Planes of ventilators, oxygen supplies and antiviral drugs began arriving last week, with photos showing massive packages being unloaded at New Delhi airport.
There is just one problem: for many days much of the cargo remained in the airport hangars as hospitals on the ground called for more supplies.
But on the ground, many states and local authorities say there has been little or no communication from central government on how and when they would receive assistance.
“We have sent delegations to (government) for clarity on (oxygen) supplies, medicines and vaccination campaign, but we have not been informed with clarity from the Union government,” said Tuesday Raghu Sharma, Minister of Health of Rajasthan. “Regarding imports or foreign aid, no information or details of the supply have been shared with the state government. “
The central government has “kept states in the dark during the pandemic,” he added, calling for a “more transparent environment”.
The health ministry announced on Tuesday that it had distributed aid to two hospitals in Rajasthan, in the cities of Jodhpur and Jaipur.
There are a number of possible reasons for this delay: unnecessary bureaucracy, human error, or time-consuming protocol. But for those in the field, these possible explanations do not matter; all they want is for the government to act faster and get aid to their intensive care units, where thousands of people die every day.
India reported 382,315 new coronavirus cases and 3,780 virus-related deaths on Wednesday, according to the health ministry. The country has now recorded more than 20.6 million cases since the start of the pandemic.
Oxygen shortages are particularly pronounced in the Union Territory of Delhi, which does not produce its own oxygen and relies on the central government to send allowances from different manufacturers and states.
“It is the government’s duty to provide us with oxygen,” said Dr SCL Gupta, director of Batra Hospital in the capital New Delhi.
At least 12 patients, including a doctor, died in Batra hospital on Saturday after lacking oxygen. Gupta said hospital staff spent the day telling authorities there were only a few hours of oxygen left; towards the end, they had to rely on oxygen provided by the families of the patients.
“Patients die in front of us,” Gupta said. “I’m sorry we can’t save you. “
A logistical nightmare
One distribution problem highlighted by the Indian media is simply that the government did not have protocols in place prior to receiving the aid, and had to quickly concoct guidelines on allocation and coordination.
It took the government seven days to create a mechanism to distribute supplies to states, the health ministry said in a press release on Tuesday. They started work on the plan on April 26 and didn’t release their standard operating procedure (SOP) – guidelines on how to distribute aid – until May 2. The statement did not indicate on what day aid distribution began.
During those seven days, more than 23,000 Indians died from Covid-19.
Even with the published SOP, the distribution process is complex, with some additional delay.
Once the aid arrives in India, it is received by the Indian Red Cross, which works closely with the government. The Red Cross works with customs to approve goods, the health ministry said, adding that customs “are working 24/7 to expedite and clear goods upon arrival.”
After clearing customs, the items are turned over to the ministry and a government-owned health product manufacturer called HLL Lifecare, which takes care of transporting the aid to its final destination.
But it is a massive logistics undertaking because “materials from overseas are currently arriving in different numbers, specifications and times,” the ministry said in its statement on Tuesday. A number of problems could arise, he said: “in many cases” the type or number of aid supplies does not match the inventory list provided by the foreign donor.
The authorities must then waste precious time “reconciling (the differences) at the airport” while the aid remains inactive, according to the statement. It is only when the documents are updated with the correct details that the authorities can proceed with the distribution.
India is a huge country, with a population of 1.3 billion, and most of the foreign aid is channeled to New Delhi – which means much of it must then be redistributed to distant states. The Army has been deployed to assist in this process, with the Air Force carrying supplies to various cities and also carrying out flights overseas.
States with a high workload, or those that are regional medical centers, will be given priority, the health ministry said on Tuesday. Donations are also allocated to states with fewer resources or to those in remote areas.
It’s unclear how much aid is still being processed, but images have started to emerge this week of supplies finally arriving on the ground.
However, these supplies will only provide minimal relief. As of Tuesday, Chennai had more than 32,000 active cases, while Mumbai had more than 56,000. Hospitals in both cities are so under-resourced and the situation is so dire that patients are dying by the dozens.
Desperate patients wait for oxygen
As the government struggles to secure overdue aid for desperate states, it is also working to increase domestic oxygen production. And at every turn, federal officials have claimed they have enough supplies to meet states’ demands.
“The (daily) oxygen production in the country was 5,700 metric tonnes (6,283 tonnes) on August 1, 2020, which has now grown to around 9,000 metric tonnes (9,920 tonnes),” a ministry spokesperson said. Health at a press conference on Monday. Last month, the ministry said it had 50,000 metric tonnes (55,115 tonnes) of excess oxygen stocks.
On Monday, the ministry spokesperson again affirmed: “There is sufficient oxygen available in the country”.
But doctors, government officials and desperate patients tell a very different story.
At a hospital in Meerut, a town in Uttar Pradesh, a family worked around the clock to treat their 55-year-old mother in the intensive care unit. The family told CNN this week that they had been in the hospital for six days before receiving a ventilator and that they had to bring their own oxygen cylinder.
At one point, her vital signs began to drop dangerously; her sons were frantically pumping her chest, screaming and squeezing her hands as the family members cried beside the bed. A doctor was able to help stabilize the woman – but she later stagnated again. This time, she could not be resuscitated; her body was left in intensive care for almost an hour before being moved.
The same scenes take place in almost every major city. In New Delhi, the situation has deteriorated so badly that the Indian Supreme Court has ordered the central government to address oxygen shortages by the end of Monday.
Similar hearings were held in the Delhi High Court. “Are you saying that we will turn a blind eye to the people who are dying in Delhi?” The court told the central government on Saturday, according to CNN affiliate CNN-News18. ” Enough is enough. “
Some state authorities have also been criticized for their handling of the oxygen crisis. A Uttar Pradesh high court demanded “immediate corrective action”, reporting specific cases of patients who have died due to oxygen shortages.
“The death of Covid patients just for not providing oxygen to hospitals is a criminal act and no less than genocide on the part of those who have been given the task of ensuring the continuous supply and the chain supply of liquid medical oxygen, ”the court said on Tuesday.
The central government responded by stepping up emergency measures.
This week, some of those increased oxygen supplies are sent to various hard-hit states by rail, in what has been dubbed “oxygen express.”
But until those supplies arrive, whether from domestic factories or foreign donors, patients have no choice but to wait, terrified for their lives.