For Hrishikesh Pandey, the scene outside Mahaveer Ghat in Ballia in Uttar Pradesh was reminiscent of the endless summer of 2021. A long queue of grieving people stood outside the ghat, each family carrying a body in their arms. “The last time I saw such a situation was during the COVID-19 pandemic,” he said.
Hrishikesh, a retired chemistry faculty member from the Satish Chandra College in Ballia, was at the ghat on the banks of the river Ganga with his friend Subharanshu Shekhar Pandey. On the evening of June 14, Subharanshu’s wife, Shashi Prabha, 68, went for a bath. When she came out, she complained of high fever. Subharanshu gave her paracetamol, but the fever would not subside. “The next morning, Prabha became unconscious. When we took her to the hospital, the doctors declared her dead,” said Subharanshu, a lawyer.
More agony followed. Subharanshu and his son Amit, 40, took the body to the ghat for cremation, but they were forced to wait for hours just to collect wood from a nearby shop because of the winding queue. The wait was also painful as the temperature had soared to more than 43°C. Earlier this summer, the India Meteorological Department (IMD) had warned about potential heat-related casualties across the country.
Amit, a worker with the Delhi Metro who had come to Ballia to spend time with his family, said he also developed a fever and felt weak on June 16. He went to the Ballia District Hospital, some 3 kilometres from the cremation ground, where a doctor asked him to take medicines and oral rehydration solution (ORS). Amit believed that extreme heat was the cause of his illness.
Like him, between June 15 and 19, when Ballia recorded temperatures between 43°C and 45°C, dozens of people, both young and old from the district of 33 lakh people, streamed into the hospital and the primary health centre nearby complaining of high fever and difficulty in breathing.
On June 17, Dr. Diwakar Singh, the Chief Medical Superintendent of the Ballia District Hospital, announced that 34 people had died in the hospital in two days, many due to “heatstroke”. He said most of the patients were above 60 and had pre-existing ailments.
Singh was promptly removed from the post. Uttar Pradesh Deputy Chief Minister Brajesh Pathak, who holds the Health Department portfolio, said Singh had given “a careless statement on deaths caused by heatwave without having proper information”. Pathak said officials had been instructed to identify and treat each patient. “All medicines are available and I am monitoring the situation,” he said.
‘An unusual scene’
On the morning of June 19, Reena Devi, 30, a resident of Piprapati locality under Dubhar block, walked from her hut to the adjoining field to cut grass to feed her goats. She returned home hours later, her body burning with fever. Her husband Sushil Kumar brought medicines from a quack to treat her. But by noon, her condition had deteriorated. “She died on her way to the district hospital,” said Sushil, a labourer and father of five. The family said Reena had no co-morbidities. They insisted that she had died due to the heat.
Editorial | Heat and state: On a heatwave being only one half of the issue
According to the IMD, a heatwave is “a condition of air temperature which becomes fatal to the human body when exposed.” There are also non-heatwave conditions that could be fatal to the human body at a lower temperature, if the relative humidity is high. When the maximum temperature of a station reaches at least 40°C or more in the plains and at least 30°C or more in hilly regions, the IMD classifies it as a heatwave. Heatwaves occur mainly between March and June in India. In some rare cases, they also occur in July.
In regions like Ballia, a semi-arid small town of three lakh people, which is located in a heatwave-prone State, high temperatures could result in heat strokes. The World Health Organization has said that heat strokes are among the most dangerous of natural hazards, but they rarely receive adequate attention because their death tolls and destruction are not always immediately obvious. A recent study in The Lancet said India recorded a 55% rise in deaths due to extreme heat between 2000-2004 and 2017-2021.
“The changing climate is responsible for extreme heat. Whenever the monsoon is late, we hear about such incidents,” said Rajesh Kumar Mall, who teaches at the Department of Environment and Sustainable Development at Banaras Hindu University. Areas near Ballia and the adjoining State of Bihar also reported at least 42 deaths in five days in June as they grappled with heatwaves.
Dr. D. Rai, a physician based in Ballia, said a heatstroke takes place when the body is no longer able to control its temperature and the sweating mechanism fails. “In such situations the body temperature can rise to 105°F (about 40°C) or higher, leading to disability or death,” he said. The symptoms of a heatstroke include high body temperature, altered mental state or behaviour such as confusion or slurred speech, flushed skin, nausea and vomiting, and headache. When people with heat-related illnesses visit hospitals, doctors try to lower their temperature with an ice slab. And if that is not available, they press a sponge with cold water or place cold, wet pieces of cloth on the body. They also try to ensure that there is enough air circulation near the patient to hasten the process of cooling, and provide medicines to contain symptoms like vomiting.
To prevent such illnesses, doctors recommend constant hydration. Singh told the media that he had asked everyone to keep hydrating and refrain from leaving their homes during the day unless they had urgent work outside. He said most of the cases were clear examples of a heatstroke. A few paramedic staff also said on the condition of anonymity that some of the deaths were heat-related.
But Rai, who runs the Gaurav Nursing Home, said the deaths at the district hospital were likely due to co-morbidities. He remembered a similar situation in June 19, 2003, when he was working as a government doctor at the Ballia District Hospital. Hundreds of people were rushed to the hospital from the railway station as they started losing consciousness and began gasping for breath, he said. “When people have low immunity, their bodies face difficulty in coping with extreme temperatures,” Rai said.
The Ballia administration rejected any direct relation between the deaths and the heatwave. “The matter is under investigation. A two-member team is visiting the rural areas to know the exact situation and cause of deaths,” said Dr. S.K. Yadav, the recently appointed Chief Medical Superintendent of Ballia District Hospital.
The two-member team comprising Uttar Pradesh Health Department Director (Communicable Diseases) Dr. A.K. Singh and Director of Medical Care Dr. K.N. Tiwari visited the Ballia District Hospital and the blocks where people fell ill. They said they have not found any convincing evidence to link the deaths with heatstroke.
Meanwhile, the 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”. The District Magistrate, Ravindra Kumar, also said there is no clear evidence that the deaths were caused by heatstroke. Since it takes more than seven days to issue death certificates, the official ‘cause of death’ is not known.
On June 19, Chief Minister Yogi Adityanath held a special meeting with senior officials to take stock of the situation. He asked the administration to make arrangements at every level to protect life, livestock, and wildlife.
The State Integrated Disaster Control Centre considers the time between May and June as the “heat wave period”. “Everything is in the public domain. Directions have been issued to provide medical facilities to everyone in case of any illness. The temperature is now decreasing,” Renu Srivastava Verma, Director General of Medical Health, told The Hindu.
Mangal Pandey, a 52-year-old priest who oversees cremations on the banks of the river, described the scene in those few days as “unusual”. “There were 20-25 cremations at the ghat on June 15 alone. And the numbers only increased over the next four days. At least 50 bodies were burned on Saturday (June 17),” he said.
Allegations of corruption
The Ballia District Hospital is the only government hospital in the region. Attendants described those few days as “scary”. They said they ran around, much like they did during the pandemic, desperately searching for vacant beds and medical help amid a sudden flow of patients.
“All the beds were occupied. We occupied the floor of the in-patient department where our treatment began,” said Ali Murtaza from Rasra block, who visited the hospital with his brother.
Political workers, including from the ruling Bharatiya Janata Party (BJP), alleged that there is corruption in the Health Department. They claimed that no facilities were available when patients reached the hospital during those crucial five days. “I complained about malpractices worth ₹18 crore by the District Chief Medical Officer months ago,” said Nagendra Pandey, State executive member of the BJP, who is based in Ballia. He said there is corruption in the purchase of medicines, beds, food and health equipment sent to the hospital and the primary health centre. The State government had allocated funds to the Health Department for providing all the necessary facilities to the patients at government health centres, but the department and the hospital failed to perform their duty, he alleged. The Chief Medical Officer, Jayant Kumar, did not reply to questions.
The District Magistrate, who has been visiting the hospital, called for the suspension of the store in-charge for failing to install fans, air-conditioners and air coolers near hospital beds. “It’s too much,” said Ravindra Kumar, visibly upset during one such visit. “Dozens of fans are getting wasted.” Amid the alleged mismanagement, wealthy people in town have donated air coolers and water coolers to the hospital.
Tackling heatwaves
Long summers, interspersed with periods of intense heat, are common in this region. Like many other regions which have heat action plans, Uttar Pradesh has a standard operating procedure for tackling heatwaves. It calls for a coordinated effort between various departments to assess risks, review heatwave preparedness in districts, disseminate heatwave forecasts to agencies and the public, and coordinate responses. The medical response to heat illness includes giving ORS, IV fluids, life-saving medicines, ice packs, and ensuring that there are wards/beds with cooling facilities. The document also calls for creating drinking water and bathing facilities at public places, sprinkling water on roads, opening public parks and gardens, issuing instructions to gram panchayats for monitoring cooking schedules in rural areas to reduce fire hazards, and identifying blocks and villages that are in need of fodder and water for animals. There was no official confirmation that the plan has been followed.
While doctors and officials speak of co-morbidities, some of the families insisted that their loved ones had no other health issues. Paras Nath Ojha, 55, an agriculturalist hailing from Tikhampur locality, did not have any ailments, said his 80-year-old father. On June 19, despite the searing heat, Paras decided to visit his farmland to oversee agricultural work. Around 5 p.m., after he returned home, he collapsed while talking to his father. “He suddenly fell on the ground. We took him to the District Hospital. A paramedic outside the hospital checked him and said he was no more,” said Sesh Nath Ojha, Paras’s brother. In disbelief and holding onto the hope that another hospital could perhaps save him, the family took Paras’s body to the Mahavir Hospital nearby. The doctor there too said nothing could be done. “There is no doubt that his death was due to heatstroke. His temperature was beyond belief,” said Om Ji Ojha, Paras’s brother.
Sesh Nath also said there was a rush at the cremation ground where he saw the last rites of a woman neighbour being performed. “At 10:30 p.m., when we went with the body, there were more than 50 vehicles near the ground. The owner of the wood shop also told us that there was an unusually high demand for wood,” he said.
“People suddenly fell sick, collapsed, and died within hours, ” said Arvind Giri, a local Samajwadi Party leader. “Everyone had the same story to narrate those five days.”
