Sher Chand, a daily wage worker employed by the local administration in Delhi, sat on the floor of his one-room shanty flanked by three toddlers, his wedding photographs spread out before him. He pulled out his phone to show me a video of the last time he saw his wife, Manju, alive. She managed a wan smile from behind the oxygen mask that was helping her breathe. “This is my Manju Begum [queen],” he says in the video. “My wife has corona, but she’ll get well soon.”
That very night in April 2021, the oxygen supply to the intensive care unit of the hospital where Manju was admitted ran out. Manju, just 30, was among 20 patients who died; this was just one case among scores in hospitals across the country. Amid oxygen shortages, hospitals posted desperate SOS messages, families carried bottle-size oxygen cylinders to their relatives, and Sikh gurudwaras that usually feed the poor for free organized oxygen drives instead.
Despite this catastrophe, India’s Parliament was informed this year that there was not a single death from oxygen shortage reported by any state during the pandemic.
The unforgivable erasure of these covid-19 deaths has been underscored again by the recent dispute between the World Health Organization and the Indian government over exactly how many people died during the pandemic. According to the WHO, there were 15 million excess deaths worldwide in 2020 and 2021, more than double the official covid-19 death toll of 6 million. WHO estimated 4.7 million people died in India, a figure nearly 10 times the official number. The Modi government has fiercely contested the WHO’s mathematical modeling and released official data that shows only a 6 percent increase of all-cause deaths in 2020 from 2019.
I am not an epidemiologist. I can’t speak to whether it's a factor of 10 or 4 that separates the government-acknowledged fatalities from the actual count. But as someone who spent two years traversing the length and breadth of India, I witnessed exactly how and why people fell through the cracks.
Based on my reporting, at least hundreds of thousands of Indians — most of them abjectly poor — have died overlooked, forgotten and eventually uncounted.
The reasons were manifold. Oxygen shortage led to several hospitals closing their gates to new patients, unwilling to take on the moral and legal liability of more deaths on their watch. Then there was the stigma that made many, especially in rural India, averse to getting tested. Along riverbanks in northern India, bodies were hurled into the water or left in the sand in the cover of night; grave keepers and boatmen told me this was either because the poor didn’t have money to buy wood for cremation or because they were too frightened to own their dead.
There was also the maze of bureaucracy that families had to navigate to get a death certificate listing covid-19 as the cause of death. Those who didn’t get an RT-PCR test but died from covid-like symptoms during the peak of the surge, for instance, were not counted in the tally. In rural India, where primary health-care centers were often closed or abandoned during the pandemic’s peak, a test was often not easily accessible. But in April and May 2021, community leaders in every village I traveled to testified to a sudden spike in deaths in their area.
In the city of Bhopal, 45-year-old auto rickshaw driver Vikas Singh Chauhan died after driving from hospital to hospital in vain. “We don’t have any proof” of cause of death, his wife, Jyoti, told me in tears.
In the southern state of Tamil Nadu, the teenage daughters of Rudresh, a 45-year-old house painter, told me their father traveled from Bangalore to his ancestral home an hour away, hoping that hospitals would be less crowded there. But he could not find a free bed with oxygen. He died in an ambulance without formal documentation of his cause of death.
And in Jaipur, Ramavatar Singh, a daily wage worker in a textile factory, spent weeks fighting with the hospital where his wife, Santosh, had been treated for covid-19. The death certificate he eventually obtained from municipal authorities did not mention her cause of death.
Our pandemic toll has not even begun to look at those who die from other diseases — cancer, tuberculosis, kidney failure — because they could not access care in an overwhelmed health system. There was a 60 percent decline in the notification of tuberculosis cases during the nationwide lockdown in 2020. And between March and May 2020, there was a 54 percent reduction in the number of cancer cases registered, suggesting half of all new cancer cases in India might have gone untreated.
India is free to question the credibility of the WHO, whose poor handling of the origins of covid-19 has weakened its authority. But India owes an answer to its citizens.
As epidemiologist Prabhat Jha told me, the government could lead its own investigation by asking a question about covid deaths to every family in the upcoming census.
To link the question of how many Indians really died to faux nationalism is in fact anti-national. Indians who died deserve to be so much more than numbers.
How can they not even be that?