ASIAN HUMAN RIGHTS COMMISSION - HUNGER ALERT PROGRAMME

Hunger Alert Update: AHRC-HAC-003-2009

 <http://www.ahrchk.net/ua/support.php?ua=HAC-003-2009 >
<http://www.ahrchk.net/ua/support.php?ua=HAC-003-2009>

16 July 2009

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INDIA: Three children died of malnutrition for past two months and
four children are currently suffering from malnutrition in Dahbiya
village of Madhya Pradesh where children had died of malnutrition in
2008

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

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Dear Friends,

The Asian Human Rights Commission (AHRC) has received information
from a human rights group based in Madhya Pradesh Spandan, Samaj Seva
Samiti (Spandan) regarding three children who died of malnutrition.
The deceased children lived in Dabhiya village of Khandwa district,
where two children had died of malnutrition in 2008. At present, four
children living in the same village suffer from severe malnutrition.
Sixty two children died of malnutrition associated with various
related diseases in the Khandwa district alone. As a result, the
state and the district administrative government announced that they
would ensure food security and eradicate children's deaths from
malnutrition. However, further deaths this year proved that the
government has again failed.

CASE DETAIL:

Richu Baliram, a two and a half year old girl died of malnutrition on
May 10, 2009. She lived in Dabhiya village, Khalwa Block, Khandwa
district, Madhya Pradesh. She was admitted for treatment at the
Khandwa district Nutrition Rehabilitation Centre (NRC).

Richu was admitted to the Khandwa district NRC on May 2, 2009,
suffering from grade IV Severe Acute Malnutrition (SAM), associated
with diarrhoea. It was not the first time that she had been taken to
the NRC. In September 2008, she was treated for 14 days and
discharged. Her condition deteriorated as her family could not afford
to provide proper food for her continued recovery. All in all, Richu
was admitted four times, once for six days and once for five days.
She continued to suffer from malnutrition for almost a year without a
full recovery.

Richu's death demonstrates that the NRC returns malnourished children
from remote rural areas to the same environment that caused their
malnutrition in the first place. Her death also shows that the
Anganwadi centre (AC; Child Care Centre) for Dabhiya village failed
in its duty of care to continue to provide nutritious food for those
children sent back home from the NRC. The AC provides only dried
ration as supplementary nutrition for the children in the village.
They erroneously presume that all families can afford to give proper
food to their malnourished children at home. This practice is
widespread in the village with children suffering from malnutrition.

In the same village two more malnourished children died. A two
month-old girl Payal Brijlal died on June 19, and 18 month-old Shanta
Ramesh died on June 30. The latter suffered from malnutrition
associated with measles and respiratory infection.

The inadequate practices of the NRC are seen in the following cases.
Ramnarayan Rameshm, was returned home after a 12 day admission
period. Ramnarayan, one and a half years old, suffering from grade IV
malnutrition associated with respiratory difficulties, was taken to
the NRC on September 12, 2008 and discharged on September 24, 2008.
He was still suffering from grade III malnutrition. Ramnarayan's
parents took him to a private hospital for treatment where his
condition did not improve. In early June, as a last resort, he was
taken to a person healing through religious methods. A few days ago,
Ramnarayan was again admitted to the NRC where he is currently being
treated.

At the present time in the village, three more children suffer from
malnutrition. Biliya Shivram a two year old girl, Richai Baliram two
years old, and Bamcham Radhelal one and a half years old. They suffer
from grade III or IV malnutrition. All are severely malnourished.

ADDITIONAL COMMENTS:

No substantial improvement in preventing children s deaths from
malnutrition

In a breakthrough in 2008, the state government acknowledged
children's deaths from malnutrition. Both the state and the district
administrative government had paid more attention to taking care of
malnourished children in 2009, particularly during the rainy season
from June to September.

In 2008, thousands of malnourished children were taken to the
Nutrition Rehabilitation Centres (NRC) in different districts.
According to the announcement this year of the department of Woman
and Child Development, parents who have malnourished children are
encouraged to take them to the NRC for treatment. But there has been
no substantial change in the treatment protocol for malnourished
children at the NRC.

Malnourished children are generally admitted for a maximum of
fourteen days at the NRC. The treatment consists merely in providing
nutrition. It does not render any medical care for diseases or
multiple infections associated with malnutrition. During the rainy
season, the malnourished children are more vulnerable to related
illnesses and infections due to an unhygienic environment. This takes
the form of an absence of a proper sanitation system and a clean water
supply. The compounded four factors; rainy season, unhygienic
environment, diseases and malnutrition, continuously escalate
children's deaths in rural areas.

Policy of the NRC is that it looks after SAM but only grades III and
IV malnutrition. All other malnourished children in grade I or II are
left behind without proper treatment and as a result develop SAM
sooner. To prevent further deaths, it is necessary to look after all
malnourished children no matter what stage they are in. Should there
not be sufficient space to accommodate all children at the NRC, the
government should make arrangements with the AC. The AC can provide
appropriate nutrition such as Ready to Use Therapeutic Food (RUTF) or
F 100, a preparation of full-fat milk, vegetable oil, peanut butter
(only for RUTF) and mineral-vitamin mix, usually recommended for
malnourished children.

There are two ACs in Dabhiya village. Each has one worker and one
helper. There is a NRC at Khandwa district for malnourished children.
There is a Supreme Court Order to ensure food and health security.
However, the existence of these systems in itself does not mean that
the Government of India, as a state party of International Covenant
on Economic, Social and Cultural Rights (ICESCR), fulfils its
obligations. In fact, the state, district and local facilities fail
in their basic functions resulting in poor results and deaths.

No food security at home

If there was enough nutritious food at home, the government would not
need to earmark such a substantial budget for malnourished children.
All the families of the deceased children, all members of the Korku
tribal community, suffer from lack of food at home.

Richu's family has a two acre farm land which is not properly
irrigated. The family of four harvest soy beans which are sold at 10
Rupees per kilograms. Her father used to work as a day labourer for
50 rupees a day. Payal's family has no land for farming. The family
only gets 20 kilograms of rice and wheat from the ration shop with
their Below the Poverty Line ration card (BPL card). 20 kilograms of
rice and wheat is consumed by eight family members within a week. Her
father also migrates to neighbouring districts like Harda or
Hoshangabad twice a year in order to find additional jobs. Shanta's
family of four has a one acre farm land. They recently took out a
loan of 5,000 rupees to buy food for the home. Her father also
migrates for work from time to time.

The villagers from the Korku community, living in a remote rural
area, need enough farm land to make a living thus ensuring food
security. Without farm land, they cannot afford to provide enough
food for their families. And although some have farm land, they do
not have irrigation facilities to maximize production. As a result,
they are forced every year to migrate to find work.

The ration distribution under the Public Food Distribution System
(PDS) does not reach the tribal communities in rural areas. Despite
the fact that the Korku community in the village continue to face a
lack of food and child malnutrition, they do not have the priority to
obtain a ration card AAY card for the poorest among the poor (For
details on living condition of Korku community, please refer to
previous hunger alert
<http://www.ahrchk.net/ua/mainfile.php/2009/3139/>
<http://www.ahrchk.net/ua/mainfile.php/2009/3139/>
and statement
<http://www.ahrchk.net/statements/mainfile.php/2009statements/2066/>
<http://www.ahrchk.net/statements/mainfile.php/2009statements/2066/>
). As shown in the case of Payal's family, BPL card holders pay about
five rupees for one kilogram of wheat and seven rupees for one
kilogram of rice. In Madhya Pradesh, BPL card holders are supposed to
collect 20 kilograms per month which only lasts for a week or so. In
practice, it can be seen that for the last two years, the actual
number of BPL families are far more than the quota that the central
government has assigned. The state government cut down the amount of
earmarked grains, which is supposed to be 35 kilograms of rice (15
kilograms) and wheat (20 kilograms), in order to meet the needs of
all the card holders.

The current market price of wheat in Khandwa district is about 12
rupees per kilogram and 20 rupees per kilogram for rice. All these
families who have already lost children or may lose children soon
cannot afford to buy grain in the market. They even find it difficult
to buy broken rice or wheat which costs half the price of normal
grain. The price for broken grain is also rising as the demand goes
up.

SUGGESTED ACTION:

Please write a letter to express your deep concern about these four
children's deaths from malnutrition associated with various diseases,
as well as the increasing number of malnourished children who may die
soon.

The AHRC has also written a separate letter, calling for
intervention, to the UN Special Rapporteur on the Right to Food and
the right of everyone to the highest attainable standard of physical
and mental health.

To support this appeal, please click here:
<http://www.ahrchk.net/ua/support.php?ua=HAC-003-2009 >
<http://www.ahrchk.net/ua/support.php?ua=HAC-003-2009>

SAMPLE LETTER:

Dear __________,

INDIA: Three tribal children died while other children are suffering
from Malnutrition in the rural village of Madhya Pradesh

Children who died of malnutrition associated with diseases:

1. Richu Baliram, two and half year old girl, died on May 9, 2009

2. Payal Brijlal, two month old girl, died on June 19, 2009

3. Shanta Ramesh, 18 month old girl, died on June 30, 2009

Children suffering from malnutrition associated with diseases:

1. Ramnarayan Ramesh, one and a half year old boy, grade IV
malnutrition

2. Richai Baliram, two year old, grade IV malnutrition

3. Bamcham Radhelal, one and a half year old, grade III malnutrition

4. Biliya Shivram, two year old girl, grade III malnutrition

Location: Korku tribal community, Dabhiya village, Khalwa Block,
Khandwa district, Madhya Pradesh

I am writing to you to express my deep concern about four children
who died of malnutrition associated with various diseases since May.
I am also writing to alert you to more children becoming malnourished
in Madhya Pradesh.

I am informed that four children died of malnutrition in Dabhiya
village, Khalwa Block, Khandwa district. I am aware that the Asian
Human Rights Commission (AHRC) has been monitoring and reporting on
children's deaths from malnutrition since they occurred in 2008.

I am surprised to learn that children are dying of malnutrition and
various other diseases again this year since the rainy season
started.

I am informed that Richu Baliram, a two and a half year old girl died
of malnutrition on May 10, 2009. She was at the Khandwa district
Nutrition Rehabilitation Centre (NRC) when she died. Richu was
admitted to the Khandwa district NRC on May 2, 2009 suffering from
grade IV Severe Acute Malnutrition (SAM), an illness associated with
diarrhea. I am further informed that she had been admitted four times
including this time while suffering from malnutrition since September
2008.

I am of the opinion that her death demonstrates that she continuously
suffered from malnutrition for a year although she had been admitted
four times for treatment. It shows that the NRC sends the child back
home without complete treatment for the malnutrition. Due to the home
situation, her family could not give her enough nutritious food to
make her healthy.

I have understood that the Anganwadi centre (AC; Child Care Centre)
for Dabhiya village, aiming to ensure heath and food security for
malnourished children at the village level, merely provides dried
grains as supplementary nutrition. They erroneously presume that all
malnourished children are given proper food at home. This practice
was also operative with the other deceased children and the children
currently suffering from malnutrition in their village.

I am informed that a two month old girl Payal Brijlal died on 19 June
and 18 month old Shanta Ramesh died on 30 June in the same village.
The latter suffered from malnutrition associated with measles and
respiratory infection. Both were not able to obtain treatment either
at the NRC or the AC.

I am further informed that apart from these three children's deaths,
four children currently suffer from malnutrition in Dabhiya village.

A one and a half year old boy Ramnarayan, suffering from grade IV
malnutrition associated with respiratory difficulties was taken to
the NRC on September 12, 2008. He was discharged from the NRC on
September 24, 2008, still suffering from grade III malnutrition
categorized as SAM. Ramnarayan's parents took him to a private
hospital for treatment, where his condition did not improve. In early
June, as a last resort, he was taken to a person in the area healing
through religious methods. A few days ago, Ramnarayan was again
admitted at the NRC where he is currently being treated. Two year old
girl Biliya Shivram, two year old Richai Baliram, and one and a half
year old Bamcham Radhelal suffering from grade III or IV
malnutrition, are all severely malnourished.

As it is shown in Richu and Ramnarayan's case, the NRC does not
provide full treatment for the malnourished child. Once the children
get a little better or a maximum of 14 days has gone by, the children
are sent back home without ensuring further treatment either at home
or at the AC.

I am also aware that the NRC aims to treat the malnourished children
by providing nutrition. It does not provide any medical care for
diseases or multiple infections associated with malnutrition. In
fact, during the rainy season, the unhygienic environment with its
absence of a proper sanitation system and lack of clean water causes
various diseases and infections to escalate with further
deterioration. I am of the opinion that without treatment for their
other diseases or infections, the malnourished children cannot
completely recover. Rather, it has been used as an excuse for the
children's deaths.

I am also aware that the NRC merely looks after the children
suffering from SAM with grade III and IV malnutrition. All other
malnourished children in the stage of I or II are left behind without
proper treatment. Particularly during the rainy season, their health
conditions deteriorate and they develop SAM sooner.

However, most of all, all the families of the deceased children and
currently malnourished children do not have food security at home.
Some have no farm land and are forced to migrate to neighbouring
districts twice a year in order to make a living. Those who have
small farms of one or two acres are also forced to do some other
kinds of work as the farm is neither irrigated nor productive. As
such, the families find it difficult to supply sufficient food for
their entire families. I am of the opinion that the farm lands and
facilities are the main key to ensuring food security at home.

I am also informed that the Below the Poverty Line (BPL) card
holders, like Payal's family, can afford to collect 20 kilograms of
rice and wheat at the ration shop. It lasts only a week for all
family members. I am informed that the quota from the central
government for the BPL families is much smaller than the quota of the
state government. The state government reduced the earmarked amount,
which is supposed to be 35 kilograms of rice and wheat under the
Public Food Distribution System (PDS), for the last two years.

I am of the opinion that the existence of this system in itself does
not mean that the government of India, as a state party of
International Covenant on Economic, Social and Cultural Rights
(ICESCR), fulfils its obligations. In practice, the institutions do
not prevent the children s deaths, as their policies are faulted and
do not reach the poorest tribal communities.

In the light of this, I urge you to intervene to prevent these
children's deaths, as well as to ensure food security at home by:

1. Providing not only nutrition but also medical care at the NRC for
malnutrition associated with various diseases and infections;

2. Providing treatment at the NRC for all stages of malnourished
children;

3. Keep on providing nutrition and food through the Anganwadi centre
for all stages of malnourished children;

4. Providing AAY cards to all families who had/have malnourished
child;

5. Providing farm land and facilities to improve productivity in
order to ensure food security at home as well as prevent additional
children s deaths in the future.

I am looking forward to your immediate intervention in this
situation.

Yours sincerely,

--------------

PLEASE SEND YOUR LETTERS TO:

1. Krishna Tirath

Minister of Women and Child Development

Government of India

INDIA

Fax: +91 11 2331 4788

E-mail: [email protected]

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: [email protected]

3. Principal Secretary

Ministry of Health & Family Welfare

Nirman Bhavan

Maulana Azad Road

New Delhi - 110011

INDIA

Fax: +91 11 2306 1751

E-mail: [email protected]

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: [email protected]

6. S.B. Singh

District Collector

Khandwa District, Madhya Pradesh

450001

INDA

Fax: +91 733 2224233

E-mail: [email protected]

7. Country Director

World Food Programme

2 Poorvi Marg, Vasant Vihar

New Delhi 110057

INDIA

Fax: +91 112 615 0019

E-mail: [email protected]

8. UNICEF

73 Lodi Estates

New Delhi 110 003

INDIA

Fax: + 91 11 2462 7521 / 11 2469 1410

E-mail: [email protected]

Thank you.

Urgent Appeals Programme

Asian Human Rights Commission ([email protected])

 <http://www.ahrchk.net/ua/support.php?ua=HAC-003-2009 >
<http://www.ahrchk.net/ua/support.php?ua=HAC-003-2009>



-----------------------------
Asian Human Rights Commission
19/F, Go-Up Commercial Building,
998 Canton Road, Kowloon, Hongkong S.A.R.
Tel: +(852) - 2698-6339 Fax: +(852) - 2698-6367



-- 
W A Laskar
Freelance Reporter and Human Rights Activist
with Barak Human Rights Protection Committee,
http://bhrpc.net.googlepages.com
15, Panjabari Road, Darandha, Six Mile,
Guwahati-781037, Assam, India
Cell: +919401134314

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