The global coronavirus crisis has been called many things: a pandemic, an unprecedented crisis, a re-run of sorts of the Spanish flu’s decimation of the human population just over a century ago. In India, from the eyes of anyone who studies public health, it is also a catastrophe that has been in the making for decades, perhaps since as far back as Independence.

In weeks of reporting since India saw its first COVID-19 cases and deaths, I am yet to speak with an epidemiologist or infectious-disease expert who is surprised that the country is utterly unprepared for what awaits us—which, they all agree, is a surge of infections and resulting deaths.

One assessment published in a medical journal in January reckoned that India had 2.3 ICU beds per 100,000 people. The medical system in Iran, for which the assessment put the figure at 4.6, is overwhelmed with COVID-19 cases. Experts in the United States, where the ratio of ICU beds was reckoned to be more than six times higher, are warning that it will soon run out of ICU beds too. India has less than one allopathic doctor per thousand people—the minimum recommended by the World Health Organisation. As of 2016, the Indian Medical Association was showing a shortage of tens of thousands of critical-care specialists. The dominant share of doctors and beds are in the private healthcare sector, which has enormous leeway to set its own prices and make its own rules—and to exploit both to put profits before patients.