A “mystery fever” is believed to have killed more than 150 people, nearly half of them children, in India’s most populous state over the past six weeks.

The unidentified fever has created a medical emergency in Uttar Pradesh, a state ruled by the Bharatiya Janata Party (BJP), but one where the healthcare system has repeatedly failed.

Nabi Hasan, a grocer from Lakhimpur Kheri district in Uttar Pradesh, lost his 18-month-old daughter Shama to a sudden week-long outbreak of fever.

Shama, he said, did not respond to medical treatment and the fever kept recurring, despite her being admitted to the Lakhimpur Kheri district hospital last Tuesday. “Doctors suspected it to be malaria, but we are yet to receive the test report from the hospital,” said Hasan, whose daughter died on Sunday.

State Health Minister Siddharth Nath Singh said the high casualty rate stemmed from people going to “quack” doctors – unqualified people who practice medicine, before coming to government hospitals, according to local media reports.

Dr AK Pandey, the chief medical officer at the Bahraich district hospital where 70 children have died over the last one and a half months, said the recent deaths were due to birth asphyxia, pneumonia, infections, encephalitis and other diseases.

“There is nothing to worry about… yes, the deaths are unfortunate, but look at the flow of patients here. We have patients from adjoining districts as well,” Pandey said. The Bahraich district hospital also serves as the closest tertiary care center for patients from Shravasti, Gonda and other adjoining districts that lack specialized healthcare facilities.

While deaths have been reported mainly from four districts – Badaun, Bareilly, Pilibhit and Bahraich – several patients have died in other districts like Shahjahanpur, Sitapur and Lakhimpur Kheri.

Alarming staff shortage

Last year, more than 60 children died within a week allegedly due to a shortage of oxygen cylinders at the Baba Raghav Das (BRD) Medical College in Gorakhpur. Pandey claimed that this time the deaths came from very different circumstances. The infant mortality rate in the state in 2015-16 was 64 deaths per 1,000 live births, according to the National Health Family Survey, well over the national average of 39. This may be the result of overcrowding in government hospitals and a lack of adequate secondary and tertiary healthcare centers.

A major problem in Uttar Pradesh has been the inability of understaffed government hospitals to handle a multitude of patients. Rural Health Statistics indicate that the state has a serious shortage of doctors at the primary-health-center level, which is considered the backbone of India’s health services.

Figures from 2015 suggest the state had less than half the staff it needed, with 2,300 vacancies out of 4,509 sanctioned positions in some 3,497 primary-health centers. The report also showed that community health centers had an alarming shortage of 2,608 medical specialists, out of 3,092 surgeons, gynecologists, pediatricians, and other experts required in community centers.

Pandey maintained that the Bahraich district hospital was trying its best to save lives, but said every bed had two to three kids in them because bad weather had triggered a spread of diseases.

The chief medical officer said that the cases of vector-borne diseases were on the rise because heavy rainfall since August left villages waterlogged. “Be it encephalitis or malaria, the cause is almost the same,” he said.

The worst affected districts were Badaun and Bareilly, where hospitals had been swamped with patients. According to Bareilly Chief Medical Officer, Dr Vinit Kumar Shukla, the district hospital was overcrowded but they had treated around 1,500 patients so far, so the situation was under control.

Uttar Pradesh Chief Minister Ajay Singh Bisht blamed the state’s poor public healthcare on the previous Samajwadi Party government. He had promised to revamp the system last year. However, tangibles outcomes are yet to be seen.

Mystery behind the fever

Despite the official denial, some believe a ‘mystery fever’ really did kill their family members.

Hasan had taken his daughter initially to a private doctor, whose medicine brought down the child’s fever. But it returned within three days, after blood test results came back normal. “So the doctor assumed that fever was recurring due to weather conditions. We then took Shama to the district hospital,” he said. But she didn’t survive.

Meanwhile, Kumari Savitri from Ambia village is fearful because her “fit and fine” 19-year-old son Akash was admitted to Badaun district hospital last Monday with symptoms similar to that of the “mystery fever”.

“Doctors are saying it’s malaria fever,” Savitri said, adding that Akash’s condition had improved over the last two days. His fever persisted even after over-the-counter painkillers for headache and fever. His condition worsened when he stopped eating, and eventually, he was brought to the hospital.

Dr Padmakar Singh, Uttar Pradesh’s Health Director, said the outbreak was assumed to be a vector-borne disease but the actual cause could only be identified after a medical investigation into each death. The state health minister ordered a probe into the cause of death while on a visit to Bareilly last week.

The Chief Medical Officer of Lakhimpur Kheri district, Dr Manoj Agarwal, said the symptoms of the fever – a strong headache, fever and a cold sensation that makes one shiver – seemed to be “a combination of malaria, typhoid and viral [infection]”.

But Dr BP Shukla, a senior doctor with Shekhar Hospital in Lucknow, also denied the existence of a “mystery fever” in the state. “These are all curable diseases and doctors at the primary and community level need to understand the cause behind the outbreak. All these diseases can be avoided by prevention.”

The state’s health administrators, while slow off the mark, took action after the health minister took notice of the situation. Dr Singh said teams from both the federal and the state governments had been deployed. A few health department officials were also suspended.

“Mosquito fogging, spraying of larvicides and distribution of medicines which prevent people from falling prey to such diseases are being done and within few days, we will bring the situation under control,” he said.

(With input from Gopal Giri and Rahul Arora)