In a garbage-infested village outside Delhi, fevers have been claiming lives this monsoon

Just 10 minutes of rain in Sarfabad village caused floods in its bylanes. The village is in Noida, a township in Uttar Pradesh that is part of the National Capital Region and just outside Delhi. Children in Sarfabad who decided that it was time to play ended up wading in blackish sewage water in the streets. The roads are lined with mounds of garbage. On Friday, civic authorities had removed silt from the gutters that were then piled up in black heaps near the gutters. That silt was washed away again by the next round of rain.

In this village, there have been ten deaths just in the month of August. Residents claim that most of the deceased had suffered fever and body pain for a few days before they died. Public health authorities in Noida investigating the deaths have said that the the causes of death were different in each case including. Some died of heart attacks, they said. There was no outbreak of any disease, they claimed.

Despite this, television reports have started talking about a mystery virus afflicting the area's residents.

Ten deaths with no pattern

Twenty two-year-old Vipin Sharma was preparing for a test in a law college on August 15, when he said he was feeling feverish. The next morning at around 7, he complained that he was cold. He was shivering. His family took him to the nearby District Government Hospital at Noida's Sector 30, but say they were sent back. Sharma died at home at around 8.30 am.

“Only two youths have died, among the 10," said Dr VD Verma, the chief medical officer, Gautam Buddha Nagar district which covers Noida. "Another youth who died had a problem of convulsions. Most others were either between 50-60 years of age.”

Verma listed a litany of medical complaints that affected the victims.

“One died of heart attack, one of paralysis, one had acute liver failure, one had pancreatitis, one had chronic obstructive pulmonary disease,” he said. "All of them have died of different reasons."

Sukhpal Yadav, 60, was “perfectly healthy” before he was struck with fever, according to his family. “He was in hospital for ten days," said his son Moolchand, who works as a driver. "We got all the tests done, but nothing came out positive.”

Sarfabad village is contained within a three-kilometer radius and has about 10,000 to 15,000 inhabitants. “If there are 10 deaths in two weeks time associated with fever there is clearly an outbreak,"said Dr Rajib Dasgupta, from the community medicine department of Jawaharlal Nehru University, Delhi. "It is most certainly an unusual event though we cannot comment on what has really happened.”

The district administration did about five rapid malaria tests, and tested a few people for dengue, all of which have turned up negative. While admitting to the lack of sanitation in the area, the administration has denied finding any disease-carrying organisms like the dengue-causing Aedes mosquito.

No primary health centre nearby

Nevertheless, the district administration has also held a medical camp in the area to treat patients who have fever. The camp has been running since August 25, and will continue for some time, said Verma.

Even though temporary, this is the first government facility within the village that Sarfabad residents are getting access to. There is no primary health care centre nearby. It is little wonder that patients were excited about the free medicines available in the camp.

The villagers usually rely on jholachap or quacks in the area, or doctors with Ayurveda degrees. There is not a single MBBS doctor in the village.

Scroll.in visited two doctors who claimed to a have degree in Ayurvedic medicine. Both were receiving many patients with symptoms of fever, cold and cough.

“Many of my patients complain of pain in the leg and fever," said Dr Veer Singh, whose desk was strewn with different formulations of injections. "Some of their blood tests are showing that they have a drop in platelets. We get about 200-250 patients a day, mostly with fever.”

As he spoke, Singh was tending to to a man complaining of knee pain. The doctored administered and injection to the patient through his shirt, without exposing the skin of his arm – a method that could possible infect the site of the injection.

The sanitation problem

Whether this round of sickness in Sarfabad is connected to its filth or not, it's evident that the village has a huge sanitation problem, the root of which lies in politics.

Last year, the Uttar Pradesh government decided against having panchayat elections in the villages of Gautam Buddha Nagar. The farmers had then complained that in the absence of an elected body, no one could be held responsible for the development of rural areas and protection of the rights of the villagers, the Times of India reported at the time.

Now, everyone in Sarfabad complains bitterly that the Noida Authority has not taken care of the village's sanitation.

“Earlier, we had a pradhan [elected sarpanch] who would ensure that the village is kept clean," said Sukhvir Pehelwan, a social worker in the area. "It was running better then. Dabav rehta hai." There are pressures in living in the same society.

Residents complained that municipal workers now come only twice a week.

This is the first monsoon without a panchayat system. The authority has started a cleanliness drive in Sarfabad, a few more villages nearby till September 15.

Risks in peri-urban landscapes

Villages like Sarfabad are peculiar in nature. These peri-urban habitations on the fringes of cities are just one turn off a four-lane highway on a lanes that lead to hamlet-like enlosures where people still live in havelis or kothis.

“In developing countries they are often called ‘peri-urban interfaces’," said Dasgupta. "It is a zone of interaction between urban and rural socioeconomic systems, a transition zone between fully urbanized land in cities and areas in predominantly agricultural use. It is characterised as zone of rapid economic and social structural change. These have implications for urban governance.”

Many people in Sarfabad, like Moolchand, have sold their ancestral land. Just outside the core of the village, where the original village dwellers live, there are buildings and farm houses that are have come up. Some are using their land to build small cemented hutments in which the construction workers live.

There are people who are involved in the construction business, like Bhirampal Yadav, who supplies land mowers. His 62-year old father, Bhimpal Yadav, died of after fever on April 24. The district administration maintains he suffered from pancreatitis.

There is also an influx of migrant populations who work in Noida and rent in Sarfabad village, the villagers said.

“Urban health systems are weak in India, deficient in core public health functions. Peri urban typically falls between two stools, lacking in services provided by either the rural health services or excluded by the municipal system,” said Dasgupta. This, he added, increases the risk of such infections.

The villagers, in the meanwhile, feel the administration is only trying to push things under the carpet. By all the different account the number of deaths in Sarfabad in August varies between 13 and 35. Residents maintain that one or two people have been dying every day for the past three weeks.

Prajwala Sharma, the mother of the 22-year-old Sharma wants the village to be cleaned better. “ I do not want any other mother in this village to cry over a dead son,” she said.