A country struggling to breathe: India's Oxygen Crisis
Oxygen Crisis of India
India, the second most populated country in the world, has recently been facing a lot of internal criticism and international scrutiny due to the rising coronavirus cases and oxygen shortage. As social media fills with distress calls from frantic relatives asking for contacts for hospital beds and oxygen and news channels show heartbreaking visuals of ambulances lined up outside hospitals waiting for beds to be available, India’s healthcare system seems to be on the verge of collapsing.
The second wave of the Covid-19 has come as a massive blow for the country, with the almost three times the amount of oxygen being utilized for medical purposes, as compared to the first wave. Generally, 15 percent of the total oxygen produced is used in the medical industry, which has been increased to almost 90 percent recently to bring oxygen to the lungs of our gasping patients. And yet it is still not enough.
Let’s analyze a few numbers. India has a daily production capacity of 7,100 MT which has been increased to 8,922 MT recently to accommodate the rising demand. The approximate daily sale is 7,017 MT. The States are funded by an inter-ministerial group of bureaucrats and have been ordered to help the flow of quintessential medical kits for the pandemic. A quick look at the demand and production numbers clearly show that production is not the cause of the crisis.
The main large-scale producers, namely steel and metals producers and petrochemical plants, readily agreed to divert their production and the Health Ministry issued a statement that India’s daily production capacity was “comfortably more than daily consumption”.
But just production of oxygen is not enough, as is clearly visible by the current situation. Liquid Medical Oxygen (LMO) is a highly hazardous substance. We need thousands of specialized cryogenic containers, not to mention millions of high-pressure steel cylinders, regulators and non-sparking valves to safely transport this oxygen from our production hubs to the lungs of our patients.
The main cause is the transport of this manufactured oxygen to where it is needed most. Most of this oxygen is produced in Eastern India. To get it transported to the worst hit areas, like Delhi, Maharashtra and Gujrat, takes about 6-7 days. There have also been incidents of oxygen cylinders being looted and hoarded throughout the country, not to mention cases of cylinders being black marketed. Additionally, there is a gross shortage of tankers. We only have 1,224 tankers with a combined capacity of 16,732 MT; when the demand is of 3,500-4,000 MT at any given day aided by only 200 tankers in transit.
The Indian Government, for their part, has invoked the Disaster Management Act of 2005 and ordered free inter-state movement of vehicles carrying oxygen. Argon and nitrogen tankers have been ordered to convert to oxygen tankers. The Indian railways have been activated solely to move multiple tankers across the country from refilling plants to the worst hit regions. Sterlite plant in Tamil Nadu, as well as many other production centres, previously closed, have been temporarily restarted to meet the demand.
Working with Linde India, an industrial gas major, the Indian Air Force is airlifting empty oxygen tankers to speed up the transportation process by delivering them to industrial units dedicated to produce liquid oxygen. Refilled tankers will then be transported by road. Additionally, 23 mobile oxygen generation plants are being airlifted from Germany, to be sent to the worst hit hospitals. The Tata Group is importing 24 specialised containers to aid in transport.
The Health Ministry said in an official statement that “Out of 162 PSA plants sanctioned by the union government, 33 have already been installed - five in Madhya Pradesh, four in Himachal Pradesh, three each in Chandigarh, Gujarat, and Uttarakhand, two each in Bihar, Karnataka, and Telangana; and one each in Andhra Pradesh, Chhattisgarh, Delhi, Haryana, Kerala, Maharashtra, Puducherry, Punjab, and Uttar Pradesh.”
Despite all of these measures and initiatives, the regular distress calls from hospitals and the significant number of helpless relatives scrambling to acquire oxygen beds for their loved ones has turned this into an example of gross misjudgement, wilful neglect and poor planning, experts say. The second wave was largely expected and even called by many experts, as was the surge in oxygen demand. India is seeing around 3,00,000 reported positive cases with almost 3,000 deaths every day; the real numbers assumed to be much higher. The current crisis, or at least the level of intensity we are seeing today was predicted and consequently, could have been prevented.
The situation is at such a point right now, that acquiring oxygen has turned out to be a competition between states. The local governments of Haryana and Delhi have recently been in a conflict over this matter, accusing each other of controlling deliveries and now have their tankers escorted by police. Uttar Pradesh, Haryana and Rajasthan have blocked tankers from reaching Delhi. Maharashtra and Delhi High Courts have been forced to intervene to restore the oxygen supply. The Delhi High Court even advised the Central Government to “beg, borrow or steal” oxygen supplies for Delhi’s hospitals. The Supreme Court has been forced to intervene and ask the Indian Government to come up with a national level plan to tackle the oxygen crisis at the earliest.
As of right now, oxygen supply is being monitored by an Empowered Group 2 (EG 2), which has members from all the states, all the major oxygen producers, Petroleum and Explosives Safety Organisation (PESO), the All India Industrial Gases Manufacturers’ Association (AIIGMA), the Road Transport Ministry and the Indian Railways. The EG 2 is constituted by the Prime Minister’s Office to look into the crisis of supply.
The World Health Organisation is working towards delivering four thousand oxygen concentrators to the country. French industrial gas giant Air Liquide has increased its production of medical oxygen in India by four, and is aiding in the delivery of 200 tonnes of liquid oxygen from overseas which would allow a daily supply for up to 10,000 patients.
They have stated that “In a context where Air Liquide has a regional presence in the country and mostly in two regions (north and west), we are exploring all possibilities to bring more oxygen to Indian patients, including imports.” America’s Air Products is also reallocating its resources from around the world to support the oxygen supply crisis in India. They have stated “We are liaising with government agencies and other local logistics experts to deliver multiple ISO liquid oxygen containers to India by air. These large storage containers will then be filled with medical oxygen within India by INOX Air Products, who will coordinate their transport to needed areas.”
The need of the hour is proper allocation and distribution of the oxygen in an equitable, fair and transparent manner by the Centre. It is a matter of grave concern for the country that such neglectful planning has resulted in so many lives unnecessarily lost, specially when this situation was foreseen by both the Empowered Committee of the government and the parliamentary standing committee on health a year ago, during the first wave of the Coronavirus.