not have religious moorings. The front explained that “they were killed because they harassed and warned the parents with dire consequences if the students did not attend the school function on August 15 (India’s Independence Day).

In a tweet, the Inspector general of Kashmir police disclosed that 28 civilians had been killed din the valley during 2021”. Five persons belonged to local Hindu and Sikh communities. . Two persons were non-Hindu labourers (pic.twitter.com/j5R2MVWrT3).

Each killing follows massive crackdowns, cordons and searches, and rounding up of innocent people as suspects mostly members of Jammat-e-Islami now banned, and Hurriyat members.

Who the Resistance Front is?

Very little is known about the Front. The Resistance Front publicly emerged in the aftermath of August 5, 2019, when the Central government stripped Jammu and Kashmir of autonomy under Article 370 and split the state into two Union Territories.  The Article 15-A also was abrogated. This article guaranteed special protections to Kashmiri people defined as “permanent residents” of Jammu and Kashmir.

The Front came into limelight when it owned a grenade attack in October 2019. Eight civilians on Srinagar’s busy Hari Singh High Street were injured in the attack. The Front is shy of social posts. But, it did announce its debut on the chat platform, Telegram.

India attributes the April intense gunfight between with security forces in the Keran sector (Kupwara district) to this Front.  It left five personnel of the army’s elite Special Forces dead.

Another encounter has continued for five days until October 19 in Mendhar sector.  India admits having lost several soldiers, including a junior commissioned officer, in the fight The Indian forces dared not enter into the forest. They were content to use heavy guns from the outside. The Indian forces’ initial impression was that the front uses only pistols and improvised explosives. That has been proved wrong.

 To disguise their ignorance about the Front, the forces say, ‘These acts are committed by newly recruited terrorists or those who are about to join terrorist ranks’.  

IGP Kashmir Vijay Kumar says, ‘A total of 28 civilians have been killed by terrorists in 2021. Out of 28, five persons belong to local Hindu and Sikh communities and two persons are non-local Hindu labourers.’

India shaken

The non local Kashmiri migrants have no faith in police protection. They are returning to their home towns. The remaining persons are being shifted to army camps.

India’s home minister has planned a visit to Srinagar to familiarize himself with the situation. Indian prime minister Modi is being blamed at home and abroad for emergence of the Resistance Front. The critics point out that Kashmiriat had been the crucible of several civilizations. But India’s reign of terror compelled the native Kashmiri to become xenophobic.  

Modi ventilated his ire at rights criticism in his speech before the National Human rights Commission.

He stressed that welfare measures like providing electric connection, alleviating poverty were more important than human rights.

The NHRC is a statutory body that was constituted on October 12, 1993, under the Protection of Human Rights Act. It takes cognisance of human rights violations, conducts enquiries and recommends compensation to victims from public authorities besides other remedial and legal measures against the erring public servants. However its present chairman is believed to be BJP stooge.

Kashmir, a Guantanamo Bay

Even Mehbooba Mufti, a former BJP ally, has been compelled to call Kashmir a Guantanamo Bay prison. She called for lifting ban on Jammu and Kashmir Liberation Front, Jama’at-e-Islami, withdrawal of `sedition’ or `terrorism’ cases against Kashmiri leaders or ordinary folk. Her voice proved to be a voice in the wilderness.  What else could Mehbooba call Kashmir _ `Kashmiris feel that they are literally imprisoned in a cage from which almost all exit routes are barred save one, to India, which is also not without peril. Kashmiris are distrusted and treated poorly in many parts of India, whether as students or as traders’ (A.G. Noorani, Kashmir, a prison, Dawn January 12, 2019). Trade across the Line of Control has been stopped and `terrorism’ charges slapped on some traders. Even the tyrannical Dogras and their British overlords facilitated Kashmir trade with Central Asian and other states. Kashmiri markets used to be flooded with foreign traders and their merchandise _books, shawls, gold tillas, Russian textiles, Kokandi silk, Bukharan rumals (handkerchiefs) and coral.  Trade from British India would flow through Kulu via the Chang Chenmo route to Yarkand, bypassing the maharaja’s customs officials in Leh. In 1870, Maharaja Ranbir Singh signed a special treaty in Sialkot with Viceroy Lord Mayo to accept this route as a ‘free highway’, later known as Treaty Route.  Central Asians intending to perform hajj used to travel through this route to Karachi or Bombay sea-ports to board ships.  To facilitate pilgrims, highway provided rest houses, and supply depots jointly supervised by British and Kashmir officials. Now, even the Kashmir Highway stands closed to civilian traffic during military-convoy movement.. A minor, violating road closure, was brutally crushed by an Indian army vehicle.”

Mehbooba revealed her government was dismissed for expressing ennui at central-government atrocities, not returning dead bodies of `encounter’ victims and burning them, not allowing funeral prayers, demanding talks with Pakistan, registering an FIR against an army officer, resisting change in Kashmir’s special status, and so on (Indian Express dated April 18. 2019). A cursory look at Kashmir press is horrifying _ Sedition cases were slapped on three Aligarh- university Kashmiri students for trying to hold prayers for Hizb militant Wani, Kashmiri students and traders at Wagah border are forced to chant anti-Pakistan slogans and post them to face book. Kashmir students and traders were attacked or looted throughout India. About 700 students, including girls, fled to Valley. Even holders of PM Modi’s merit-based competitive scholarships had to rush back to Valley for safety. Kashmiri journalists in Indian states were roughed up, mercilessly beaten, and told to go back Meghalaya governor officially directed to boycott everything Kashmiri. Some Kashmiris petitioned Supreme Court to intervene. In its order, the Supreme Court directed 10 states and various institutions to take remedial steps, but in vain.

Fake encounters

People have lost trust In India’s claims of success in “encounters”, mostly fake. In July last year, security forces in Kashmir claimed to have killed three “unidentified hardcore terrorists” in a gunfight in Amshipora village of Kashmir’s Shopian district. They had last made phone calls to their families on July 17, 2020, a day before the purported gunfight had taken place.

An army inquiry and a police probe into the encounter established that the three suspected militants killed in Amshipora were shot dead in a fake encounter.

Indian army stages such encounters to earn reward of Rs. 20 lac per encounter. A year has gone by but the captain accused of masterminding and executing the fake Amshipora encounter is still unpunished.  He abducted three labourers from their homes and shot them dead as “terrorists”. Those killed in Shopian in July 2020 were Mohammed Ibrar of Tarkasi village, Imtiyaz Ahmad of Dharsakri village, and Ibrar Ahmad.

Concluding remark

It is obvious that it is not all hunky dory in Kashmir as India claims. The changed dimension of “militancy” is an incurable headache for the Modi’s government.

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