Editorial: Infernal anomaly

The death toll in the aftermath of a devastating fire that ripped through the neonatal intensive care unit of the Maharani Laxmi Bai Medical College in Jhansi on Nov 15, rose to 18 on Monday. While 10 children died on the night of the fire, suspected to have been caused by an electric short-circuit, the remaining eight, who were among the 39 rescued, succumbed to ailments over the week. A Supreme Court advocate has written to the Chief Justice of India, seeking a time-bound inquiry into the blaze. The letter highlighted reports of severe negligence, including the alleged absence of functioning fire extinguishers in the ward.

The fire in the NICU must not be seen as an isolated incident, but as a continuation of systemic failures that plague healthcare facilities across India. In May, a blaze in a private neonatal facility in Delhi killed seven babies, which prompted citizens to raise concerns about the hospital’s fire safety protocols, whether fire extinguishers and fire alarms were present, and whether electrical maintenance was carried out on time. Delhi has the distinction of reporting as many as 66 hospital fire incidents over the past two years, with 30 cases in 2022 and 36 in the previous year. That might pale in comparison to what transpired on Dec 9, 2011, when a fire broke out at AMRI Hospitals, a large private speciality institution in Kolkata, which snuffed out 93 lives.

With regard to the Jhansi incident, the special newborn care unit (SNCU) was faced with a problem of overcrowding as well. At any point in time, the SNCU with 12 incubators could admit 18 children. At the time of the fire accident, there were 49 infants packed into the facility, which is often stretched, housing almost 60 babies together. Data available in the public domain tells us that UP has a doctor-to-patient ratio of 1:2,158, significantly higher than the national ratio of 1:836, and twice the WHO recommendation of 1:1,000. Patients from underserved communities often travel between 100-250 km to access a relatively affordable critical care facility. Some government doctors have also been accused of prioritising private practice over public service, which has exacerbated the healthcare crisis.

In the backdrop of the incident, notices have been issued to 80 hospitals in Lucknow found lacking in fire safety measures as authorities intensified inspections in these parts. If the facilities fail to address the issues, their licences could be revoked, and the establishments could be sealed. The Centre on its part has asked all states to review and update fire prevention and response plans of all health facilities, including training of healthcare staff on safety protocols and ensuring regular maintenance of electrical circuit systems.

The Central directive called for the installation and optimum maintenance of fire detection and suppression systems, including smoke alarms, fire extinguishers with regular checks on expiry date, sprinklers etc. What was also flagged was the lack of a centralised database of all health facilities and issues relating to the implementation of Section 32 of the Clinical Establishments (Registration and Regulation) Act, 2010, which provides for the cancellation of registration of health facilities if there is imminent danger to the health and safety of patients. Closer home, the TN Health Department had instructed hospitals across the state to ensure fire-safety compliance, adhere to regulatory requirements, and obtain valid NOCs from the TN Fire and Rescue Services Department (TNFRS).