COVID-19 outbreak in Kashmir: the Indian government deploys a bureaucratic response to a public health emergency

On 7 March 2020, as sporting events across the world were postponed due to the threat of coronavirus (COVID-19), a junior minister of the Narendra Modi government in New Delhi, Kiren Rijiju, inaugurated a five-day winter sports festival in Kashmir’s garrisoned tourist resort of Gulmarg. The event drew nearly a thousand athletes from across India besides several hundred spectators, government officials, and troops mobilized to secure it.

Two days later, on 9 March, Indian administered Jammu and Kashmir (J&K) had reported its first confirmed COVID-19 case in Jammu. Schools in the Jammu division had already been closed over fears of contagion, but between bracing for the spread of the pandemic and scoring a political point, New Delhi seemingly chose the latter as it insisted on the Gulmarg event despite opposition and, ironically, in spite of the Jammu and Kashmir administration itself making appeals against large gatherings.

The Gulmarg festival was described by Rijiju as a “great day for Indian sports” even as many quarters in Kashmir opposed the event not only for its political overtones, but also because of the threat of contagion. At this point the disease had spread to several countries while more than three thousand lives, mostly in China then, had been lost.

The event in Gulmarg was held just a month after India confirmed its first case and nearly eight months after the Hindu nationalist government abrogated Jammu and Kashmir’s limited autonomy. Since early August 2019, with a total lockdown to prevent protests, the State has been reduced to a Union Territory under New Delhi’s direct oversight and is currently administered by a bureaucracy answerable directly to New Delhi that, until 13 March, insisted that the coronavirus was not a health emergency.

The New Delhi-appointed Lieutenant Governor of the region, Girish Chandra Murmu, declared the outbreak an epidemic four days later. At this point Jammu and Kashmir had tested a meagre 113 samples in both Kashmir and Jammu divisions, detecting four infected individuals, of whom one was from Kashmir.

In the quasi-federal system of the Indian Union, public health falls under the ambit of the elected governments in the States. J&K, however, has been under New Delhi’s oversight — through federally appointed Governors at the helm of a battery of bureaucrats. This situation began in 2018, when India’s ruling Hindu nationalist Bharatiya Janata Party (BJP) withdrew from the coalition government and was subsequently consolidated when the Indian Parliament annexed the region as a federally administered Union Territory the following year.

“They should have asked doctors what to do and assisted them in handling the situation. Instead, their approach is in total deviation from scientific guidelines and, despite raising this issue repeatedly, they unfortunately have not reviewed their decisions.”During several interviews, a senior doctor in Kashmir told me that the Jammu and Kashmir administration may have complicated the situation by treating a public health emergency as an administrative matter with little medical guidance. “They [the bureaucrats] treat everything as a law and order issue because it is the easiest response for them,” he said wishing anonymity. “They should have asked doctors what to do and assisted them in handling the situation. Instead, their approach is in total deviation from scientific guidelines and, despite raising this issue repeatedly, they unfortunately have not reviewed their decisions.”

An administrative approach

As the Gulmarg event came to an end, the bureaucratic establishment in Kashmir began conducting standard screenings for symptoms and gathering self-declaration of travel histories from all passengers arriving at the fortified military airbase in Srinagar that also doubles as a civilian airport. The regional administration announced Kashmir Valley’s first confirmed coronavirus case on 18 March and enforced a lockdown on the following day. Further, without advance communication, it was also decided to mandatorily quarantine all international travelers even if they were returning from countries that were at low risk at that time.

Instead of communicating the rationale behind the decision, a traveler who had returned from the United States (and underwent the mandatory quarantine) told me that the indifference of officials at the airport had led to a scuffle with the stranded travelers, mostly young medical students returning from Bangladesh – a country that had fewer reported cases than India at the time. After the administration allowed at least two travelers, both family members of government officials, to bypass the mandatory quarantine, the traveler from the US said that the other returning students “felt stranded and were protesting against that.” Meanwhile relatives of the travelers waiting outside the airport also protested and were baton-charged by the Police.

The hammer and nail approach, the senior doctor said, had complicated the handling of travelers returning to Kashmir and fueled mistrust in the administration’s handling of the pandemic. The mistrust was reinforced after Kashmir’s social media was abuzz with pictures and videos of poor facilities at the quarantine centers and debated the “VIP status” accorded to influential families.

The senior doctor – who did not want to be identified as official rules prevent employees from criticizing the government – said that these measures pushed a social media narrative about alleged harassment by the authorities and miserable conditions of the quarantine centers and compelled travelers to hide their travel histories. “When they [the bureaucrats] decided to quarantine everyone, [people] began hiding their travel histories. In fact, this flawed approach has allowed travelers from higher risk areas to mingle back into the society,” the doctor said.

As bureaucrats focused on international travelers regardless of the spread of the disease in the countries they were arriving from, several travelers from coronavirus-affected Indian cities returned to Kashmir relatively unbothered. On 16 March, a 65-year-old man who had symptoms of coronavirus – according to his patient card issued on 21 April – was screened and allowed to go home since he had no international travel history. In the absence of quarantine instructions, and perhaps motivated by a false sense of security from the symptom screening process at the airport, the man continued with his routine. He had recently returned after participating to a gathering at the Tablighi Jamaat’s New Delhi center a week before arriving in Srinagar. Five days after arriving in Srinagar, his symptoms had worsened. The man visited a hospital where doctors, despite noting down his symptoms and his age, gave him the option of quarantining himself at home. He then went to another hospital the following day and on 24 March, he was declared Kashmir’s first COVID-19 casualty. After the slip was realized, other Kashmir residents who had attended the gathering in New Delhi were traced and some tested positive for the virus. Although the administration attempted to link the subsequent confirmed cases to the 65-year-old, some of the individuals who subsequently tested positive denied having been in contact with the man, but instead were visitors of the same event that emerged as one of the known major hotspots in India.

In addition to a flawed protocol, the large number of travelers arriving at both the airport and the entry point via road overburdened the small staff deployed at both locations. As a result, several suspected cases would have possibly been missed, a doctor who was involved in the travellers’ screening process told me. “We were supposed to man the queue, check travel papers, even interrogate them if we felt they were lying [about their travel histories],” he said. 

Beating coronavirus with suits and jackboots

The doctor said that travelers returning to Kashmir, from COVID-19 affected cities, and hiding their travel histories had become a problem for both the administration and the health workers. “This problem can be solved if the administration simply announces a one-time amnesty so that such travelers can come forward without fearing legal consequences,” the doctor said. However, authorities in Kashmir had instead gone ahead with coercive measures and tracing out travelers with the help of the Police.

On 24 March, a press release from the office of Police director Dilbag Singh termed Police officers as “first responders.” By 16 April, the Police had lodged 1,012 First Information Reports (FIRs) across Jammu and Kashmir, arresting 2,303 person while 1,295 shops and vehicles were seized for defying government orders. Since then several more people have been arrested or booked by the Police for violating anti-COVID-19 measures.

District Magistrates across Kashmir began ordering en masse quarantine of all travelers and family members of confirmed cases in designated government centers as opposed to the guidelines by the federal Health Ministry and the World Health Organization advising home quarantine for fourteen days. However, as they still failed in convincing travelers to voluntarily come forward, the administration resorted to intimidation threatening travelers with formal complaints after the same was suggested by the region’s High Court.

On 31 March, District Magistrates also issued ultimatums to recent travelers to disclose their travel histories, failing which the individuals later discovered would be prosecuted under various sections of the Penal Code. The District Magistrate in Srinagar, Shahid Choudhary, told an Indian newspaper on 10 April that about 800 travelers had hidden their travel history adding that “the situation would have been better” had they not.

Decades of governing a conflict-stricken region has given a deep sense of entitlement and impunity to the regional powers that be. They expect submission from the people who, in turn, have learned to distrust the government and resist its diktats.Decades of governing a conflict-stricken region has given a deep sense of entitlement and impunity to the regional powers that be. They expect submission from the people who, in turn, have learned to distrust the government and resist its diktats. The use of systemic coercion has also, to some extent, led Kashmir to treat this lockdown as just another in a series of routine suspensions of civil liberties.

On 14 April, District Magistrates in different districts of Kashmir ordered the erection of concrete barricades on roads leading to residential localities deemed “red zones” owing to multiple confirmed cases of COVID-19. The move was criticized on social media for its obvious overtones of militaristic control and ghettoization of affected neighborhoods. Kashmir had been turned into red zones within a red zone: on a micro level, several pockets of Srinagar city and other towns, and on a macro level entire districts, were declared as red zones. The barricades erected to seal neighborhoods and entire villages were dug into roads and, in some places, walls of sheets of corrugated tin were erected to prevent civilian movement. On 25 April, a family from south Kashmir’s Anantnag district alleged that a woman, pregnant with twins, died after doctors at the hospital were hesitant to treat her since she hailed from a red zone. A day later, hospital authorities claimed she had tested positive for COVID-19. An inquiry has been initiated on the matter.

Since mid-May, the administration prepared to ease the lockdown in Kashmir, formally announcing it on 13 June, even as cases continued to be on the rise. However, on 22 July, the administration once again ordered a fresh lockdown that was abruptly announced in the middle of the day. According to the order, the lockdown was lifted three days before the Muslim festival of Eid, during which Kashmiris thronged the markets.

Babus in-charge

In the initial months after the first reported case, not a single health expert was given charge of leading the administration’s response to the outbreak. At the district level, Deputy Commissioners were designated in-charge of mitigation efforts “assisted” by the Chief Medical Officers in their districts while the Directors of the Health Services in Kashmir and Jammu divisions were to assist the respective Divisional Commissioners.

The overall in-charge of response effort coordination in J-K is Atal Dulloo, a bureaucrat whose official designation is Financial Commissioner, Health and Medical Education Department. Dulloo reports to his seniors including the Lieutenant Governor Girish Chandra Murmu, also a former bureaucrat.

As of 1 August 2020, the number of laboratory-confirmed cases in the Kashmir Valley stood at 16,383, of which 5,751 were active cases while 360 people had lost their lives to the disease – a figure comparatively lower than other states in India. Still, healthcare infrastructure already begun to show signs of being overwhelmed: hospitals have run out of beds and ventilators are still being procured three months after a lockdown was first announced.

It took the bureaucracy in J&K more than three months – after enforcing a lockdown as it announced the outbreak of the coronavirus pandemic – to appoint a committee of medical experts to guide the administration’s response to the public health emergency in a region that has been devoid of an elected government for the last two years.

The eleven-member advisory committee consisting of senior doctors from J&K was constituted on 15 June, headed by the former director of the Sher-i-Kashmir Institute of Medical Sciences, Dr. Mohammad Sultan Khurroo, to “review protocol, guidelines and other issues relating to the treatment of COVID-19 patients.”

The formation of the committee had taken some senior doctors by surprise. A senior doctor, who is part of this advisory committee, told me that his first reaction was to term the reports of the committee’s formation as “fake news” circulating online. The doctor said that the committee was limited to an advisory role to the senior officials of the administration on treatment protocols and had no say in the manner in which lockdown was eased or restricted. The senior doctor said that the committee had recommended temporary lockdowns in pockets where infections were confirmed, deeming the areas as red zones. However, he added: “We have not identified any [locations to be turned into a red zone].” At the end of July, about 800,000 of Kashmir’s more than seven million inhabitants were under red zones, according to the COVID-19 Divisional Control Room in Srinagar. These locations are barricaded to prevent the movement of residents.

The doctor added that they had also advised against mandatory administrative quarantine, likening it to “jailing” individuals. A month after the advisory committee’s formation, the senior doctor said that a policy on isolation and quarantine protocol recommended by the medical experts remained unaddressed by the top brass of the J&K administration. The revised protocol, allowing home quarantine for asymptomatic infected individuals, was finally approved on 30 July.

“They have made places available, created lots of beds but the problem is [freeing up space in] isolation and quarantine centers,” he said, referring to the mandatory quarantine of asymptomatic individuals. Recently, the Sher-i-Kashmir Institute of Medical Sciences in Srinagar has ordered patients treated for other ailments, to vacate thirty rooms to accommodate COVID-19 cases instead. “As per the current policy, we also have to keep asymptomatic people in quarantine,” the doctor added. “People are afraid of tests because they fear being ‘jailed’ if they test positive. If the policy is changed [allowing home quarantine and better outreach], people would be more willing to get tested to protect their families.”

The senior doctor in Srinagar, quoted earlier, said that the Valley’s few main hospitals must be reserved for critically ill patients and not to be used as quarantine centers for all individuals confirmed to have been infected. “There is a line they don’t want to deviate from because, for them, the law is the word reserved for their masters,” the senior doctor said of the bureaucrats. “But, as doctors and experts, who do we complain about this to? Several experts have raised this issue on various fora, but no one has listened to us. This is a police state.”

On 1 April, the Directorate of Health in Kashmir issued a circular that threatened health workers with punishment under Section 188 of the Indian Penal Code for publicly criticizing the administration or speaking to the pressThe administration, on the other hand, has only sought to tighten the noose. On 1 April, the Directorate of Health in Kashmir issued a circular that threatened health workers with punishment under Section 188 of the Indian Penal Code for publicly criticizing the administration or speaking to the press. The circular noted that public criticism of the administration “is causing more harm than good to the public & administration” and advised them to “bring their disagreements into the notice of concerned authorities” instead of putting it out on social media or the press. Section 188 of the Indian Penal Code — “disobedience to order duly promulgated by public servant” in this case violations of the guidelines issued to contain the pandemic — has provisions for a fine up to 1,000 Rupees (USD 13) and/or imprisonment up to six months.

Government officials – including the Director of Health Services, Kashmir (DHSK), the Director of the National Health Mission (NHM) in Kashmir (a bureaucrat of federal cadre), and senior doctors in-charge of treatment and isolation centers – refused to speak despite several attempts at reaching out to understand the administration’s policies and the current status of the overall healthcare infrastructure.

Breaking the chain of bureaucracy

When New Delhi enforced a lockdown in Kashmir in August 2019 after taking away the last remaining semblance of autonomy from Kashmiris, bureaucrats emerged as the face of state repression at par with the Police. Since then Kashmir’s mistrust towards an administration dominated by non-natives has only deepened.

Senior bureaucrats who were at the forefront in August are at the forefront even today as the pandemic spreads. Among them two senior bureaucrats, Rohit Kansal and Sehrish Asghar, are again in charge of the dissemination of information regarding the pandemic – which has largely meant unilateral press briefs.

The urgency of the public health emergency was being obfuscated with the deep misgivings against the bureaucracy since last August, a government official and a doctor by qualification told me. “I would see Rohit Kansal and Sehrish [Asgar] announcing restrictions on 5 August last year, I am seeing them today telling me the same,” he pointed out. “They have equated the two issues [politics and health] and obfuscated the whole problem. The police state feeling has overpowered the administration’s sense of the situation, it’s just like the 5 August crisis.”

According to him there is “a gap between public health experts and the public” in the government’s outreach as “the visibility [of the government] is only through the Police and the bureaucrats.” But this is a public health emergency, he pointed out: “Why should the bureaucrats be taking the lead when medical queries need to be answered by those qualified to do so? Why will people take seriously a bureaucrat’s advice on health?”

The best approach, another senior doctor in Srinagar said, would be to let prominent doctors take the center stage of frequent communication “instead of the administration that is perceived as anti-people. We are not going to the grassroots, that is not on Twitter but on shopfronts,” he said. “It makes sense to use a face that people would listen to and not someone from the outside.”

The doctor reluctantly added towards the end: “This was the time the government should have set aside its ego and seek help from separatist leaders,” who inspired more confidence among Kashmiris than the arms of the State. However, the doctor said that this would not be possible without the intermediary unionist politicians, many of whom have lost their voice or are still in detention since August 2019.