[Assam] Hunger, Dispossession and the Quest for Justice by Binayak Sen

[Chan Mahanta]

http://mrzine.monthlyreview.org/2010/sen140510.html


Hunger, Dispossession and the Quest for Justice
by Binayak Sen
Address at the Convocation of the Class of 2010, Asian College of  
Journalism

In 1876, Lord Lytton, who was then Viceroy of India, decided to  
arrange a massive celebration in Delhi to mark the accession of Queen  
Victoria as the Kaiser-i-Hind, Empress of India.  The feasting, with  
all rajas and maharajas in attendance, went on for a week and has been  
described by one historian as the biggest party in the history of  
mankind.  But 1876 was also the third year of an El Nino drought.   
Grain prices had reached unprecedented levels.

Grain traders took advantage of recent technological advances -- the  
railways, which allowed rapid transport of large quantities of grain,  
and the telegraph, which allowed traders to have accurate knowledge of  
grain prices in distant places -- and, instead of selling their grain  
stocks in the local markets, used these stocks for profiteering.   
Buckingham, after whom the canal in Chennai is named, who was then the  
governor, wanted to forcibly release the grain stocks in the local  
market, but Lytton, a follower of the Reverend Thomas Malthus, forbade  
him from doing so.  During the one week of Lytton's festivities, a  
hundred thousand people died of hunger on the streets of Chennai.  Dr  
Ida Scudder of Vellore, then a young girl of six, tried to feed some  
bread to some starving children, but recorded later that they were too  
weak to eat what she gave them.

Coming to the present, in the last six years, globally, more children  
have died of malnutrition and easily preventable illnesses than the  
number of adults who were killed in the six years of the Second World  
War.  Every three seconds another child dies from malnutrition and  
preventable diseases.  In those three seconds, globally, 120,000  
dollars are spent on arms and militarisation that specifically targets  
civilian populations asserting their rights to equity and protesting  
against inequity.

Inequity is not a subtle phenomenon.  Yet it is only if we have a  
standpoint that validates political commitment to equity that we see  
its manifestations and linkages.  While it is true that there are none  
so blind as those who will not see, for those who wish to do so,  
inequity is a major feature of the global political architecture.  As  
young journalists, it would be good to remember that inequity is not a  
default option, and keeping inequity in place requires diligent and  
sustained international effort, supplemented where necessary by  
military intervention.  The state of Chhattisgarh from where I come  
presents a glaring example of this.

Hunger

Looking at the overall situation in India, I would like to follow  
Virchow's dictum that politics is medicine writ large and read my  
politics off the bodies of our patients.  For the purposes of this  
address, I have treated hunger as a surrogate for inequity.  The  
National Nutrition Monitoring Bureau (NNMB) tells us that over 33% of  
the adult population of India has a BMI of less than 18.5 and can be  
considered as suffering from chronic under-nutrition.  If we  
disaggregate the data, we find that over 50% of the scheduled tribes  
and over 60% of the scheduled castes have a BMI below 18.5.  The total  
population of Orissa has more than 40% below 18.5.  The population of  
Maharashtra, which is considered to be a relatively "developed" state  
with a high per capita GNP, has 33% below 18.5.  We in Rupantar have  
carried out censuses in tribal villages in which over 70% of the  
adults had a BMI below 18.5.  All this is, of course, in addition to  
the mundane reality, to which we have become inured, of 43% of  
children under 5 being malnourished by weight for age criteria.   
Reporting on the Mumbai Cohort study, Pednekar found increased  
mortality in all underweight categories.  The WHO says that any  
community with more than 40% of its members with a BMI below 18.5 may  
be regarded as being in a state of famine.  By this criterion there  
are various subsets of the population of India -- the scheduled  
tribes, scheduled castes, the population of Orissa -- which may be  
regarded as being permanently in a state of famine.

But there is more good news to follow.  Utsa Patnaik, a senior  
professor of economics at JNU, tells us that there has been a major  
decline in cereal consumption since 1991 in India -- that is, since  
the onset of globalisation.  In 1991, an average family of five  
consumed around 880 kg of cereals in a year.  By 2005, this had  
declined to around 770 kg., a decline of 110 kg.  In fact, at the  
higher end of the scale, cereal consumption -- direct and indirect,  
i.e. as meat -- had increased, so the decline at the lower end of the  
scale was actually much greater.  So not only do we have a chronic  
famine, but it's getting worse.

Dispossession: the Situation in Chhattisgarh

It is precisely this section of the population, walking through time  
with famine by its side, that is today the principal target of a  
widespread policy of the expropriation of natural and common property  
resources, in a concerted and often militarised programme run by the  
state.  The adivasis of central India, living in extreme poverty,  
nevertheless survived through their access to common property  
resources -- the forests, the rivers, and land -- all of which are now  
under a renewed threat of sequestration and privatisation as global  
finance capital embarks on its latest phase of expansion.

The doctrine of eminent domain vests ultimate ownership of all land  
and natural resources in the state.  Under cover of eminent domain,  
vast tracts of land, forest and water reserves are being handed over  
to the Indian affiliates of international finance capital.  In many  
ways, the history of 'development' projects in many parts of the  
Indian republic are illustrative of the way in which the doctrine of  
eminent domain, which was hotly debated at the sessions of the  
Constituent Assembly, and finally not included in the final draft that  
was adopted, has been applied to ensure, for a so-called public  
interest, major havoc and displacement in the lives of many of the  
poorest citizens living at subsistence levels.

The tragedy of Chhattisgarh, and of Bastar, is compounded by its  
richness of resources.  One-fifth of the country's iron ore -- about  
2,336 million tones averaging 68% purity -- is found in the Dantewada,  
Kanker, Rajnandgaon, Bastar and Durg districts.  The Bastar region is  
one of the richest in mineral resources -- not only in iron ore, but  
also perhaps a host of other unexplored minerals including limestone,  
bauxite, and even diamond and uranium.  When Ajit Jogi became the  
first Chief Minister of the nascent state of Chhattisgarh, he said  
that, in the new state, we had the poorest people inhabiting the  
richest land.  Since much of this 'rich land' was covered by forest  
and was difficult to reach in earlier times, there was not much effort  
to access these riches, and hence not much challenge to the control  
exercised by the poor people over the rich lands.  With increasing  
industrial and economic development, especially under the impact of  
globalisation, which is the current avatar of actually existing  
colonialism, the hold exercised by the poor people over their  
resources came increasingly under challenge.

Once the nature and scope of the enormous natural wealth, in the form  
of forest and mineral wealth, deposited and secure in the forest areas  
of Chhattisgarh became clear, it became imperative for the Indian  
state to assert its sovereignty over these areas, which had hitherto  
remained relatively unclaimed by the state, under the law of eminent  
domain: the principle that, in the final analysis, the state has a  
preeminent right to all land.  In its turn, the Indian state could  
stand guarantor for the secure sequestration of these resources in the  
hands of the Indian affiliates of international finance capital, such  
as, in recent years, the TATAs, Essar, Lafarge, Holcim, and other  
industrial houses.  Land acquired from ordinary people was to be  
handed over to the industrial houses; gram sabha related procedures  
were faked, in an attempt to justify the transfer by the letter, if  
not the spirit, of the existing Laws.

However, what became fairly clear fairly soon was that this process of  
the assertion of the state's decisive right was going to be a rough  
ride.  Land acquisition for Essar and Tata was resisted in several  
places in South Bastar.  While land acquisition took place literally  
at gunpoint in the Bhansi area, several village assemblies (gram  
sabhas) in the Lohandiguda area are still refusing to sign away their  
land for the proposed Steel Plant of the TATAs.

Even as the state has forcibly controlled the resistance at several  
places, the sense of outrage and popular protest has proved difficult  
to curb.  Bastar has a long history of popular resistance to  
oppression; its ways of defining and asserting property rights are  
also different from those prevalent in mainstream governance.  It also  
has not helped that, with a few honourable exceptions, the personnel  
articulating the agency of state power have almost uniformly possessed  
a colonial mindset.  Under these circumstances, one consequence has  
been that, in conjunction with a pervasive failure of governance,  
characterised by massive levels of corruption, as well as abysmal  
levels of 'development', there has been a tendency on the part of the  
enforcement agencies to be quick on the draw.  Long before the state  
government embarked on its current mission to rid Bastar of the  
'Maoist menace', Praveer Chandra Bhanj Deo, the charismatic ruler of  
Bastar, who refused to trim his sails to the winds blowing from the  
capital of Madhya Pradesh, was killed in an 'unfortunate incident'  
during the Chief Ministership of DP Mishra.  The Salwa Judum is being  
characterised by the government of Chattisgarh as well as by its media  
bandwagon as a 'spontaneous adivasi response to naxalite oppression'.

It therefore becomes necessary to appreciate that popular resistance  
to state control and efforts to articulate eminent domain has a  
history in Bastar, which has a far greater spread, in terms of  
duration, geographical extent, as well as political and institutional  
identity, than the current operational entity known as the CPI  
(Maoist), although the latter is undoubtedly a major political entity  
in the region.  The CPI, for instance, is a political entity with a  
long history of struggle on the trade union, peasant, adivasi, women's  
and student fronts, apart from its parliamentary and electoral  
identity.  In Chhattisgarh , the term 'Maoist' has become a catchall  
attribution that includes anyone whose activities the state finds  
inimical to its current interests, including self confessed Gandhians  
like Himanshu Kumar of the Vanvasi Chetna Ashram, human rights groups  
like the PUCL, and pesky PIL wielding academics.  The believers in  
armed overthrow of the state have been only one stream out of many in  
the resistance to state policies.  It is the systematic dispossession  
of the people that has polarised the situation beyond immediate  
rectification.

Based upon carefully differentiated positions, they have gone on to  
repeatedly indict the widespread and pervasive violence that the state  
has deployed over widespread areas in this region.  Careful reports  
have been prepared with regard to specific incidents of state violence  
such as encounter deaths, kidnappings, rape, arson, and custodial  
maltreatment.  Investigations have been conducted and reports have  
been prepared with respect to starvation deaths, dysentery epidemics,  
lack of drinking water, and other basic needs.  It is the state  
response that has been singularly undifferentiated.  Today, in the  
months since the launching of operation Green Hunt, Bastar is a war  
zone, its people dispossessed and scattered, women subjected to brutal  
rape; violent (and tragic) military encounters shake the foundations  
of whatever normalcy remains.  One is reminded of what Prashant  
Bhushan said on an earlier occasion.

Those who are going to become homeless and uprooted in this race of so- 
called development, they will also be finally forced to accept the  
bitter truth that they cannot stop the loot of their lands and  
resources by any democratic and non-violent means.  This is a  
dangerous situation.  Even a combative organization like "Narmada  
Bachao Andolan", which included a large number of educated persons,  
has accepted the bitter truth that there is no administrative or legal  
means of preventing the loot of resources.  Now it is only through  
unity and by force that these plunderers can be stopped.  That is the  
reason why today, in Kalingnagar, Nandigram etc. there is a situation  
of "do or die".  All these struggles are proving to be landmarks in  
stopping the loot.  The people of these areas have firmly resolved  
that come what may, they will not let any government officer set foot  
on their land.  In these circumstances if the government uses force,  
violence may erupt.

There is a question that I would like to raise before this assembly,  
and that is the issue of genocide.  Most people think that genocide  
has to do only with large scale direct killing, but the declaration of  
the Convention on the Prevention of Genocide -- which was issued on  
9th Dec 1948, one day before the Universal Declaration of Human Rights  
-- tells us clearly that in addition to killing, the creation of  
physically and mentally hazardous conditions which could put the  
survival of particular communities at risk would also come within the  
ambit of genocide.  Evidence that what is happening in central India  
is tantamount to genocide on a massive scale stares us in the face.   
What is shocking is the inability of large sections of our leadership  
to read the writing on the wall.

The Inability to Interpret Evidence: Example from Health Policy

The inability to interpret evidence that is crying out to be  
recognised and the tendency to lapse into facile and convenient  
formulae for resolution is a curse that plagues many professions.  I  
would like to give an example from my own, with regard to the  
formulation of the national policy for the control of tuberculosis.   
In a country where 33% of the adult population have a BMI below 18.5,  
and which also has 1/6 of the world's population and 1/3 of the total  
global burden of tuberculosis, one would think that the bidirectional  
association between malnutrition and tuberculosis would be the focus  
of intense study.  This is not the case.  India is the single largest  
contributor to the global burden of morbidity, mortality and drug  
resistance in tuberculosis.  An estimated 8.5 million Indians suffer  
from tuberculosis.  There is an annual incidence of 87,000 cases of  
multidrug resistant tuberculosis and an estimated annual mortality of  
370,000 persons.

And yet, a recent WHO-based systematic review study which established  
a consistent log-linear relationship between tuberculosis incidence  
and BMI was unable to include a single Indian study.  Similarly, a  
Cochrane systematic review of randomised control trials of nutritional  
supplements for people being treated for active tuberculosis did not  
include a single Indian study in its ambit.  But I would like to draw  
your attention to two studies that do not figure in either review --  
the first with pride, and the second with shame.

The first study has been formed by my colleagues at the Jan Swasthya  
Sahyog (People's Health Support Group), a nonprofit voluntary  
organisation, which runs a community health program in 53 forest  
related villages in central India.  They have reported an as yet  
unpublished study on the nutritional status of 975 patients with  
pulmonary tuberculosis -- the largest such study to emerge from  
India.  They report that patients with active pulmonary tuberculosis  
in rural central India were found to have macronutrient malnutrition,  
i.e. starvation, almost as a universal association, with less that 5%  
having weights in the normal range.

Certain groups like scheduled tribes and women fared worst, with life  
threatening levels of under-nutrition.  There was evidence of long- 
standing under-nutrition with low height for age (stunting) in the  
majority of patients.  The report goes on to conclude, "This report is  
a stark illustration of the adverse synergy of the epidemics of under  
nutrition and tuberculosis.  The consequences are extensive disease on  
the one hand and severe wasting on the other, both of which can cause  
mortality independently and in concert.  The need to address the  
nutritional needs of poor patients with tuberculosis is an urgent  
imperative on scientific, ethical and humanitarian grounds".

However, the fundamental architecture of the National Tuberculosis  
Programme, formulated in 1962, was based on a specific repudiation of  
this "urgent imperative."  This fundamental architecture has been  
preserved into the present programme, hence this is a current  
problem.  What was the evidence on which this repudiation was  
premissed?  This brings us to the second study that I had mentioned,  
published in the Bulletin of the World Health Organisation in 1961.   
The recent Cochrane review of the effect of nutritional supplements in  
people being treated for active tuberculosis excluded this paper from  
their review as "the groups were not randomized to different dietary  
interventions".  This study was carried out at the Madras Chemotherapy  
Centre in Guindy.  I would like to read out to you the summary of  
findings of this study.

A study has been undertaken on the diet of 157 patients with pulmonary  
tuberculosis admitted to a controlled comparison of treatment with  
isoniazid plus PAS for a year at home with the same treatment in  
sanatorium.  The patients have been drawn from a poverty-stricken  
section of the community living in overcrowded conditions in Madras  
City.  A comparison has been made of the dietary status of the home  
and the sanatorium patients before and during treatment, and the role  
of the diet in the attainment of bacteriological quiescence of the  
tuberculous disease has been evaluated.

Before treatment the patients in both series had poor and similar  
diets.  During the early months of treatment, the dietary intake of  
the patients in both series increased.  However, the sanatorium  
patients received a clearly superior diet through the year in terms of  
total calories, fats, total and animal proteins, phosphorus and  
several of the vitamins.  The home patients were physically more  
active during treatment than the sanatorium patients, further the  
accentuating the dietary disadvantage of the home series.

The home patients gained on the average 10.8 lb in weight over the 12- 
month period, as compared with 19.8 lb for the sanatorium patients.   
This greater weight gain among the sanatorium patients was not,  
however, indicative of superior clinical results.  The response to  
treatment (as measured by the radiographic and bacteriological  
progress) was not directly associated with the level of dietary intake  
of any of the food factors, either in the patients treated at home or  
in those treated in sanatorium.

It may be concluded that none of the dietary factors studied appears  
to have influenced the attainment of quiescent disease among  
tuberculous patients treated with an effective combination of  
antimicrobial drugs for a period of one year.  The successful initial  
treatment of patients at home is therefore possible even if the levels  
of dietary intake are low.

The fact that such a poor study could play such a critical role in  
determining the architecture of a program of such enormous importance  
shows how the politics of callousness takes precedence over evidence  
in such matters.

The Scientific Community and Bhopal

A similar refusal to take a stand on what was correct and so patently  
obvious characterised the response of the official scientific  
community in India to the Bhopal gas disaster.  Twenty-five years ago,  
on the night of 2-3 December an industrial accident of massive  
proportions spewed a huge cloud of methyl isocyanate gas into the  
atmosphere of Bhopal, the capital of Madhya Pradesh.  In the next 72  
hours, 8,000 people died of the effects of the gas, and innumerable  
people were blinded and developed major pulmonary disorder, major  
psychiatric disorder, abnormal pregnancy outcomes, and a whole host of  
other acute and chronic morbidity.

The ground water of the factory became contaminated with harmful  
chemicals, which then leached into the soil and contaminated the water  
table.  This is not the forum to detail all the harm that Union  
Carbide caused to the people of Bhopal.  What I wish to draw your  
attention to is the role that evidence and scientific information --  
and the people responsible for dealing with this information -- played  
over the last twenty five years.

Neither the Union Carbide Corporation, nor their successor, the Dow  
Chemical Company, has ever acknowledged the nature of the chemical  
that spewed out of their factory.  Nor did they ever specify the  
specific antidote -- sodium thiosulphate -- that would have made a  
major difference in the treatment outcomes of a large number of gas  
affected people if it had been used in time.  Strangest of all was the  
posture adopted by the ICMR.  In one of Arthur Conan Doyle's Sherlock  
Holmes stories, Holmes says to Watson, "I would like to draw your  
attention to the curious incident of the dog in the night time."   
Watson says, "But the dog did nothing in the night time."  "That" said  
Holmes, "was the curious incident".

The ICMR initiated something like 34 research studies in Bhopal.  As  
far as I know, none of these studies was carried through to  
completion.  They were, instead, shut down in batches, and finally in  
1994 -- 10 years after the incident -- the last two remaining studies  
were terminated by executive fiat, and the entire body of data was  
quarantined indefinitely.  At that time, there were 18 fresh proposals  
that had been fully approved, but these proposals were also terminated.

The ground water in the area of the accident has been heavily  
contaminated, but the Government has consistently refused to admit  
this.  Finally, now, the Centre for Science and Environment in Delhi  
-- an independent NGO with a formidable reputation -- has come forward  
to test the water.  Their report showed the ground water to be heavily  
contaminated with highly toxic chemicals.

The Quest for Justice

The Directive Principles of State Policy enshrined in our Constitution  
are asserted to be "fundamental in the governance of the country".   
The Directive Principles clearly mandate that all exercise of state  
power should be for the reduction of inequity and the promotion of  
equity.

Article 37 of the Constitution declares that the DPSP "shall not be  
enforceable by any court, but the principles therein laid down are  
nevertheless fundamental in the governance of the country and it shall  
be the duty of the state to apply these principles in making laws".   
Viewed in this context, recent trends in the exercise of state power  
very clearly violate this mandate and have actually resulted in  
increasing inequities in important areas such as livelihood, education  
and health.

According to Dr B D Sharma, formerly Commissioner for Scheduled Castes  
and Tribes, the fifth schedule is like a constitution within the  
Constitution.  It empowers the Governor to intervene in governance on  
behalf of the interests of tribal people, but we note to our great  
surprise that there is not a single instance when the Governor of any  
single state has so intervened.  Once again when we look at the  
operationalisation of PESA, we find that the entire issue of peoples'  
sovereignty enshrined therein has been sidestepped in practice.   
Development in the tribal areas is not only a matter of building  
roads, buildings and infrastructure.  Rather, it is all about the  
operationalisation of equity, social justice, and the establishment of  
a genuine peoples' sovereignty.  Everyone today talks of PEACE.  Peace  
cannot mean an acquiescence in an exploitative and unjust social  
order.  A genuine peace can only be the result of a movement for  
equity and justice.  At the beginning of this discussion we considered  
the essentially political and ethical nature of the concept of  
equity.  In the course of our discussion, I have tried to examine the  
ways in which evidence influences -- or does not influence -- the  
praxis of equity.  Evidence is, of course, central to the scientific  
enterprise.  A commitment to evidence is what took Galileo to jail,  
and a commitment to evidence is what caused Giordano Bruno to be burnt  
at the stake.  Evidence is what democratises the generation of  
knowledge: without it, all we have is esoteric bodies of dogma, to be  
passed on from feudal mentor to feudal apprentice.

Equity is a political concept, and an ethical one.  Political  
questions cannot be rephrased in terms of informatics or evidence,  
although once these questions are adequately formulated, evidence can  
be used to settle the question one way or the other.  The ethical  
dimension of questions regarding equity means that the answers contain  
an inbuilt imperative to moral action.  As Amartya Sen says in his  
latest book, The Idea of Justice, "Proclamations of human rights, even  
though stated in the form of recognizing the existence of things that  
are called human rights, are really strong ethical pronouncements as  
to what should be done.  They demand acknowledgement of imperatives  
and indicate that something needs to be done for the realization of  
these recognized freedoms that are identified through these rights".

One of the ironies that confront the witness dealing with 'evidence'  
is that one has to appeal for appropriate interventions to the very  
forces that are at such violent odds with poorest sections of the  
population.  For the student of evidence based policy, this situation  
raises some challenging problems.  One is that in any study of an  
intervention one ethical assumption is that the intervention is  
carried out by someone who comes to the table with clean hands, whose  
bona fides are beyond question.  In India today, as in many other  
places across the world, this is an assumption that is no longer  
tenable.  Cynicism and disengagement may be one response to this  
situation, but I do not believe that this is the only tenable  
response. As young journalists at the beginning of new careers, the  
challenge is upon us to acknowledge the imperatives and recognize that  
'something needs to be done'.  We need to ask ourselves on this very  
important day in our lives whether we are up to accepting this  
challenge and putting in the response that it demands.

Dr. Binayak Sen is a pediatrician, public health specialist, human  
rights activist, and national Vice-President of the People's Union for  
Civil Liberties (PUCL) based in Chhattisgarh state, India.  He has  
been extending health care to the poorest people, monitoring the  
health and nutrition status of the people of Chhattisgarh, and  
defending the human rights of indigenous tribal and other poor  
people.  In May 2007, he was detained in connection with his human  
rights work, raising global concern about his welfare.  In 2008, he  
was awarded the prestigious Jonathan Mann Award for Global Health and  
Human Rights for "his years of service to poor and tribal communities  
in India, his effective leadership in establishing self-sustaining  
health care services where none existed, and his unwavering commitment  
to civil liberties and human rights."