Cometh the hour, cometh the man’ aptly describes the role of Iqbal Singh Chahal – the Commissioner of Brihanmumbai Municipal Corporation – in handling the Covid crisis. I have no doubts that there are many such crisis managers making a difference all over India. However, media reports highlight that in a large number of small towns and rural areas with poor health care infrastructure, Covid-19 management is below par.
Every officer, Junior Commissioned Officer and Non-Commissioned Officer of the armed forces is a trained crisis manager. He has no choice but to be the one to accomplish the assigned mission in battle that is contingent on organisation, coordination and minute-to-minute management, apart from combat per se. In aid to civil authority or in disaster management, the Commanding Officers, who have 15-20 years of experience and have 500-800 personnel and ample transport under command, are the ideal crisis managers. They are backed by even more experienced brigade and division commanders.
This managerial capacity, workforce, and transport resource in conjunction with the Army’s capability to establish nearly 100 field hospitals may be the solution for the catastrophe unfolding in our rural areas. 516 districts out of 734 are returning a positivity rate of more than 10 per cent, and that too with a very low testing rate.
Are the armed forces being optimally utilised?
On 10 May, the Chief of Defence Staff General Bipin Rawat gave an interview to India Today on the contribution of the armed forces in the management of the pandemic. He emphasised that the Disaster Management Act 2005 empowers the government to employ the armed forces to assist the civil administration. The Defence Minister, advised by the Director General of the Armed Forces Medical Services, is coordinating the employment of armed forces’ resources through the Defence Secretary, based on feedback from empowered committees, various ministries and state governments. Under Aid to Civil Authorities, the civil administration is also requisitioning military assistance. Emergency financial powers have been delegated to relevant military commanders to procure the necessary additional medical equipment.
The tangible contribution of the armed forces has been in the transportation of medical oxygen and related equipment from abroad and within the country by the Indian Air Force and the Indian Navy. The forces are manning the various DRDO hospitals created through outsourced construction in various cities. They are also assisting the civil administration in various states, primarily in urban areas on as per need by setting up field hospitals to supplement the existing infrastructure.
The current focus of the armed forces’ effort seems to be on a few large cities to create 100-to 1,000-bed hospitals through outsourcing by the DRDO. These are being managed by the medical staff from the armed forces. Most of these hospitals do not have ICU facilities and primarily focus on management of moderately severe Covid cases. No effort of the armed forces has been deployed in rural areas.
No doubt these facilities have supplemented the State’s response in the cities, but these have also led semi-permanent commitment (until the situation stabilises) of the bulk of the armed forces’ doctors and medical personnel. Resources have also been moved from field formations impinging on their capabilities to create military-style field hospitals. There are reports of the Battle Field Nursing Assistants of field units and even personnel of Remount and Veterinary Corps being deployed to assist the hard-pressed medical staff. 400 retired doctors are also being reemployed.
Normally, the principle should be that the medical staff of the armed forces must be superimposed on state/city resources to enable them to be redeployed for war or in other critical areas. At best, their commitment can be a stopgap measure until the State creates the resources by invoking emergency powers to deploy private doctors and other medical staff. This should have been the rule for 100-to 1,000-bed hospitals created by the DRDO and armed forces. It is not too late for remedial action to relieve the military medical staff for redeployment in critical rural areas for the recurring Covid waves.
A plan of action
Covid-19 is rapidly spreading in our rural areas. The media is full of harrowing tales of rural Covid spread from UP and Bihar with hundreds of dead bodies (most likely of Covid victims) floating in river Ganga or buried in shallow graves on the banks. One should presume, sooner than later, similar conditions may prevail in all villages and small towns of the country. The media has also highlighted the pathetic state of medical infrastructure in rural areas. The Allahabad High Court observed that the “entire medical system” of Uttar Pradesh “pertaining to the smaller cities and villages can only be taken to be like a famous Hindi saying, Ram Bharose (at the mercy of God)”. The situation in most of the other states is no different. The central government has sent down an idealistic and elaborate advisory on management of Covid in rural areas.
In my view, given the experience so far, there is no way the states can implement this advisory without the help of the armed forces. A case in point is my own district — Fatehgarh Sahib — where rural cases are on the rise and the eight district hospitals do not have a single ventilator. The patients are rushed to already-choked large city hospitals. Most village sarpanches are ignorant of fundamental Covid management.
I recommend the following plan of action:
- Invoke emergency powers under the National Disaster Management Act, Civil Defence Act, Union War Book, Defence of India Act, Epidemic Diseases Act, among others. This will authorise the mustering of not just doctors, paramedics and civil defence volunteers but also transportation, buildings and other essential services and facilities. Relieve the military personnel deployed in the large-size temporary hospitals to enable them to move to rural areas.
- Place affected districts under a Brigade/Battalion Commander to manage the battle against Covid. They must run rural district/town Covid war rooms/command posts.
- Armed forces must deploy tents/prefabricated shelters/requisitioned buildings to operationalise field hospitals. These must retain their mobility to redeploy once the civil infrastructure is created.
- The armed forces must be utilised to manage/supplement Covid testing, transportation of patients, hospital beds, medical oxygen and the vaccination programme.
- Our citizens deserve a decent cremation/burial. Armed forces have done this before and can do it now.
Time is running out. The government and the military need to review their strategy to optimise the utilisation of the armed forces by shifting the focus from urban to rural areas. Utilise the managerial skills and vast medical, transport and workforce of the armed forces to manage the fight against Covid in rural areas and mofussil towns.
Lt Gen H S Panag PVSM, AVSM (R) served in the Indian Army for 40 years. He was GOC in C Northern Command and Central Command. Post retirement, he was Member of Armed Forces Tribunal. Views are personal.
(Edited by Anurag Chaubey)