On an April afternoon this year, a month before cyclone Yaas ripped through the region, a severe storm struck Sagardwip, a remote island on the Bay of Bengal and a part of the Sundarban delta, situated at the point where the river Ganges flows into the sea. Winds whipped up the deep dark waters of the river Muriganga, a distributary of the Ganges that separates the islands from the mainland, swished through leaves and tops of trees and hissed through the grass below. But an eighty-year-old man, an islander, who had contracted Covid-19, was gasping for breath. His son, Srikrishna Das, the only member of the family who had not tested positive, rushed him to the local hospital but the old man’s oxygen level was dipping and his condition was deteriorating steadily. Doctors on duty advised that he be shifted to a more advanced medical facility on the mainland, but on his way there he died. “Perhaps if we had the option of travelling by road to reach the hospital on the mainland instead of by river, we could have made it in time to save his life,” says his son, a 40-year-old trader. 

During health emergencies, people living on the delta islands of the Sundarban, are often referred by local doctors to hospitals on the mainland for critical care as in the case above. They then have to travel by boat across rivers because many of these remote regions are not connected by road or bridge. Frequently delays occur in undertaking the journeys because during inclement weather water travel is not permitted because of the danger of boats capsizing. Delays occur during good weather too especially when tides begin to ebb, making movement of vessels difficult and often water levels become so shallow that boats get stuck on the riverbed.

Interestingly, plans to construct a bridge over a strategic stretch of the river had been in the pipeline for several years until it got stuck in limbo with unresolved disagreements between state and central governments about logistics, costs and other issues. The suggestion that a bridge ought to be built for commuting between Sagardwip and Kakdwip which is the closest port on the mainland, unhindered by weather or water levels is understood to have been made by West Bengal chief minister Mamata Banerjee during a visit to Sager Island before the state elections of 2016 when her government was reinstated to power for a second term. Banerjee’s interest in Sagar Island is rooted in her keenness to develop the region as a tourist attraction which is already a site of pilgrimage, hosting as it does the Sagar Mela, the second largest religious fair in the country after the Kumbh Mela. Every year, in mid January, hundreds and thousands of pilgrims throng the island to bathe at the confluence of the river and the sea, a religious ritual considered auspicious.

Islanders claim that Banerjee’s government has flushed the region with a large number of public doles. “Not just the schemes for poor people like free ration to BPL (below poverty line) families or for women, like the Lakshmi Bhandar Scheme, which provides monetary assistance to women of BPL households or for girls, like the Kanyashree, which awards monetary sops for the education of female members of the BPL family, but she has also invested in the healthcare sector by introducing free-of-cost medical insurance schemes like the Swasthsathi,” says a schoolteacher in Sagar Island.

The state government has also introduced a water ambulance service for the islanders. There is a water ambulance service that was earlier provided only during the days of the Sagar Mela.  At this time health emergency services receive an additional boost and not just water ambulances but even air ambulances, namely helicopters, are kept on standby so that the sick can be airlifted and taken to the mainland for treatment if required.

The decision to extend the water ambulance service to the locals for the rest of the year came into effect three years ago according to Sagar Block Development Officer (BDO) Sudipta Mondal. He says, “It is now available for the region’s islanders seven days a week. Other than the four to five hours per day when the tide is low (timings change according to the lunar cycle) making it impossible for the boat to ply, the service can be availed any time of the day or night”. He says that on an average three to four patients use the services of the water ambulance per day. The phone number of the service is printed in bold letters across the sides of the vessel and people who want to book it need to call up.“Depending on where the vessel is situated at that point, it becomes available,” he explains. “If the ambulance is anchored at Sagardwip, it is ready to move within ten to fifteen minutes. However, at times the vessel is already engaged and if that happens then the patient needs to wait until it returns after dropping off other patients. Discussions are on about dedicating at least one more boat for use as a water ambulance and that would go a long way in dealing with this concern.” The water ambulance is fitted with rudimentary medical equipment including oxygen cylinders and stretchers as well as lifejackets. A hundred rupees is the one-way charge and it includes the travel cost of one patient and a maximum of two persons who are allowed to accompany him or her.

Islanders say that while this service is very helpful, it is limited in its ability to deal with the magnitude of the problem. “It alone is not enough to solve the serious issue of health emergencies in Sagardwip and the nearby islands,” says the school teacher. “Timely medical intervention is crucial and the process of transporting the sick by the water route is not just time-consuming but also fraught with difficulties and discomfort as far as the patients are concerned.” It entails shifting the patients first onto a regular, road ambulance from the rural hospital where they are admitted or from their homes, bringing them to the only port on the island, which is at least 15 kilometres from the nearest and main hospital in Rudranagar (located at central Sagardwip), taking them off the car ambulance and carrying them on a stretcher to the dock and onto the water ambulance. After reaching Kakdwip, the port on the mainland, the patient would need to be carried from the dock to another car ambulance on a stretcher and then finally driven to the hospital on the mainland. “If there is a bridge connecting the island to the mainland, the car ambulance can go directly from the rural hospital to the hospital on the mainland.  Only that would adequately address the plight of the people of the island,” the school teacher says.

Other islanders agree. This includes 21-year-old Avijit Mondal, a resident of Sagardwip’s Harinbari village, who lost his father to a heart attack in January 2020 while he was being transferred from a rural hospital on the island to the mainland, on the water ambulance. Recalling, he says, “My father was only 46. He was very active and quite fit. He used to work as a mechanic repairing water pumps. He never complained of feeling ill. But one day he said he felt uneasy and was experiencing chest pain. When we took him to the local hospital here, doctors advised that we immediately shift him to a hospital on the mainland. We booked the water ambulance but the boat got stuck midway because by the time we embarked on the journey, the tide had turned low and the vessel couldn’t move. It usually takes four to five hours for the tides to turn. As we waited for high tide, he stopped breathing. If there had been a bridge over the river we would have reached the mainland in less than half an hour.”

Currently boats, ferries, launches and vessels are the only options for islanders and visitors to commute to and from Sagardwip and the other islands in the vicinity. It takes thirty minutes to travel across the Muriganga river which stretches from Kakdwip to Sagardwip for four kilometres. Sagardwip is the largest island with a population of nearly two hundred thousand, spread over forty-three villages. As pointed out earlier, it has only one port, which is situated at a locality called Kochuberia, in the northeastern bank of the island. Ganga Sagar, the site of the pilgrimage (where the Ganges flows into the Bay of Bengal) is situated in the extreme south, thirty kilometres from Kochuberia.  A temple dedicated to the sage Kapil Muni, who is said to have meditated in this spot centuries ago, has stood here for hundreds of years. However, the original temple is said to have disappeared into the encroaching sea and the current one is believed to be the third reconstruction.

As far as medical facilities are concerned, Sagar Island is considered the region’s best with three government hospitals (the main one is located at Rudranagar at the centre of the island and the other two are located in different parts of the island). “But these do not have intensive care units or critical care units or blood banks and are not really equipped to deal with emergencies or critical patients,” points out the schoolteacher. There are also primary healthcare centres in each of the eight “gram panchayats (GP), which are village-level administrative units and comprise a cluster of villages. In Ghoramara, a nearby island, too there is a primary healthcare centre.

Says the schoolteacher, “At the primary healthcare centres, a host of rudimentary medical activity takes place such as the administration of polio vaccines to children and pre or post natal care. But complicated pregnancies, deliveries and operations are not dealt with here, not to mention serious illnesses or emergencies.”

During a visit to the islands on any given day, one comes across a number of sick people boarding the regular boats and launches.  And this is true not just of Sagardwip and the other islands like Ghoramara mentioned earlier, which are scattered over the western part of the delta, but also of the islands located on the other, eastern end of the Sundarban.

Here it must be mentioned that the Sundarban delta is separated into the Indian and the Bangladeshi sides. One-third of it falls into India and two-thirds into Bangladesh. On the Indian side, the distance between the eastern and western ends of the delta is roughly 150 to 200 kilometres and it takes between four and five hours to cover it by road. Eastern Sundarban comprises 102 islands, only 54 of which are habitable by humans. The rest are covered in mangrove and is the haunt of the famed Royal Bengal Tiger. For locals, river routes are the only way to travel to the mainland and as with the inhabitants of Sagardwip and the other islands on the western end of Sundarban, here too the sick are often forced to do so to seek advanced medical treatment in spite of having access to basic facilities in the islands.

“She has just delivered a baby,” says Gayatri Sardar, a mother-in-law, clutching her daughter-in-law, Jyotsna’s arm with her left hand and cradling the infant, wrapped in layers of cloth, with her right. “It was by caesarean section,” she adds. The younger woman limps, holding the side of her stomach, dragging her feet on the ground. The elder woman can’t stop smiling. She says, “After two girls, it’s a boy.” Clearly in pain, the new mother too tries to force a smile. They walk slowly towards and board a motorized canoe anchored at Godkhali Ghat, a main ferry point of eastern Sundarban from which boats leave for different islands in the vicinity. After the operation at a hospital on the mainland the two women and the baby are headed to an island called Goshaba.

Recently a part of eastern Sundarban has been connected to the mainland with a bridge built over the mighty Matla River that slithers through the region like a stupendous snake. The rivers and creeks on this side of the Sundarban is the habitat of crocodiles and snakes and since ancient times the medical emergencies emanating from these parts included bites of poisonous snakes and injuries from crocodile and tiger attacks.

Human encroachment into their territory and the shrinking of their habitat because of deforestation has long been held responsible for these attacks by wild beasts but in spite of the dwindling numbers, tiger and crocodile attacks continue to be a major cause for concern for doctors in the area. 

The more recent health concern, as far as a section of medical practitioners and doctors of the region are concerned, however, is the possibility that climate change is impacting the health of the Bay of Bengal islanders adversely.

A comparative chart compiled by doctors associated with the Sunderban Foundation, an NGO based in Goshaba, which conducts regular medical camps among the residents, indicates an annual, if marginal, increase in the number of heat and salinity-related illnesses.  Says Prasenjit Mandal, the founder-director of the NGO, “While it is difficult to establish a direct connection between the slight increase in numbers of certain diseases which our doctors are registering and global warming, there is no denying that increased heat and salinity is a growing concern in the Sundarban. That this would eventually adversely impact health or even imminently lead to health complications is entirely logical to assume.” 

Dr Prafulla Safui, a medical practitioner associated with the NGO says, “The adverse impact of salinity in water and soil is very evident in diseases like skin ailments which, in my experience shoot up significantly soon after a region has been inundated with sea water after cyclones and floods. Its adverse impact is more difficult to diagnose when the effect is internal, like when it causes a rise in blood pressure, for instance. We cannot currently state with any certainty that there is a connection but over a period of time, it would become more evident.” 

The physician further observes that the poor people of the region rarely rush to the doctor with mild symptoms, making it difficult to gauge the impact. He says, “A visit to the doctor is usually not a priority unless it is an emergency. They usually only visit the physician with very serious complaints and often diagnosis of ailments like hypertension would be a side issue.”

Villagers’ voices seem to corroborate this. “Headaches and neck pain have become our constant companions,” says Sujit Mandal of a village in eastern Sundarban. “But who has the time to complain?”  The 28-year-old construction worker laughs it off while his wife, 26-year-old Shampa Mandal quips, “Actually he complains all the time but he will not visit the doctor.”

Perhaps it is this lack of urgency among the islanders and villagers of the Sundarban to rush to the doctor with complaints of such “small symptoms” as “dizziness, nausea, etc” as one villager in Goshaba described it, which is reflected in government records, or the lack thereof.

The Sundarban’s chief medical officer, Dr Debashis Roy, sent out a questionnaire to the rural hospitals in the region asking details of certain diseases which could be traced to heat or increased salinity. The responses did not indicate any alarming or even marginal rise.

Dr Roy said, “After getting information from all concerned, it can be stated that apprehensions about salinity of water and soil at the coastal areas of Sundarban adversely impacting health in the region cannot be supported by conclusive evidence. I did not get any negative reports. This is our information.”  Agreeing with Dr Roy, a doctor at a Goshaba hospital said, “There is no upward graph. People of this region are not unused to, if not resilient to, conditions of heat and salinity in the air, water and land. It would be difficult to establish a perceptible rise.”

Others, however, notice changes. A nurse at Sagardwip said, “In my nearly decade long practice, I feel there are more people today who are arriving with complaints of vertigo, trembling and other symptoms associated with hypertension and high blood pressure than earlier. Checking BP is a mandatory process of check-ups when patients drop in for medical treatments. I have noticed an upward trend.”

The trend perhaps is in too nascent a stage to be anything other than a point of debate. Whatever the impacts on health, informed islanders are aware that they are amongst the worst victims of climate change. “We have been battered by cyclones and storms and the rising sea is swallowing our land,” says Gouranga Mete, a resident of Ghoramara, which is being chipped away day by day and disappearing into the sea.

“We have never witnessed so many cyclones or storms before,” says the Sagardwip schoolteacher, echoing a common refrain in all the islands. “Nor so many floods or so much rain.”

The unpredictable weather patterns with its cyclones, storms, untimely rain and floods are impacting travel over the region’s river routes too. 

Interestingly, while the acrimonious political dynamics between the two main political parties of Bengal, Banerjee’s TMC and BJP which heads the Central government, is said to be at the centre of the logjam over the bridge issue, there is consensus and representatives of both the state and central governments agree that a bridge connecting   Sagardwip with Kakdwip is the need of the hour.

“Mamata Banerjee is committed to having the bridge constructed for the benefit of the people of Sagardwip,” said Gautam Deb, former tourism minister of the West Bengal government. “She has said that repeatedly.”A TMC spokesperson asked rhetorically, “Why is the Centre not coming forward with the funds?” He adds, “After all, this kind of a project cannot take off without the involvement of the central ministry of road transport and highways.”

Suvendu Adhikari, BJP spokesperson and leader of the Opposition in the West Bengal Assembly said “Construction of the bridge is extremely important. For the benefit of the people of Sagar Island, I am ready to bring up the issue with the Central government but the proposal needs to come from the state government.”

The technical aspects of the bridge construction too would need to be evaluated even if political parties bury the hatchet and decide to work together. “There are important issues that need to be worked out if the two governments do decide to work amicably together,” says an engineer of the state’s Public Works Department, who was involved in the construction of a similar bridge close to the proposed Sagardwip bridge. “The approximate cost of construction of such a bridge would be no less than 1000 crore rupees, which includes the preparation of a detailed project report (DPR). Engineering difficulties which would need to be worked around include constructing over a relatively long stretch of river (four kilometres) which, unlike fresh water rivers, is practically the sea, determined by tidal ebbs and flows. It must also be remembered that this is a route used by Bangladeshi ships for trade with India. The height and arch of the bridge must be constructed keeping in mind that ships at high tide would be able to pass through. These and other considerations would have to be researched and a detailed report prepared before construction can begin.But the first step is for the two governments to decide to work together,” he said.

Check out Cuckoo News’ YouTube Channel for a video version of this story:

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This story was produced with the support of Internews’ Earth Journalism Network.