In a Delhi heat ward, a lonely battle for life

Unconscious, frothing in the mouth, holding ice packs: Migrant workers are the biggest casualty of India's worst heatwave

Anumeha Yadav

NEW DELHI: On Thursday afternoon, the busy campus of Safdarjung hospital had patients and attendants trying to protect themselves from the searing heat in the shade of the building and under trees. A tall security guard, in a black and red uniform, stepped out of the hospital’s new emergency block and called out: “Rohit ke saath kaun-Rohit ke saath kaun? Who is with Rohit?” he repeated. No one responded.

Rohit, who is registered in the hospital with only one name, was unconscious and had not responded to treatment in the past eight hours. Doctors attending to him estimated his age at just over 20. No one knew his full name or exact age.

Critically ill Rohit is amongst the tens of thousands of migrant workers who come to New Delhi to earn a living, and are the worst hit in an unprecedented heat wave sweeping across northern India.

Since mid-May, temperatures in the concrete-heavy national capital region have breached historical highs. As per an analysis by Carbon Brief, a UK publication on climate change, after a brief four-day respite, from May 12 onwards, the city witnessed 16 days when the temperature breached the 45 degree C mark.

Nights have been warm, with even the minimum temperatures hovering around 40 degree C on six consecutive nights. There is no respite in even the pre-dawn hours. The cumulative effect of this severe and relentless heat has taken a toll on the city’s migrant workers, said doctors at Safdarjung hospital.

Doctors treating Rohit in the “Red Zone”, a ward for critically ill patients brought to the public hospital’s emergency, told The Migration Story that he was brought with “loss of consciousness” on June 20. He was running a temperature of over 105 degree F (40.5 degree C).

Rohit worked the oven as a cook in a pizza delivery service, an attendant who was his roomate informed the hospital staff. Working in the big city, miles away from his village, he shared a small room with others in similar jobs.

His roommates told the hospital staff that when they left the room for their night shift on Tuesday, Rohit had returned from his evening shift. He was exhausted and ran a high fever when they left. That night stretching to the morning of June 19 would be the warmest recorded in 60 years in Delhi, scientists said.

When they returned at 6 am after their night-shift, Rohit was unconscious, unresponsive, his head burning. By the time they brought him to the hospital, he had to be immediately “intubated”, put on a ventilator to breathe.

Away from his family back in the village – his address column is blank in hospital records – Rohit lay all alone on Bed Number 4 on Thursday morning, dressed in a pair of shorts and a vest, with tubes running down his dark, thin face. His heartbeat was racing at 170 per minute, his blood pressure ‘beyond safe limits’, said treating doctors. His chances of recovery were poor, said the junior resident doctor treating him.

On the upper floors of the same building in “ER Ward 13”, Sunil Kumar Singh, a migrant worker in his 50s from Etawah in Uttar Pradesh, who works in a metal factory, has been on life-support for heatstroke since June 17.

He worked 25 km away in NOIDA industrial area in neighbouring Uttar Pradesh without a written contract or any social security benefits in a factory that makes metalware.

When Singh was brought to the Safdarjung hospital, he had a fever of 106 degree F (41.1 degree C), seven degrees above what is normal for a human and much higher than 104 degree F (40 degree C), the standard used at the hospital for diagnosing a heatstroke.

A gaunt man, he lay in the ward with his face covered in tubes and two ice packs wrapped with a gamcha (cotton scarf) on his chest.

His older son Aman Singh, who waited by his side, said that Singh worked as a “helper” in the same factory since 2022 and had fainted on the shop-floor on Monday evening, when his shift was about to get over. Several factories in the industrial area have no air conditioning, employees like Singh work under fans, routinely standing for up to nine hours every day. Aman, who left his temporary job last year, added that his father was working to support the family.

“His co-workers arranged a vehicle to drop him to this hospital and called me here on the phone,” Aman said. “He remained unconscious and has been on oxygen support for two days. Then yesterday, when he became conscious for some time, he started vomiting.”

On a small table, he pointed to a fruit milkshake he had got for his father, which the doctors told him Singh was in no position to eat yet. “I am waiting for him to eat something soon.”

The resident doctors attending to the patients on heat-stroke and heat-related illnesses on three floors of the new emergency block building said a majority of cases of severe heat-linked illnesses they had treated the past week included “car drivers, auto rickshaw drivers, security guards, wall painters, ragpickers, and cooks,” all of whom either work outdoors, or are directly exposed to intense heat.

He remained unconscious and has been on oxygen support for two days. Then yesterday, when he became conscious for some time, he started vomiting.
– Aman Singh, a migrant worker’s son

CUMULATIVE EFFECT

Between May 23 and June 18 – a period of 26 days – Safdarjung hospital received 27 patients suffering from heat-related illness, hospital data shows. Four of them died.

But after June 19, the warmest night recorded since 1964, the number of patients reaching the hospital with heat exhaustion and heatstroke increased to 33 in 48 hours. Rohit was one of them.

The hospital recorded a total of 13 deaths between June 19 and 20, a hospital spokesperson said on Thursday.

“We saw people reaching in an unconscious state, some were breathing with difficulty, some were even frothing at the mouth (from seizure),” one security guard who was on duty on Wednesday night told The Migration Story.

The patients were both young and old, he said. “Their families were shocked. They said they could not understand what had happened.”

“In the 48 hours between June 18 and June 20, we witnessed nearly ten times the mortality that we had recorded earlier in the month,” said Dr S. K. Gupta, a senior doctor in the medicine department.

Patients are categorised as suffering from a heat-stroke, the most severe of heat-related disorders, if they show “an altered mental state, such as confusion and an impaired consciousness, and whether their body temperature has crossed 104 degree F (40 degree C)”, Dr Gupta said.

“We are seeing a lot of patients with heat-related illness presenting with gastrointestinal disorders, extremely high fevers, even seizures, and organ failure. Some with altered mental state undergo seizures,” Dr Gupta said.

India lacks a system of recording heat-related mortality comprehensively and doctors acknowledge that the numbers may be higher than the official count. Dr Gupta said in cases where other comorbidities or conditions are present, they record that as the cause of death. “If we find other medical history, such as epilepsy or say a previous liver disease, then we are writing that down as the cause even if heat exacerbated their illness and precipitated death,” Dr Gupta said.

RUSH TO SCALE UP FACILITIES

Safdarjung Hospital, set up in the 1940s, is one of the largest government hospitals in Delhi with over 1,500 beds.

The hospital which had so far reserved 13 beds in the emergency room, medicine and emergency medicine wards for heat-related cases, has now set up a dedicated “heat ward” to treat patients, said Poonam Dhanda, the hospital’s medical social welfare officer. She said that in the 24 hours preceding June 20, there was a “sudden spike” in deaths. Two patients had reached the emergency ward with 107-108 degree F and succumbed within an hour, she said.

“We are giving the patients cold saline, ice packs. We have increased the bed numbers.” In a statement shared with The Migration Story, she stated the hospital had adequate cooling mechanisms for patients, including “centralised AC, pedestal fans, and garden hose spray.”

On Thursday, most patients were still being treated in the emergency wards on the ground and third floor. The new “heat ward” set up on the sixth floor had one patient, Pradeep Kumar, a Haryana police personnel in his mid 40s. Kumar was unconscious for nearly 24 hours, said doctors.

This week, after several hospitals recorded deaths from heat illnesses, India’s union health minister JP Nadda said that “heat clinics” will be set up at all government hospitals.

Delhi health minister Saurabh Bhardwaj has also directed all state hospitals to add more beds for heat-related illnesses.

The Ram Manohar Lohia hospital, another central government hospital 10 km from Safdarjung hospital, was the first to set up a designated “heat clinic” in May. The clinic has recorded seven deaths due to heat illness and offered treatment to 40 patients since its opening. Dr Ajay Shukla, the medical superintendent of the hospital, told journalists that a majority of those succumbing to heatstroke are migrant workers.

As the heat intensified around 2 pm on Thursday, the guards manning the emergency ward – the silent record keepers of death and distress the heatwave has unleashed – said they felt stretched and exhausted with their work demands.

“We are on our feet all day. It is not easy to even find cool water to drink. When the staff fills water coolers in waiting areas, it finishes in a few minutes when so many people need it and is not refilled,” said one of the older guards, an ex-army personnel from Uttarakhand.

“I have worked here for more than three years and never witnessed anything as intense as this.”

Anumeha Yadav is a freelance journalist. Her reportage focuses on the rights and social security of lower income workers, primarily migrants to India’s metropolises