Slow Internet Is Speeding the Spread of the Coronavirus in Kashmir

SRINAGAR, Jammu and Kashmir—When Indian-administered Kashmir confirmed its first coronavirus case on March 18, Iqbal Saleem, a professor of surgery at Government Medical College in the capital, Srinagar, sensed the days ahead would be challenging. He sent a WhatsApp message to his friend, a surgeon in the United Kingdom, asking about the country’s response to the pandemic. His friend sent back a detailed protocol adopted by hospitals in Kent.

For Saleem, just downloading the document was a herculean task. Kashmiris have not had access to high-speed or 4G internet for more than eight months. Because of his erratic connection, he could not open the file. After a few unsuccessful attempts, the doctor vented his frustration on Twitter. “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,” Saleem wrote.

In August 2019, India’s government revoked Kashmir’s special autonomous status and locked down the region, which has a population of around 8 million. The lockdown was followed by the democratic world’s longest internet shutdown, which was partially lifted on Jan. 25 when authorities restored access to 2G internet. But the denial of high-speed internet still prevents people from using banking apps, paying their bills, and accessing services—even forcing some out of their homes.

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The Indian government will not restore the high-speed internet despite the pressing need for the population to stay informed about the coronavirus pandemic. On April 3, authorities ordered a continuation of the ban “in the interest of the sovereignty and integrity of India,” after a review of the situation in Kashmir, a territory whose sovereignty has been disputed with Pakistan for decades.

“The entire world is united in the fight against this disease, sharing experiences and information online, but we have been isolated.”

Like the rest of India, Kashmir is now under a 21-day government-mandated lockdown to contain the coronavirus. Inadequate internet access has compounded the challenges for health care workers in the isolated region, who face the looming pandemic with a severely deficient health infrastructure. In depriving Kashmir of the internet now, the government is “being inhuman,” Saleem said. “The entire world is united in the fight against this disease, sharing experiences and information online, but we have been isolated thanks to the continued curbs on the internet.”

In recent days, the number of confirmed coronavirus cases in Jammu and Kashmir has jumped to 224 with four deaths. The numbers are far less than across all of India, which has registered 242 deaths and more than 7,000 confirmed cases—a figure that is rising rapidly. But Kashmiri doctors fear that community transmission has already begun and that the real number of cases could be much higher.

Aadil Ashraf, a young doctor in Srinagar, said that the government’s denial of internet service was adding to frustration among his colleagues. They couldn’t access guidelines updated regularly by the Indian Council of Medical Research or videos posted by the World Health Organization (WHO). “We can’t download the information on our mobile phones or share it with our colleagues or launch an awareness campaign on social media [due to]erratic internet,” Ashraf said. “It is so frustrating.”

Last month, the Doctors Association of Kashmir started a telemedicine initiative for patients in the Kashmir Valley as the outpatient departments in major hospitals shut down. Many hospitals posted rosters of doctors available by phone on a daily basis. But telemedicine doesn’t work well without the internet. “Telemedicine is not only about talking to patients on phone. A doctor needs to analyze reports and scans of patients online and consult them through video conferencing,” said Suhail Naik, who heads the Doctors Association. “But you can’t do it in Kashmir even in these trying times, because you have been denied access to the high-speed internet.”

The pandemic comes just a month after Kashmir emerged from its prolonged political lockdown. Now the concertina wire and barricades are already back on the roads, with Indian forces patrolling the streets to enforce the coronavirus lockdown. Local police have arrested 760 people for leaving their homes since the lockdown began, at times using drones to track citizens. For many, the situation doesn’t appear much different from the brutal clampdowns in the past.

Doctors fear the situation could negatively affect those with mental illnesses. Nearly 1.8 million adults—45 percent of Kashmir’s adult population—had symptoms of mental illness after 30 years of conflict, according to a 2015 study by Doctors Without Borders. Research published in 2016 by Srinagar’s mental health institute and ActionAid estimated that 11.3 percent of Kashmir’s total population had a mental health disorder—4.3 percentage points higher than the national average.

A psychiatrist who requested anonymity said the restricted mobility under the lockdown could be “catastrophic” for some patients, who won’t have access to video-conferencing sessions. “Many of them will slip into depression, and that is where counseling sessions could be vital,” the psychiatrist said.

Amid the coronavirus lockdown, there have been reports of excessive use of force against people who had left their homes for legitimate purposes, as well as complaints of police forcibly shutting essential services such as grocery stores.

To the human rights activist Khurram Parvez, the approach appears “militaristic.” “The mindset of [the] administration, police, and forces imposing curfew for protection against coronavirus needs to be demilitarized first,” he said.

As the coronavirus spreads, the biggest challenge that Kashmir faces is that its hospitals are acutely deficient in intensive care capacity. There are only around 132 ventilators in the region’s hospitals, according to official data. The ventilators remain in use at any given time, leading to fears other patients may be shifted away from the ventilators to make room for critical COVID-19 patients. “We are nowhere in terms of the critical care facilities, if the number of coronavirus cases surges,” Ashraf said.

Last month, Samia Rashid, the administrator of Kashmir’s Srinagar-based hospitals, requested more equipment from the prime minister’s office. “We have been promised 40 high end ventilators by the end of this month,” she said in a tweet.

But the region is also grappling with a shortage of doctors. There is one doctor for every 3,866 people in the region, according to a 2018 report by the Jammu and Kashmir health ministry. That ratio falls short of the WHO norm (one doctor per 1,000 people) and India’s nationwide average (one doctor per 2,000 people). And, as elsewhere, the doctors on the frontline of the battle against the coronavirus in Kashmir are experiencing a shortage of personal protective equipment and disinfectants.

On March 20, medical workers at one Srinagar hospital suspended work for two hours to highlight their vulnerability due to the lack of protective equipment. As the protest spread to other hospitals in the city, authorities warned the doctors they could face punishment including six months in prison for speaking publicly about the risky working conditions and shortages.

Kashmir is also behind on diagnostic testing. The region has tested around 2,000 people in the past month and only screens people with a recent travel history or those who have come into contact with a positive case. But people with no travel history are already exhibiting symptoms.

A 62-year old man in the village of Tangmarg, west of Srinagar, who died of COVID-19 on March 29, had no travel history. “There is a distinct indication of community spread,” said Parvaiz Koul, an influenza expert at the Sher-i-Kashmir Institute of Medical Sciences. “I fear the cases will be on the higher side in Kashmir due to lack of testing.”

The greatest fear is that many people who have returned to the Kashmir Valley from other parts of India or from abroad have not followed the quarantine policy, which requires those with travel history to remain at home or in administrative quarantine for 14 days.

Since the lockdown began, many students—including those studying medicine—have returned. More than 400 people have avoided quarantine, according to the Hindu. “We don’t know whether any of them have come in contact with any infected person outside and if they have spread the infection here,” said Naveed Nazir, a pulmonologist in Srinagar. They are “like walking bombs.”