In the summer of 2017, 69 children--many of them infants--died over the course of four days after the supply of oxygen to the Baba Raghav Das Memorial Medical College & Hospital in Gorakhpur was disrupted

Officials say the shortage of liquid oxygen was due to non-payment of dues to a vendor.

Sadly, the 69 lost children are just the tip of the iceberg. Underinvestment in healthcare and other basic public services like sanitation and clean water has been killing children in Gorakhpur in Eastern Uttar Pradesh - and across India - for years.

India spends a paltry 1.4 per cent of its Gross Domestic Product (GDP) on healthcare. Compared to the world average of six per cent, India’s 1.4 percent is dismal and a disservice to its 1.2 billion population. India falls below many other poor and developing nations in the region including Sri Lanka’s 1.9 per cent, Nepal’s 2.3 percent, Bhutan’s 2.6 percent and China’s 3.1 percent.

This underinvestment is due in part to corporations and wealthy individuals evading and avoiding their taxes. According to Oxfam’s estimates, India may lose $74 million each year due to tax avoidance by the four largest US pharmaceutical companies.

Threat of encephalitis

In 2017, more than 1,300 children died at Baba Raghav Das Memorial Medical College & Hospital (known as BRD). The leading cause of death is acute encephalitis , including Japanese encephalitis, a mosquito-borne disease most often contracted because of poor sanitation, proximity to livestock, and lack of preventative public health services. Acute encephalitis can be prevented, but not easily cured.

Sanitation and primary health facilities in the area are abysmal. Gorakhpur is located along the banks of the Rapti River near the Nepal border in the state of Uttar Pradesh in northern India. Uttar Pradesh has a population of over 200 million, of which 60 million live below the government-defined poverty line. If it were a country, Uttar Pradesh would be the 6th most populous nation in the world, but it has “…no water, no sanitation, none of these things exist,” says Rema Nagarajan, senior correspondent for the Times of India.

Since 2002 Uttar Pradesh’s population has increased by 25 percent, but over the same period the number of primary healthcare centers has fallen by eight percent. Baba Raghav Das hospital is the only health facility that can handle serious cases of acute encephalitis in the Gorakhpur district, which has more than 4.4 million people and stretches over 1,200 square miles. BRD treats 60 percent of the acute encephalitis cases in India, but patients must travel sometimes for hours to reach the hospital.

Local officials and employees at the hospital told Oxfam that while the hospital has the best facilities in the region, it is not adequately staffed and the number of beds is not enough. The real underlying problem, these officials say, is the absence of primary health care and sanitation facilities in rural areas.

“When a child is falling sick, they diagnose it much too late, and then the travelling … further accentuates the suffering of the child, says K Sujatha Rao, former Health Secretary of India. “By the time you crowd into BRD, they are forced to put two to a bed, three to a bed, on top of the mismanagement of the hospital itself…So the whole Gorakhpur tragedy to me is really just because there is just one BRD hospital and there is a huge vacuum down below.”

The state budget for BRD Medical College was $2.3 million in 2016-17 and was cut to just $1.1 million from 2017-18.i In February of 2016, the Principal of BRD hospital wrote to the director general of Medical and Health Services of Uttar Pradesh seeking $5.5 million for the treatment of acute encephalitis cases. Neither the federal nor state governments managed to provide the requested funds.

Had the Indian government received the estimated $74 million the four US drug companies may avoid in tax annually, and allocated these funds to fighting encephalitis, it would be more than enough to buy Japanese encephalitis vaccines and bed-nets for every child born in the whole of India in one year.