The recent debate on demonetisation-related deaths has taken place mainly in the context of people who died while waiting in bank queues or collapsed while standing in these queues and died soon after. In addition, there are those whose sudden death is being attributed to stress from not finding valid currency for urgent needs, such as a wedding. There are also those who committed suicide due to frustration at not getting cash or related hardships. And finally there are the few bank employees who are reported to have died due to stress and overwork.

Several cases falling in all four categories listed above have been reported in the media. Not all of them were poor. Retired Flying Officer Prahlad Singh bravely fought in two wars to defend his country, but collapsed and died while waiting in a bank queue in Laadnu (Rajasthan). Senior cashier Purushottam Vyas died while counting cash in his bank in Bhopal. Saud-ur-Rehman, a poster designer, died while standing in a bank queue in Old Delhi. Satish Kumar, a west Delhi vegetable vendor, died while waiting in a bank queue. Asha Rani, a widow living in Ludhiana, was waiting in a bank queue to withdraw cash needed for a family wedding when she collapsed after being pushed and died. Rajesh Kumar, a cooperative bank manager in Rohtak, died in his cabin due to overwork, he had not been able to go home for three days. Rambhavan Singh of Banda district in Uttar Pradesh committed suicide after he could not withdraw money from his bank. Mohammad Haider had struggled to arrange a loan for his daughter’s wedding, but after demonetisation he could not use these notes for wedding expenses and died in a heart attack right on the wedding day.

These are only a few of the several tragic examples already reported in the media. In terms of numbers, various media sources have been between 80 and 100 deaths, while Congress leaders mentioned 84 deaths in parliament. The Uttar Pradesh government has promised compensation of Rs 2 lakh to family members of such victims in the state, while the Bengal government has offered a job to a family member of a deceased. The Union government, however, has not acknowledged the existence of these victims or the reality of such deaths.

Demonetisation-related deaths are likely to be much higher than what has been reported generally in the media or even alleged by opposition leaders. The reason for this is that while bank queue deaths have received considerable attention, another category which is likely to have much higher numbers has not received the same attention. The reference here is to people requiring urgent medical attention who could not get this due to the cash crunch.

Of course in India even in normal times many people desperately needing medicare are denied this due to poverty, absence of adequate public healthcare facilities, poor transport and other factors, in many cases resulting in death. This happens in cases relating to diseases as well as injuries (accidental as well as other injuries). However, as a result of demonetisation, the number of such serious patients increased dramatically. People could not access even their own savings, while wages were not paid in time and crops remained unsold or fetched much less price because of the cash crunch. Even money needed for immediately taking patients to hospitals could not be arranged in many cases, let alone the full costs of treatment.

I checked at some hospitals famous for providing low-cost treatment to poor patients in remote areas and found that the number of patients coming to these hospitals came down significantly after demonetisation. Shaheed Hospital in Dalli Rajhara, Chattisgarh, is one such hospital. Dr Saibal Jana, coordinator of the hospital, said that after demonetisation, the number of patients coming to the OPD of this normally crowded hospital decreased suddenly by about 30%.

Jan Swasthya Sahyog is one of the most respected rural health initiatives in India. Its famous hospital in Ganiyari village, Bilaspur district, Chattisgarh generally has a large number of patients waiting for their turn, but after demonetisation this number declined significantly. Dr Yogesh Jain, the coordinator of the initiative, said that this decline has been to the extent of about 30%. As most of the patients come here with very serious ailments, it is clear that a large number of seriously ill patients who would have come otherwise did not come in the post-demonetisation days due to the cash crunch and related factors.

Social activist Rehana Adib of Uttar Pradesh said that soon after demonetisation, she had difficulty in purchasing her regular medicines which she had to obtain on credit – so she can imagine how difficult it must have been for poorer people to ensure supply of essential medicines. Most of the people I talked to could give at least one example among their acquaintances of medical care becoming more difficult or inaccessible because of the lack of cash.

At the same time, tens of millions of people have experienced at least a temporary loss of earnings and employment. Their worries regarding meeting essential expenses and withdrawing money have increased. Even elderly and ailing people have been forced to stand in queues for long hours.

The overall result is that over a period of several weeks, there has been a decline in nutrition and an increase in mental stress as well as physical weakness and ailments. This can be a problem in itself and can aggravate existing medical problems. At the same time, the ability to obtain timely medical care has declined significantly. It is due to the combination of these factors that a large number of demonetisation deaths are likely to have taken place in various parts of the country, over and above the reported death rate. These may be defined as deaths relating to the denial of medical care and aggravation of medical problems due to cash crunch-related factors. In a large country with a total population of around 1,200 million, the number of such demonetisation deaths is likely to be in thousands and not hundreds .

It would be safe to conclude, then, that the number of all demonetisation-related deaths is much higher than what has been quoted so far in the media or even by opposition leaders. A realisation of this reality should be accompanied by stronger efforts to improve public health facilities for vulnerable sections. Denial of the problem will only aggravate it further.

Bharat Dogra is a freelance journalist who has been involved with several social movements and initiatives.