Written by Nem thian ngai Guite
The conflict in Manipur will complete two protracted years of crisis in May. It has resulted in arguably one of the highest numbers of forcibly displaced persons in contemporary times. The recent interim political arrangement in the form of presidential rule in the state is yet to address the humanitarian crisis that has been a fallout of the violence. Urgent action is needed to prevent further deterioration of the situation.
In wars and conflicts, direct injuries and mortality usually represent a small proportion of the overall loss of lives. Far more lives are lost as a consequence of the breakdown of structures of governance. The relationship between conflict displacement and morbidity is complex and intersects with political, social, military, economic, and demographic factors. Healing Manipur will require a nuanced understanding of and an expanded perspective on the quiet but catastrophic effects of the conflict — health-system disruption, disease-burden amplification, and healthcare-access barriers.
The death of an 11-month-old infant in the same relief camp that he was born in — Sangai University relief camp in Lamka, Churachandpur district — illustrates this point. His family had fled from Saikul, their village, during the conflict. There are similar stories of loss coming out of other relief camps in places such as Moirang. The Community Health Centre (CHC) in Kangpokpi district is facing a shortage of supplies, especially gloves, vaccines and medicines. The CHC also recorded information about three children with congenital heart disease who died as they could not access medical care. The children were eligible for treatment under the Rashtriya Bal Swasthya Karyakram of the National Health Mission. But the tragedy is that the hospital where the scheme could be availed is in the Imphal district, which has become inaccessible for many due to the conflict. There are hundreds of such cases of illnesses and deaths and exacerbated mental-health crises. The sad and uncomfortable truth is that this is a reality that has barely been acknowledged from the beginning. The incompetence and apathy of the Manipur government in addressing conflict-induced displacement and the multi-dimensional effects on the health system have been glaring.
There have been other health fallouts, too. Displaced populations have limited access to clean water, food, and sanitation — the basics of public health. There is a heightened risk of communicable diseases. Women and children are also rendered vulnerable to sexual assault, harassment, isolation, early marriages and exploitation. The effect on mental health is equally grave. Psychological consequences of war include post-traumatic stress disorder (PTSD), anxiety, depression, and somatoform disorders. Rather than addressing these, the Home Minister felt it is more vital to have an empty bus travel through the hill districts.
The issue of displacement tends to get subsumed within the broader dynamics of violence and conflict. Unfortunately, its impact will go on for several years. Therefore, the more significant challenge that the government needs to focus on is developing effective interventions to address long-term impacts of the crisis. Even now, the situation remains such that people in districts such as Churachandpur and Kangpokpi districts tend to avoid travelling to the Imphal district for medical care.
The conflict in Manipur has exposed the poor public-health delivery system and the absence of strong health infrastructure in the hill districts of Manipur. The concentration of health service infrastructure, from hospitals to medical colleges to diagnostic centres to healthcare professionals, in both the private and public sectors, are all mostly in the Imphal district. The State Health Report, NFHS data throughout the years, the National Health Resource Centres highlight the neglect of the hill areas in the public-health delivery system, be it in budgetary allocation, placement of efficient health professionals, or developing proper communications and transport.
This could, however, also be an opportunity for constructive change if systemic inequalities are addressed and the healthcare system is strengthened through collaboration and innovation. For example, Sweden, which is a leader in quality universal healthcare, developed its current system after a crisis in the mid 20th century. Given the endemic nature of ethnic conflicts in Manipur, we need to have a multi-layered approach. There are many unaddressed traumas, which necessitate strengthening mental healthcare provisions. Manifestations of unresolved conflict need to be addressed immediately with greater political will. At the micro level, community ownership and civil society-driven initiatives need to be encouraged. Community mobilisation and citizenship engagement are required to make administrative measures effective. The situation in Manipur is far worse than what mainstream media or government reports tell us. It is high time that the governor addresses the reality.
The writer is associate professor, Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi
