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INDIA: The government ignores deaths of forty-three children due to malnutrition in Madhya Pradesh

Chhotu (four years old) and Sagar (six months old) died in August and September 2008, respectively. Chhotu had diarrhoea and weight loss, while Sagar had a respiratory infection but both suffering from malnutrition before they died. Their father Mr. Suraj lives in Mohalkhari village, Khalwa Block, Khandwa district has two acres of non-irrigated farmland which is not enough to provide his children with sufficient life-sustaining food to eat.

ASIAN HUMAN RIGHTS COMMISSION - HUNGER ALERT PROGRAMME

Hunger Alert Case: AHRC-HAC-002-2009



3 April 2009
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INDIA: The government ignores deaths of forty-three children due to malnutrition in Madhya Pradesh

ISSUES: Malnutrition; right to food; negligence of government; corruption
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Dear friends,

The Asian Human Rights Commission (AHRC) has received information from a human rights group, Spandan Samaj Seva Samiti (Spandan) in Madhya Pradesh (MP). It appears that the state government did not take any action, but rather denied 27 child malnutrition deaths, occurring within a two month period, in August and September 2008. Previous to this, 12 children had died of malnutrition and later, six more. All the families of the deceased children continue to struggle. There has not been any improvement in their living conditions, besides which government services for the poor were recently withdrawn.

CASE DETAILS:

27 children died of malnutrition in Khalwa Block:

Chhotu (four years old) and Sagar (six months old) died in August and September 2008, respectively. Chhotu had diarrhoea and weight loss, while Sagar had a respiratory infection but both suffering from malnutrition before they died. Their father Mr. Suraj lives in Mohalkhari village, Khalwa Block, Khandwa district has two acres of non-irrigated farmland which is not enough to provide his children with sufficient life-sustaining food to eat.

Due to the illness of the two children, Suraj could not manage to cultivate his land and was forced to borrow 2000 Rupees (USD 40) at an interest of 50% for their treatment. The family had an Antyodaya Anna Yojana (AAY) card earlier which is a public food distribution card for the poorest, which has been replaced with the Below the Poverty Line (BPL). The family is getting poorer, but now they have to pay more to get rice and wheat from the ration shop. The family had also borrowed grain which they have to pay back double. The job card for the family says that the elder daughter has been working for two weeks, but does not clearly show the specific time period.

In this village, five children, including these two, had suffered from lack of sufficient and nutritious food and clean water at home. As a result they died from malnutrition and some diseases aggravated by malnutrition in August 2008.

In the following month, Mr. Shivram living in Medhapani village of Khalwa Block lost his eighteen-month old child Shivani. The infant suffered from fever and respiratory infection and malnourishment. Shivram is a migrant and a landless farm labourer who finds it difficult to provide food on a daily basis for his family. He had to borrow 1000 Rupees (USD 20) to buy grain as he has no ration card.

In the same month, Ravishanker, a three-year old died. He had wasted away with fever and diarrhoea before his death. His father Vishram is also a landless labourer but has neither a ration card nor a job card.

Besides these four deaths, 23 children died of malnutrition with symptoms such as fever, diarrhoea, respiratory infection, blisters, swelling, from August to November in 13 villages in Khalwa Block alone. All these symptoms are well known signs of malnutrition and can aggravate the effects of malnutrition as well.

The World Health Organization (WHO) report "MANAGEMENT OF THE CHILD WITH A SERIOUS INFECTION OR SEVERE MALNUTRITION - Guidelines for care at the first-referral level in developing countries" (2000), clearly state that malnourished children have signs and symptoms such as wasting, oedema, airway and breathing difficulties, dehydration from diarrhoea, infections of the ear, throat, skin, pneumonia, mouth ulcers.

Action from the government:

According to the report submitted by Spandan, after the malnutrition deaths were publically reported, the administrative authority provided relief for the children in the villages. Hundreds of children were brought to the Nutrition Rehabilitation Centres (NRC; Bal Shakti Kendras) and the Shaktiman project was introduced to 299 Child Care Centre (Anganwadi centre; AWC) all over the district. The NRC is a welfare scheme to treat malnourished children living in remote forest villages. The Shaktiman project was launched in 2007 to ensure nutrition for children with a focus on predominantly tribal areas in MP. UNICEF India also provided skilled human resources and Ready to Use Therapeutic Food (RUTF) for malnourished children.

Seven PDS shops in these thirteen villages used to sell only 20 kilograms of rice and wheat until the children's deaths occurred. According to guidelines of the central government, the state government ordered that every PDS shop must provide 35 kilograms of rice (15kilogrmas) and wheat (20 kilograms) per month for card holders since 2003. Only after the children died did the district Collector order that the shops should open throughout the month and provide 35 kilograms of grain.

All these relief measures did not last long. Spandan was told that the main reason why some programs for the children's nutrition were withdrawn is the limited funds which were only meant to tide over the emergency situation. The emergency treatment and nutrition supply did not prevent another malnutrition death in this Block. Two-year-old Tulsi Bisram died a few days after she received treatment at the NRC for only eight days because she was not provided any supplemental food after coming back home in November 2008.

According to Spandan, all seven PDS shops currently do not open everyday and provide merely 20 kilograms of wheat. After providing some relief for the children, the authorities did not monitor the PDS shops or AWC which is the primary service to ensure food security. The children have been abandoned again with only a few months provision which resulted in the deaths of six more children from malnutrition.

Six more children deaths in Khalwa Block:

According to the report conducted by Action Aid India with the cooperation of Spandan after the above 27 children's deaths, six more children died of malnutrition in three villages of Khalwa Block between October and December 2008.

Tulsi Bisram of is one of the six children who died even after visiting the NRC. She received treatment for eight days at the NRC and was also given RUTF which improved her condition. However, Tulsi died a few days after she came back home where the family could not provide continued adequate food and nutrition. Her death reflects the fact that temporary treatment and health care neither saves lives nor ensures food security in the long term.

Tulsi has never been provided medical care by the AWC which is far away from her house. No children in Tulsi's community have visited the AWC since it is not in the community area. No one visited the community for regular medical check-ups for the mothers and their infants either.

None of the deceased six children's families have AAY cards or BPL cards. However, all these six families pleaded that they have been suffering from lack of food and some had to borrow money for food. Many of them are landless or merely have non-irrigated small scale farms which people finds difficult to produce food for everyday consumption. In particular, the rainy season when most of the children died is the hardest time of the year.

Additional Comments:

Despite the government providing immediate relief for the emergency, the children died of malnutrition anyway. It demonstrates that emergency treatment cannot prevent malnutrition deaths and cannot ensure food security. Unless those most vulnerable are continuously provided with the basic needs of food and health care, which should be guaranteed by the public health institutes and public food distribution, will people's livelihood be improved.

The public services of food and health care for the poor such as PDS, AWC, Primary Health Centre and Public hospital do not aim to provide for emergencies, but aim consistently to ensure food security as well as to prevent child malnutrition. They have been developed since India had ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) in 1979. The right to food is a fundamental right in India.

The Supreme Court Order states that the PDS shop keepers authorizations should be cancelled for the following reasons. They do not keep their shops open throughout the month, fail to provide grain to BPL families only at BPL rates, make false entries on the BPL cards, engage in black-marketing, and siphon away grain to the open market and hand over ration shops to non-authorised persons/organisations.

The Public Distribution System (Control) Order 2001 also puts down in law that any person who contravenes any provision of the order will be punished under Section 7 of the Essential Commodities Act (ECA) 1955. The punishment is imprisonment for a term of not less than three months which could be extended up to seven years together with a fine. Furthermore, Session 9 of the ECA 1955 stipulates that if any person makes a false statement in any book, account, record, declaration or other document they shall face imprisonment for a term which may be extended to five years and subject to pay a fine.

However, the PDS shops in this area have never been punished which led them to infringe on the Orders again.

There is a more important issue regarding food security in tribes. According to the Supreme Court Order dated 2 May 2003, six "priority groups'' including primitive tribes would be entitled to AAY cards. In addition, in April 2004, the Court asked the Central government to direct the State governments to accelerate the issue of AAY cards especially to primitive tribes. Some tribes in Khalwa Block such as Korku have neither AAY cards nor BPL cards. They do not have priority for AAY card since they are not officially identified as a primitive tribe. They have been demanding to be entitled to AAY card as they are tribes and vulnerable groups in food security.

As they have been continuously exposed to malnutrition and food insecurity, in September 2008, the Supreme Court Commissioners and Advisors have recommended to the state government that whoever has no ration card and have applied in this Block be entitled to AAY cards.

The AWC or public health institutes are not working efficiently since the poor in the area cannot access the services due to distance or the absence of easy access. Many of the villagers go to see a private doctor, who is more accessible than public health institutes, even though they have to pay more besides the cost of taking out a loan for the same.

Despite all these failures of the government service for the poor, they attempt to avoid responsibility by saying that the children did not die of malnutrition but of diseases. However, what the government called 'diseases' are all the symptoms and signs of malnutrition according to the WHO.

Furthermore, the government blames parental ignorance because they belong to a tribal community which holds superstitious beliefs. This has nothing to do with the malnourishment of their children.

In January 2009, Spandan submitted a letter with the relevant reports to the Khandwa district Collector and responsible government authorities who have yet responded.

SUGGESTED ACTION:
Please send a letter to the authorities mentioned below expressing your concern about malnutrition deaths in Khandwa district of MP.

The AHRC has also written a separate letter to the UN Special Rapporteur on the Right to Food calling for intervention.

To support this appeal, please click here:

SAMPLE LETTER:

Dear __________,

INDIA: Please ensure food security to stop malnutrition deaths in Khandwa district, Madhya Pradesh

Name of the deceased children in Khalwa Block, Khandwa district, Madhya Pradesh:
1. Chhotu Suraj, four years old, died in August 2008, Mohalkhari village
2. Sagar Suraj, six months old, died on 10 September 2008, Mohalkhari village
3. Gudiya Shersingh, fifteen days old, died in August 2008, Mohalkhari village
4. Virendra Bihari, twelve months old, died in August 2008, Mohalkhari village
5. Child of Mr. Sukai, eight days old, died in August 2008, Mohalkhari village
6. Nandini Kamalsingh, eighteen months old, died in August 2008, Salidana village
7. Lalita Rajaram, eighteen months old, died in August 2008, Salidana village
8. Child of Ms. Pramila, eight days old, died in August 2008, Salidana village
9. Child of Mr. Sushila, eleven days old, died in August 2008, Salidana village
10. Sravan Munna, three years old, died in August 2008, Ambada village
11. Kriparam Mnasaram, three years old, died in August 2008, Ambada village
12. Child of Ramlal, nine days old, died in September 2008, Ambada village
13. Manisha Onkar, twelve months old, died in August 2008, Chimaipur village
14. Umesh Shivram, eighteen months old, died in August 2008, Chimaipur village
15. Mukesh Patel, two years old, died in September 2008, Chimaipur village
16. Kalai Shantulaal, two years old, died in September 2008, Jhirpa village
17. Ramvilas Patiram, two years old, died in September 2008, Jhirpa village
18. Child of Mr. Shivlal Mongia, two days old, died in July 2008, Chattu-Battu village
19. Child of Mr. Shantulal, eight days, died in August 2008, Jhinjari village
20. Sevti Rammu, fifteen months old, died in August 2008, Garbedi village
21. Jamvanti Ramdev Bhau, four years old, died in September 2008, Sunderdev village
22. Rajesh Ramesh, twenty days old, died in September 2008, Langoti village
23. Ravishanker Amarsingh, three years old, died in September 2008, Jamnapur village
24. Susham Sukhram, eighteen months old, died in September 2008, Jamnapur village
25. Kusum Balaram, five years old, died in September 2008, Hasanpura village
26. Karina Harnath, three months old, died in August 2008, Medhapani village
27. Shivani Shivram, eighteen months, died in September 2008, Medhapani village
28. Muuna Sobhram, 21 days, died in October 2008, Salidhana village
29. Vivek Pratap, four years old, died in November 2008, Salidhana village
30. Tulsi Bisram, two years old, died in November 2008, Mathni village
31. Samoti Keshar Singh, three months, died in November 2008, Mathni village
32. Golu Chhotelal, ten days, died in December 2008, Mathni village
33. Badal Kailash, ten months, died in November 2008, Bawdiya village
The PDS shops to be monitored:
1. PDS Shop at Roshni covering Roshni, Mohalkhari, Salidhana and Ambada villages
2. PDS shop at Maujwadi covering Mojwadi, Chimaipur, Garbedi and Jamnapur villages
3. PDS shop at Jhinjari covering Jhinjari and Chattu-Battu villages
4. PDS shop at Sunderdev covering Sunderdev village
5. PDS shop at Patajan covering Patajan and Langoti villages
6. PDS shop at Dabhiya covering Dabhia and Medhapani villages
7. PDS shop at Tigriya covering Tigriya and Hasanpura villages

I am writing to express my concern regarding the deaths of 33 children caused by malnutrition with attendant symptoms of fever, diarrhoea, respiratory infection, blister, swelling, from late July to December 2008.

The deceased children lived in the villages predominantly inhabited by tribal communities who have suffered from food insecurity caused by lack of livelihood and failure of public service for the poor. In particular, the rainy season, when the children died, is the hardest time to manage food provision and safe drinking water resulting in malnutrition and sickness every year.

According to the report conducted by the local group and Action Aid India, most of the families are either landless or small scale farm owners of non-irrigated plots. Many of them have no job card. The ration card under the Public Food Distribution System (PDS) has not been issued properly to the tribal communities. According to the Supreme Court Order 2003 and 2004, the primitive tribes are one of the priority groups to be entitled to Antyodaya Anna Yojana (AAY) card for the poorest among them.

I am informed that some tribes such as Korku living in Khalwa Block have not yet officially been indentified as a primitive tribe although they have been demanding on it. In September 2008, the Supreme Court Commissioner and Advisors have suggested to the state government that whoever has no ration card and have applied be entitled to the AAY card or Below the Poverty Lind (BPL) card as they have been continuously exposed to malnutrition and food deprivation. Despite, I am further informed that many of them have no ration card.

I have learned that until the children died, the PDS shops in the villages opened once or twice a week and merely provided 20 kilograms of grain. I am aware that the shops must provide 35 kilograms of rice and wheat per a month to the BPL card holders by the state government order of 2003.

I have studied that the Supreme Court Order states that the PDS shopkeepers should be cancelled if they do not keep their shops open throughout the month and fail to provide grain to BPL families strictly at BPL rates and no higher, make false entries in the BPL cards, and engage in black-marketing or siphoning away of grain to the open market and hand over such ration shops to other persons/organizations. The Public Distribution System (Control) Order 2001 also puts down in law that any person who contravenes any provision of the order will be punished under Section 7 of the Essential Commodities Act (ECA) 1955. However, I am informed that the shops have not been punished under these orders so far.

I am informed that after the children's deaths, the administration provided relief for the children in the villages only on an emergency basis. The Collector ordered that the PDS shops should open daily and provide 35 kilograms of rice and wheat. However, the temporary treatment and nutrition supply did not last long because of limited funds meant to tide over the emergency. In addition, all seven PDS shops covering the thirteen villages where the 27 children died, currently do not open every day and merely provide 20 kilograms of wheat.

As the temporary assistance was withdrawn, six more children died of malnutrition with similar symptoms in the same Block in November and December 2008. One of six, two-year-old Tulsi Bisram died a few days after she received rations for eight days at the Nutrition Rehabilitation Centres (NRC.) She was also given Ready to Use Therapeutic Food (RUTF) by UNICEF India which improved her heath condition temporarily but failed to eventually prevent her death of malnutrition. Her demise reflects the fact that temporary provisions and health care do not prevent death without long-term treatment and food provision at home.

Tulsi has never been provided medical care by the AWC which is far away from her house. No children in Tulsi's community have visited the AWC since it is not in the community area. No one visited the community for regular medical check-up for the mothers and their infants.

I have learned that none of the deceased six children's families have AAY cards or BPL cards meant for food distribution to the poor. All these six families pleaded that they have been suffering from lack of food and some even had to borrow money to buy food.

I am of the opinion that the public services on food and health care for the poor such as PDS, AWC (child care centre), Public health institutes do not aim to provide only for emergencies. They aim to ensure food security as well as prevent child malnutrition routinely. These services had been developed since India ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) in 1979. The right to food is a fundamental right in India.

Despite all these failures of government service for the poor, I am informed that the government attempts to avoid its responsibility by saying that the children did not die of malnutrition but died of diseases. However, what the government called 'diseases' are all the symptoms and signs of malnutrition according to reports of the WHO published in 2000.

I am of the opinion that when the government officially denies children's malnutrition, they should provide rational and scientific assessments, examining the social and economic background and the government's administration of a public system for them, also suggested by the WHO.

Further, the government blames the parents for their ignorance and superstitious beliefs since they belong to a tribal community, which has nothing to do with the malnourishment of children. I am of the opinion that the duty of the government is not to blame the poor or tribal community's culture but to provide government services equally to all.

In the light of this, I urge you to intervene by taking the following concrete steps to prevent further deaths and ensure food security in Khalwa Block:

1. Issue AAY cards to all the families who lost their children due to malnutrition

2. Visit the villages and issue AAY cards or BPL cards and job cards to other families in the villages who do not have adequate livelihood and suffer from lack of food in particular to tribal community families.

3. Build Child Care Centres (Anganwadi Centre) in order to provide regular nutrition and health care for the children in all the victims' communities

4. Monitor the PDS shops and punish whoever infringes the Supreme Court Order or PDS (control) Order for food distribution for the poor

5. Ensure compliance of all government authorities to provide public service

6. Above all, support the villagers so that they can produce enough food on their own by allotting farm land to the landless and providing irrigation facilities which will be the ultimate way to ensure food security

I am looking forward to your immediate action and will keep monitoring this issue.

Yours sincerely,

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PLEASE SEND YOUR LETTERS TO:

1. Renuka Chowdhury
Minister of Women and Child Development
Government of India
INDIA
Fax: +91 11 2307 4054
E-mail: min-wcd@nic.in

2. Justice Mr. Balakrishnan
Chief Justice of India
Through the Office of the Registrar General
Supreme Court of India
1 Tilak Marg, New Delhi
INDIA
Fax: +91 11 2338 3792
E-mail: supremecourt@nic.in

3. 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

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

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

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

7. 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

8. 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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