Kashmir’s doctors, patients struggle as critical medical services are crippled by year-long Internet shutdown in region

This is the final part in a series of three articles chronicling the impact of the nearly year-long disruption in internet services in the Kashmir region, one of the longest in the world. Part Three looks at how medical services have been affected.

It had been two months since Shaista Jan lost her mother to cardiac arrest and a month prior to that her brother had lost his life in a car accident. The loss of two close family members in quick succession had taken a major toll on her mental health. “I would not be able to sleep and I would get panic attacks,” said Jan, who decided to start seeing a London based psychiatrist online. “I wasn’t in a condition to see a psychiatrist physically and all the household responsibilities had come on me now, and online counseling was going well.”

On August 5 last year, Jan, a resident of Srinagar realized that phone lines and the internet had stopped working in her state. Assuming that she will miss her online counseling sessions for a few days, Jan kept working on her issues based on the advice she received in prior sessions.

However, when the central government snapped all lines of communication in Kashmir along with the imposition of massive restrictions in August 2019, while stripping the restive region of its semi-autonomous status and splitting it into two union territories, Jan didn’t know how to react to the situation.

“For almost a week, I was hopeful that things will get back to track soon, but after that, each passing day turned out to be a nightmare,” Jan told MediaNama. She soon started getting panic attacks and her mental health got worse. The strict lockdown on the region meant that she couldn’t even call anyone and seek psychiatric help at a hospital either.

“I would keep walking inside the house. It felt like my heart was going to explode and sometimes I would get suicidal thoughts,” she said. Her condition continued to worsen for over a month until her father finally managed to get her some sleeping pills. “Even if there was a curfew but communication lines would have been working I don’t think my mental condition would have gone so bad,” she said. “Depriving of communication channels in this time is like snatching oxygen.”

Dr. Majid Shafi, a psychiatrist based in Srinagar says a dozen patients would consult him either via internet or phone till the communication lines got snapped in Kashmir.

“The shutdown of communication lines affected our health sector badly,” said Dr. Shafi.

Dismantling the #SaveHeart initiative

Around 1,200 doctors in Kashmir were connected through a Whatsapp group called the #SaveHeart initiative. The chat group effectively served as a virtual hospital for many Kashmiris with cardiac issues. When a heart attack patient was brought to any remote hospital in the valley, this group would connect the junior doctors to the senior specialists.

“Doctor would upload an ECG report of the patient and the doctors available at the moment would advise him,” a doctor who is part of the Whatsapp group said. “Since the first couple of hours are very crucial in this situation the advice from the senior doctors would help the juniors,” adding “A patient would otherwise lose the battle with life if he is referred to a tertiary hospital.” A number of lives, doctors say, have been saved like this.

But when the communication ban was imposed in Kashmir this Whatsapp group received no ECG report for six months and many people who had a cardiac arrest in the remote places couldn’t connect to the senior specialists. “Many people could have been saved had there been no internet shutdown,” the doctor said.

Cutting off e-pharmacies

In January 2018, Irfan Wani co-founded an online medicine delivery venture in Kashmir. The idea came from his friend who lost his father while he was fetching medicine for him. “Customers would call us. Sent us their prescription and we would deliver them the medicines,” said 38-year-old Wani.

The venture, a first of its kind in the valley, received an overwhelmingly positive response, Wani said. “Our sales grew at a good pace and our customer base was increasing day-by-day,” he added. But with the internet shutdown, they had to close their business for six months completely. During this time, people who could not physically go out to buy medicines were rendered helpless.

Testing labs rendered defunct

Most pathology labs in Kashmir lack sophisticated testing equipment and most samples collected by them are sent out to labs in bigger cities, who send reports back over the internet. Shifa Clinical Lab, in south Kashmir’s Pulwama district, couldn’t provide test reports to patients for months following the communication blackout in August.

“We received samples till August 4 normally but then for months we didn’t get the reports,” said Syed Shahjahan, the owner of Shifa Clinical Lab. The internet shutdown meant that people like Shahjahan were left without work and more critically patients in the region had no means to get these test results for four months. Noting that this doesn’t happen anywhere in the world, Shahjahan added that the impact of the blanket internet shutdown could end up being fatal for many of the patients who rely on reports from his lab for diagnosis.

Mental toll of a communications blackout

Nida Farooq, a 26-year-old content writer and teacher from Pulwama says the internet shutdown took a toll on her mental health. “It is frustrating to remain isolated for months. It doesn’t only affect your work and communication but takes a toll on your mental health,” she said.

Farooq used to consult doctors online and it was one of the ways to keep going without disturbing her work schedule. “You can google a health complication and get expert advice within minutes but during Kashmir’s internet shutdowns such a thing is an unimaginable luxury,” said Farooq.

Dr. Shafi also believes that the mental health of his patients had got affected badly due to the internet shutdown. “It is not only the absence of medical advice but the sense of siege and isolation which affects the health of people,” said Dr. Shafi.

Internet restrictions during a global pandemic

The complete shutdown on all internet services remained for six months, with the union government lifting the ban on January 25. The restoration of the internet was however limited only to the obsolete and sluggish 2G services and only 301 government-approved websites could be accessed.

In March, Kashmir slipped from a security lockdown to a pandemic related lockdown as the world was engulfed by Covid-19. Knowledge of the novel coronavirus causing the disease was limited at first but treatment and prevention guidelines were evolving rapidly. Global agencies and medical professionals around the world relied on the internet to access and share information about tackling the deadly disease. 

Kashmir’s doctors had to deal with both the deadly disease and severe internet restrictions at a time when knowledge about the virus was being shared online. “The advisories were coming in on a daily basis from the global experts on how to handle the situation and how to deal with patients,” said Dr. Irfan Ahmad, a specialist based in Srinagar, “but we were caught in the slow speed internet.”

“It takes hours to download an advisory document released by the World Health Organization (WHO),” said Ahmad. “On one side we are caught by the extraordinary situation and on the other, we are being denied the requisite information on time.”

The doctors in Kashmir say that they are also not able to attend the online conferences and programs which would have enhanced their knowledge about the handling of the Covid-19 situation. “We need to regularly update our knowledge through conferences and medical journals but the slow speed internet is making that difficult,” said Ahmad.

Aakash Hassan is an independent journalist based in Srinagar.


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