Nida S. Zubairi and Omar J. Baqal
COVID-19 continues to take a heavy toll in Kashmir, with over 317,000 cases and 4,343 deaths reported by early July 2021 in a region of around 13 million people. But Kashmiris are concerned not just about COVID-19 and the Indian government’s human rights failings regarding the pandemic in the region; since early June 2021 a large number of paramilitary personnel have been deployed there. This is the first large-scale movement of troops into the region since August 2019, when Kashmir’s special constitutional position, protected by Article 370 (1947), was suddenly revoked, local leaders were detained, and many civilians were arrested. Kashmiris are speculating the recent troop movement is a prelude to a possible administrative restructuring and reorganization of the union territory.
Article 370 granted semiautonomous rights and acknowledged the special status of Jammu and Kashmir (J&K) in India. Its sudden abrogation by the Indian government in August 2019 led to a major social upheaval. Over 900,000 Indian army personnel were deployed to the region which is recognized as the world’s most militarized zone. A lockdown was implemented, strict curfew was imposed, all forms of communication and internet links were suspended, and roads were blocked. Thousands of Kashmiris were arrested and while some have been released, many remain imprisoned. Although communication restrictions are common in Kashmir and have been imposed time and again over the years, there was a complete blackout and neither 2G nor 4G services were available for six months from August 2019.
The safety and freedom of the Kashmiri population faced a major threat from the strong military presence, with the worst repercussions of conflict and violence affecting physical and mental health. Travel restrictions and prolonged curfews impeded people’s access to health care which was particularly difficult for elderly people and women. Curfew passes were often declined and delays at checkpoints prevented people from receiving timely medical attention. Lack of internet and other communication services meant tele-medicine, emergency helplines, and the electronic-based government-funded insurance scheme were all unavailable to patients and health workers.
Lack of 4G affected education, trade, and health care significantly. A petition filed by the Private Schools Association of J&K which demanded the restoration of 4G internet services to resume online classes during the COVID-19 lockdown was rejected by the Supreme Court of India. This denied people their right to access information and express opinions, as well as their right to education.
Health care workers in the region were unable to access latest updates and guidelines pertaining to the prevention and management of COVID-19. The ban on high-speed internet impacted work from home for many, which denied them their right to employment. Information regarding the COVID-19 pandemic was conveyed via print newspapers, posters, radio announcements, and very limited messaging capabilities, with fake news and misinformation spreading. While Kashmiris based their actions primarily on the restricted available information, lack of awareness and the need to overcome financial strains hindered effective COVID-19 prevention measures. Kashmiri doctors and other government workers were threatened with strict punishment if they chose to publicly criticize the administration’s handling of the pandemic. Efforts by various non-governmental organizations to mobilize essential services (staff, oxygen, medications, etc.) initially provided some relief to the public but eventually the Indian government banned them from operating.
After an 18-month ban, 4G services were finally resumed in February 2021.
Health care infrastructure has always been inadequate in Kashmir in terms of availability of health centers, equipment, and manpower. Contrary to the World Health Organization’s (WHO) recommended minimum 1:1000 doctor patient ratio, there is one doctor for every 3,866 people according to a 2018 audit of health care facilities in J&K. The health care system cannot become accessible to all, and of good quality, without much greater funding.
The roots of the long-drawn conflict over Kashmir trace back to 1947, following India’s annexation of Kashmir. There have been wars over the valley between India and Pakistan, each country currently claiming control over different parts of the territory with a ceasefire line agreed. Cycles of protests, disputes, and violence are common and people face a constant fear of dispossession. Kashmir is the only region in India where shotgun pellets are used as a crowd control method. In 2016 more than 6000 people were maimed by these pellets and such injuries can result in death, amputations, and permanent disabilities including psychological and economic impacts. Police brutality and human rights violations have left a lasting impact on the lives of many Kashmiris. A survey conducted by Médecins Sans Frontières/Doctors Without Borders reported that almost one in five Kashmiris show symptoms of post-traumatic stress disorder and nearly 45% of the Kashmiri population are under “significant mental distress”. Nearly 1.8 million Kashmiris suffer from some form of mental disorder, but most people are unable to access appropriate mental health services.
Kashmiri youth are resorting to drug use to cope with uncertainty, trauma, and anxiety arising from daily conflicts and surges in the use of heroin and cocaine have been observed. Poly-substance use with mental distress poses a great challenge for health care providers and an immediate need for preventive, curative, and rehabilitative strategies is required.
These current public health issues in Kashmir are deeply rooted and reflect the socio-political problems the valley has long endured. The Indian government violates many human rights through its repressive administration over Kashmir and these have been criticised by local and international bodies. The United Nations High Commissioner for Human Rights highlighted extensive violations of human rights and torture imposed on civilians by armed forces. Recommendations made to the governments of India and Pakistan have not been implemented.
There is an urgent need for a comprehensive response that addresses the political, social, economic, and public health challenges Kashmir faces. The Indian government has human rights obligations to protect the safety and health of Kashmiris, ensuring that they are not put through the same nightmare they endured due to the communications blackout of 2019 and throughout the first year of the COVID-19 pandemic.
Nida S. Zubairi, is a medical student at Alfaisal University, Class of 2021 in Riyadh, KSA.
Omar J. Baqal, MBBS, is a resident physician in the Department of Internal Medicine, Mayo Clinic, Phoenix, USA. Email: firstname.lastname@example.org.
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