In the weeks before he died in India’s West Bengal in August, 30-year-old migrant worker Sanjoy Sardar rarely ate more than one meal a day. Activists say the government is systematically failing to classify such deaths as starvation.
Sardar, who travelled near and far to find what manual labour he could, was forced to stop working altogether after being diagnosed with tuberculosis in June. That left his wife, Saraswati, putting aside most of the little food they could afford for their children.
“We had been eating only one meal daily, or the equivalent of one meal split across two meals, before Sanjoy’s death,” Saraswati Sardar told The New Humanitarian in the village of Bhula Beda, in Jhargram district.
The government hasn’t logged a single death from starvation since 2016, but Mrinalini Paul, who works with the Right to Food and Work Network (RTFWN), a local NGO, said it’s clear Sardar’s death should have been recorded as one, as should many others.
The Sardar family was eligible for 35 kilos of rice and grain monthly from a government-run aid programme but had been approved for just two kilos because they lacked the right ID documents, according to Paul. “They had been without even these minimal benefits for six months,” she told The New Humanitarian.
Sunil Agarwala, the district magistrate of Jhargram, refuted the allegations, telling The Hindu newspaper they were "baseless", while insisting that Sardar’s death “was due to illness, TB, and other reasons”.
“We had been eating only one meal daily, or the equivalent of one meal split across two meals.”
According to the World Health Organization, undernutrition is a key driver of TB, while malnutrition also makes TB therapy less effective and raises the risk of TB-related death.
The recently published Medical Certification Cause of Death (MCCD), 2020 report found that fewer than a quarter of the 81,15,882 registered deaths in India that year had known causes. Hunger activists are alarmed that a country with 1.4 billion people can only verify the causes of 22.5% of its documented fatalities.
Swati Narayan, assistant professor at the School for Public Health and Human Development at O.P. Jindal Global University, told The New Humanitarian that medical workers are unlikely to catch if the cause of death is starvation given how post-mortems are typically carried out.
She said it was crucial to also consider the person's socioeconomic position and the condition of their body, including the weight of their organs, visceral fat, and diseases brought on by a weaker immune system and malnutrition.
“The post-mortem reports are not an accurate reflection of hunger or starvation deaths in the country,” Narayan said. “Oral autopsies are much better at determining if the cause of death was hunger.”
Worsening hunger and the fight for a stronger safety net
Question marks around Sardar’s death and others like it – a similar case involving three “hunger deaths” in the same family went before the high court last month in Jharkhand, which borders West Bengal to the east – come amid signs of growing food insecurity in India.
The 2022 Global Hunger Index ranks India at 107 out of 121 nations, six places lower than its previous ranking, and below the likes of Ethiopia, Bangladesh, and Pakistan.
While India remains in the “serious” category rather than “alarming” or “very alarming”, it recorded the highest percentage (19.3%) of any country of children under five who are “wasting”, meaning they’re below average weight for their height.
The pandemic made hunger worse, but income losses and rising debt continued to drive it up long after the worst of the health crisis had passed. A survey by the Right to Food Campaign in late 2021/early 2022 found that nearly 80% of respondents faced food insecurity, and almost half had run out of food the previous month.
However, the hunger problems also pre-date COVID. India’s last National Family Health Survey, which used data from 2019, found that stunting – a sign of chronic malnutrition – had risen in 11 out of the 17 states. In 13 states, wasting had also increased.
“I had resorted to begging on the streets because I had no food at home.”
Over the last two decades, the Indian government has developed the Public Distribution System (PDS) – which relies on the world’s largest biometric system, Aadhaar – to try to alleviate hunger by distributing staple foods at low cost to those in most need.
But experts say there are some major holes in the system.
“The main limitation of the PDS is that it does little more than to provide a modicum of food and economic security to poor households,” economist Jean Drèze told The New Humanitarian.
“That is certainly an important achievement, but it falls far short of ensuring adequate nutrition,” he said. “That requires a broader range of interventions, including child nutrition programmes, maternal care, public health measures, and quality education.”
Plenty of people appear to be slipping through the cracks.
“I receive only rice, but how can I survive on just rice?”
For example, as someone suffering from leprosy, Swapan Sahis is entitled to a separate ration from the state government in West Bengal. But he hasn’t received this ration for the past year because the biometric system can’t accommodate people with no thumbs or fingers, a common symptom in leprosy patients. To verify their identities, Aadhaar card-holders have to punch their thumb or fingerprints into point of sale devices at PDS stores, as their information is checked against a central database.
“I had resorted to begging on the streets because I had no food at home,” Sahis told The New Humanitarian.
Likewise, Fani Deswali requested rations that are separately provided for widows, but they were denied to her because she was over the age of 60. “I receive only rice, but how can I survive on just rice?” she asked. “I need salt, oil, and other rations to cook a meal with rice, but the ration dealers only give me eight kilos of rice every month.”
There’ll be even greater concern going into 2023 as the government’s additional “free food programme", which has provided families with five kilos of grain every month since April 2020 as a COVID relief measure, is due to wrap up at the end of December.
In January 2022, the central government told the Supreme Court that no states had reported any deaths due to hunger in the previous year. At issue before the three-judge bench was a public interest litigation petitioning the central government, individual states, and union territories to establish a plan for coordinating the operation of community kitchens in the fight against hunger and malnutrition.
Anun Dhawan, Ishann Dhawan, and Kunjana Singh filed the petition seeking an order to establish a national food grid for those who don’t qualify for food aid under the PDS. It remains to be seen whether it will be implemented.
Edited by Abby Seiff.