The cost of forgetting Ballia

In the day or so before June 1, 14 people died in Bihar of heat stroke. Ten of these people were election personnel deployed to oversee voting and associated activities in Bihar and Uttar Pradesh, and of them, five died in Bhojpur alone. On Friday, at least 17 people in Uttar Pradesh, 14 in Bihar, and four in Jharkhand had died of heat-related morbidity. And of the 17 in Uttar Pradesh, 13 deaths were reported from Mirzapur alone. This is a toll rendered all the more terrible by two other issues.

First, after the first phase of the polls, the Election Commission of India (ECI) recorded lower voter turnout than expected (from previous Lok Sabha polls) and blamed the heat. Srinivasan Ramani, my colleague at The Hindu, subsequently found “little correlation” between the maximum temperature recorded and turnouts in various constituencies, and in fact an anti-correlation in some places. By this time the ECI had said it would institute a raft of measures to incentivise voters to turn up. These were certainly welcome irrespective of there being a relationship between turnout and heat. However, did it put in place similar ‘special’ measures for electoral officials?

On March 16, the ECI forwarded an advisory that included guidelines by the National Disaster Management Authority to manage heat to the chief electoral officers of all states and Union territories. These guidelines had the following recommendations, among others: “avoid going out in the sun, especially between 12.00 noon and 3.00 pm”; “wear lightweight, light-coloured, loose, and porous cotton clothes. Use protective goggles, umbrella/hat, shoes or chappals while going out in sun”; and “avoid strenuous activities when Balliathe outside temperature is high”.

A question automatically arises: if poll officers are expected to avoid such activities, the polling process should have been set up such that those incidents requiring such activities wouldn’t arise in the first place. So were they? Because it’s just poka-yoke: if the process itself didn’t change, expecting poll officers to “avoid going out in the sun … between 12 pm and 3 pm” would have been almost laughable.

The second issue is worse. Heat wave deaths in India are often the product of little to no advance planning, even if the India Meteorological Department (IMD) has forecast excessive heat on certain dates. But to make matters worse, there was a deadly heat wave last year in the same region where many of these deaths have been reported now.

Recall that in the first half of June 2023, more than 30 people died of heat-related illnesses in Ballia village in Uttar Pradesh. After the chief medical superintendent of the local district hospital told mediapersons the people had indeed died of excessive heat, the state health department — led by deputy chief minister Brajesh Pathak — transferred him away, and his successors later denied heat had had anything to do with the deaths.

So even if the IMD hadn’t predicted a heat wave in this region for around May 30-31, the local and national governments and the ECI should have made preparations for heat exposure leading at least to morbidity. Did they? To the extent that people wouldn’t have had to be hospitalised or have died if they’d made effective preparations, they didn’t. Actively papering over the effects of extreme weather (and of adverse exposure) has to be the most self-destructive thing we’re capable of in the climate change era.

Featured image: Representative image of a tree whose leaves appear to have wilted in the heat. Credit: Zoltan Tasi/Unsplash.

Hot in Ballia

More than half of the deaths reported during the heatwave in Uttar Pradesh and Bihar this week were reported from just one district in the former, called Ballia. On (or around) June 17, the medical superintendent of the Ballia district hospital was transferred away after he attributed the deaths (until then) to the heat. He was replaced with someone else.

The state government also dispatched a team of two experts to the district to assess the local situation (as they say). One of them was director of the Uttar Pradesh health department for communicable diseases, A.K. Singh. In one of his first interactions with the press, Singh indicated that they weren’t inclined to believe the Ballia deaths were due to the heat and that the team was also considering alternative explanations, like the local water source being contaminated. I think something fishy could be going on here.

First, Hindustan Times reported Singh saying “the deaths at the hospital were primarily due to comorbidity and old age and not heatstroke”, erratic power in the area, and the time taken to reach the hospital — in effect, everything except the heat. Yet all these factors only worsen a condition; they don’t cause it. What was the condition?

Second, a reporter from The Hindu who visited Ballia learnt that it will take “more than seven days” to issue the medical certificates of the cause of death (MCCDs), so the official cause of death — i.e. what the state records the cause of each death in this period and circumstance to be — won’t be clear until then.


Aside: During the COVID-19 pandemic, the Indian Council of Medical Research issued guidelines that asked healthcare workers to not list comorbidities as the underlying cause of death for people who die with COVID-19. This didn’t stop workers from doing just this in many parts of the country. I’m not sure but I don’t think similar guidelines exist for when the underlying cause could be heat. The guidelines also specified the ICD-10 codes to be used for COVID-19; such codes already exist for heat-related deaths.


Third: Do the district authorities, and by extension the Uttar Pradesh state government, have complete knowledge of the situation in Ballia? There was the unfortunate superintendent who said there was a link between the heat and the deaths. Anonymous paramedic staff at the Ballia hospital also told The Hindu that “some of the deaths were heat-related”. Yet the new superintendent says the matter is “under investigation” even as one member of the expert team says it’s yet to find “any convincing evidence to link the deaths with heatstroke”.

I really don’t know what to make of this except that there’s a non-zero chance that a cover-up is taking shape. This is supported by the fourth issue: According to The Hindu, “the [Uttar Pradesh] State Health Department has asked the Chief Medical Officers of districts and the Chief Medical Superintendents of district hospitals to issue statements in coordination with the concerned District Magistrate only during ‘crucial situations'” — a move reminiscent of the National Disaster Management Authority’s response to the Joshimath disaster.

For now, this is as far as the facts (as I know them) will take us. I think we’ll be able to take a big stride when the hospital issues the MCCDs.