Delhi hospital fire calls for more than mourning
THE MAY 25 FIRE IS THE OUTCOME OF POORLY MANAGED HEALTH CARE DELIVERY APPARATUS BY PRIVATE PRACTITIONERS, ALLOWED TO GO FREE BY AN IRRESPONSIBLE PUBLIC HEALTH CARE REGULATOR
On May 25, seven newborn babies were killed in a major fire at a private hospital in Delhi. The usual elements of a post-tragedy set-up in India were played out: Condemnation by politicians, promises of strict action by the regime, a few hasty arrests and a sudden knee-jerk reaction by public health regulators. All of this will play out over a couple of weeks and then all will be fine — till the next hospital fire. We, as a nation, fail our people in the introspection of such heartbreaking tragedies.
India is one of the few liberal democracies where health care has nearly completely passed into private hands. From dingy clinics in bylanes to posh corporate hospitals, private players now provide more than 80% of health care in this country. In other words, the government of a country with 1.4 billion people is responsible for the health of only 280 million of its citizens. This is what should worry us more than anything else. The May 25 fire is thus not just any accident. It is the outcome of a poorly managed and operated health care delivery apparatus by private practitioners, allowed to go free by an irresponsible public health care regulator. It was thus an accident manufactured with the consent and connivance of multiple players, both private and public.
Fires at hospitals are not uncommon in this part of the world. The AMRI hospital fire in Kolkata killed 90 people in 2011. In April 2021, at the peak of the Covid-19 pandemic, 13 patients were killed in a fire at the Vijay Vallabh Hospital near Mumbai. In the same year, 11 patients were killed at the Sunrise Hospital fire, again in Mumbai. In 2022, eight patients perished in a fire at the New Life Multispecialty hospital in Jabalpur and 50 patients were killed in a fire at the Murshidabad Medical College in West Bengal in 2016. A 2023 study (Shravishtha Juyal, Tabassum-Abbasi, Tasneem Abbasi and SA Abbasi), which compiled all the major fires in Indian hospitals from 2010 to 2023 found the incidence of fires was equal between private and public hospitals but the number of deaths in private hospital fires far outweighed those in government hospitals.
Private health care in India is poorly regulated. In a welfare state promising to provide free health care to its people, health remains a state subject which may be explained by the fact that each state has its own health priorities. Having said this, health regulations, particularly for private health set-ups at the state level are not only poorly implemented, but are liable to the pressures of money and power. The implementation is patchy in most places and private practitioners go scot-free even after blatant violations. Hospitals and nursing homes in the Capital city are regulated by the Delhi Nursing Homes Registration Act, 1953, which stands amended by the Clinical Establishments (Registration and Regulation) Act, 2010. But even after all approvals, the act remains to be implemented, thanks to the tug of war involving the Centre and the Delhi state government. Political ambitions remain the single most important determinant of health in the world’s largest democracy!
It is an open secret that most private hospitals in Delhi fail to provide free treatment and beds to poor patients, despite this being a legal requirement in lieu of the land given at the time of their construction. If this can happen in the country’s Capital, we can only imagine the situation in smaller towns and cities. Having said this, it is important to realise that private health care is here to stay. Mere condemnation of private health care providers is not a solution in a system where private health care delivery is so tightly entrenched that the system now depends on it for its own viability and survival. Failures such as the killer fire can only be minimised through the proper implementation of regulatory mechanisms. The common causes of fires in hospitals are usually poor building structure with no escape routes, presence and improper storage of inflammable liquids and gases in the vicinity and, most importantly, lack of fire safety standard operating protocols.
As a nation enamoured by the West, we need to learn what happened after the Grenfell Tower fire in London in 2017 that killed 72 people. The synthetic cladding used in the exterior of the tower, which was the main cause of the fire, was banned in the country. Criminal charges have been brought up against the company which manufactured those claddings. A total of 180 investigators, in collaboration with international experts, prepared an extensive report that set off a broad reckoning of British regulations and fire safety. All in all, accountability was set and regulations enforced.
For the new government that will soon assume charge at the Centre, the Delhi hospital fire should provide a moment for reflection: It must take steps on priority to enhance public investment in health care besides regulating the private facilities that have mushroomed all over the country. It is the shortage of affordable health care facilities, which only the State can provide, that has facilitated the emergence of a market for establishments with poor facilities and untrained personnel.
What has happened to us as a civil society is that our sense of outrage has been blunted by deaths and mishaps about which we feel we can’t do much except mourn. Whether it’s a bridge crash, a hoarding collapse, a train accident, a tunnel caving in on workers or a hospital fire killing the ill, we have learnt the art of looking the other way. Accountability is no longer ingrained in the apparatus of civility. We shall continue this way if the offenders, and equally the lawmakers and the law enforcers, continue to go unnoticed, unaccounted and most importantly unpunished.