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UPDATE (India): Two children suffer from malnutrition in Khandwa district of Madhya Pradesh

Sumantra is a twenty-two months-old girl merely weighing 5.5 kilograms. She is identified as Sever Acute Malnutrition according to the Mid Upper Arm Circumference (MUAC) indicating 94 millimeters (mm).


Hunger Alert Update: AHRC-HAU-003-2009

29 April 2009

[RE: AHRC-HAC-002-2009: UPDATE (India): The government ignores deaths of forty-three children due to malnutrition in Madhya Pradesh]
INDIA: Two children suffer from malnutrition in Khandwa district of Madhya Pradesh

ISSUES: Right to food; right to health; malnutrition; government neglect; corruption

Dear friends,

The Asian Human Rights Commission (AHRC) had reported that forty-three children died of malnutrition in Madhya Pradesh (MP). According to the human rights group, Spandan Samaj Seva Samiti (Spandan)'s visiting report in April, two children continue to suffer from malnutrition, in the Khalwa Block of Khandwa district where forty-three children died. The AHRC urges the state government to take immediate action for the malnourished children and their families to prevent more deaths in MP.


1. Case one:

Sumantra is a twenty-two months-old girl merely weighing 5.5 kilograms. She is identified as Sever Acute Malnutrition according to the Mid Upper Arm Circumference (MUAC) indicating 94 millimeters (mm). [Photo 1: Sumantra]

MUAC is the circumference of the left upper arm, measured at the mid-point between the tip of the shoulder and the tip of the elbow. For children, MUAC is useful for the assessment of nutritional status. MUAC, less than 108mm indicates Severe Acute Malnutrition (SAM) and between 109 mm and 124 mm indicates Moderate Acute Malnutrition (MAM) and between 125 mm to 134mm indicates children at risk.

In October 2008, Sumantra was taken to the Nutrition Rehabilitation Centre (NRC; Bal Shaktee Kendra) temporarily set up at Roshni village. This temporary centre was set up to provide nutrition for the malnourished children after the thirty three children reportedly died of malnutrition in Khalwa Block since July 2008. Please refer previous hunger case for details.

While at the centre for just for four days, Sumantra was provided with only three Rotis (Indian bread) a day. Sumantra was identified as SAM proved by MUAC 84mm at that time. According to her father Kamalsingh, however, the doctor diagnosed that she was not sick. The family also found that the water facility and sanitation at the centre was neither enough nor hygienic to take care of the children as well as the parents. Ever since the family along with Sumantra came back home, they could not afford to provide nutrition for Sumantra.

Sumantra's family lives in Chadida village, Khalwa Block in Khandwa district of MP. Kamalsingh has four acres of non-irrigated farm land shared with his brothers. They harvest soybean, rice and pulse lasting only four months a year. Due to insufficient output from the farmland, he is forced to look for work elsewhere and even to migrate to the neighbouring district. He has just returned home from Harda district with two quintals (200 kilograms) of wheat as his two month wages for harvest work. It will last for barely two or three months for the entire family. Despite his hard work, he will be left with nothing, since he has to return two and a quarter quintals of soyabean and Rupees 10,500 that he had borrowed from his neighbour. In addition, he has to take care of his elder daughter who has been suffering from malnutrition for months.

Kamalsingh has been consulting private doctors nearby since the government health facility at Roshni village is 20 kilometres away from his village.

Despite his living condition, he only has an Above Poverty Line ration card under the Public Food Distribution System (PDS) with which he can get only kerosene oil, not rice and wheat. The family received 130 days of employment under the National Rural Employment Guarantee Scheme (NREGS), which does not last any more. He has to manage food by migrating to Harda district twice a year due to the food scarcity at home.

2. Case two:

Another child in the same village, Sonaram Manag Kasde also suffers from malnutrition. He is three years old weighing 5.3 kilograms and his MUAC currently indicates 108, which also means malnutrition. [Photo 2: Sonaram]

Sonaram was also admitted at NRC last year but was sent back home since he was diagnosed as a mental patient without hope of recovery. Apart from his mental illness, he was not properly treated for malnutrition at that time and still suffers from undernourishment. The Anganwadi centre currently provides 80 grams of porridge per day for Sonaram.

Sonaram's father grows soybean, wheat, rice, and pulses. The family consumes wheat and rice for daily food while soybean and pulses are sold. The grains from the farm land are not sufficient for the entire family for a year and the family cannot afford buy nutritious food for their children.

Sonaram's family has a Below the Poverty Line (BPL) ration card. The ration shop is located five kilometres away from their house and currently sells merely 20 kilograms of wheat. A Supreme Court Order (2008) states that the ration shop should sell totally 35 kilograms of rice (15 kilograms) and wheat (20 kilograms). The state government also ordered the ration shops to sell 35 kilograms of rice and wheat since 2003. Please see the previous hunger alert for more details on how the ration shops in Khandwa Block have been selling the rations so far and their unlawful patterns.


Chadida village, located in the forest is predominantly occupied by the tribal community, Korku. Since they are not officially identified as a primitive tribe, they are excluded from the priority such as an entitlement to the Antyodaya Anna Yojana (AAY) ration card for the poorest among the poor. Further, the lands they farm are non-irrigated or many families are landless. The Korku find it difficult to manage daily food for a year so they are forced to migrate to other districts to work as daily workers or as seasonal workers.

As the AHRC reported earlier, the state government and district government have failed to prevent malnutrition deaths of children in Khalwa Block. They have provided temporary relief and continue to neglect their duty, resulting in more children suffering from malnutrition-like Sumantra and Sonaram.

Despite the Supreme Court recommendation in September 2008 to the state government, the government has not taken substantial action to ensure food security in four districts including Khadwa district. In particular, among 16 recommendations, the Supreme Court requested a submission of reports as below:

1. Investigate into the deaths of all the children and send a report within 15 days;
2. Undertake a survey in all these villages and identify the children who suffer from malnutrition and make necessary requirements for their food within the community and send an action taken report within one month;
3. All the BPL and AAY card holders should be provided 35 kilograms of food grain every month as per the Supreme court order dated 10 January 2008 and should also be allowed to lift their quota of grain in more than one instalments if they want. Send a) a copy of instructions that would be issued in this direction within two weeks and b) an action taken report within one month;
4. Conduct a social audit to find out the cases of corruption in all the food schemes including National Rural Employment Guaranteed Scheme. Send an action taken report within one month.

The recommendations by the Supreme Court have not been reflected in the practice. As it is seen in the above two cases, Sumantra's family cannot afford buy any ration as they only have an APL card while Sonaram's family cannot afford to buy 35 kilograms of ration although they have a BPL card as the ration shop currently sells only 20 kilograms of rice and wheat. Both of them suffer from lack of food while the ration shop infringes the Supreme Court order and the Public Food Distribution (control) order. The AWC, a primary health service for the child at village level does not function well. Further, even the immediate relief for emergency did not help these two children.

Most of all, however, the tribal community such as Kurku are so marginalised that they cannot enjoy their basic rights, in particular right to food and right to work. If they had sufficient and fertile irrigated farm land, they would not need to migrate to look for food and eventually the government would not need to have a PDS shop and prevent the children's death since people could ensure food security for themselves at their home.

Please write a letter to express your concern about two children suffering from malnutrition for months. Please make a note that the state as well as district government have failed to prevent children's deaths in Khalwa Block since last July.

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

To support this appeal, please click here:


Dear __________,

INDIA: Please prevent more malnutrition deaths in Madhya Pradesh

Children suffering from malnutrition:
1. Sumantra Kamalsingh, twenty two months old, suffering from Severe Acute Malnutrition (Mid Upper Arm Circumference: 94 millimetres)
2. Sonaram Manag Kasde, three years old, suffering from Sever Acute Malnutrition (Mid Upper Arm Circumference: 108 millimetres)
Location: Chadida village, Khalwa Block, Khandwa district, Madhya Pradesh

I am writing to express my concern about two malnourished children living in Khalwa Block, Khandwa district of Madhya Pradesh.

According to the report by the Spandan Samaj Seva Samiti (Spandan), a local human rights group in Khandwa district and the Asian Human Rights Commission (AHRC), forty-three children died of malnutrition along with malnutrition related diseases since last June in Khalwa Block of Khandwa district alone. As the mass media also reported more than 125 children deaths due to malnutrition in four districts including Khandwa district, the Supreme Court of India sent a recommendation letter to the state government.

I am informed that despite this, two children are currently struggling with malnutrition in Khalwa Block. Twenty two-month-old Sumantra weighing 5.5 kilograms is identified as Sever Acute Malnutrition according to the Mid Upper Arm Circumference (MUAC) indicating 94 millimetres. Another child living in the same village, three-year-old Sonaram weighs 5.3 kilograms whose MUAC indicates 108 millimetres is also suffering from malnutrition.

I have learned that both the children had been taken to the Nutrition Rehabilitation Centre temporarily set up at Roshni village. Sumantra was sent back home four days later as the doctor at the centre diagnosed she was not sick any more. Sonaram was also sent back home a few days later as being diagnosed with a mental illness. The families even found a serious problem with water supply and sanitation facility at the centre. However, both of them are still suffering from malnutrition which highlights the fact that they had not recovered from malnutrition at the centre.

I am informed that both the families have small scale farmland which is neither irrigated nor fertile to harvest enough grains for all families throughout the year. Due to insufficient output, the heads of two families are forced to find daily work and to migrate to neighbouring districts. Despite all their efforts through the year, they find it difficult to manage enough and nutritious food for the whole family. They took a loan from the neighbours to manage food and health care for the children, which they continue to be burdened with.

I am further informed that Sumantra's family has an Above the Poverty Line ration card while Sonaram's family has a Below the Poverty Line ration card under the Public Food Distribution System in India. I am of the opinion that both families are entitled to have an Antyodaya Anna Yojana (AAY) card for the poorest among the poor by the fact that their children suffer from malnutrition due to lack of nutritious food. They are likely to face the same fate of the children died of malnutrition several months back.

I am also informed that the ration shop for Chadida village sells the entire amount of 35 kilograms of grains and does not remain open everyday, which has already happened to the other villages where the children died of malnutrition in Khandwa district.

In September 2008, the Supreme Court of India sent a letter to the state government delivering 16 recommendations to ensure food security in four districts: Satna, Sheopur, Shivpuri and Khandwa. I have learnt that the state government was recommended to investigate and send an action taken report on children's health condition as well as all forms of government service aiming to ensure food security.

In the light of this, I request you to intervene in order to prevent two more deaths of malnutrition in Khandwa district in the following manner:

1. Ask the state government and district government to provide long term relief to help the above-mentioned two children recover from the malnutrition;

2. Ask the state government to issue the AAY ration card to both families;

3. Ask monitoring ration shop and Child care centre (Anganwadi Centre); if there is any corruption and neglect, punish them according to the law, and;

4. Ensure food security at home by providing sufficient and fertile farmland to both families.

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

Yours sincerely,


1. Renuka Chowdhury
Minister of Women and Child Development
Government of India
Fax: +91 11 2307 4054

2. Justice Mr. Balakrishnan
Chief Justice of India
Through the Office of the Registrar General
Supreme Court of India
1 Tilak Marg, New Delhi
Fax: +91 11 2338 3792

3. Principal Secretary
Ministry of Health & Family Welfare
Nirman Bhavan
Maulana Azad Road
New Delhi - 110011
Fax: +91 11 2306 1751

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

5. R. C. Sahni
Chief Secretary
Government of Madhya Pradesh
Bhopal 462 004
Madhya Pradesh

6. S.B. Singh
District Collector
Khandwa District, Madhya Pradesh
Fax: +91 733 2224233

7. Country Director
World Food Programme
2 Poorvi Marg, Vasant Vihar
New Delhi 110057
Fax: +91 112 615 0019

73 Lodi Estates
New Delhi 110 003
Fax: + 91 11 2462 7521 / 11 2469 1410

Thank you.

Urgent Appeals Programme
Asian Human Rights Commission (

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