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Text of the address by Dr. Binayak Sen at the Convocation of the Class of 2010

Hunger, Dispossession and the Quest for Justice

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The Word

In 1876, Lord Lytton, who was then Viceroy of India, decided to arrange a massive celebration in Delhi to mark the accession of
Queen Victoria as the Kaiser-i-Hind, Empress of India. The feasting, with all rajas & maharajas in attendance, went on for a week,
and has been described by one historian as the biggest party in the history of mankind. But 1876 was also the third year of an El
Nino drought. Grain prices had reached unprecedented levels.

Grain traders took advantage of recent technological advances- the railways, which allowed rapid transport of large quantities of
grain, and the telegraph, which allowed traders to have accurate knowledge of grain prices in distant places; and instead of selling
their grain stocks in the local markets, used these stocks for profiteering. Buckingham, after whom the canal in Chennai is named,
who was then the governor, wanted to forcibly release the grain stocks in the local market, but Lytton, a follower of the Reverend
Thomas Malthus, forbade him from doing so. During the one week of Lytton’s festivities, a hundred thousand people died of
hunger on the streets of Chennai. Dr Ida Scudder of Vellore, , then a young girl of six, tried to feed some bread to some starving
children, but recorded later that they were too weak to eat what she gave them.

Coming to the present, in the last six years, globally, more children have died of malnutrition and easily preventable illnesses than
the number of adults who were killed in the six year of the Second World War. Every three seconds another child dies from
malnutrition and preventable diseases. In that three seconds, globally,120,000 dollars are spent on arms and a militarization that
specifically targets civilian populations asserting their rights to equity, and protesting against inequity.

Inequity is a not a subtle phenomenon. Yet it is only if we have a standpoint that validates political commitment to equity that we
see its manifestations and linkages. While it is true that there are none so blind as those who will not see, for those who wish to
do so, inequity is a major feature of the global political architecture. As young journalists, it would be good to remember that
Inequity is not a default option, and keeping inequity in place requires diligent and sustained international effort, supplemented
where necessary by military intervention. The state of Chhattisgarh from where I come presents a glaring example of this.

Hunger

Looking at the overall situation in India, I would like to follow Virchow’s dictum that politics is medicine writ large, and read my
politics off the bodies of our patients. For the purposes of this address, I have treated Hunger as a surrogate for Inequity. The
National Nutrition Monitoring Bureau (NNMB) tells us that over 33% of the adult population of India has a BMI of less than 18.5,
and can be considered as suffering from chronic undernutrition. If we disaggregate the data, we find that over 50% of the
scheduled tribes, and over 60% of the scheduled castes have a BMI below 18.5. The total population of Orissa has more than
40% below 18.5. The population of Maharashtra, which is considered to be a relatively “developed” state with a high per capita
GNP, has 33% below 18.5. We in Rupantar have carried out censuses in tribal villages in which over 70% of the adults had a BMI
below 18.5. All this is, of course, in addition to the mundane reality, to which we have become inured, of 43% of children under 5
being malnourished by weight for age criteria. Reporting on the

Mumbai Cohort study, Pednekar found increased mortality in all underweight categories.The WHO says that any community with
more than 40% of its members with a BMI below 18.5 may be regarded as being in a state of famine. By this criterion there are
various subsets of the population of India-the scheduled tribes, scheduled castes, the population of Orissa- which may be
regarded as being permanently in a state of famine.
But there is more good news to follow. Utsa Patnaik, a senior professor of economics at JNU, tells us that there has been a major
decline in cereal consumption since 1991, in India –that is, since the onset of globalization. In 1991, an average family of five
consumed around 880 kg of cereals in a year. By 2005, this had declined to around 770 kg., a decline of 110 kg. In fact, at the
higher end of the scale cereal consumption – direct & indirect i.e as meat-had increased, so the decline at the lower end of the
scale was actually much greater. So not only do we have a chronic famine, but it’s getting worse.

Dispossesion: the situation in Chhattisgarh

It is precisely this section of the population, that walks through time with famine by its side, that is today the principal target of a
widespread policy of the expropriation of natural and common property resources, in a concerted and often militarized programme
run by the state. The adivasis of central India, living in extreme poverty, nevertheless survived through their access to common
property resources- the forests, the rivers, and land- all of which are now under a renewed threat of sequestration and
privatization as global finance capital embarks on its latest phase of expansion.

The doctrine of eminent domain vests ultimate ownership of all land and natural resources in the state. Under cover of eminent
domain, vast tracts of land, forest and water reserves are being handed over to the Indian affiliates of international finance
capital. In many ways, the history of ‘development’ projects in many parts of the Indian republic are illustrative of the way in
which the doctrine of Eminent Domain,( which was hotly debated at the sessions of the Constituent Assembly, and finally not
included in the final draft that was adopted) has been applied to ensure for a so called public interest major havoc and
included in the final draft that was adopted) has been applied to ensure for a so called public interest major havoc and
displacement in the lives of many of the poorest citizens living at subsistence levels.

The tragedy of Chhatisgarh, and of Bastar is compounded by its richness of resources. One-fifth of the country’s iron ore – about
2336 million tones averaging 68% purity is found in the Dantewada, Kanker, Rajnandgaon, Bastar and Durg districts The Bastar
region is one of the richest in mineral resources – not only in iron ore, but also perhaps a host of other unexplored minerals
including limestone, bauxite, and even diamond and uranium.. When Ajit Jogi became the first Chief Minister of the nascent state
of Chhattisgarh, he said that in the new state, we had the poorest people inhabiting the richest land. Since much of this ‘rich land’
was covered by forest and was difficult to reach in earlier times there was not much effort to access these riches, and hence not
much challenge to the control exercised by the poor people over the rich lands. With increasing industrial and economic
development, especially under the impact of globalization, which is the current avatar of actually existing colonialism, the hold
exercised by the poor people over their resources came increasingly under challenge.

Once the nature and scope of the enormous natural wealth, in the form of forest and mineral wealth, deposited and secure in the
forest areas of Chhattisgarh became clear, it became imperative for the Indian state to assert its sovereignty over these areas,
that had hitherto remained relatively unclaimed by the state under the law of Eminent Domain; the principle that, in the final
analysis, the state had a pre eminent right to all land. In its turn, the Indian
state could stand guarantor for the secure sequestration of these resources in the hands of the Indian affiliates of international
finance capital, such as, in recent years, the TATAs, Essar, Lafarge, Holcim, and other industrial houses . Land acquired from
ordinary people was to be handed over to the industrial houses, gram sabha related procedures were faked, in an attempt to
justify the transfer by the letter, if not the spirit of the existing Laws.

However, what became fairly clear fairly soon, was that this process of the assertion of the state’s decisive right was going to be a
rough ride. Land acquisition for Essar and Tata was resisted in several places in South Bastar. While land acquisition took place
literally at gunpoint in the Bhansi area, several village assemblies (gram sabhas) in th Lohandiguda area are still refusing to sign
away their land for the proposed Steel Plant of the TATAs.

Even as the state has forcibly controlled the resistance at several places, the sense of outrage and popular protest has proved
difficult to curb. Bastar has a long history of popular resistance to oppression; its ways of defining and asserting property rights
are also different from those prevalent in mainstream governance. It also has not helped that, with a few honourable exceptions,
the personnel articulating the agency of state power have almost uniformly possessed a colonial mindset. Under these
circumstances, one consequence has been that . in conjunction with a pervasive failure of governance, characterized by massive
levels of corruption, as well as abysmal levels of ‘development’, there has been a tendency on the part of the enforcement
agencies to be quick on the draw. .Long before the state government embarked on its current mission to rid Bastar of the ‘Maoist
menace’, Praveer Chandra Bhanj Deo, the charismatic ruler of Bastar,who refused to trim his sails to the winds blowing from the
capital of Madhya Pradesh, was killed in an ‘unfortunate incident’ during the Chief Ministership of DP Mishra. The Salwa Judum is
being characterized by the government of Chattisgarh as well by its media bandwagon as a ‘spontaneous adivasi response to
naxalite oppression’.

It therefore becomes necessary to appreciate that popular resistance to state control and efforts to articulate eminent Domain has
a history in Bastar, that has a far greater spread, in terms of duration, geographical extent, as well as political and institutional
identity than the current operational entity known as the CPI (Maoist), although the latter is undoubtedly a major political entity in
the region. The CPI, for instance, is a political entity with a long history of struggle on the trade union, peasant, adivasi, women’s
and student fronts, apart from its parliamentary and electoral identity.. In Chhattisgarh , the term ‘Maoist’has become a catch-all
attribution that includes anyone whose activities the state finds inimical to its current interests, including self confessed Gandhians
like Himanshu Kumar of the Vanvasi Chetna Ashram, Human Rights groups like the PUCL, and pesky PIL wielding academics. The
believers in armed overthrow of the state have been only one stream out of many in the resistance to state policies.-it is the
systematic dispossession of the people that has polarized the situation beyond immediate rectification.

Based upon carefully differentiated positions they have gone on to repeatedly indict the widespread and pervasive violence that
the state has deployed over widespread areas in this region. Careful reports have been prepared with regard to specific incidents
of state violence such as encounter deaths, kidnappings, rape, arson, and custodial maltreatment. Investigations have been
conducted and reports have been prepared with respect to starvation deaths, dysentery epidemics, lack of drinking water, and
other basic needs. It is the state response that has been singularly undifferentiated. Today, in the months since the launching of
operation Green Hunt, Bastar is a war zone, its people dispossessed and scattered, women subjected to brutal rape, violent (and
tragic) military encounters shake the foundations of whatever normalcy remains. One is reminded of what Prashant Bhushan said
on an earlier occasion.

“Those who are going to become homeless and uprooted in this race of so-called development, they will also be finally forced to
accept the bitter truth that they cannot stop the loot of their lands and resources by any democratic and non-violent means. This
is a dangerous situation. Even a combative organization like “Narmada Bachao Andolan”, which included a large number of
educated persons, has accepted the bitter truth that is no administrative or legal means of preventing the loot of resources. Now
it is only through unity and by force that these plunderers can be stopped. That is the reason why today, in Kalingnagar,
Nandigram etc. there is a situation of “do or die”. All these struggles are proving 10 to be landmarks in stopping the loot. The
people of these areas have firmly resolved that come what may, they will not let any government officer set foot on their land. In
these circumstances if the government uses force, violence may erupt.”

There is a question that I would like to raise before this assembly, and that is the issue of genocide. Most people think that
genocide has to do only with large scale direct killing, but the declaration of the Convention on the Prevention of Genocide–which
was issued on 9th Dec 1948, one day before the Universal Declaration of Human Rights – tells us clearly that in addition to killing,
the creation of ‘physically and mentally hazardous conditions which could put the survival of particular communities at risk” would
also come within the ambit of genocide. Evidence that what is happening in central India is tantamount to genocide on a massive
scale stares us in the face. What is shocking is the inability of large sections of our leadership to read the writing on the wall.

The inability to interpret evidence:

example from health policy
The inability to interpret evidence that is crying out to be recognized, and the tendency to lapse into facile and convenient
formulae for resolution is a curse that plagues many professions. I would like to give an example from my own, with regard to the
formulation of the national Policy for the control of tuberculosis. In a country where 33% of the adult population have a BMI below
18.5, and which also has 1/6 of the world’s population and 1/3 of the total global burden of tuberculosis, one would think that the
bidirectional association between malnutrition and tuberculosis would be the focus of intense study. This is not the case. India is
the single largest contributor to the global burden of morbidity, mortality and drug resistance in tuberculosis. An estimated 8.5
million Indians suffer from tuberculosis. There is an annual incidence of 87,000 cases of multidrug resistant tuberculosis,and an
estimated annual mortality of 370,000 persons.

And yet, a recent WHO-based systematic review study which established a consistent log-linear relationship between tuberculosis
incidence and BMI was unable to include a single Indian study. Similarly, a Cochrane systematic review of randomized control
trials of nutritional supplements for people being treated for active tuberculosis did not include a single Indian study in its ambit.
But I would like to draw your attention to two
studies that do not figure in either review-the first with pride,and the second with shame.

The first study has been formed by my colleagues at the Jan Swasthya Sahyog (People’s Health Support Group), a nonprofit
voluntary organization, which runs a community health program in 53 forest related villages in central India. They have reported
an as yet unpublished study on the nutritional status of 975 patients with pulmonary tuberculosis – the largest such study to
emerge from India. They report that patients with active pulmonary tuberculosis in rural central India, were found to have
macronutrient malnutrition ie. starvation, almost as a universal association, with less that 5% having weights in the normal range.

Certain groups like scheduled tribes and women fared worst, with life threatening levels of under-nutrition. There was evidence of
long- standing under nutrition with low height for age (stunting) in the majority of patients. The report goes on to conclude, “This
report is a stark illustration of the adverse synergy of the epidemics of under nutrition and tuberculosis.The consequences are
extensive disease on the one hand and severe wasting on the other, both of which can cause mortality independently and in
concert. The need to address the nutritional needs of poor patients with tuberculosis is an urgent imperative on scientific, ethical
and humanitarian grounds”.

However, the fundamental architecture of the National Tuberculosis programme, formulated in 1962, was based on a specific
repudiation of this “urgent imperative.” This fundamental architecture has been preserved into the present programme ,hence this
is a current problem.What was the evidence on which this repudiation was premissed?This brings us to the second study that I
had mentioned,published in the Bulletin of the World Health Organisation in 1961.The recent Cochrane review of the effect of
nutritional supplements in people being treated for active tuberculosis excluded this paper from their review as “the groups were
not randomized to different dietary interventions.”This study was carried out at the Madras Chemotherapy Centre in Guindy.I
would like to read out to you the summary of findings of this study.

‘A study has been undertaken on the diet of 157 patients with pulmonary tuberculsos admitted to a controlled comparison of
treatment with isoniazid plus PAS for a year at home with the same treatment in sanatorium.The patients have been drawn from a
poverty-stricken section of the community living in overcrowded conditions in Madras City. A comparison has been made of the
dietary status of the home and the sanatorium patients before and during treatment, and the role of the diet in the attainment of
bacteriological quiescence of the tuberculous disease has been evaluated.

Before treatment the patients in both series had poor and similar diets. During the early months of treatment, the dietary intake
of the patients in both series increased. However, the sanatorium patients received a clearly superior diet through the year in
terms of total calories, fats, total and animal proteins, phosphorus and several of the vitamins. The home patients were physically
more active during treatment than the sanatorium patients, further the accentuating the dietary disadvantage of the home series.

The home patients gained on the average 10.8 lb in weight over the 12-month period, as compared with 19.8 lb for the
sanatorium patients. This greater weight gain among the sanatorium patients was not, however, indicative of superior clinical
results. The response to treatment ( as measured by the radiographic and bacteriological progress) was not directly associated
with the level of dietary intake of any of the food factors, either in the patients treated at home or in those treated in sanatorium.

It may be concluded that none of the dietary factors studied appears to have influenced the attainment of quiescent disease
among tuberculous patients treated with an effective combination of antimicrobial drugs for a period of one year. The successful
initial treatment of patients at home is therefore possible even if the levels of dietary intake are low.’

The fact that such a poor study could play such a critical role in determining the architecture of a program of such enormous
importance shows how the politics of callousness takes precedence over evidence in such matters.

The Scientific community and Bhopal

A similar refusal to take a stand on what was correct and so patently obvious characterized the response of the official scientific
community in India to the Bhopal gas disaster. Twenty five years ago, on the night of 2-3 December an industrial accident of
massive propotions spewed a huge cloud of methyl isocyanate gas into the atmosphere of Bhopal, the capital of Madhya Pradesh.
In the next 72 hours, 8 thousand people died of the effects of the gas, and innumerable people were blinded, developed major
pulmonary disorder, major psychiatric disorder, abnormal pregnancy outcomes, and a whole host of other acute and chronic
morbidity.

The ground water of the factory became contaminated with harmful chemicals, which then leached into the soil and contaminated
the water table. This is not the forum to detail all the harm that Union Carbide caused to the people of Bhopal. What I wish to
draw your attention to is the role that evidence and scientific information- and the people responsible for dealing with this
information –played over the last twenty five years.

Neither the Union Carbide corporation, nor their successor, the Dow Chemical Company, have ever acknowledged the nature of
the chemical that spewed out of their factory. Nor did they ever specify the specific antidote-sodium thiosulphate – that would
have made a major difference in the treatment outcomes of a large number of gas affected people if it had been used in time.
Strangest of all was the posture adopted by the ICMR. In one of Arthur Conan Doyle’s Sherlock Holmes stories, Holmes says to
Watson, “ I would like to draw your attention to the curious incident of the dog in the night time.” Watson says, “But the dog did
nothing in the night time.” “That” said Holmes, “was the curious incident”.

The ICMR initiated something like 34 research studies in Bhopal. As far as I know, none of these studies was carried through to
completion. They were, instead, shut down in batches, and finally in 1994- 10 years after the incident, the last two remaining
studies were terminated by executive fiat, and the entire body of data was quarantined indefinitely. At that time, there were 18
fresh proposals that had been fully approved, but these proposals were also terminated.

The ground water in the area of the accident has been heavily contaminated, but the Government has consistently refused to
admit this. Finally, now, the Centre for Science and Environment in Delhi- an independent NGO with a formidable reputation -has
come forward to test the water. Their report showed the ground water to be heavily contaminated with highly toxic chemicals.

The quest for Justice

The quest for Justice

The Directive Principles of State Policy enshrined in our constitution are asserted to be “fundamental in the governance of the
country,” The Directive Principles clearly mandate that all exercise of state power should be for the reduction of inequity and the
promotion of equity.

Article 37 of the Constitution declares that the DPSP “shall not be enforceable by any court, but the principles therein laid down
are nevertheless fundamental in the governance of the country and it shall be the duty of the state to apply these principles in
making laws.” Viewed in this context,recent trends in the exercise of state power very clearly violate this mandate, and have
actually resulted in increasing inequities in important areas such as livelihood, education and health.

According to Dr B D Sharma, formerly Commissioner for Scheduled Case and Tribes, the fifth schedule is like a constitution within
the constitution . It empowers the Governor to intervene in governance on behalf of the interests of tribal people , but we note to
our great surprise that there is not a single instance when the Governor of any single state has so intervened. Once again when
we look at the operationalization of PESA, we find that the entire issue of peoples’ sovereignty enshrined therein has been
sidestepped in practice. Development in the tribal areas is not only a matter of building roads, buildings and infrastructure. Rather,
it is all about the operationalization of equity, social justice, and the establishment of a genuine peoples’ sovereignity. Everyone
today talks of PEACE. Peace cannot mean an acquiescence in an exploitative and unjust social order.A genuine peace can only be
the result of a movement for equity and justice. At the beginning of this discussion we considered the essentially political and
ethical nature of the concept of equity. In the course of our discussion, I have tried to examine the ways in which evidence
influences -or does not influence – the praxis of equity. Evidence is of course, central to the scientific enterprise. A commitment
to evidence is what took Galileo to jail, and a commitment to evidence is what caused Giordano Bruno to be burnt at the stake.
Evidence is what democratizes the generation of knowledge: without it, all we have is esoteric bodies of dogma, to be passed on
from feudal mentor to feudal apprentice.

Equity is a political concept, and an ethical one. Political questions cannot be rephrased in terms of informatics or evidence,
although once these questions are adequately formulated, evidence can be used to settle the question one way or the other. The
ethical dimension of questions regarding equity means that the answers contain an inbuilt imperative to moral action. As Amartya
Sen says in his latest book, “The Idea of Justice,” “Proclamations of human rights, even though stated in the form of recognizing
the existence of things that are called human rights, are really strong ethical pronouncements as to what should be done. They
demand acknowledgement of imperatives and indicate that something needs to be done for the realization of these recognized
freedoms that are identified through these rights.”

One of the ironies that confront the witness dealing with‘evidence’ is that one has to appeal for appropriate interventions to the
very forces that are at such violent odds with poorest sections of the population. For the student of evidence based policy, this
situation raises some challenging problems. One is that in any study of an intervention one ethical assumption is that the
intervention is carried out by someone who comes to the table with clean hands: whose bona fides are beyond question. In India
today, as in many other places across the world, this is an assumption that is no longer tenable. Cynicism and disengagement may
be one response to this situation , but,I do not believe that this is the only tenable response. As young journalists at the beginning
of new careers, the challenge is upon us to acknowledge the imperatives and recognize that ‘something needs to be done’. We
need to ask ourselves on this very important day in our lives whether we are up to accepting this challenge and putting in the
response that it demands.

Dr. Binayak sen is a pediatrician, public health specialist, human rights activist and national Vice-President of the People’s Union
for Civil Liberties (PUCL) based in Chhattisgarh state, India. He has been extending health care to the poorest people, monitoring
the health and nutrition status of the people of Chhattisgarh, and defending the human rights of indigenous tribal and other poor
people. In May 2007, he was detained in connection with his human rights work, raising global concern about his welfare.

He had a distinguished academic career in Vellore, graduating in Medicine and later acquiring an M.D. in Paediatrics. From 1976 to
1978, he was a faculty member at the Centre for Social Medicine and Community Health at the Jawaharlal Nehru University, New
Delhi. He left his academic appointment to work in a community based rural health centre in Hoshangabad district of M.P. focusing
on problems of tuberculosis. He has been an active member of the Medico Friend Circle, a national organization of health
professionals working towards an alternative health system responsive to the needs of the poor.

Binayak Sen worked with mine workers in Dalli Rajahara and helped them set up and manage their own Shaheed Hospital. He
then moved to a mission hospital in Tilda where he worked in Paediatrics and Community Health. After the death of Shankar Guha
Niyogi with whom he was closely associated, Binayak moved to Raipur. From 1991, he has worked in developing relevant models
of primary health care in Chhattisgarh. He was among those who initiated the community based health worker programme across
Chhattisgarh, now well known as the Mitanin programme. He continues to provide health care to the children of the marginalised,
especially the migrant labourers.

He helped organize fact finding campaigns into human rights violations in Chattisgarh including custody deaths, fake encounters,
hunger deaths, dysentery epidemics and malnutrition. He brought the large scale oppression and malgovernance within the so
called Salwa Judoom in Dantewara to national and international attention.

Dr. Sen and his wife, Dr. Ilina Sen, are the founders of Rupantar, a community-based nongovernmental organization that has
trained, deployed and monitored the work of community health workers spread throughout 20 villages. Rupantar’s activities
include initiatives to counter alcohol abuse and violence against women, and to promote food security. Dr. Sen is an advisor to Jan
Swasthya Sahyog, a health care organization committed to developing a low-cost, effective, community health programme in the
tribal and rural areas of Bilaspur district of Chhattisgarh. Dr. Sen was the recipient in 2004 of the Paul Harrison award for a
lifetime of service to the rural poor. In 2007, Dr. Sen was awarded the R.R. Keithan Gold Medal by The Indian Academy of Social
Sciences. The citation describes him as “one of the most eminent scientists” of India.

In 2008, he was awarded the prestigious Jonathan Mann Award for Global Health and Human Rights for “ his years of service to
poor and tribal communities in India, his effective leadership in establishing self-sustaining health care services where none
existed, and his unwavering commitment to civil liberties and human rights…”
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