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COVID Crisis: How India’s red tape is holding foreign aid at airports as patients gasp for breath

As India's COVID-19 crisis tipped past breaking point last month, dozens of countries pledged critical aid. Planeloads of ventilators, oxygen supplies and antiviral drugs began arriving last week, with photos showing massive parcels being unloaded at New Delhi airport.
 
There's just one problem: for many days, much of the cargo sat in airport hangars as hospitals on the ground pleaded for more provisions.
 
Medical workers and local officials are still reporting the same devastating shortages that have strained the health care system for weeks now — raising questions, even among foreign donors, of where the aid is going.
 
In a US State Department news briefing on Friday, a reporter asked where the US aid was, demanding "accountability for US taxpayers' money," according to the briefing transcript. "Is there anything being done to check on how it is being distributed, the aid that we are sending?" the reporter asked.
 
The Indian government issued a strong denial of any delay on Tuesday, saying it had installed a “streamlined mechanism” for allocating aid. Nearly 4 million donated items, spanning 24 categories, have already been distributed to 38 health care facilities across the country, the Health Ministry said in a statement.
 
But on the ground, many state and local authorities claim there has been little to no communication from the central government on how or when they would receive relief.
 
“We sent delegations to (the government) for clarity on supplies of (oxygen), drugs and vaccination drive but were not spoken to in clarity from the Union Government,” said Raghu Sharma, health minister of Rajasthan state, on Tuesday. “Regarding the import or foreign aid, no information or supply details have been shared with the state government.”
 
The central government has “kept states in the dark during the pandemic,” he added, calling for a more "transparent environment.”  The Health Ministry said that it had distributed aid to two hospitals in Rajasthan, in the cities of Jodhpur and Jaipur.
 
There are a number of feasible reasons for the delay: unnecessary bureaucracy, human error, or time-consuming protocol. But to those on the ground, such possible explanations matter little; all they want is for the government to take quicker action and get the aid to their ICU wards, where thousands are dying every day.
 
India reported 382,315 new coronavirus cases on Wednesday and 3780 virus-related deaths, according to the Health Ministry. The country has now recorded more than 20.6 million cases since the pandemic began.
 
Oxygen shortages are particularly pronounced in the union territory of Delhi, which does not produce its own oxygen and relies on the central government to send allocations from different manufacturers and states.
 
"It's the duty of the government to provide us oxygen," said Dr SCL Gupta, director of Batra Hospital in the capital, New Delhi.
At least 12 patients, including a doctor, died at Batra Hospital on Saturday after it ran out of oxygen.
 
Gupta said hospital staff spent the day telling authorities they only had a few hours of oxygen left; toward the end, they had to rely on oxygen provided by patients' families. “Patients are dying in front of us,” Dr Gupta said. “I'm sorry we cannot save you.”
 
A logistical nightmare
 
One distribution problem highlighted by Indian media is simply that the government did not have protocols in place before receiving the aid, and had to quickly cobble together guidelines on allocation and coordination. It took the government seven days to create a mechanism to distribute supplies to states, the Health Ministry said in a news release on Tuesday.
 
It began working on the plan on April 26, and only issued its Standard Operating Procedure (SOP) — guidelines on how to distribute aid — on May 2. The release did not state what day the distribution of aid began. In those seven days, more than 23,000 Indians died of Covid-19. Even with the SOP issued, the process of distribution is complex, with room for further delay.
 
Once the aid arrives in India, it is received by the Indian Red Cross Society, which works closely with the government. The Red Cross works with customs to approve the goods, the Health Ministry said, adding that customs is “working 24 x 7 to fast track and clear the goods on arrival.”
 
After being cleared, the items are handed to the ministry and a government-owned health care product manufacturer called HLL Lifecare, which handles transportation of aid to its final destination.
 
But it’s a massive logistical undertaking because "the materials from abroad are currently coming in different numbers, specifications and at different times," the ministry said in its Tuesday release.
 
A number of problems might arise, it said: "in many cases," the type or number of aid supplies don't match the inventory list provided by the foreign donor. Authorities then have to waste precious time “reconciling (discrepancies) at the airport” while the aid sits idle, according to the release. Only when the paperwork is updated with the correct details can authorities move forward with distribution.
 
India is a huge country, home to 1.3 billion people, and most of the foreign aid is being flown to New Delhi — meaning much of it then has to be redistributed to far-flung states. The military has been deployed to help with this process, with the air force flying supplies to various cities and making overseas flights, too.
 
States with high caseloads, or those that are regional medical hubs, will be prioritised, the Health Ministry said on Tuesday.
Donations are also allocated to states with fewer resources or those in remote areas.
 
It's unclear how much aid is still being processed, but images began emerging this week of supplies finally arriving on the ground.
 

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