Balaghat (Madhya Pradesh): Kaushila Markam, a resident of Madhya Pradesh’s Matla village in Balaghat district, visits her three-year-old daughter Babita’s grave only once in a fortnight. Babita’s grave is a pile of large stones that sits atop a hill in the village, located next to the Chhattisgarh border. Surrounded by lush green forests, the hilltop hamlet is home to the Baiga Adivasi community whose customs suggest that after death, the deceased’s existence is purged from the family home, with their belongings too buried along with them. Babita’s remains have no gravestone, or any other marking to suggest that a three-year-old child lies buried in these hills. Only a small steel plate that Babita used lies a few steps away.Babita’s plate. Photo: Sravasti Dasgupta“I don’t come here often. I feel like crying thinking of my daughter. Only once in 14-15 days,” said Kaushila.Babita died on May 18 after four days of fever, and presenting with rashes all over her body. She was one of the first victims of the measles and malaria outbreak in Balaghat’s picturesque forested hill villages of Matla, Kondekasa, Bondari and Macchurda that surround the Kanha National Park.No one from the health administration knew that she died. It was only in mid July, two months after Babita’s death, that word on multiple deaths of Baiga Adivasi children from these villages reached the Panchayat leaders, and then the district administration, that led to an official response.Four months on, the outbreak in Balaghat has grabbed national attention, forcing the Bharatiya Janata Party (BJP)-led Madhya Pradesh government in the state to provide Rs 2 lakh compensation to the children’s families, and a Rs 225 crore package for Balaghat’s development. Yet Babita’s name is still not on any record, nor has her family received any compensation.Kaushila said that when Babita first fell ill, a doctor was called to the house who said that the child had “mata”, the local term for measles.“The doctor gave her an ointment and said that she would recover in four-five days. But she did not. Her body was filled with rashes and then she died here at home,” said Kaushila.According to figures available with Balaghat chief medical and health officer (CMHO) Dr Shatrughan Singh Dahiya, who took charge only on September 7 after his predecessor Dr Paresh Uplap was removed amid the furore over the outbreak, the official toll in the epidemic is 32. The local MLA from the Congress Sanjay Uikey on the other hand has said that a total of 43 deaths have taken place. The death toll of 32 does not take into account deaths like Babita’s, which remains unreported in official documents.Shatrughan Singh Dahiya took charge as the Balaghat CMHO only on September 7, after his predecessor was removed amid the furore over the outbreak. Photo: Sravasti DasguptaOfficial figures provided by the CMHO to The Wire say that both measles and malaria have been found among the affected. Since the health screening started in July, of the 27,000 people tested till September, 980 were found to be positive for malaria, and another 22 for measles. Yet a single cause of the outbreak is yet to be narrowed down on; officials say the diseases were worsened by malnutrition-related complications.“We found out (about the outbreak and deaths) in the second week of July from the local public representatives of the area. Three days later our team visited the area. At present the count of the epidemic is 32. As you know, India’s CMR (child mortality rate) is 27, several children under five die due to malnutrition, diarrhoea and other natural causes. But we are monitoring the situation, we have formed a death audit team and if they find more deaths related to the epidemic those will be added as well,” said Dahiya.While the administration has now swung into action, the severity of the outbreak and its fast spread, has highlighted how the Baiga tribal community has suffered institutional neglect at the hands of the government.Villages surrounding the Kanha National Park paint a picture of tranquillity. Photo: Sravasti DasguptaInstitutional neglect and a lack of trustThe Baiga community is among the 75 recognised Particularly Vulnerable tribal groups (PVTG) in India. The Union government identifies PVTG as those with pre-agricultural level of technology, low level of literacy, economic backwardness and a declining or stagnant population. However, the community’s vulnerability is visible on the ground not just for historical reasons but for the fact that basic amenities have not reached these remote villages, where healthcare centres are at least 20 km away, public transport linkage is not available and the terrain difficult to navigate for healthcare workers inside forested hills. This not only restricts access to healthcare benefits but also deepens existing inequalities, with physical distance, cultural differences and a lack of trust playing a role.That the state administration only swung into action after the outbreak claimed nearly a dozen lives in July has only put the spotlight on how the community has been deprived of their basic rights.Devalal Baiga, a local community leader who accompanied The Wire to these villages, and has been working there to record its spread, said several deaths have gone unreported because neither members of the panchayat nor healthcare workers visit due to the lack of road access.“The Baiga community also believes in local faith healers who suggest ways to calm the disease, including keeping water [next to the affected person] signifying offering it to maata [goddess], for instance for nine days in case of measles. While this has been a custom, we are now urging people that they continue with this but also visit hospitals,” he said.Devalal Baiga has been working with the community to bring attention to the outbreak. Photo: Sravasti DasguptaHowever, in the villages, it would be false to say that all affected families have simply turned to local faith healers. In Matla, Jethin Markam’s three-year-old daughter Jambatti Markam died on August 5. She was taken to a primary healthcare centre in Saliwada twice on a relative’s motorcycle but brought back home when she did not get better. It was then that she turned to the local faith healer.“We brought her back and took her to a faith healer who suggested keeping water next to the child. We kept ten bottles but she died after five days of fever and rashes all over her body,” said Jethin Markam.Jethin Markam in Matla. Photo: Sravasti DasguptaIn the same village, Maha Singh Parte’s four-year-old son Samlu and six-year-old daughter Samkunwar died on the same day in May after developing fever and rashes for five days. Unlike Jethin Markam, though, Parte did not take the children to a doctor or a hospital which is 25 km away from his hut.“We feared that their illness would get worse,” he said. “The faith healer asked us to keep water next to them. We did this for two days but they both died on the same day – my daughter in the morning and my son that evening.”Maha Singh Parte’s two children have been listed as the first victims of the outbreak. Photo: Sravasti DasguptaHis hut is the last house in Matla, on the Madhya Pradesh-Chhattisgarh border. Photo: Sravasti DasguptaWhile Matla is where the outbreak of the disease began, deaths were soon recorded in nearby villages. According to a list of the local panchayats seen by The Wire, Parte’s children have been recorded as the first deaths on May 18. Since then, along with Matla, deaths have been recorded in the villages of Bondari, Kundekasa, Usekal, Macchurda, Korka, Tendudeeh and Chikhli.In Bondari, where at least five deaths have been recorded, Chainsingh Markam’s son, five-year-old Sachin, died on July 31. Chainsingh had not gone to any faith healer; he took his son first to the district hospital in Balaghat about 100 km away and then to a private hospital in Gondia, another 40-odd km away. He died on the way back from the Gondia hospital.“We still don’t know what caused his death, though they are saying it could be one of these two diseases,” said Chainsingh.Chainsingh Markam’s son Sachin died in Bondari. Photo: Sravasti DasguptaChainsingh, who works as a farmer, spent over Rs 1 lakh on hospitalising his son, amounting to two season’s worth of income that he makes on the farm. Since his son’s death, a stream of visitors have trooped in – healthcare workers, journalists, content creators and even Madhya Pradesh chief minister Mohan Yadav who visited Bondari on August 29. When Yadav met the bereaved families, Chainsingh sat in the front row. The Rs 2 lakh compensation promised by the government had already been delivered to his account the night before. But he did not get a chance to have a word with the chief minister.“All of them have come after my son died. If they had come before then all this would not have happened,” he said.The way to Chainsingh Markam’s house in Bondari village, Balaghat. Photo: Sravasti DasguptaJay Ramteke, a medical anthropology research scholar who runs the Paigam organisation in Balaghat working with tribal communities, said that while it’s true that not everyone would put their faith in the medical system the way Jethin and Chainsingh had tried to do, the outbreak cannot simply be explained away as the “Baiga way of living”.“From my experience, people do not necessarily see traditional healing and biomedicine as opposites. I met families who consulted a gunia or panda, and had also taken their children to doctors and hospitals. To me, this is ‘medical pluralism’ (when people switch to different systems of medicine to seek care), not simply an overreliance on faith healers. People often switch to different faith healers too,” Ramteke told The Wire.What happens then, he continued, is that assigning blame becomes more important than finding ways to work together. “Healthcare workers blame Baigas, because they trust their biomedical system; Baiga people blame healthworkers and the system, because they trust their traditional system. Both are doing the same thing, though the blame and othering is inherently human. While yes there is vaccine hesitancy, it is also a question of trust. People don’t like when awareness is imposed on them. Instead of blaming, we should find ways to work with the community.”A primary school in Kundekasa has been turned into a temporary health centre. Photo: Sravasti DasguptaA delayed response straining fragile healthcare infrastructureSeven days after Chainsingh’s son died, about five km away from his village Bondari, a temporary healthcare facility was set up at a primary school in Kundekasa on August 7 – almost a full three months after the children first started dying in the villages.Records of the OPD at the Kundekasa temporary health centre show that the number of patients visiting has reduced from about 100-120 a day to about 15 now. Healthcare workers at the Kundekasa temporary health centre said that while the number of patients have decreased, systemic concerns remain.Dr Sudha Jain at the Kundekasa temporary health centre. Photo: Sravasti Dasgupta“Distance is the biggest factor, hospitals are far away. This is anyway a malaria endemic zone. Besides Balaghat’s Baiga community lives in poor financial conditions, there’s little education, malnutrition is rampant and they are not feeding their children a proper balanced diet. Hygiene is also a concern and there are cases of rashes which are not malaria but scabies,” said Dr Sudha Jain at the Kundekasa centre.The national media attention may have forced the Madhya Pradesh government to act on the outbreak, but it has in turn put pressure on the district’s strained healthcare system without the state support needed to properly address the situation. Healthcare workers have been sent on door to door visits with medicines and malaria kits, providing medicines to villagers and raising awareness about the need to give medicine to the children if found ill.“If any case is found to be serious, ambulances are called to take them to the Kundekasa centre, where the pediatrician sees them and if necessary they are then moved to Balaghat district hospital,” said Dr Nazin Khan, who was on a door-to-door visit in Bondari.Nazin Khan on a door-to-door visit in Bondari village. Photo: Sravasti DasguptaThese door-to-door visits too began in the second week of July, two months after the disease had already spread. Under pressure, the state government has diverted its urban healthcare workers from the semi-urban areas of Balaghat like Birsa to these villages.“There is a shortage of healthcare workers, whether it is ASHA workers, ANM, CHO (community health officers). For instance we have come here from the Birsa community health centre because there are no workers here. But what happens to our areas if all workers are being diverted here?” said community health officer Gyan Singh Dhurwey, who was on a door-to-door visit in Adori village.“Apart from this there is pressure from the top. The question is, why is there no infrastructure here?”District hospital in Balaghat, where severely ill patients are referred from the villages. Photo: Sravasti DasguptaPoor health indicatorsThe absence of healthcare is also apparent in rural Madhya Pradesh’s health indicators, with poor vaccination rates, childhood diseases among children under age five and, most importantly, malnutrition.According to NFHS-6 data, in rural Madhya Pradesh, 79.9% children have been fully vaccinated, in comparison to a national rate of 82.6%. NFHS-6 data shows that among children aged 12-23 months in rural Madhya Pradesh, 91.1% received the first dose of the measles-containing vaccine, close to the national average of 91.7%. But when it comes to the second dose, only 65.5% of children aged 24-35 months received it in rural Madhya Pradesh – against 71.8% nationally.Villagers queue with their children at the Kundekasa temporary health centre. Photo: Sravasti DasguptaThe figures for malnutrition are even more concerning. NFHS-6 data says that 33.2% children under five years are stunted in rural Madhya Pradesh, against 29.3% nationally; 24.9% are wasted against 19% nationally; and 42% are underweight against the national figure of 31.8%.In Balaghat district, these figures also manifest locally. According to data available with the Balaghat CMHO, of the total 16,784 children screened between July 14 and August 31 in Birsa block, there were 213 cases of severe acute malnutrition, while in Baihar block the figure was even higher, at 986 of the total 10,418 screened.Malnourished children receive care at the ANM centre in Birsa. Photo: Sravasti DasguptaCM blames a past of left-wing extremismWith no clear cause yet to be identified, officials including chief minister Yadav have said that the area has been deprived of healthcare benefits and other development infrastructure as the area was affected by left-wing extremism (LWE) until December 2025, when the state was declared “Naxal free” following the surrender of two operatives in Balaghat.Following his visit on August 29, Yadav wrote on X while announcing the Rs 225 crore package that the fact a chief minister has been able to visit the area for the first time in 25 years is itself “proof that a new era of development and trust is beginning”.“For years because the administration was not even able to reach inside these areas, there were several challenges. But now that these areas are open we need to confront these challenges,” Yadav said while addressing the media on his visit.A road built under the PM Gram Sadak Yojana in Siletekri, on the way to Kundekasa. Photo: Sravasti DasguptaCMHO Dahiya’s first explanation too was to blame the influence of LWE, and then a combination of factors including malnutrition and migration.“This area was affected by Naxalism, which restricted villagers from leaving the area as well as the administration from going in. Health services were compromised, that is a fact. Malnutrition is also rampant,” said Dr Dahiya.Dahiya said that people from the region migrate to neighbouring Maharashtra and Telangana for work, and the measles virus may have originated from an external source bringing it into the community, which resulted in complications due to malnutrition.“We have found that despite receiving malaria vaccines, the children have not developed antibodies because they are malnourished. Measles as a disease subsides in about seven days, complications arise if the child is malnourished even though the disease itself does not cause deaths. It appears the source of infection came from somewhere but the casualties were due to various causes including malnutrition, the community not taking treatment, and absence of healthcare facilities.”Lush green forests surround the villages in Balaghat that have become victim to the malaria and measles outbreak. Photo: Sravasti DasguptaWhile officials are now rushing to ramp up healthcare infrastructure in the area, local representatives said that while LWE may have been a concern, it did not stop the government from setting up infrastructure when it wanted to.“From the beginning these villages were cut off. Whether it is Rs 225 crore or Rs 500 crore, if the system is not changed, things will remain the same,” said Parshuram Dhurwey, the sarpanch of the Adori panchayat.Parashuram Dhurwey, Adori sarpanch who first initiated the official response to the outbreak. Photo: Sravasti DasguptaIt was Dhurwey who initiated the institutional response to the outbreak after he found out about two deaths in Bondari in the last week of July, following which he informed the district authorities.“Last year when they announced that they would end Naxalism in this region, CRPF camps were built overnight. But even after 30 children have died, no hospital has been built, not even a primary health care centre is there, and a single school is housing both primary and middle school children. If the government can manage to build CRPF camps, then why not schools and hospitals for the people?” he said.