Cholera outbreak: Odisha flush with systemic rot
The morning air hung heavy with grief and an unknown fear. On the fringes of Suanri village, about 25 km from Cuttack, 17-year-old Lopamudra Bal struggled to keep the earthen stove burning as she stirred rice for her mother’s ninth-day ritual, an essential part of Hindu rituals. She now has an additional responsibility of watching over her polio-afflicted brother, Rohit.
The siblings lost their 38-year-old mother Urmila Bal to severe diarrhoea. She is one of the victims in the recent outbreak that gripped at least nine districts in coastal, central and western Odisha. “I was in my maternal uncle’s place when Maa fell sick on June 14. I rushed home but by that time she had been shifted to SCB medical college and hospital in Cuttack after preliminary treatment at Tangi hospital. Doctors could not save her. She succumbed the next morning,” Lopamudra said with a choked voice.
Urmila’s death has left the family broken. Her husband Santosh Bal, a contract labourer in a cement factory nearly 8 km away, first caught the infection. He suffered from diarrhoea and vomiting when he was at work on June 13. As his condition worsened, his nephew, also a worker in the same firm, brought him home. After treatment, he recovered but Urmila fell sick. Soon 12 others in the village were affected, one after another.
Eleven days later, Sulochana Bal (70), another member of their extended family died at a hospital. What has made the pain worse is the way villagers turned their back on them. “People are scared ever since the outbreak. Neighbours have stopped coming to our house. Some believe diarrhoea and cholera transmit by touch or simply by being close to those who are infected,” said Santosh. His elder brother Gobinda Bal said the situation was so horrible that he and his four family members were to be shifted in a transport vehicle as the ambulance was not available at the nearby Tangi hospital.
Suanri was not where it all began. The diarrhoea outbreak was reported first in Pakhara village under Dharmasala block in neighbouring Jajpur district on June 9, a day after hundreds of villagers had food at the reception party in the village. At least 60 of them suffered from diarrhoea. While 23 were hospitalised, the rest were managed at the village by a medical team.
Widespread affliction
In Jajpur district, six blocks and one urban local body were worst affected. People from Dharmasala, Danagadi, Korei, Jajpur Road, Dasarathpur, Rasulpur and Vyasanagar municipality areas came under the grip of diarrhoea within a week. Patients initially suffered due to shortage of doctors as the hospitals in the district are being managed by only 39 per cent (pc) of the sanctioned posts.
As cases spiked, understaffed hospitals in the district were overwhelmed by patients. Dharmasala community health centre (CHC), where an additional team of seven doctors camped, has treated over 400 diarrhoea patients in one fortnight. Of the sanctioned strength of 21 in the CHC, only five have been posted.
Community feasts, marriage receptions, birthdays or engagement parties, Ekadasah (11th day of death) or death anniversary functions emerged as a common thread. “Though the exact source of infection is yet to be ascertained, contaminated water or food could be the reason. We have advised people not to drink packaged or bottled water or use water from untreated borewell and open wells,” chief district medical officer of Jajpur Dr Bijay Mishra said.
The state administration responded by shutting down a few bottling plants and roadside eateries as part of containment measures but the damage was done. At least 24 lives, 18 alone from Jajpur district, had been lost and more than 4,000 people were affected in Jajpur, Cuttack, Bhadrak, Keonjhar, Dhenkanal, Kendrapara, Balasore, Puri and Bargarh districts. The official death toll stood at 13.
Suanri is among four revenue villages that come under Safa (literally means clean) panchayat in Cuttack district. Well- connected by road and with sound pucca house coverage, the village depicts a contrasting picture as far as access to water and sanitation is concerned. With a population of around 1,000, the village has five deep borewells and as many tube wells. Except the one on the primary school premises, a couple of them are defunct and water from the rest is unsafe for drinking.
Systemic failure
In fact, the outbreak of cholera and diarrhoea in relatively developed coastal districts has laid bare the systemic gaps in the state’s public health and water infrastructure. As per the latest data of Panchayati Raj and Drinking Water department, the industrially and mineral-rich Jajpur is one of the bottom-10 districts in terms of piped drinking water coverage. On record, a little over 72 pc of the households (3.22 lakh out of 4.47 lakh) in the district have tap water connection. While Keonjhar district tops the chart with 99.63 pc households (3.45 lakh out of 3.47 lakh), Malkangiri has the lowest coverage of 54.5 pc households (67,731 out of 1.24 lakh).
The average coverage of tap water connection in districts affected by the outbreaks stood at around 84 pc against the state coverage at 76.8 pc households (68.11 lakh out of 88.68 lakh). While 19 districts are in the range of above 75 pc, 11 districts are in between 51 pc to 75 pc range. Har Ghar Jal certification has been completed in 9,435 villages and 403 gram panchayats.
Acknowledging that several drinking water projects have been delayed by years, officials said 18,533 single village projects (groundwater-based projects) have been commissioned and 1,289 are under implementation. Of the 207 mega water supply projects, only 16 have been completed and 191 are under various stages of implementation. Similarly, 4,855 solar projects have been completed and 3,652 are under various stages of implementation. The pending mega projects will be completed by the end of next year, they said.
Amid the hype over sustained inclusive growth and industrial expansion, the diarrhoea outbreak has exposed the public health scenario. “Economic growth cannot be achieved without foundational public health and infrastructure. Diseases like cholera thrive where governance is weak. If a government cannot guarantee safe water and sanitation, it means the development model is fundamentally flawed,” said public health expert Dr Tribhuban Mohan Mohapatra.
Of the 314 faecal and rectal swab samples tested so far, Vibrio cholerae has been detected in 35 samples. A 14-member central team, which visited the state to support the containment measures, also attributed contaminated water to the outbreak.
Minister for Health and Family Welfare Mukesh Mahaling said drinking water sources were chlorinated and disinfected in areas with suspected water contamination. “Public announcements are being made in the affected areas of the district advising people to use boiled water. Prophylactic doses of doxycycline are being administered to family members and close contacts to break the chain of the waterborne disease,” he said.
Panchayati Raj and Drinking Water minister Rabi Narayan Naik outrightly denied that water contamination could be the cause of the outbreak. “The water sources have not been contaminated. We have completed chlorination of all water sources. As many as 5.2 lakh tube-wells have also been disinfected. The diarrhoea might have spread due to consumption of contaminated food,” he observed.
Piped water projects in limbo
In Pakhara village, 65-year-old Kanakalata Das stood by a tap, a piped water outlet that has stopped releasing water for months. “There is an overhead water tank more than two km away which was supposed to take care of the supply. But since the pipes connecting the tank were damaged during construction of a bridge for the Expressway expansion, supply has been snapped. We are now forced to fetch water from a tube well which is not fit for consumption,” she said.
The state may be blaming people’s behaviour and unhygienic practices, but the core of the problem lies in dependence on untreated water sources. In both rural and peri-urban pockets of the affected districts, large sections of the population continue to rely on borewells, tube wells and open wells, many of which are contaminated, especially during the monsoon. Though piped-water networks have been laid under schemes like Basudha and Jal Jeevan Mission, supply is erratic and far from universal. People still use water from borewells or open wells as the projects are either incomplete or lying defunct for years.
According to the information obtained through RTI, mega water supply projects worth around Rs 1,505 crore were sanctioned in Jajpur district in 2018-19 and the projects were supposed to be completed by 2022. “Hyderabad-based Megha Engineering Infrastructure Pvt Ltd bagged projects in four out of 10 blocks in the district while others like KEC International Ltd, KPIL, NCC Limited and KEC Limited were entrusted with other projects. Three years after the deadline, barring Sukinda block, the mega drinking water projects in all other blocks are incomplete. On paper, Rs 1,064 crore has been utilised so far and more than 40 pc works are pending,” social activist Sarbeswar Beura pointed out.
Broken infrastructure
The story of incomplete or abandoned piped water schemes, broken pumps and no chlorination of wells repeats across all areas affected by the gastro outbreaks.
Rights activist Pradip Pradhan said drinking water projects of around Rs 35,000 crore were sanctioned to a number of agencies by the previous BJD government in 2018-19. Though four to five years have passed since the projects were sanctioned, not a single project has been completed in the affected blocks in Jajpur district and other parts of the state. The lack of potable drinking water led to the diarrhoea outbreak, he said.
After the BJP government came to power in 2024, Pradhan said they had filed complaints seeking a special audit into the allotment of mega projects. Despite assurances, no inquiry has been conducted so far, he added. Officials, meanwhile, refused to share a list of completed versus pending water projects, or water testing reports from affected villages.
Tags of falsehood
The cholera outbreak is a telling story of poor sanitation. In Suanri, on record, 126 families have been allotted pit toilets and the village declared an Open Defecation Free (ODF) Plus Model as per the dashboard of Swachh Bharat Mission (Grameen) 2.0. But none of the borewells have clean surroundings while garbage and stagnant water are common near every water source. An open well that was used by the Bal family has been declared unsafe for use by the district administration.
In Pakhara, out of the eight deep borewells for the village with a population of over 1,500, only one is fit for use. While the village pond has been declared unfit, the local administration is supplying drinking water through tankers once in a day after the outbreak. The SBM dashboard says the village has been allocated 128 toilets and it is ODF Plus aspiring.
On record, of the 1,573 villages in Jajpur, 1,523 have been categorised ODF Plus, 1,444 ODF Plus Model and 79 ODF Plus aspiring villages. Similarly, Cuttack has 1,781 ODF Plus out of 1,864 villages, Dhenkanal has 1,023 out of 1,064, Bhadrak has 1,146 out of 1,219, Keonjhar has 2,009 out of 2,041, Balasore has 2,478 out of 2,588 and Kendrapara has 1,325 out of 1,423 villages. All 30 districts have been declared ODF Plus districts.
Although the officials claimed that the state has 77 water testing labs, including one state lab, 30 at district-level and 46 at sub-divisional level, about 2.28 lakh tests per annum are conducted for chemical parameters and bacteriological tests at 1.57 lakh sources twice a year. However, the ground reality is more than that meets the eye. “Had these tests been conducted regularly, the outbreaks could have been prevented,” said Beura.
Flying under the radar
Adding to the menace is the unchecked proliferation of private water bottling plants, some of which operate without proper licences and routine water quality testing. In several reported cases, villagers fell ill even after consuming bottled water at public functions that resulted in multiple infections and hospitalisations. Sale of packaged water without lack of basic information - BIS certification, batch number, and in some cases, a label and expiry date - are rampant. Pouch water, in particular, is a menace.
Locals alleged that these plants mushroomed over last few years, selling water to retailers, events and even government offices. The food safety authorities, whose job it is to routinely inspect, sample and shut non-compliant units do not bother until an outbreak occurs.
“Bottled water has flooded the rural markets and one can find the bottles and water pouches in weddings, birthday parties, funerals and even temple events. The so-called mineral water is being sold without labels. People assume they are safe. But who is checking them? People died because the government did not do its job,” alleged Daitari Das, a resident.
Though the food safety officials swung into action after the outbreak and shut down roadside eateries and even sealed 18 water bottling plants, including nine in Jajpur and four in Cuttack, it was already late. In Cuttack, officials found bottling plants selling untreated 20-litre drinking water containers without proper purification measures. There were no reverse osmosis water filter systems and the plants were directly collecting water from the tap. A senior food safety official said they are severely short-staffed. “There are very few complaints. We act whenever a complaint is filed,” he said.
No accountability
Twenty days after the first outbreak, the number of cases may have come down, but it has not completely stopped. Surprisingly, no official has been held accountable despite the mounting cases and death toll. Families who lost their loved ones have received no compensation.
While grieving families fend for themselves, those entrusted with ensuring safe water and food continue unaffected. Not a single engineer has been held responsible for the delay in completion of piped-water projects. No food safety officer has been made answerable for the unchecked plants. In Jajpur, though, a doctor was placed under suspension for making a senior citizen procure drugs outside the hospital campus.
Public health experts and rights activists demand an independent inquiry into the outbreak, including audits of water projects and inspections of all private water plants in the state. “This is not just a public health crisis, it is a chronic state failure, a water supply system that collapsed, a food safety wing that looked away, and a government that continues to dodge accountability,” said Beura.
Commissioner-cum-secretary of Health and Family Welfare department Aswathy S said cholera has been detected only in Jaipur district and has not spread to other districts. “The outbreak has been reported in five districts so far. Every reported cholera or diarrhoea death is being audited by a team of doctors. The cholera test has been found positive in Jaipur, not in other districts yet,” she said.
Cause of outbreak
1.Health officials attribute contaminated water to the outbreak. Community feasts, marriage receptions, birthdays or engagement parties, Ekadasah or death anniversary functions emerge as a common thread
2.Adding to the menace is the unchecked proliferation of pvt water bottling plants, some of which operate without proper licences and routine water quality testing
3.No official held responsible for delay in completion of piped water projects. No food safety officer made answerable for the unchecked plants. Even, no compensation released for those who lost their loved ones