In a shocking revelation about medical care facilities in Bihar, which is facing an outbreak of acute encephalitis syndrome, the state government on 2nd July told the Supreme Court that there are only 5,205 doctors in government-run health centres against the sanctioned strength of 12,206.

The state government, in an affidavit filed in the apex court, said that only 5,634 nurses were there in government run hospitals and health centres against sanctioned strength of 19,155. The court had on June 24 directed the state to apprise it about the status of public medical care facilities, nutrition and sanitation within a week in view of deaths of over 100 children in Muzaffarpur due to the outbreak of AES.

Regarding AES cases, the state government said 824 cases have been reported and the number of deaths was 157. It, however, said that it was not known whether 24 deaths out of 215 cases were due to AES. "State of Bihar had already taken all possible steps to prevent the spread of the disease by providing additional medical facilities at the affected region, public awareness campaign at the village level, involving various agencies to assist the government etc," it said.

Giving details of the status of available clinical human resource, the Bihar government said there was 57 per cent and 71 per cent vacancy of doctors and nurses respectively. In case of lab technicians and pharmacists, the vacancy stands at 72 per cent and 58 per cent of the sanctioned strength, the affidavit said.

"It is respectfully submitted that the overall human resources available in health system in the state is not as per standard norms," the affidavit said, adding that health department has taken steps to recruit medical officers, para-medical and other technical support staff.

It said that requisition for recruitment of 4,012 general duty medical officers and 2,425 specialist doctors has been sent to the Bihar technical services selection commission. The state government said that Bihar Chief Minister himself "is personally involved and actively engaged in finding ways and means to control and treat the dreaded AES disease" in Bihar. 

It said that the state, in cooperation with the Centre, All India Institute of Medical Sciences and other agencies, has simultaneously provided all medical facilities to treat the affected children. "The steps taken up by the State has prevented spread of the disease and has reduced the fatality rate arising out of the AES disease," it said, adding, "In view of the steps taken by the state of Bihar, the fatality rate has come down to 19 per cent whereas the global fatality rate of AES is around 30 per cent".

"In view of the constant and consistent efforts taken by the state of Bihar and in view of the change in weather conditions, there is a substantial reduction in number of reported cases of AES and JE in the State. The state of Bihar would continue its efforts to prevent any such condition in future," it said. The state government said that malnutrition is associated with the issue of sanitation and safe drinking water and they are already working on sanitation and hygiene issues under the 'seven-nischay yojana'.

"It is respectfully submitted that the state government has initiated a socio-economic survey in affected areas to ascertain socio-economic factors behind AES incidence to initiate vigorous and coordinated campaign with the active involvement of the concerned departments to bring about speedy improvement/change in the socio-economic status of the relatively poor people who are mainly susceptible and vulnerable to the threat of AES disease," it said.

The state government said that they are fully aware and "quite conscious of recurrent resurfacing" of AES cases in Bihar and has been continuously taking steps to protect and save precious human lives. Besides Bihar, the apex court had also asked the Centre to file response on the issue. The apex court is hearing a petition filed by advocate Manohar Pratap who has said that he was deeply "pained and saddened" by the deaths of more than 126 children, mostly in the age group of one to 10 years, in Bihar due to AES.

"The deaths of children are a direct result of negligence and inaction on the part of the respective state governments of Bihar, Uttar Pradesh and Union of India in handling the epidemic situation which arises every year due to outbreak of AES also called Japanese encephalitis," the plea said. The petitioner has also sought directions for all possible steps to stop the disease outbreak in the earlier epicentre, Gorakhpur in Uttar Pradesh, and to create awareness about preventive steps and first aid.

Symptoms of AES include high fever, convulsions and extremely low blood sugar levels. Among the factors said to trigger the syndrome are malnutrition. There were more than 44,000 cases and nearly 6,000 deaths from encephalitis in India between 2008 and 2014, said a 2017 study published in The Indian Journal of Medical Research (IJMR).

Researchers said the patients often report acute onset of fever and altered consciousness, with a rapidly deteriorating clinical course, leading to death within hours. Litchis grown in Muzaffarpur, the country's largest litchi cultivation region, are said to contain a toxin which can cause a drop in blood sugar levels if consumed by a malnourished child.