Recent news reports state that the Chhattisgarh government has asked International Committee of the Red Cross (ICRC) to suspend its operations in the Bijapur district where it had operated for the past two and a half years. ICRC had been providing medical help to violence hit people in the tribal dominated area. This order of suspension raises important questions about (a) the duty and ability of the state to provide medical services to the tribal population in that area, and (b) the willingness of the state to allow medical services to affected people in an area affected by Maoist violence.
Bastar district is a predominantly tribal area, with more than two-thirds of the population belonging to the Scheduled Tribes category. Ninety percent of the population is rural, more than 87% of the population is employed only seasonally, and literacy levels are among the lowest in Chhattisgarh. Two thirds of the Village Reports, or Jan Rapats prepared by the villagers themselves (Jan Rapats are prepared by all villages in Chhattisgarh, and reflect the needs and views of the villagers) state that health facilities in these areas are very poor.
“Most villages emphasise that the availability of medicines, appointment of health personnel, improvement in the quality of health care, Government aid, and the availability of clean drinking water are areas that require attention.”
Though 6.25% of Chhattisgarh’s population is based in the Bastar district, the area had 3 hospitals, no dispensaries, and 57 Primary Health Care centres as of 2001. Forty percent of the population had no access to toilet facilities, safe drinking water, and electricity as of 2001.
(Human Development Report Chhattisgarh, 2005. Available here.)
Bastar has also been in the news recently owing to the naxal attack on Congress’ Parivartan Yatra convoy on May 25, 2013, during which senior Chhattisgarh Congress functionaries and security personnel were killed.
ICRC first expressed its willingness to enter Naxal affected areas in Chhattisgarh in 2008, and was welcomed by Chief Minister Raman Singh (Sourced from here):
“Certainly, ICRC plays a vital role in mitigating the sufferings of people in conflict zones across the globe. With the kind of resources and expertise ICRC has at its command, its presence will benefit the poor tribals of the region where a huge population is suffering and hundreds of children have been orphaned in the conflict…”
Interestingly, he went on to say,
“We have no problem even if such organisations provide medical assistance to Naxalites injured in encounters with security forces…We also do the same thing. Whenever Naxalites are injured, they are hospitalised so that they can be punished by a court of law for their crimes.”
Since 2010, ICRC has run a Primary Health Care centre, mobile clinics, and a hand-pump rehabilitation programme to ensure safe drinking water for the tribal population. According to another Times of India story, international agencies have helped play a crucial role in providing essential health care facilities in the region:
“Last year, when a diarrhoea epidemic broke out in South Bastar, killing nearly 100 people, Bijapur administration had enlisted the support of MSF and UNICEF, apart from calling doctors from other districts. But in Dantewada, in the absence of such an intervention, and in the face of an acute shortage of doctors, a large unknown number of people died without medical support.”
Then why the order of suspension?
The order of suspension has ostensibly been given by the district administration because “…ICRC is yet to enter into a Memorandum of Understanding with the state government” regarding its work in the region. State government sources have said that since ICRC is an international organization, it needs “certain clearances from the centre” for carrying out its operations.
If ICRC has operated in Bastar since 2010, how was it able to function without obtaining clearances from the central and state governments for almost three years? How was it able to bring in medical equipment, and (presumably) foreign personnel into a security sensitive area, and operate without the required permissions for all this time? Does the state and district administration seriously expect people to believe that they allowed ICRC to work in a Naxal dominated area for close to three years without the proper paperwork?
News reports indicate that other reasons may also be at play here. In 2011, the police in south Bastar and Dantewada had alleged that ICRC, along with MSF (Doctors Without Borders) which had been operating there since before ICRC started working there, was facilitating the treatment of Maoist rebels. Two Maoist rebels who had been arrested claimed that they were being treated by ICRC and MSF.
“These two organisations are deliberately going to Maoist camps and spending weeks. The foreign doctors should know what they are doing. I am from an enforcement agency and can’t welcome them having extra love for Maoists, but not for people injured in Maoist brutalities.” – Senior Superintendent of Police, Dantewada (Sourced from here)
According to him, people from the two organisations could be prosecuted under the Chhattisgarh Special Public Security Act that prohibits direct or indirect contact with Maoists.
The recent order of suspension, coming soon after the Maoist attack on May 25 can then also be seen through the lens of an overzealous state and district administration irked by the fact that ICRC is treating Maoist rebels. If in fact this is the case, several questions beg to be asked: What prevents doctors from treating Maoist rebels injured in conflict, especially after the Chief Minister himself expressly stated that he would be fine with such treatment? Does the duty of a doctor to treat injured people depend on whether a person is suspected of being an insurgent or terrorist? Does such treatment in itself make a doctor an accomplice in the crimes the injured is suspected of having committed? If yes, should lawyers representing suspected terrorists also be made accomplices to crimes committed by their clients?
The central government has repeatedly touted its plan of combining development with improving law and order as a solution to Naxalism in these regions. ICRC is one of the most reputed health care agencies operating in Bastar, an area with a clearly documented lack of health care facilities. The administration at all levels clearly needs to reconcile its twin goals of development and security enforcement in a transparent, and rational way. Essential health care for tribals in a conflict-ridden area, and the work of doctors cannot be left to the alternating prioritization of security enforcement and development. This is especially so when the Jan Rapats reveal how miserably the state has failed in meeting the expectations of the local population.