A deserted chowk in Srinagar. © Athar Parvaiz

While the world anxiously awaits a scientific breakthrough in vaccine or drug development to fight the novel coronavirus, in India’s conflict-hit and politically volatile region of Jammu and Kashmir, where COVID-19 has just set foot with four positive cases, people have entirely different concerns.

Sample these posers: Why is the Indian government not restoring high speed 4G mobile internet connectivity in Kashmir even in times of a pandemic when rapid access to accurate information is key? Is the health infrastructure in the strife-beleaguered valley enough to handle an epidemic? Social distancing – so what’s new?

The first positive case of coronavirus came to light in Jammu & Kashmir’s summer capital Srinagar on 18 March 2020, triggering concern among people in the valley. The threat of a highly infectious virus has been compounded with the region’s long months of being cut off from the rest of India and an information deprivation thanks to 2G internet speeds.

Jammu and Kashmir was stripped of internet and mobile phone communication on 5 August 2019, when New Delhi decided to abolish the region’s semi-autonomous status and passed the Jammu & Kashmir Reorganization Act in India’s Parliament. In order to control protest demonstrations, the government imposed a security and communication clampdown. The security restrictions have been relaxed in recent weeks across the region as also mobile phone network and low-speed 2G internet.

“We are as much worried about the coronavirus as people in the rest of the world,” said Sajjad Ahmad, a post graduate student of Kashmir University, over phone. “But what multiplies our worry is the lack of basic facilities like effective internet and healthcare.”

This tweet by Iqbal Saleem, a professor of surgery at the Government Medical College (GMC) in Srinagar has become emblematic of the hardships faced by healthcare professionals in Kashmir: “This is so frustrating… trying to download the guidelines for intensive care management as proposed by docs in England.. 24 Mbs and one hour.. still not able to do so... (sic)”.

Medical professionals and scientists have faced career-breaking problems because of the communication shutdown. They have neither been able to consult colleagues nor advise patients through Whatsapp, a preferred medium in the valley which has seen years of unrest. Even a simple software update is a challenge for most people.

Through the clampdown, scientists and researchers from Jammu and Kashmir have been unable to publish papers or attend important scientific conferences and events elsewhere. Imran Khan, a research scholar in Kashmir University (KU), told Nature India that he missed an important opportunity of collaborating with international researchers.

Khan, who was selected for the Estonian government’s Dora Plus programme at Tartu University in August 2019 could not get a visa in time due to the shutdown. “This is a huge loss for me. I was imagining myself working with the great researchers – this has disturbed me mentally,” Khan said. His colleague at KU Javid Imdad did not receive the email for a BRICS collaborative programme with scientists in Brazil. “I feel so sad that I missed it,” Imdad says.

High speed internet over health facilities

The clamour for restoration of 4G internet in the region got renewed following the imminent threat from COVID-19. Politicians, journalists and common people have joined the chorus. Iltija Mufti, daughter of former J and K chief minister Mehbooba Mufti, tweeted using her mother’s Twitter handle: “World’s battling coronavirus but J&K admin still unrelenting & refuses to lift inhuman ban on 4G. In times of COVID pandemic, access to Internet & info is a necessity not a privilege” (sic.)

“Prioritizing ‘imaginary security threats’ over healthcare for 9 million Kashmiris in a calamity like Coronavirus is a war crime. GOI (is) impervious to collective appeals of restoring 4G,” she wrote.

Veteran Member of Parliament from Srinagar and National Conference (NC) president Farooq Abdullah wrote a letter to Prime Minister Narendra Modi seeking immediate restoration of high-speed mobile internet in Kashmir. “As you are aware, the first case of Coronavirus was detected in Kashmir yesterday which has resulted in authorities locking down large parts of the valley…The people are being advised to work/study from home, but this is impossible with 2G internet speed and limited fixed line internet penetration,” Abdullah wrote in the letter.

Mental health challenges

As a conflict-torn region, Kashmir has reported widespread prevalence of mental health issues in recent years. A 2015 survey by the humanitarian organisation Medicines Sans Frontiers estimated that nearly 1.8 million adults in the Kashmir Valley (45% of the population in Kashmir region) showed symptoms of mental distress. The survey found that 41% of the population showed signs of depression, 26% showed signs of anxiety and 19% showed probable symptoms of post-traumatic stress disorder (PTSD).

The region is still smarting under the losses in the trade and education sector post the recent shut down. The COVID-19 crisis can be a huge burden on the mental health of people already anxious over lack of proper healthcare as well as poor awareness of the disease.

“We are not just talking about the outbreak of COVID-19, what we are also seeing is an increase in the anxiety the people are experiencing. So, it is really important to think about mental health as part of the public health response to COVID-19,” the WHO warned recently.

“…people who might be vulnerable to experiencing mental health or stress during this time might include people who have preexisting mental health conditions… So we are not only talking about protection from COVID-19, but we are also talking about prevention from mental stress.”

Arshad Hussain, a mental health expert in Kashmir emphasized that consequences of COVID-19 in Kashmir can be minimized if scientific approaches about tackling it are made popular. “I am glad that so far we have not allowed COVID-19 cases to pile up.”

Dismal state of healthcare

While COVID-19 is not a challenge unique to Kashmir, the quality of healthcare and insufficient infrastructure is a perennial problem.

Suhail Naik, president of Doctors Association of Kashmir (DAK), says though the Jammu and Kashmir administration has acted swiftly to spread the ‘stay at home’ message, the state’s health infrastructure is not enough to cope with a COVID-19 emergency, should it arise.

“The health infrastructure in Kashmir is overburdened and it can’t take the extra load and will crumble,” Naik told a local newspaper in an interview . “…in Kashmir even a cancer patient gets appointment after months.”

Samia Rashid, the Principal of GMC Srinagar, however, claimed that they have enough ventilators to meet an exigency. India’s health ministry has promised 40 high-end ventilators by the end of this month though the medical college did not have sufficient manpower to run the machines, she said.

A March 2018 health department report paints a gloomy picture of the facilities in the state.

While the private sector accounts for 72% of healthcare services in rural areas and about 79% in urban areas in the country, in Jammu and Kashmir, nearly 97% of the healthcare needs of the 14.3 million population of the state are met by public health institutions. “The private sector has not developed in the state due to its geographical remoteness, disturbed security scenario and restrictive land laws,” the report says.

The doctor to patient ratio in the state is amongst the lowest in India. “Compared to the doctor-patient ration of 1:2000 in India, J&K has one allopathic doctor for 3,866 people against WHO (world Health Organization) norm of 01 doctor for 1,000 population,” the report says.

[Nature India's latest coverage on the novel coronavirus and COVID-19 pandemic here . More updates on the global crisis here .]