Report in the death of Irfan Masih, a sanitary worker in Umerkot

Irfan Masih

Background:  On 1st June 2017, three sanitary workers, Yaqoob, Shaukat and Irfan Masih, fell unconscious while cleaning a deep manhole in Umerkot (Sindh). They were brought to hospital where Irfan Masih, a young sanitary worker died whereas two others were taken to Karachi for further treatment. Victims family members claimed and media reported that he died because doctor(s) on the duty refused to treat him asking first wash his body then they will touch as he was filthy and full of sludge. The media highlighted the case and it has turned into a high-profile case and reported at national and international levels. After protests by victims, an FIR was lodged against three doctors and some low-grade staff of Municipal Committee Umerkot. Medical Superintendent (MS) of Civil/ District Headquarter Hospital of Umerkot was arrested but later released on bail next day. Civil Society condemned the incident and asked for justice. Minority members in the National Assembly boycotted the proceedings in protest. Sindh government has announced compensation and investigations in the case.

Process: Given the importance of the case a team of Sindh Human Rights Defenders Network visited Umerkot on 10 June 2017 to offer condolences with the family of Irfan Masih, and meet civil society and other actors in the city to have a detailed account of the matter and get firsthand information on issues and to know facts. The team comprised of Senior civil society activist Punhal Saryo, Advocate Ali Palh, Pirbhu Lal Satyani, Zulfiqar Shah, Ms Pushpa Kumari and Ms. Naghma Shaikh. Local activist, Ali Akbar Rahimon, Munneer Walhari and a local councilor and activist Ghulam Mustafa Khoso also joined the team.

What stakeholders say:

Victim’s family: The team met victim’s family including father and mother of deceased Irfan Masih and others and interviewed two close relatives Parvez and Liaquat of the deceased and injured who brought three victims to hospital and were eyewitness and party in the entire issue. They said that all the three victims were brought to hospital alive. This fact was also verified by shop keepers at the site of incident who told the team that the three were alive when taken out from the manwhole. According to Parvez and Liaquat three doctors Dr. Jam Kumbhar, MS, Dr. Yousuf, another senior doctor and also brother of MS and Dr. Allah Dad were present. Bodies of the three victims were in sludge as they were directly taken out of gutter and brought to hospital. According to Parvez at first instance Dr. Yousuf came and when he saw filth on bodies he just went away. According to Liaquat Dr. Jam asked to wash the body of Irfan first. According the Parvez, when he begged Dr. Allahdad to do something to save patients, the reply was “Ap hamara kam hamen batao gay?” Parvez and Liaquat categorically claimed that Irfan was alive for at least 30-35 minutes inside the hospital and could have survived if immediate medical treatment was provided. They said that same doctors later treated the victims but by then Irfan was dead whereas two were referred to Karachi. Victims’ family members said that hospital was in a bad shape with no oxygen was available. The oxygen cylinder, which hospital staff provided was actually empty.

They said that they took the body and staged protest during which they were joined by many citizens of Umerkot for whom they are thankful. They wanted to lodge an FIR on the first day but it was lodged on second day only after support from civil society and media reporting. Since they are illiterate so do not know much about importance of FIR but what they want is justice for the deceased and a punishment for all those who were responsible and whose negligence resulted in death.

Doctors (accused of negligence): We meet three doctors under accusations. The MS categorically denied using the words “I am fasting and first wash the body then I will touch.” He rather said that Irfan was brought dead in the hospital and we treated the two alive and referred them to Karachi. He also alleged that those who accompanied the victims and some staff of the hospital created trouble and damaged the hospital. They also denied that there was no oxygen available at the hospital but failed to provide any details on how many cylinders etc. were available at that time. They also declined to provide budgetary details. All the three doctors said that the hospital is short of facilities and they are trying to cater to the needs of a civil hospital with facilities of a Rural Health Centre. The MS complained about police attitude that they did not provide required security and did not stop enraged mob from damaging the hospital.

Police: The Team met SSP Umerkot Usman Ejaz Bajwa. He explained that he was not present on the scene so do not know whether doctors declined to treat patients immediately or not but what victims’ families are saying that doctors declined to treat Irfan immediately because his body was in sludge. He said that it was sad that such incident has earn a bad name for the area. However, he said that police are investigating the case according to FIR and a final report will be submitted in few days. The FIR was lodged under section 319 PPC (Qatle Khatta) but we have also added section 322 PPC on the instruction of the honourable judge. When asked about doctor’s allegations of police not be supportive, he said that police performed duty according to law. “I am not responsible when oxygen is not available in the hospital or patients are not treated.” He said that people were angry as they had lost one of their family members and two were injured, “You cannot use force in such circumstances.”

He said every citizen has a right to lodge an FIR or register a complain. However, he does not see any point that doctors’ application against people from victim families is accepted. These are very poor people and we cannot further victimize them. They were sitting on protest with body in this sizzling heat for eight hours. “I told people for God seek go and get this protest end and after some time got them agreed to end protest and burry the body.” “You cannot end such protest by lathi charge.”

Municipal Committee Chairman: The team also met Municipal Committee Chairman, Khalid Siraj Soomro who had also been head of the Taluka Municipal Committee Umerkot previously. While giving account of the incident he said that there was a team of four sanitary workers lead by Irfan Masih who was “Jamadar” to open the gutter on 1st June early morning. According to him Irfan was expert in opening such gutters. He was not the first who went inside but he just went to rescues the other two. All three were brought to hospital. He said according to victims’ relatives and staff, all three were alive when brought to hospital. He said he did not know exactly if doctors declined to treat patients or not. But he agreed that the hospital is in a bad shape and many deaths are occurred due to negligence and shortage of facilities. He said there is no concept of any health and safety equipment in the sanitary work and the municipal committee is responsible to provide two dresses to each worker every year. He said that he is considering to do away with the underground sewerage systems in the city and go for open drain, which is easy to clean. He said he could not visit victims’ family immediately because he went with the injured workers to Karachi and then stayed there for two more days for important meetings and when he came back to the city on third day he went and offered condolences. According to MC chairman, 50-60 sanitary workers are appointed on daily wages and have not been regularized because of ban on permanent jobs. He also accepted that many people appointed against sanitary workers’ positions are not willing to do the job of cleaning so have been assigned other duties. He said he has recommended a compensation for the victim’s family but did not give details of amount. However, MC is taking care of injured persons treatment in Karachi.

Journalists: Journalist stand divided. A group of journalists who first broke the news and said were eyewitness as they immediately arrived in the hospital said that doctors attitude was not good as they misbehaved with victim’s relatives. They said they reported what they heard and saw and were not bothered if someone changed his words afterwards. They also verified the victims claims that doctors used words like “wash the body first”. “I am fasting and wash body so I can treat”. “Don’t tell us what we are supposed to do etc.”. But they cannot say with certainty, which doctor said this because there was rush and many voices were there at the same time. Another group of journalists who were not present at the scene said that their colleagues did report in haste and made the issue an international. They said that journalists should have avoided such reporting and waited for some more facts to come. Another group of journalists blamed the hospital and doctors for the entire mess and some others said MC is the main responsible.

Civil Society: Civil society members clearly pointed to the poor treatment of sanitary workers by MC and poor conditions and negligence of doctors at the hospital as a result death of sanitary worker happened on that day. They said that the city has become “la’waris” as roads are damaged, hospital is in shambles, MC does not care for its workers. Given such a situation, deaths due to negligence is a routine matter. It is only when one case is highlighted otherwise this is frequent happening at the government hospitals. They could not verify the victims’ claim that doctor (s) refused treatment and there was any religious factor involved in this matter.

A reliable civil society member who was an eyewitness said that he himself saw that an oxygen cylinder was removed from the mouth of a girl child to be put on victim’s mouth in this emergency and father of that child cried saying that “My daughter will die”. He said that “then I saw the father took his daughter and ran out of hospital”. Since then it is unknown that whether the child died or was taken to any private hospital. He said when the same oxygen cylinder was given to one of the three victims, it came to know that it was empty of gas. “I cannot say that whether doctor asked the victims’ relatives to wash his body, but I can say that there was no oxygen in the cylinder provided and there was clear issue of absence of required facilities.”

Civil society members also urged for improvement in working conditions and employments conditions of sanitary workers and reminded that nothing has changed since the last incident in 2012 in which two sanitary workers lost their lives.

They also expressed dissatisfaction on the inquiry being conducted by an Assistant Commissioner and instead demanded a judicial inquiry.

Key Findings:

  1. We believe that what happened with three sanitary workers on 1st June 2017 in Umerkot was not a mere accident but a result of a series of lapses and negligence on part of the Municipal Committee for which Chairman and Chief Municipal Officer are responsible and negligence inside Civil Hospital, Umerkot for which MS, senior doctors and relevant officials of health department are responsible.
  2. There is strong evidence that doctor (s) expressed displeasure/declined to immediately treat sanitary worker(s) when they were brought to the hospital as their bodies were in sludge and filthy with dirt. They were directly taken from gutter and brought to hospital. Similar attitude was faced at the scene of incidence as at least two rickshaw-walas also refused to take the injured/ unconscious to hospital as they were full of filth. It was the third rickshaw-wala (a flat rickhsha) who took the first recovered person. Many actors we meet also accepted that there is general discriminatory attitude towards sanitary workers because of their work and their low status in the society. For example, their crockery is separate in Municipal Committee.

Therefore, the team believes that there is a weight in the claim of relatives of the deceased that the doctors initially refused to treat Irfan and asked first to wash the body. However, which doctor had said that is not clear as three doctors were accused in the case.

  1. District hospital in Umerkot is in poor conditions and lacks facilities, human resources and management required to deal with emergencies hence the claim of victims that Irfan Masih died because of delay in treatment and non-availability of required facilities including Oxygen also carries a heavy weight. Even doctors accepted that many lives could have been saved had the hospital had required facilities. “Deaths due to lack of facilities and non-availability of the required staff is a routine matter but they are just not reported,” said one of the doctors. Family members of Irfan claim that there were no Oxygen in the hospitals and gas cylinder was empty. Doctors denied this. However, a reliable eyewitness told a horrible story saying that the hospital staff removed gas from a small child to meet the emergency and he himself saw the father of small child yelling that if you removed gas from child, she will die. Nobody listen to him and “I saw the father took his child and ran out of hospital,” said the eye witness. “Nobody knows what happened to that child.” According to him there were two gas cylinders and one was put on a victim being shifted to Karachi while the other removed from girl child turned to be empty. Current MS as well as a former MS of the hospital agreed that though the hospital is District Hospital in the documents, it qualifies only as a basic health unit because of lack of facilities. There are average 100 patients admitted against the capacity of 50 beds. Only 19 doctors are working against sanctioned strength of 80. Add to the injury is that senior doctors do private practices at a private facility with a distance of few hundred meters and there is no mechanism to monitor their workings at the hospital. Whose is responsible for a such a bad condition of hospital is not a secret.
  2. Major responsibility lies with the Municipal Committee (MC) Umerkot. It failed to provide any health and safety equipment to its employees and failed to play any constructive role while this incident happened. The Committee is also responsible for poor working conditions of its sanitary staff particularly who are engaged in hazardous work without any health and safety measures. All actors the team met pointed to the negligence of the MC in letting sanitary workers enter in such a deep and dangerous manhole and then not reaching for immediate rescue. The team also visited the site of incident and found that a long queue of shops has been constructed on the drain and this manhole was almost inside a shop. MC is also responsible for removing encroachments and stopping illegal constructions in the city. It is also important to note that two sanitary workers had died in a similar incident in 2012 but no precursory measures were taken after that incident. The team met the Chairman of MC Umerkot and the only solution he offered was that the MC is considering to do away with the underground sewerage system. He said that he is not aware of any health and safety equipment available for cleaning gutters and insisted that the deceased Irfan who was an “expert” in cleaning such blocked gutters should have taken care on his own. MC was also not clear on compensation amount for the deceased but the Chairman said that the Committee is taking care of medical expenses of injured at Liaquat National Hospital Karachi.
  3. Mishandling by local administration: After the incident happened on 1st June morning, victim family members along with a number of citizens took the body and staged a sit-in for more than 8 hours, seeking justice. The first demand they made was that the MC chairman should come and listen to their demands. The Chairman did not go to them for the obvious reasons. He only visited and offered condolences three days after Irfan’s death. Multiple sources confirmed that the Chairman did not give it serious attention until the case was highlighted by media and drew national level attention. The explanation offered by Chairman MC to the visiting team was that “I went with injured people to Karachi.” This explanation is not enough to justify his absence from the city for which he is a custodian and where there was an agitation and emergency.
  4. Sanitary Workers Conditions: There are over 200 people appointed on sanitary workers positions for Umerkot city. A large number of them known as “white color” are deputed on some other tasks. We were told that these people either do work at the personal places of influential people of the city or do not do job at all but are paid regular salaries. The entire cleaning work is done by around 90 Christian sanitary workers, Gujrati and Marwari which are called “Bhungi”, and sadly a majority of them are appointed on daily wages basis for years. The MC chairman accepted that no person from other castes is willing to do cleaning work so only Christians and “Bhungi” are doing it. However, the question that then why people are not willing to do job were appointed as sanitary workers, he has no satisfactory answer and shifted the responsivity to his predecessors for appointing wrong people. All actors we met highlighted the issues of those appointed as sanitary workers but not doing sanitary workers job and demanded that either they be removed or made to the job for which they have been appointed. They also agreed that the conditions of sanitary workers are very poor and exploitative in nature as they are compelled to do hazardous work on daily wages without any health and safety measures etc.
  5. Police’s Role: In a sharp contract of general perception, police played positive role. The victims expressed confidence in police investigation and measures taken by police for security. The role played by the SSP in negations during the protest, registration of FIR as desired by victims and arrest of the MS (now released on bail). The police have not yet submitted its final challan and investigation reports, so far victims are satisfied with the progress. The visiting team was told that various quarters tried to influence the police to break the protest by force or use force when some enraged members of victim families tried to damage hospital equipment. The SSP said that it would have been inappropriate to use force in such conditions. “When people found watermelons instead of medicines in hospital refrigerator and a person has died, anger is natural.” We cannot use force in such circumstances. He assured that police would act according to the law.
  6. Sharp divisions: It is interesting to note people are divided on the basis of parties and also on the basis of caste. For example, people from a particular caste were in favor of the accused doctor and said they will stand for him because he is from same caste. Obviously, they gave the justification that he is innocent. Similarly, people even working in social sector from a particular caste advocated for the innocence of MC Chairman saying that he did not ask sanitary workers to go inside the manhole. However, this should not be seen as a division on the basis of religion as victim families said that many citizens regardless of religion have stood with them.

Recommendations

  1. Since the victims as well as civil society activists have rejected inquiry under an Assistant Commissioner, a judicial inquiry by a District and Session Judge may be ordered to fix the responsibility of negligence that led to the death of Irfan Masih including alleged refusal of doctor (s) at district hospital Umerkot.
  2. Same inquiry should look into the alleged negligence and lapses of Municipal Committee Umerkot particularly with reference to compelling sanitary workers to do hazardous work without health and safety measures, negligence in providing immediate rescue and alleged discriminatory and exploitative treatment of sanitary workers ( Christian, Gujrati and Marwari).
  3. There are serious allegations of negligence against senior doctors of Civil Hospital Umerkot including MS, all the three doctors accused by the victim family and media, may be put under suspension till a judicial inquiry is completed.
  4. A separate departmental inquiry in matters related to Civil Hospital Umerkot may be conducted to ascertain the poor conditions at the hospital and necessary corrective measures are taken to save several lives on daily basis.
  5. Private practice by doctors must be discouraged and banned. There was general complain against the doctors of private practices, which has resulted in compromise on doctors performance at the government hospital.
  6. MC of Umerkot should clearly declare sanctioned posts of sanitary workers and make appointments on regular basis of only those willing to do this job, rest should be immediately removed. All current daily wage sanitary workers should be made permanent.
  7. MC must ensure that proper health and safety measures including safety gears are in place before sanitary workers venture on hazardous job of cleaning sewerage manholes. Deep holes should be pumped through machines not by manually.
  8. Instead of doing away with underground sewerage systems, MC should remove encroachments of the markets built on gutter line and sewerage system.
  9. Deceased family may be paid a compensation of Rs. 5 million and jobs offered to family members. These jobs must be regular, not three month temporary jobs. Rs. 1 million already announced by Sindh government should immediately be disbursed.
  10. Sindh government may consider a uniform policy guidelines, prohibiting discriminatory behaviors with cleaning staff which include keeping separate crockery for them in the offices. GoS should also regularize all sanitary workers in the province.
  11. Federal and provincial government may consider to launch a campaign seeking behavioral change towards those belonging to lower social status in the society because of their descend such as sanitary workers or because of their caste. Use of words such as “Bhungi” should be banned.
  12. There is also need to seriously look into why cities like Umerkot are so under developed despite the fact that there have been reasonable budgetary allocations and the district has representation in Sindh cabinet currently as well since the last tenure of PPP government. The entire city is in shambles. Road infrastructure, hospitals, schools- almost all public infrastructure is in very poor condition and poor people are paying the price.
  13. It is also important for the civil society including NGOs, Bar Council, Journalists Association and human rights defenders to join hands and build alliances at the district level to operate as watchdog aimed at improved public services and play role of active citizens.

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