In November 2021, Chand Sayyed was squatting outside the intensive care unit at the Ahmednagar Civil Hospital, located on the ground floor, when he saw smoke emanating from the ward's window.
Sayyed's 65-year-old mother was on oxygen support and was too depressed to walk on her own. She rushed towards the ICU, but award boy harmed him, and assured him that staffers were working on the situation.
The silence passed, and the smoke shrank.
Sayyed and other relatives of patients were pushed past the ward boy as they entered the ICU, so that the smoke was so intense, and they could hear screams of patients, most of whom elderly individuals.
Sayyed and his cousin retreated to the nearest bed, claiming that the patient was his mother's neighbour in the room. She had an oxygen mask on, but the mask was filled with smoke. She did not shake when Sayyed shaked her. He realised she was dead.
In that moment, he also realized that his mother could not have survived the tragic incident.
The ICU was composed of 17 people, including eleven people in that day; three more have died in the upcoming days.
When a patient yelled, "Sister! Sister!" minutes before Sayyed saw the smoke, nurses Sapna Pathare and Anant Channa were sipping tea in a room to one side of the ICU.
Both stepped out and saw smoke emanate from the misleading ceiling above beds numbered 17, 18, and 19. Bed number 17 was occupied by Sayyed's mother.
In the ICU near the nursing facility, Channa grabbing it, pulled its trigger, and directed it towards the ceiling. Eventually, Pathare asked nurse Asma Shaikh, who was sitting at a counter outside the ICU, to complete case papers.
Shaikh called police for help. "It all happened in a few minutes," she said. "The entire ICU was filled with smoke. We could not see anything."
District officials said they suspected the fire sparked by an overheated air conditioner, and that smoke spread between the false ceiling and the main ceiling before entering the courtyard. The heat from the fire and smoke melt the plaster of Paris, which collapsed suddenly, allowing smoke to spread rapidly in the ward.
Nurses Channa, Shaikh, and Pathare have lost their jobs. Vishakha Shinde, the resident doctor on duty, was placed on administrative leave.
All four were arrested on Nov. 9, on allegations of causing death by negligence. They were then subjected to a week of police custody, then reprimanded to a magistrate's custody, which ensued. Dr Sunil Pokharna, the district's civil surgeon, was also suspended and detained on November 9.
The whole staff of the hospital went on a strike for six days to protest arrests. If the hospital had a fire alarm, a smoke detector, and a sprinkler, the fire would have been detected earlier, said nurse Surekha Andhale. Why are nurses and doctors being punished for dreading by the district government and the state?
Where is the fault?
Documents from Scroll.in show that a proposal to construct a firefighting system in the hospital was then moved from one department to another for eight months that year, as it waited for approval. The state government finally sanctioned 2.60 crore rupees ($341,667) to build a system on November 9, three days after the tragedy killed 14 patients.
The quagmires in the hospital's safety systems are far from entirely unique.
In January 2021, the public health department of Maharashtra had ordered all state hospitals to undergo fire safety inspections. First, a total of 484 hospitals were audited, of which 90% were found to be functioning without a no-objection certificate from the fire department. An NOC is then issued to a hospital when the fire department undertakes an audit and confirms that a hospital has a firefighting system.
Scroll.in filed Right to Information requests with the central government and the Delhi government, seeking information on clinics that function without firing NOCs. So, the government does not maintain such data centrally, and transferred the RTI requests to several major government hospitals in Delhi and across India. So far, only ten hospitals have responded, of which eight provided data.
Four central government-funded hospitals are operating without or without partial NOCs from fire departments. These include: Ram Manohar Lohia Hospital in Delhi, Lady Hardinge Medical College Hospital in Delhi, and the Post Graduate Institute of Medical Education and Research, the largest public hospital in Chandigarh and All India Institute of Medical Sciences, Bhubaneswar, one of the most famous public hospitals in Odisha. In the Chandigarh hospital, 385 fire mishaps between 2016 and 2021, or one fire
The serious damage to this fact has been caused by scroll.in's media reports from August 2020 to the present show that 122 people have died in 29 major hospital fires across India in just 20 months. The compilation included only fires that resulted in massive damage or fatalities. Twelve of the 29 hospitals involved were government facilities, including the Ahmednagar hospital.
The Ahmednagar fire department received a call from the hospital, which is the largest in the district, on November 6, 2015. According to a sub officer Balasaheb Ghatvisave, the hospital was three kilometers away, and provided assistance to staffers and relatives with the surgery. Three patients were lucky that their cots were placed near the hospital entrance. One local Shiv Sena leader has been involved in fire safety issues in the district's hospitals.
Sayyed, a van driver, fled the hospital with his mother, grinning through dark smoke to reach her bed. "Some nurses were also trying to get patients out. "Although the fire brigade arrived, seeing the elderly woman out of the hospital, Sayyed was able to return.
His mother's mouth was a little open. An oxygen mask positioned tightly over her face was filled with smoke. She was unable to respond.
A nurse cut something into her, slugged her into another restroom, where she declared Chababi Sayyed dead.
Government-run hospitals are in danger.
Millions of Indians depend on government-led hospitals. In many districts, these hospitals, such as the Ahmednagar Civil Hospital, are only available healthcare. At any given time, their corridors are falling over with people, and their wards are filled with patients. These hospitals are still alarmingly vulnerable to disasters.
Between 2010 and 2019, a 2020 publication in the International Journal of Community Medicine and Public Health analysed 33 major fire mishaps in Indian hospitals, including 25 in government hospitals. Only 19 of the 33 hospitals had a good firefighting system.
Dr Rashmi Sharma, an associate professor of community medicine at GMERS Medical College in Ahmedabad, has stated that government hospitals are the most serious violations of fire safety regulations.
"Davon all of the 19 fire incidents I've investigated since 2011, 90% have occurred in government hospitals," she said.
Manoj Choudhury, the director of Edifice Consultants Private Ltd, an architectural and construction company, echoed this concept. "A lot of designing is compromised to save money, according to him. That way, government hospitals always go for the lowest bidder, lowering quality standards. This is why public projects are prone to such delays."
Hospitals in India are classified under the C1 category, because such buildings must have additional infrastructures for fire safety.
Fire alarms, smoke detectors on every floor, fire extinguishers, and fire hydrants must be provided in basement spaces, as well as ventilating ducts, which must be secured in non-combustible materials.
The National Building Code is comprehensive and detailed. But most hospitals do not even follow it, said Choudhury. It is ignorance about safety standards that causes fire mishaps.
The central government introduced an existing model bill on fire safety, which many states had used as a reference point for state-level laws. (Fire services fall under the state list, and the model bill was drafted to serve as an advisory document for states.) The revised model bill included several additional modifications, including that buildings measuring 15 meters high should be equipped with automatic fire alarms and fire extinguishers, according to scroll.in. no state had yet fully adopted the provisions of the model bill into its own laws.
When it comes to fire safety, hospitals must be cautious. Sharma explained that intensive care facilities, air-conditioned wards, operation theatres, paediatric or neonatal ICUs, and X-ray and dialysis rooms are susceptible to fires due to the presence of heavy equipment. Oxygen-rich environment provides fuel to the fire.
Hospitals should not use combustible materials, such as plaster of Paris, for walls or ceilings inwards, according to Choudhury. Instead, fire-resistant sheets, made of materials such as. That must be capable to resist fire for at least two hours, he said.
Fires were triggered due to electrical difficulties in 78 percent of the 33 cases it examined. Air conditioners were "the most common source" of the fires.
According to the study, around a third of the incidents occurred in or near ICUs. According to Rahul Kadri, the partner and principal architect of IMK Architects, which has constructed hospitals in Mumbai, Hyderabad, Pune, and Latur, said that when a hospital space is transformed into an ICU, it is critical to ensure that sufficient power supply is provided and that adequate electrical wiring is required to carry large loads.
"Each bed in an ICU requires a ventilator, monitors, and multiple machines," Kadri said. "The design and function of an ICU are different from the standard wards, and their electrical load is always high."
The ICU complex at the Ahmednagar Civil Hospital was, in fact, not designed for intensive care treatment. Instead, it was constructed in 2016-17 under the National Health Mission, to treat paediatric, dialysis, burn, and orthopaedic situations.
As the war spread across the country and the cases increased in Ahmednagar, one of the civil hospital's buildings was subsequently converted into a covid-19 ICU. According to Shiv Sena's Girish Jadhav, the work was quickened. However, a civil surgeon's office in the district said an electrical audit was carried out to investigate the wiring system.
The shortage of staff makes government hospitals more prevalent than most government buildings. Besides, the department's engineers are also responsible for the regular maintenance of infrastructure and electrical wiring.
There are three sanctioned positions for sectional engineer, one for deputy engineer, said Jagdish Kale, the deputy electrical engineer of Ahmednagar district. I am the only one permanent post. Other two posts of sectional engineer are occupied by officials with additional charges.
Kale's labor is enormous. The electrical department is able to manage all of the government buildings in a district. Their dismal schedule means complaints of sparks or circuit breaker trips in a hospital may last for a long time.
Amal Mohite, an assistant engineer for Brihanmumbai Municipal Corporation who worked as an electrical engineer in Mumbai's Sion Hospital for over a decade, said hospitals with 50 or more beds should ideally have a dedicated electrical engineer.
According to official health officials in Madhya Pradesh, Gujarat, and Maharashtra, the only hospitals in their states that had posts for electrical engineers were those that were attached to medical facilities, which were typically larger in size; rural hospitals, and even district hospitals, did not have such positions.
Small complaints such as sparking, tripping, overheating are often ignored, according to Mohite. A hospital is always increasing, adding ventilators, ICUs, and additional equipment, he added. The electrical load is steadily increasing, and regular audit is very important, according to Mohite. While some corporate hospitals conducted electrical audits, most government hospitals in India did not.
In Indore, a brutal fire
In 2017, a fire struck the sick newborn care unit, or SNCU, at Indore's Maharaja Yeshwantrao Hospital, or MY Hospital.
A ventilator had provided enough protection for the newborn on November 23, 2017, causing the number of children to be admitted in 28 cots in the United Methodist Church. Two babies were immediately put on the same cot, according to a nurse. At around 4:30pm, a nurse picked up the newborn who was on the ventilator, rushed to the next room, and placed the baby on a cot there.
Seconds later, there was a blast in the oxygen pipeline that stretched near the ventilator. Despite the impact, the tiles and ceilings of the SNCU were cracked. Nurses and staffers rushed all the newborns to the adjacent ward. When the flames remained, the babies were moved to an adjacent terrace.
There were no water sprinklers, hosepipes, fire alarms, or smoke detectors in the hospital. In disobedience, the hospital personnel tried to use two fire extinguishers that were placed in the hall to douse the fire, before the fire brigade arrived and controlled it.
The fire, which is believed to have started owing to a short-circuit in the ventilator or the switchboard, damaged the entire SNCU, a station in which infants are permitted to live.
A five-day-old baby girl was discovered dead at the age of 15, according to a post-mortem report mailed to the Indore bench of the Madhya Pradesh High Court in a public interest complaint. She died following the fire due to a cardiorespiratory failure.
Mulayam Singh Rajak, the 28-year-old baby's father, is struggling to believe it.
My baby's body was sober when my nurses handed her to me, he said. How did I believe she had died before the fire?
At the time of the fire, Dr. VS Pal, the hospital's superintendent, told Scroll.in that the baby was the last to be removed from the hospital, and thus, "some soot was found on her skin."
Rajak's baby girl, whom the family never had a chance to name, had died after the birth of her. "We couldn't afford a private hospital, therefore we moved her to MY Hospital," he said.
Rajak, a construction worker, filed a police complaint against the hospital following the fire. It hasn't happened, therefore, I am a regular wager. This is how I can, for a long time.
MY Hospital is Indore's largest government hospital, which was once built in 1946, but the SNCU was relatively new, according to the National Health Mission, a union government program.
The SNCU had limited equipment at its inception, according to a senior doctor. Over the years, ventilators, CPAP machines, and baby warmers, increased. Our ward's bed capacity increased, the doctor said.
Despite this, the doctor said, the electrical load of the ward was never restored after 2012. We were mixing several components into one power source a year or so before the fire, he said. We had asked the National Health Mission to increase the electrical load bearing capacity in the ward. However, there was no action.
Pal said the PWD was in charge of conducting electrical audits and upgrading wiring systems.
This is not a doctor's job, says the president. Every year, new technology is added to the hospital. The electrical wiring is old and requires regular replacement accordingly.
The hospital had also failed to meet certain of its own obligations, such as obtaining a NOC from the municipality fire department. However, in court, where it was called upon to defend itself against public interest lawsuits, which included, among others, requiring that it install a firefighting system and pay compensation to Rajak's family. This was despite the fact that in 2015, the Madhya Pradesh state government ordered all government hospitals to ensure that their premises were compatible with fire safety regulations.
This recalcitrance was particularly surprising given that the 2017 fire was not the first in recent times in the hospital. Three months earlier, the canteen in the hospital had caught fire, damaging some equipment, and causing the evacuation of around 100 patients.
Even after the SNCU fire, the hospital and the state government were slow to act to install firefighting equipment. In 2019, the Madhya Pradesh government sanctioned Rs2.42 crore to install a firefighting system in the hospital.
In November 2021, the hospital received an NOC from the Indore Municipal Corporation.
Shanno Shagufta Khan, an advocate for the Human Rights Network, has two vast files on MY Hospital. She has been closely monitoring the PIL against the hospital ever since the fire has removed the SNCU. They installed a fire system because of the court case, she said. There are tens of thousands of hospitals across India that do not bother to be fire compliant.
The SNCU was still operating out of a makeshift ward within the paediatric ICU ward when Scroll.in visited the hospital in March this year. A senior doctor said this arrangement increased the risk of infection to newborns, but added that they had no other option. The new SNCU, according to hospital officials, was postponed due to the epidemic.
The importance of fire safety
The Supreme Court has reached an agreement on the issue of poor fire safety in Indian government hospitals in 2020.
Following two major fire mishaps, the court took a suo moto hysterical understanding of the problem on December 18, and instructed all states to conduct fire audits in all covid-19 hospitals, and ensure that they received fire NOCs in four weeks. The court also advised each hospital to appoint a nodal officer to ensure fire compliance.
Officials in Gujarat, Madhya Pradesh, and Maharashtra have told Scroll.in that meeting the four-week deadline for all hospitals for the state had proved difficult, but that the process was underway.
According to a court in Madhya Pradesh's capital, 1,101 public and private hospitals did not have a fire NOC. In November 20, Sajid Khan, the fire department at the Kamla Nehru Hospital told Scroll.in that one hospital would have died, but the death figure was significantly higher.
Despite acknowledging the issue, the Gujarat government issued a notice giving state hospitals until June 2022 to obtain building-use certificates, for which a fire NOC is a requirementin effect, it appeared to extend the court's deadline for obtaining the latter clearance also.
The same month, the court rapped the state government for this move, which followed which the government issued a recommendation, declaring that the extension did not apply to fire NOCs.
According to a senior Gujarat government official, 5,688 state hospitals had been audited in the last year, of which 5,633 had received an NOC. The government was taking action against the remaining hospitals, by sending notices to them or even sealing them them, according to the official. Since the suo moto proceeding was still underway, the Supreme Court has asked the authorities to remain anonymous.
Maharashtra, among other states, failed to meet the court's deadline. It was only between last year and this year that 525 state hospitals submitted proposals to the government to implement firefighting systems.
One of them was the Ahmednagar civil hospital, which had undergone a fire audit in 2012, and received a provisional NOC from the Ahmednagar fire department, with the condition that the hospital develops a firefighting system, thus achieving a final NOC.
"We required them to make water hydrants, smoke detectors, sprinklers, and a fire alarm system," said Shankar Misal, head of the Ahmednagar Municipal Corporation.
When officers were asked to build a fire system, fireman Balasaheb Ghatvisave, who serves an additional charge of superintendent, said the hospital officials cited a lack of cash.
Dr Sunil Pokharna, Ahmednagar's former civil surgeon, said he had submitted several proposals to the health department before the Supreme Court decree to install fire equipment. "We were never sanctioned funds," he said. "I was unable to pay from my pockets."
The creation of a fire safety system at the Ahmednagar hospital was reduced down by reduced administrative processes. Since this was the first time that fire safety plans were being implemented at a large scale in the state, the activities of the PWD and the health department were unclear. As a result, the file between the hospital and the two departments continued for eight months.
What happened here is that when two departments look after one hospital, accountability is reduced, a senior health official in Maharashtra.
In February 2021, the hospital underwent a fire inspection conducted by the Pune-based India Automation and Fire Services. This audit, which has been accessed, demonstrates that the hospital still had no fire safety system, apart from fire extinguishers, and that no firefighting training had been given to the employees. On April 27, the PWD submitted the file to the health department on April 28, 2021, for approval.
"We sent the proposal twice to the health department. First they said there were only few signatures missing. Later, they returned the entire file and said PWD must provide a technical sanction first," an administrative officer in the hospital said. A technical sanction is essentially a requirement of the proposal's technical specifications.
The Ahmednagar hospital was not the only one to receive this instruction. In June 2021, the public health department advised all districts hospitals to obtain a technical sanction from PWD's chief engineer for their fire safety recommendations and then submit the proposals for approval. Six months had already passed since the Bhandara incident.
The file from the Ahmednagar hospital was returned to the PWD in June 2021. Three months later, Dr Yogesh Divte, from the hospital's administration department, agreed to grant the proposal its technical sanction, and it was approved immediately. He said, "We had no immediate reaction to calls or emails.
After the Ahmednagar fire in November, the Maharashtra government has taken steps. Among the 525 government hospitals that have submitted plans to install firefighting equipment, 451 have received approvals as of March, according to surveys conducted by Scroll.in. According to data, 131 hospitals will receive Rs126 crore from the state health department, and 320 hospitals will receive Rs92 crore from the District Planning and Development Council.
This isn't the first step, as most hospitals haven't installed firefighting equipment. The process of requesting an offer will begin now, said a district health officer. It will still take several months, he said.
The road ahead
Firefighting equipment is being installed in the civil hospital in Ahmednagar, where sprinklers were installed in March, and a new ICU was being set up. Resident doctor Shinde had been reinstated, while three staff nurses were still visiting local officials to try and get their jobs back.
Dr Pokharna, who was deposed from the position of civil surgeon in Ahmednagar, is now serving as a medical officer in Shirur Rural hospital, 50 km from Ahmednagar. "I have informed the government. However no money has come my way so far. What if another fire breaks here. Will I be held aback?"
Five months later, those who died in the Ahmednagar fire continue to get caught up.
Bharat Kadam, his 70-year-old mother, still cries for her death. "I still haven't entered her room until my mother passes by," said the 41-year-old. Days after his mother's death, he deleted all his photographs he took while she was in the hospital. "Taki wo dard bhool jau," he said, so that I forget about it.
Kodabai Madhukar Kadam, his mother, died on November 2 after testing positive for covid-19. Kadam would stay in the hospital day and night, sleeping outside the room, and returning to bed in the morning. "She was much better," he said. "We were hopeful for an end to the discharge soon. She asked me to go home and get lunch."
While he was away, a friend told him that the ICU had caught fire. I rushed back, he said. There was chaos everywhere. Families were evacuating their patients on their own. Some had broken doors to let the smoke out.
Kadam does not know who brought his mother's body outside. When he saw her, she was covered in a layer of white dust. The right side of her face and leg were broken. She had already been declared dead.
Kadam said he was shocked to discover that the hospital had no fire safety system. "This was the first time I took my mother to a government hospital, before that we always went to private hospitals," he said. "I hope the government does something to keep this going in the near future. It's horrifying."
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