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[Hunger Alert] INDIA: Three children died of malnutrition for past two months and four children are currently suffering from malnutrition in Dabhiya village of Madhya Pradesh where children had died of malnutrition in 2008

NDIA: Three children died of malnutrition for past two months and four children are currently suffering from malnutrition in Dabhiya village of Madhya Pradesh where children had died of malnutrition in 2008

[Hunger Alert] INDIA: Three children died of malnutrition for past two months and four children are currently suffering from malnutrition in Dabhiya village of Madhya Pradesh where children had died of malnutrition in 2008

ASIAN HUMAN RIGHTS COMMISSION - HUNGER ALERT PROGRAMME

Hunger Alert Update: AHRC-HAC-003-2009

16 July 2009

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INDIA: Three children died of malnutrition for past two months and four children are currently suffering from malnutrition in Dabhiya village of Madhya Pradesh where children had died of malnutrition in 2008

ISSUES: Right to food; right to health; malnutrition; government neglect
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Dear Friends,

The Asian Human Rights Commission (AHRC) has received information from a human rights group based in Madhya Pradesh Spandan, Samaj Seva Samiti (Spandan) regarding three children who died of malnutrition. The deceased children lived in Dabhiya village of Khandwa district, where two children had died of malnutrition in 2008. At present, four children living in the same village suffer from severe malnutrition. Sixty two children died of malnutrition associated with various related diseases in the Khandwa district alone. As a result, the state and the district administrative government announced that they would ensure food security and eradicate children's deaths from malnutrition. However, further deaths this year proved that the government has again failed.

CASE DETAIL:

Richu Baliram, a two and a half year old girl died of malnutrition on May 10, 2009. She lived in Dabhiya village, Khalwa Block, Khandwa district, Madhya Pradesh. She was admitted for treatment at the Khandwa district Nutrition Rehabilitation Centre (NRC).

Richu was admitted to the Khandwa district NRC on May 2, 2009, suffering from grade IV Severe Acute Malnutrition (SAM), associated with diarrhoea. It was not the first time that she had been taken to the NRC. In September 2008, she was treated for 14 days and discharged. Her condition deteriorated as her family could not afford to provide proper food for her continued recovery. All in all, Richu was admitted four times, once for six days and once for five days. She continued to suffer from malnutrition for almost a year without a full recovery.

Richu's death demonstrates that the NRC returns malnourished children from remote rural areas to the same environment that caused their malnutrition in the first place. Her death also shows that the Anganwadi centre (AC; Child Care Centre) for Dabhiya village failed in its duty of care to continue to provide nutritious food for those children sent back home from the NRC. The AC provides only dried ration as supplementary nutrition for the children in the village. They erroneously presume that all families can afford to give proper food to their malnourished children at home. This practice is widespread in the village with children suffering from malnutrition.

In the same village two more malnourished children died. A two month-old girl Payal Brijlal died on June 19, and 18 month-old Shanta Ramesh died on June 30. The latter suffered from malnutrition associated with measles and respiratory infection.

The inadequate practices of the NRC are seen in the following cases. Ramnarayan Rameshm, was returned home after a 12 day admission period. Ramnarayan, one and a half years old, suffering from grade IV malnutrition associated with respiratory difficulties, was taken to the NRC on September 12, 2008 and discharged on September 24, 2008. He was still suffering from grade III malnutrition. Ramnarayan's parents took him to a private hospital for treatment where his condition did not improve. In early June, as a last resort, he was taken to a person healing through religious methods. A few days ago, Ramnarayan was again admitted to the NRC where he is currently being treated.

At the present time in the village, three more children suffer from malnutrition. Biliya Shivram a two year old girl, Richai Baliram two years old, and Bamcham Radhelal one and a half years old. They suffer from grade III or IV malnutrition. All are severely malnourished.

ADDITIONAL COMMENTS:

No substantial improvement in preventing children’s deaths from malnutrition

In a breakthrough in 2008, the state government acknowledged children's deaths from malnutrition. Both the state and the district administrative government had paid more attention to taking care of malnourished children in 2009, particularly during the rainy season from June to September.

In 2008, thousands of malnourished children were taken to the Nutrition Rehabilitation Centres (NRC) in different districts. According to the announcement this year of the department of Woman and Child Development, parents who have malnourished children are encouraged to take them to the NRC for treatment. But there has been no substantial change in the treatment protocol for malnourished children at the NRC.

Malnourished children are generally admitted for a maximum of fourteen days at the NRC. The treatment consists merely in providing nutrition. It does not render any medical care for diseases or multiple infections associated with malnutrition. During the rainy season, the malnourished children are more vulnerable to related illnesses and infections due to an unhygienic environment. This takes the form of an absence of a proper sanitation system and a clean water supply. The compounded four factors; rainy season, unhygienic environment, diseases and malnutrition, continuously escalate children's deaths in rural areas.

Policy of the NRC is that it looks after SAM but only grades III and IV malnutrition. All other malnourished children in grade I or II are left behind without proper treatment and as a result develop SAM sooner. To prevent further deaths, it is necessary to look after all malnourished children no matter what stage they are in. Should there not be sufficient space to accommodate all children at the NRC, the government should make arrangements with the AC. The AC can provide appropriate nutrition such as Ready to Use Therapeutic Food (RUTF) or F 100, a preparation of full-fat milk, vegetable oil, peanut butter (only for RUTF) and mineral-vitamin mix, usually recommended for malnourished children.

There are two ACs in Dabhiya village. Each has one worker and one helper. There is a NRC at Khandwa district for malnourished children. There is a Supreme Court Order to ensure food and health security. However, the existence of these systems in itself does not mean that the Government of India, as a state party of International Covenant on Economic, Social and Cultural Rights (ICESCR), fulfils its obligations. In fact, the state, district and local facilities fail in their basic functions resulting in poor results and deaths.

No food security at home

If there was enough nutritious food at home, the government would not need to earmark such a substantial budget for malnourished children. All the families of the deceased children, all members of the Korku tribal community, suffer from lack of food at home.

Richu's family has a two acre farm land which is not properly irrigated. The family of four harvest soy beans which are sold at 10 Rupees per kilograms. Her father used to work as a day labourer for 50 rupees a day. Payal's family has no land for farming. The family only gets 20 kilograms of rice and wheat from the ration shop with their Below the Poverty Line ration card (BPL card). 20 kilograms of rice and wheat is consumed by eight family members within a week. Her father also migrates to neighbouring districts like Harda or Hoshangabad twice a year in order to find additional jobs. Shanta's family of four has a one acre farm land. They recently took out a loan of 5,000 rupees to buy food for the home. Her father also migrates for work from time to time.

The villagers from the Korku community, living in a remote rural area, need enough farm land to make a living thus ensuring food security. Without farm land, they cannot afford to provide enough food for their families. And although some have farm land, they do not have irrigation facilities to maximize production. As a result, they are forced every year to migrate to find work.

The ration distribution under the Public Food Distribution System (PDS) does not reach the tribal communities in rural areas. Despite the fact that the Korku community in the village continue to face a lack of food and child malnutrition, they do not have the priority to obtain a ration card AAY card for the poorest among the poor (For details on living condition of Korku community, please refer to previous hunger alert and statement). As shown in the case of Payal's family, BPL card holders pay about five rupees for one kilogram of wheat and seven rupees for one kilogram of rice. In Madhya Pradesh, BPL card holders are supposed to collect 20 kilograms per month which only lasts for a week or so. In practice, it can be seen that for the last two years, the actual number of BPL families are far more than the quota that the central government has assigned. The state government cut down the amount of earmarked grains, which is supposed to be 35 kilograms of rice (15 kilograms) and wheat (20 kilograms), in order to meet the needs of all the card holders.

The current market price of wheat in Khandwa district is about 12 rupees per kilogram and 20 rupees per kilogram for rice. All these families who have already lost children or may lose children soon cannot afford to buy grain in the market. They even find it difficult to buy broken rice or wheat which costs half the price of normal grain. The price for broken grain is also rising as the demand goes up.

SUGGESTED ACTION:
Please write a letter to express your deep concern about these four children's deaths from malnutrition associated with various diseases, as well as the increasing number of malnourished children who may die soon.

The AHRC has also written a separate letter, calling for intervention, to the UN Special Rapporteur on the Right to Food, the right of everyone to the highest attainable standard of physical and mental health and also to the Chief Justice of India.

To support this appeal, please click here:

SAMPLE LETTER:

Dear __________,

INDIA: Three tribal children died while other children are suffering from Malnutrition in the rural village of Madhya Pradesh

Children who died of malnutrition associated with diseases:
1. Richu Baliram, two and half year old girl, died on May 9, 2009
2. Payal Brijlal, two month old girl, died on June 19, 2009
3. Shanta Ramesh, 18 month old girl, died on June 30, 2009
Children suffering from malnutrition associated with diseases:
1. Ramnarayan Ramesh, one and a half year old boy, grade IV malnutrition
2. Richai Baliram, two year old, grade IV malnutrition
3. Bamcham Radhelal, one and a half year old, grade III malnutrition
4. Biliya Shivram, two year old girl, grade III malnutrition
Location: Korku tribal community, Dabhiya village, Khalwa Block, Khandwa district, Madhya Pradesh

I am writing to you to express my deep concern about three children who died of malnutrition associated with various diseases since May. I am also writing to alert you to more children becoming malnourished in Madhya Pradesh.

I am informed that three children died of malnutrition in Dabhiya village, Khalwa Block, Khandwa district. I am aware that the Asian Human Rights Commission (AHRC) has been monitoring and reporting on children's deaths from malnutrition since they occurred in 2008.

I am surprised to learn that children are dying of malnutrition and various other diseases again this year since the rainy season started.

I am informed that Richu Baliram, a two and a half year old girl died of malnutrition on May 10, 2009. She was at the Khandwa district Nutrition Rehabilitation Centre (NRC) when she died. Richu was admitted to the Khandwa district NRC on May 2, 2009 suffering from grade IV Severe Acute Malnutrition (SAM), an illness associated with diarrhea. I am further informed that she had been admitted four times including this time while suffering from malnutrition since September 2008.

I am of the opinion that her death demonstrates that she continuously suffered from malnutrition for a year although she had been admitted four times for treatment. It shows that the NRC sends the child back home without complete treatment for the malnutrition. Due to the home situation, her family could not give her enough nutritious food to make her healthy.

I have understood that the Anganwadi centre (AC; Child Care Centre) for Dabhiya village, aiming to ensure heath and food security for malnourished children at the village level, merely provides dried grains as supplementary nutrition. They erroneously presume that all malnourished children are given proper food at home. This practice was also operative with the other deceased children and the children currently suffering from malnutrition in their village.

I am informed that a two month old girl Payal Brijlal died on 19 June and 18 month old Shanta Ramesh died on 30 June in the same village. The latter suffered from malnutrition associated with measles and respiratory infection. Both were not able to obtain treatment either at the NRC or the AC.

I am further informed that apart from these three children's deaths, four children currently suffer from malnutrition in Dabhiya village.

A one and a half year old boy Ramnarayan, suffering from grade IV malnutrition associated with respiratory difficulties was taken to the NRC on September 12, 2008. He was discharged from the NRC on September 24, 2008, still suffering from grade III malnutrition categorized as SAM. Ramnarayan's parents took him to a private hospital for treatment, where his condition did not improve. In early June, as a last resort, he was taken to a person in the area healing through religious methods. A few days ago, Ramnarayan was again admitted at the NRC where he is currently being treated. Two year old girl Biliya Shivram, two year old Richai Baliram, and one and a half year old Bamcham Radhelal suffering from grade III or IV malnutrition, are all severely malnourished.

As it is shown in Richu and Ramnarayan's case, the NRC does not provide full treatment for the malnourished child. Once the children get a little better or a maximum of 14 days has gone by, the children are sent back home without ensuring further treatment either at home or at the AC.

I am also aware that the NRC aims to treat the malnourished children by providing nutrition. It does not provide any medical care for diseases or multiple infections associated with malnutrition. In fact, during the rainy season, the unhygienic environment with its absence of a proper sanitation system and lack of clean water causes various diseases and infections to escalate with further deterioration. I am of the opinion that without treatment for their other diseases or infections, the malnourished children cannot completely recover. Rather, it has been used as an excuse for the children's deaths.

I am also aware that the NRC merely looks after the children suffering from SAM with grade III and IV malnutrition. All other malnourished children in the stage of I or II are left behind without proper treatment. Particularly during the rainy season, their health conditions deteriorate and they develop SAM sooner.

Most of all, all the families of the deceased children and currently malnourished children do not have food security at home. Some have no farm land and are forced to migrate to neighbouring districts twice a year in order to make a living. Those who have small farms of one or two acres are also forced to do some other kinds of work as the farm is neither irrigated nor productive. As such, the families find it difficult to supply sufficient food for their entire families. I am of the opinion that the farm lands and facilities are the main key to ensuring food security at home.

I am also informed that the Below the Poverty Line (BPL) card holders, like Payal's family, can afford to collect 20 kilograms of rice and wheat at the ration shop. It lasts only a week for all family members. I am informed that the quota from the central government for the BPL families is much smaller than the quota of the state government. The state government reduced the earmarked amount, which is supposed to be 35 kilograms of rice and wheat under the Public Food Distribution System (PDS), for the last two years.

I am of the opinion that the existence of this system in itself does not mean that the government of India, as a state party of International Covenant on Economic, Social and Cultural Rights (ICESCR), fulfils its obligations. In practice, the institutions do not prevent the children’s deaths, as their policies are faulted and do not reach the poorest tribal communities.

In the light of this, I urge you to intervene to prevent these children's deaths, as well as to ensure food security at home by:

1. Providing not only nutrition but also medical care for various diseases and infections that the malnourished children have by a doctor at the NRCs;

2. Providing treatment and follow-up at the NRC for all stages of malnourished children;

3. Keep on providing nutrition and follow-up through the Anganwadi centre for all stages of malnourished children;

4. Providing AAY cards to all families who had/have malnourished child;

5. Providing farm land and facilities to improve productivity and education about re-usage of grey water in order to ensure food security at home as well as prevent additional children’s deaths in the future.

I am looking forward to your immediate intervention in this situation.

Yours sincerely,

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PLEASE SEND YOUR LETTERS TO:

1. Krishna Tirath
Minister of Women and Child Development
Government of India
INDIA
Fax: +91 11 2331 4788
E-mail: krishnatirath@yahoo.in

2. Principal Secretary
Ministry of Health & Family Welfare
Nirman Bhavan
Maulana Azad Road
New Delhi - 110011
INDIA
Fax: +91 11 2306 1751
E-mail: hfm@alpha.nic.in

3. Mr. Shivraj Singh Chouhan
Chief Minister
Madhya Pradesh
INDIA
Fax: +91 755 2441781

4. R. C. Sahni
Chief Secretary
Government of Madhya Pradesh
Mantralaya,
Bhopal 462 004
Madhya Pradesh
INDIA
E-mail: cs@vallabh.mp.nic.in

5. S.B. Singh
District Collector
Khandwa District, Madhya Pradesh
450001
INDA
Fax: +91 733 2224233
E-mail: singh.sb@mp.gov.in

6. Country Director
World Food Programme
2 Poorvi Marg, Vasant Vihar
New Delhi 110057
INDIA
Fax: +91 112 615 0019
E-mail: wfp.newdelhi@wfp.org

7. UNICEF
73 Lodi Estates
New Delhi 110 003
INDIA
Fax: + 91 11 2462 7521 / 11 2469 1410
E-mail: newdelhi@unicef.org

Thank you.

Urgent Appeals Programme
Asian Human Rights Commission (ua@ahrc.asia)

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