Failing them again: Beds remain empty as one-stop centres for rape survivors under Nirbhaya Fund remain crippled with low referral, official apathy

The anganwadi worker then took the girl to the OSC center at KEM Hospital with the help of an activist. “The mother even refused to accompany the child for medical examination. In such a situation, how could the police send her back to the chawl… When I asked the police to refer her to the OSC centre, they were even unaware of the existence of such a centre,” said the activist.

How Maharashtra and other states used the Nirbhaya Fund.

OSC centres were proposed by the then central government following the 2012 Delhi gang rape case to provide a single point of contact for medical, legal, social, and psychological aid to women facing sexual and domestic abuse in each district.

Set up in phases across the state spending crores of rupees, most of the OSCs are now deserted with empty beds. Some have been turned into couple counselling centres.

In response to a question in the Lok Sabha in 2021, the Union Women and Child ministry submitted data that showed that just 8,912 women were assisted in the 37 OSCs in Maharashtra — one of the lowest in India, while similar bigger states such as Tamil Nadu with 34 OSC centres catered to 19,991 women. Smaller states like Bihar with 38 centres attended to 18,005 women. Uttar Pradesh topped the chart with its OSC centres attending to 1,67,308 women.

However, it doesn’t indicate that crime cases against women are fewer in Maharashtra. In 2021, a total of 39,526 cases of crime against women were registered in Maharashtra — the third highest in India after Uttar Pradesh (56,083) and Rajasthan (40,738), as per the National Crime Record Bureau.

Earlier, while speaking to The Indian Express, Deputy Chief Minister Devendra Fadnavis also acknowledged the issue and said, “We will look into this… we are working towards better implementation of the scheme.”

The One-Stop Centre at Jogeshwari Trauma Centre and KEM Hospital. Rupsa Chakraborty

WCD Minister Mangal Prabhat Lodha didn’t respond to messages and an email sent by The Indian Express with four queries regarding the issue.

An in-depth study of the issue over two months pointed to reasons such as lack of infrastructure, training, showdown between departments and police apathy as possible reasons for the underutilisation of OSCs, along with hesitancy among women to reach out for help.

Empty beds, resolving marital disputes

At KEM’s OSC centre, empty beds and quiescent staff welcome you. One of the staff members said, “We hardly get any survivors here. No one knows about this centre, not even the hospital employees.”

The Indian Express collected data from 12 districts — Mumbai, Gondia, Wardha, Nashik, Raigad, Palghar, Parbhani, Thane, Dhule, Ahmednagar, Gadchiroli and Beed – through a series of Right to Information (RTI) applications. The response, along with ground reporting from several regions, revealed that only a marginal number of survivors of gender-based violence are being referred to OSC centres. The worst is state capital Mumbai that ranks second in recording the highest number of crimes against women in India, followed by Delhi, as per the National Crime Record Bureau (NCRB).

As per the data collected from the Mumbai Police Commissionerate, between 2020 and 2021, the city reported a total of 1,655 rape cases. Of these, just 16 or one per cent  were attended to at the city’s two OSCs — KEM and Jogeshwari Trauma Centre. In 2021, of the 888 registred rape cases, only 12 or 1.3 per cent were assisted (see graphic).

The OSC at KEM Hospital that serves Mumbai city district — a state-of-the-art centre launched in 2019, costing over Rs 1 crore — catered to seven rape survivors between 2019 and 2021. It didn’t attend to a single rape survivor in 2020, according to an RTI response.

Not just that, the centre that caters to 54 lakh women residents in Mumbai city has only one bed against the initial plan to set up five beds, as mandated by the Centre’s guidelines.Dr Nayreen Daruwalla, programme director, Prevention of Violence against Women and Children (Research, Partnership and Scaling) from Sneha NGO that maintains the centre, said that the 1,800-bed KEM hospital — the biggest civic-run hospital in Mumbai — didn’t provide the  promised additional beds. “We have been asking for the beds but to no avail,” she said.

The referrals of child sexual abuse that comes under the mandate of Child Welfare Committee are equally disturbing as only 59 such children were attended at the centre during the same period (2019-21).

Due to low referral rate, other than providing required medical treatment, the centre now mostly resolves marital disputes with the highest number of cases being of domestic violence survivors. In 2019, it catered to 13 cases that further increased to 184 in 2020 and 284 in 2021.

The staff claimed that as women who are subjected to sexual and domestic violence don’t want to take legal action against their husbands, they have to send them back home after couple counselling.

“All the women who come to our centre are provided immediate medical treatment. In 90 per cent of the cases, they refuse to take legal action against their husbands,” said a staff member.

However, women’s rights advocates say it fails to resolve the atrocities against women. Advocate Audrey Dmello, director of Majili—an NGO that works for women’s rights, cited an example where a woman in her mid-30s (kept anonymous under Section 228A of the IPC) from a slum in Mumbai was regularly subjected to domestic violence by her husband under the influence of alcohol. Once, the situation aggravated to such an extent that a neighbour had to call the police. There she was referred to the OSC centre but  was sent home after couple counseling. Later, she was beaten up so badly that she required hospitalisation.

“In very rare cases, women sustain severe and life-threatening injuries like Nirbhaya. So, more than just counselling and medical treatment, they require legal aid,” Dmello said.

“What is the point of spending lakhs of rupees on such a centre if women repeatedly keep falling prey to crime,” she added.

The condition of the OSC in the Jogeshwari Trauma Centre, which caters to Mumbai-suburban district, has six beds. However, the referral of women is still poor. The centre, which was earlier in Beggar’s Colony and later shifted to the hospital in February 2021, has catered to just nine rape survivors — three in 2020 and six in 2021.

These two centres in the financial capital point to a much larger problem. Most of the centres in the state are sailing on the same boat, failing to help victims of gender-based violence due to lack of coordination between government departments, inadequate resources such as counsellors, and failure to link these centres with helplines.

However, the referrals of survivors is much higher in districts with more semi-urban and rural populations.

In Palghar, between 2019-2021, a total of 66  rape survivors and 460 domestic violence survivors were refered to the OSC located at the Matoshri Bungalow outside the district hospital. In Thane, the OSC at Kalwa district hospital catered to 122 rape survivors between 2018 and 2021. The district had recorded 367 rape cases in 2021.

Considering the huge budget provided for the scheme, the OSC centres are not being used to their maximum limit. Most of the referred survivors are from the hospitals themselves.

Reasons galore

Police are the first point of contact who refer only one in every 300 registered cases of crime against women to OSCs, shows RTI data. There is no provision to hold them responsible for not providing help for the survivor’s mental health after their mandatory health checkup.

“In most of the cases, when a complainant goes to file a rape case, police look for physical assault marks. But the bruises are visible only in a few cases. Often, they register the case after much refusal and do the compulsory medical examination but ignore the required psychological counselling,” says Sandhya Gokhale, member, Forum Against Oppression of Women (FAOW).

The Indian Express inquired with over 10 police stations in Mumbai such as Bandra, Dharavi, Chembur, Aarey, Govandi, Bhan-dup among others about OSCs, when most of them confused the centre with shelter homes.

An officer from Mankhurd police station said, “We ask the survivor if they wish to go back to their houses. If they refuse, we make alternative arrangements in shelter homes where they generally get legal and psychological help.”

Dr Daruwalla also accepted that police don’t refer the survivors to OSCs. “Now, we have started conducting workshops to sensitise police. At some police stations, we are setting up help desks to refer the survivors to OSCs,” said Swati Bandose, incharge of OSC at Jogeshwari Trauma Centre.

Kavita Thorat, incharge of Thane OSC located at Chhatrapati Shivaji Maharaj Hospital, Kalwa, reasoned that with 14 staffers, it is impossible for them to track all the survivors from police stations. “We admit all the survivors to the centre who visit our hospital for treatment. But there is a considerable number of such women who don’t get referred and it’s not feasible for us to trace them,” she said.

There is also another side to the coin. Survivors often refuse to take shelters at OSCs because of the fear of being tagged as “raped” or being recognised by others. Nishit Kumar, who was associated with NGO Childline for over 11 years, says, “Respect the privacy of the aggrieved woman/survivor and her family, and ensure confidentiality of the case and her identity.” But the OSCs, established in a haste, are located on the crowded corridors of hospitals.

“As instructed, most of the centres are on district hospital premises… the one at KEM is  on the ground floor near the radiology department. This not only compromises the privacy of the survivors but also discourages them,” adds Kumar.

In most of the cases, social workers have observed that the families leave their homes and migrate within 24 hours after the FIR is filed. “Once a complaint is filed, the family or the survivors just want to stay away. They don’t seek any psychological counselling,” says Daruwalla.

Refusal to seek medical care is the biggest challenge that doctors face. Ignoring immediate care for the survivors can cause serious consequences, according to Dr Ankita Abhay, medical officer at the Umeed ki Kiran clinic in New Delhi, run by global international medical humanitarian organisation Médecins Sans Frontières (Doctors Without Borders) for providing medical and psycho-social care to survivors of sexual and gender based violence.

Some women even refuse to consider it as an abuse and question themselves. “In such a situation, we have to counsel and make them understand. Often the women go through psychological effects of the violence,” said Dr Ankita.

Sex-workers or transgenders, who often get abused, refuse to approach OSCs because of the fear of being discriminated against.

Staring at failure

In 2020, the Maharashtra State Commission for Women submitted a report to the Women and Child Development (WCD) ministry that  of the 11 OSCs that were subject to a study, nine didn’t function for 24 hours, nine had no trained staff, multiple centres had lack of infrastructure, nine had no implementing agency or NGO to monitor them and at many, issues of delayed funds from state government were persistent. The situation has remained the same for years, the report said.

Under the OSC centre scheme, other than providing psychiatric evaluation and legal aid, the central government also wanted to make provisions to provide facilities for medical examination under one roof. However, at most OSCs, if a woman is not severely physically injured, she is referred from one ward to another for medical examination, ignoring her mental trauma.

For instance, a 22-year-old woman who was raped by her father’s friend last year in Nandurbar, was admitted to an OSC located inside the district civil hospital. She couldn’t even eat due to the trauma. Despite being fatigued and having low blood pressure, she had to walk to the gynecology ward for medical examinations. “No doctor visited me in the centre except for the counsellor. I always had to walk for my medical examinations,” said the woman.

Dmello said that this further exposes the identity of the survivors when they are  referred from the tagged centre to other wards for examination.

The situation is the same in most OSCs. A staff at OSC in Latur which is located on a plot in Netaji Nagar, near Kalge Hospital, said that when they get a survivor, they take her to the gynecology ward for examination.

A doctor who heads one of the OSCs in Mumbai, responded that managing the OSCs in government hospitals, most of which that run with 40 per cent staff crunch, is a challenge. “The conc-ept of OSC is bizarre. Earlier, we had one room inside the gynecology ward where the survivors were  examined by doctors… it was more effective,” said the doctor.

“Maintaining a seperate centre with skeletal staff is a challenge for any tertiary care hospital. The WCD wants to push all the responsibilities on the health department,” he added.

This departmental tiff is visible in most places due to lack of clarity in the guidelines on bifurcation of duties among various departments. Dr Pratibha Thorawade from Jogeshwari Trauma Centre and former medical superintendent of the hospital, said that despite repeated requests to appoint an official at the entrance of the hospital to sensitise people about the centre, the OSC hasn’t paid any heed.

“The hospital needs to have a help desk at the entrance and sensitise people about the existence of the OSC, which is located on the 10th floor. Neither the police nor the public are aware of such a big facility which is spread over 1,500 sq ft,” she said.

Most of the OCSs also lack basic facilities required as per the guideline of the Central government. Many don’t even have the government-specified number of counsellors. RTI applications revealed that in Gondia, a rural district, of the six sanctioned posts, five are vacant. In Palghar, which has high incidences of sexual and domestic violence cases, the post of a counsellor was vacant for seven months till January 2022 after a resignation in July 2021.

Funds not used

Underutilisation and slow operationalisation of approved projects also nag the OSCs. Data collected from the Centre showed that Maharashtra received Rs 30.02 crore under Nirbhaya Fund, amounting to 4.21 per cent of the nation’s total allocation. Between 2016-17 and 2020-21, the Central government released Rs 23.56 crore from the national Nirbhaya Fund to the state for OSCs. Of which, the state submitted utilisation certificates of Rs 4.57 crore, as per the data submitted by WCD ministry in the Lok Sabha in February 2022.

Amid the Covid-19 pandemic, when there was a significant rise in instances of crime against women, especially domestic violence, the Centre released Rs 6.46 crore to Maharashtra, of which just Rs 6 lakh was utilised.

Data collected through RTI shows that for the OSC at KEM Hospital, the Centre provided Rs 45.42 lakh in the same three-year period but only Rs 26 lakh or 57 per cent was utilised. The situation is the same across other districts like the OSC in Thane — the second biggest district after Mumbai that received over Rs 96 lakh since 2017-18. However, the  utilisation is over Rs 76 lakh as of 2021-22.

Social advocates claim that the fund could have been used to increase sensitisation through advertisements and upgrading the infrastructure. “Have you ever noticed an advertisement in any hospital or public place about the presence of OCCs? The government has allocated little, disbursed even less, and utilised meagre sums,” said Gokhale.

Need for better accessibility

A clear need of decentralisation has been established so as to make the OSC more accessible to women in need.

Deepak Pandey, Inspector General (Prevention of Atrocities on Women) stated that in a state like Maharashtra with over 12 crore population, just 37 OSCs at district-level isn’t efficient to address the issue of women safety and rehabilitation. So, last December, he wrote to the Home department to have separate units at police stations to attend to complaints of crimes against women and children. “Often, women hesitate to go to OSCs. So, with these centres at the police stations itself, we will provide services like counseling, legal assistance, police protection and medical help, among others,” he said.

Activists outlined the need to make the centres more accessible, at a closest proximity. Latika Rajputa, a member of Narmada Bachao Andolan (NBA) who works in tribal-dominated Nandurbar district, also highlighted the geographical restrictions and accessibility. “It is impossible for survivors from remote talukas like Akkalkuwa which is 50 kilometers away from the district OSC to come at night through the hilly terrain without street lights. This is such a badly planned scheme without any execution,” she said.

Recommendations

(Experts suggested these recommendations for the state authorities to consider)

1. Sensitise police officers about OCSs to encourage them to refer women to the centres.

2. Improve accessibility for women to reach the centres on time for treatment.

3. Set up help desks at hospitals’ entry points so the women can be guided in reaching the centre by maintaining her anonymity.

4. The healthcare workers would be given SOPs and trained in dealing with survivors for treatment.

5. Focus on advertisements in public places to create awareness among the general population.

6. Put up posts about the centre and helpline numbers at police stations under awareness programmes.

7. Increase departmental accountability to find out the reasons behind underutilisation of the centres.

8. Focus on programmes to create awareness about the medical and treatment requirements post-gender based sexual violence.

This story was supported by the Medecins Sans Frontieres (MSF) Without Borders Media Fellowship. MSF, also known as Doctors Without Borders, works with journalists to encourage independent, impartial and neutral reporting on health and humanitarian crises.