Tag: heatwave

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.

Some comments on India’s heat

On May 5, a couple people from BBC World reached out to me, presumably after reading my piece last week on the heatwave in North India and the wet-bulb temperature, for a few comments on a story they were producing on the topic. They had five questions between them; I’m reproducing my answers roughly verbatim (since I spoke to them on phone) below.

Are these high temperatures usual?

A: Yes and no. Yes because while these numbers are high, we’ve been hearing about them for a decade or so now – and reading about them in news reports and hearing anecdotal reports. This isn’t the first such heatwave to hit India. A few years ago, peak summer temperature in Delhi touched 47º C or so and there were photos in the media of the asphalt on the road having melted. That was worse – that hasn’t happened this time, yet. That’s the ‘yes’ part. The ‘no’ part has to do with the fact that India is a large country and some parts of the country that are becoming hotter are probably also reaching these temperatures for the first time. E.g. Bangalore, where I live, is currently daily highs of around 35º C. This is par for the course in Chennai and Delhi but it’s quite hot for Bangalore. This said, the high heat is starting sooner, on this occasion from mid-March or so itself, and lasting for longer. That has changed our experience of the heat and our exposure. Of course, my answers are limited to urban India, especially to major cities. I don’t know off the top of my head what the situation in other parts is like.

The government has said India has a national heat plan and some cities have adopted heat action plans. Are they effective?

Hard to say. Only two score or so cities have adopted functional heat action plans plus they’re cities, which is not where most of India lives. Sure, the heat is probably worse in the urban centres because of the heat island effect, but things are quite poor in rural areas as well, especially in the north. The heat also isn’t just heat – people experience its effects more keenly if they don’t have continuous power supply or access to running water, which is often the case in many parts of rural India. The benefits of these action plans accrue to those who are better off, typically those who are upper class and upper caste, which is hardly the point. When North India’s heatwave was underway last week, NDTV interviewed shopkeepers and small scale traders, vendors, etc. about whether they could take time off. All of them without exception said ‘no’. Come rain or shine, they need to work. I remember there being vicious cyclones in Chennai and waking up in the morning to find the roads flooded, trees fallen down and loose electric wires – and the local mobile vegetable vendor doing his rounds. Also, in urban areas, do the heat action plans account for the plights of homeless people and beggars, and people living in slums, where – even if they’re indoors – they have poor circulation and often erratic water and power supply?

What should the government do?

That’s a very broad question. Simply speaking, the government should give people who can’t afford to shut their businesses or take time off from work the money they’d lose if they did, and rations. This is going to be very difficult but this is what should be done. But this won’t happen. Even during the COVID-19 pandemic, the Indian government didn’t plan for the tens of thousands of migrant labourers and daily-wage earners in cities, who, once the lockdown came into effect, slowly migrated back to their home towns and villagers in search of livelihoods. This sector remains invisible to the government.

[I also wanted to say but didn’t have the time:] the experience of heat is also mediated by gender, geography and caste forces, so state interventions should also be mediated by them. For example, women in particular, in rural India and especially in Central and North India (where literacy is relatively lower) operate in settings where they have few rights and little if any financial and social independence. They can seldom buy or own land and go out to work, and often labour indoors, performing domestic tasks in poorly ventilated residential spaces, venture out to fetch water from often distant sources – a task performed almost exclusively by women and girls –, often have to defecate in the open but do so early in the day or late in the evening to avoid harrassment and shame, which then means they may not drink water to avoid peeing during the day but which would render them vulnerable to heat stress, etc. If state interventions don’t bend around these realities, they will be useless.

The moment you mention data or figures that you say you obtained from this government, the first thought that comes to mind is that it’s probably inaccurate, and likely an underestimate. Even now, the Indian government has an ongoing dispute with the WHO over the number of people who died during the pandemic in India: India is saying half a million but the WHO as well as many independent experts have said it’s probably 3-5 million. For example, if the government is collecting data of heat-related illnesses at the institutional level (from hospitals, clinics, etc.) you immediately have a bias in terms of which people are able to or intend to access healthcare when they develop a heat-related illness. Daily-wagers don’t go to hospitals unless their conditions are acute – because they’d lose a day’s earnings, because their out of pocket expenses have increased or both.

Do you think parts of India will become unliveable in your lifetime?

This is a good question. I’d say that ‘unliveable’ is a subjective thing. I have a friend in Seattle who recently bought a house in what she said was a nice part of the city, with lots of greenery, opportunities to go hiking and trekking on the weekend, with clear skies, clean air and large water bodies nearby. Liveability to her is different from, say, liveability to someone living in New Delhi, where the air is already quite foul, summers are very hot and winters are likely to become colder in future. Liveability means different things to people living in Delhi, London and Seattle. Many parts of India have been unliveable for a long time now, we just put up with it – and many people do because they don’t have any other option – and our bar just keeps slipping lower.