What unfolded since June–July in the dense forest belt of Baihar and Birsa talukas in Balaghat district, eastern Madhya Pradesh, is not merely a story of an infectious disease outbreak. It is a stark illustration of how India’s health system continues to struggle to reach the “last mile” at the grassroots—and of the persistent neglect faced by Particularly Vulnerable Tribal Groups (PVTGs).
In remote villages bordering Kanha National Park—Machurda, Adori, Bondari, Korka, Gatia, Konhimor and Kundeksa—children from the Baiga and Gond communities burned with fever, developed red rashes and, in some cases, died. Yet it took weeks for the situation to receive serious administrative attention.
Only after the outbreak had escalated by mid-August did the central government dispatch the National Joint Outbreak Response Team (NJORT) to Balaghat on August 12. Teams from the Indian Council of Medical Research (ICMR) in Jabalpur and the National Institute of Virology (NIV) in Pune tested blood and water samples. A survey that initially covered three villages was expanded to nearly 50. Six mobile medical teams were deployed, and around 1,200 children received supplementary measles-rubella vaccine doses.
By the first week of September, the Union Health Ministry announced that no new measles cases had been recorded for seven consecutive days.
The system had finally moved. But for families in these forest settlements, the response came only after weeks of illness and loss.
To understand the reality of healthcare in this part of Balaghat, it is not enough to ask how far the nearest hospital is. The closest primary health centre is around 15 kilometres from the village, while the district headquarters is more than 125 kilometres away. A seriously ill patient may have to travel from the primary health centre to a block-level hospital, then to the Baihar sub-divisional hospital—nearly 70 kilometres away—and, if necessary, onward to the Balaghat district hospital.
For a sick child, such a journey through dense forest, muddy roads and hilly terrain can itself become a medical emergency.
For tribal families, “referral” can effectively mean abandonment, as one analytical note on the region observed. When ambulances cannot reach remote hamlets, sick children may have to be carried down hills in bamboo slings. It is a grim picture of healthcare in a country that has spent decades promising universal access.
The Melghat Warning
Balaghat is not an isolated story.
In the Melghat region of Amravati district in Maharashtra, child deaths among the Korku tribal community have remained a persistent concern for decades. Between 1992 and 1997, more than 5,000 child deaths were recorded as being linked to malnutrition, triggering nationwide alarm.
Judicial committees were formed, voluntary organisations became active and political parties repeatedly raised the issue. Yet data obtained through a Right to Information request in 2016 reportedly showed that nearly 6,000 mothers and children had died over a six-year period.
Public-health researchers, including Dr Abhay Bang, have argued that official figures can significantly understate the actual scale of deaths in such settings. Government officials in Melghat have, at different times, attributed the problem to difficult terrain and the “cultural customs” of tribal communities. Similar explanations are now being heard in discussions about Balaghat.
The persistence of deaths in Melghat, despite decades of attention, offers a sobering lesson: being identified as a “sensitive zone” does not guarantee lasting improvement.
For Balaghat not to become another Melghat, the response must go beyond temporary vaccination drives and emergency medical camps.
Parliamentary data on rural health infrastructure reveal the scale of the structural problem. Against a sanctioned requirement of 416 specialist doctors at Community Health Centres in Madhya Pradesh’s tribal regions, parliamentary responses have recorded only 67 specialists in position, leaving more than 300 posts vacant.
A report of Parliament’s Standing Committee on Social Justice and Empowerment has also highlighted shortages across tribal areas of more than 1,200 primary health centres, over 250 community health centres and more than 6,500 sub-centres. Madhya Pradesh accounts for a significant share of these gaps. In Birsa taluka alone, nearly 50 ASHA worker positions have reportedly remained vacant.
These are not merely numbers on a government spreadsheet. They can mean the absence of a health worker who might examine a feverish child, identify malnutrition, remind a family about vaccination or persuade parents to seek treatment before an illness becomes critical.
They also explain why expecting a doctor, medicines and an ambulance to be available simultaneously in a remote forest hamlet is often unrealistic.
For the Baiga community, another part of the crisis begins long before a child reaches a health centre: nutrition.
Kodo and kutki millets have traditionally been staple foods for Baiga families—grains that are to a rural household what rice and roti are to many urban families. Today, however, these nutritious millets are reportedly being consumed less frequently by the communities that grow them.
Some surveys have found that tribal farmers sell kodo and kutki in the market while depending on government ration grain for their own food needs. Reports have also pointed to rising anaemia among women and malnutrition among children.
At the same time, restrictions on access to forests have made it increasingly difficult for Baiga families, many of whom depend on forest produce for their livelihoods, to enter and use forest resources. Villagers have also complained in some places about interruptions in supplementary nutrition supplies.
Poor Nutrition
When access to land, forests and livelihood opportunities shrinks, the consequences eventually reach the child’s plate—and then the child’s health. Poor nutrition can weaken the body’s ability to withstand infection, turning an illness that might otherwise be manageable into a potentially life-threatening condition.
Vaccination adds another layer to the problem.
According to health workers, low vaccination coverage was among the factors contributing to the severity of the outbreak. Some families reportedly leave for daily-wage work in the forest on vaccination days, while others take sick children first to traditional healers.
But reducing this behaviour to “ignorance” would miss the deeper problem.
There is reported unease within parts of the Baiga community about the permanent mark left by the BCG vaccine and concerns about a foreign substance entering the body. Such distrust does not emerge overnight. It can grow from years of inadequate engagement, intermittent contact with the health system and a lack of sustained communication.
If medical teams reach these villages primarily when there is a crisis, how can lasting trust be built?
Tribal activists have also pointed to linguistic and cultural barriers. Doctors may struggle to understand how patients describe illness in their own cultural terms, while patients may find the language and procedures of hospitals unfamiliar.
The distance, therefore, is not only geographical.
It is also social, linguistic and cultural.
The deaths eventually drew the attention of the Madhya Pradesh High Court. A lawyer filed a public-interest petition based on newspaper reports, citing the deaths of 25 Baiga children and drawing attention to the outbreak and the condition of health infrastructure.
A bench comprising Acting Chief Justice Vivek Rusia and Justice Pradeep Mittal declined to entertain the petition on the basis of newspaper reports alone and directed the petitioner to visit the villages, verify the facts and submit a detailed affidavit. The court subsequently sought a response from the state government.
The episode illustrates how difficult it can be to establish accountability when the affected communities are far from administrative and judicial institutions. It also underlines the importance of credible, locally verified documentation when reporting tragedies in remote regions.
The government has not been without programmes for vulnerable tribal communities. Since 2008, the Centre has operated development schemes for PVTGs. More recently, under the Pradhan Mantri Janjati Adivasi Nyay Maha Abhiyan (PM-JANMAN), ₹15,000 crore was allocated over three years for housing, drinking water, healthcare and nutrition, roads and telecommunications connectivity.
The programme’s stated objective includes saturating PVTG settlements with services under schemes covering areas such as Ayushman Bharat, sickle-cell disease elimination, tuberculosis elimination and vaccination.
Yet Balaghat raises a fundamental question: how effectively do programmes on paper become sustained services on the ground?
The lesson from the outbreak is not simply that more emergency teams are needed. What is needed is continuous frontline healthcare, reliable vaccination, adequate nutrition, functioning referral systems, filled health-worker positions and an early-warning mechanism capable of identifying illness before it becomes a crisis.
The deaths of Baiga children cannot be reduced to the presence of a single virus, bacterium or episode of malnutrition. From the Korkus of Melghat to the Baigas of Balaghat, recurring tragedies across India’s tribal belt point towards a combination of systemic vulnerabilities: vacant medical posts, difficult geography, inadequate nutrition, shrinking livelihood opportunities and fragile trust between communities and the public-health system.
These factors reinforce one another. A child in a remote hamlet may face poor nutrition, limited vaccination access, no nearby health worker and difficult transportation—all before reaching a hospital.
Until these underlying conditions receive sustained policy attention rather than temporary focus during a crisis, the risk of repetition will remain.
And each time, there will be a temptation to blame the distance, the terrain or “traditional customs”.
The more difficult question is the one that must be asked now:
Will help reach these children the next time they fall sick—or will it arrive only after their deaths?
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*Contact: vikasmeshram04@gmail.com
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