Credit: DH Illustration
We are writing this article to urgently draw the attention of the general public and the medical community to the ongoing medical and humanitarian crisis in Manipur, which has persisted for over 100 days. This article is based on first-person accounts from health professionals and health volunteers working in Manipur, as well as situation reports from non-governmental organisations. Our goal is to briefly highlight the current health situation, its implications, and the action needed to address it.
The violence, arson, and killings in Manipur have led to a large number of internally displaced persons (IDPs) living in temporary shelters both in the valley and the hills. These shelters are set up in any available space, such as schools, hostels, godowns, places of worship, or community halls. While local people and civil society organisations are providing relief to the best of their ability, it is insufficient to meet the needs of those affected. Many affected individuals have left the state, moving to neighbouring states like Nagaland, Assam, and Mizoram or even to far-off places like New Delhi and Bengaluru if they have family or relatives there.
Due to the ongoing conflict, there is now an informal territorial division between the valley and the hills, with restricted movement of people, goods, and vehicles between the two regions. While this is known, we fear the full extent and scale of the crisis have not been understood.
Currently, in this volatile and dynamic situation, over 70,000 people are internally displaced, with 142 reported casualties and over 6,000 injured. These displaced individuals are seeking shelter in 253 relief camps across 10 districts of Manipur, as reported by Sphere India, a national coalition of humanitarian agencies. These reports are based on meetings of the Inter-Agency Coordination Committee and the mapping of responses from over 100 local organisations using the United Response Strategy
(URS) matrix.
The Health Situation
According to doctors working in or visiting the camps, the health situation is grim, particularly for the vulnerable. There is overcrowding with inadequate sanitation arrangements. Water is stored in large plastic tanks, filled from a tap or borewell, but not properly disinfected. Wastewater drainage is insufficient, and with the onset of the monsoon, sanitation and drainage are expected to worsen. Overcrowded and inadequate facilities raise the risk of disease outbreaks.
Some of the displaced have received bed nets, and their diet mainly consists of two meals of dal and rice with limited vegetables or meat. There is minimal provision for the care of young children, pregnant and lactating women, and the elderly; antenatal care and routine immunisation have been disrupted. There is also an inadequate supply of essential drugs like anti-hypertensives or anti-diabetics. Deliveries are occurring in these ill-equipped camps, and transferring critically ill patients to hospitals is challenging. Additionally, some drug users in the relief camps require care and rehabilitation services, and there are no facilities for people with disabilities. The lack of livelihood makes it difficult for people to get necessary medications.
Referral health facilities, as well as educational facilities, are located in the valley and are currently inaccessible to those living in the hill camps. Other public health infrastructure on the hill also has more vacant staff positions than in the valley. There is a severe shortage of specialists, medicines, and consumables in these health facilities. The conflict has further compounded the problems of an already weak health system.
While Manipur’s health indicators for infant mortality rate, maternal mortality rate, and under-5 malnutrition are better than the national average (SRS 2020), some of these indicators may worsen if the current state of unrest persists.
People are grieving the loss of their family members, property, and livelihoods. Living in overcrowded camps for three months has been emotionally challenging. There is anger and resentment in both communities towards each other. Children are traumatised by displacement and sometimes the loss of a parent or sibling. The uncertainty about the future and about the ability to return home has added to stress and mental health issues. Agricultural activities have been disrupted, with people leaving their lands for safety. Students at various levels of education are unable to resume their studies. Kuki students fear returning to colleges in the valley and face an uncertain future.
Call to Action
The humanitarian and public health crisis in Manipur is exceptional. The ongoing violent conflict between two communities has led to the loss of lives and widespread displacement, severely impacting the health system and causing short- and long-term health consequences.
While the government is striving to provide services, the broader medical and public health communities must also respond and supplement these services.
The immediate health needs include medical supplies and personnel. We call for:
Medical professionals to volunteer and provide primary care for pregnant mothers, young children, the elderly, and those with chronic diseases.
Volunteers who can provide grief and trauma counselling and/or train locals to do so
Basic health training for lay volunteers along with health kits for treating minor ailments, providing first aid, and conducting disease surveillance
Provision of drugs and supplies
The urgency of restoring peace cannot be overstated. Confidence-building measures are crucial for both communities. The government must ensure non-discriminatory relief and rehabilitation.
We identify the following priorities:
Government to take full responsibility for running all camps, including the provision of proper nutrition, safe drinking water, and sanitation.
Ensure the availability of health care services in the camps.
Strengthen public health institutions in rural areas.
Restore identity documents for people who have lost them.
Safety of women, prevention of sexual harassment, and quick response in cases of sexual violence
Safe passage for health personnel and medical supplies should be allowed to reach both patients and facilities.
Enable medical, nursing, and allied health science students to resume their studies within or outside the state.
Rehabilitation of affected persons as soon as possible.
While conflict resolution requires sustained political efforts and inter-community reconciliation, it is imperative for us, as members of the medical fraternity and Indian citizens, to alleviate suffering until lasting peace is achieved.
(Dr Zachariah is Professor of Medicine at Christian Medical College, Vellore. Dr. Atkuri works with tribal and rural communities in Central India)