July 17, 2022

Puducherry: Cholera Outbreak in Karaikal Signs of Malaise in the Public Health System

Sudha Sundararaman

WITHIN three months of having been declared “best state”, (during a much publicised visit by the home minister) the union territory of Puducherry found itself battling a sudden, serious outbreak of cholera, in its small enclave of Karaikal. It took the administration almost two months to wake up to the fact that this notifiable disease,  one that has been largely eliminated, was actually spreading fast in the Karaikal region.

Apparently, early reports of more than 30 people getting infected with cholera a couple of months back did not come to the attention of the administration. But when media headlines started reporting that more than 7000 people had contracted ADD             (Acute Diarrhoeal Disease), and that over a 1000 patients had been hospitalised, the officials of the health department, as well as the NR/ BJP ruled union territory  woke up to the looming public health crisis. There were also reports of deaths which were later denied as not being directly caused by the disease. The slogans of Puducherry being well on the way to becoming a smart city were exposed as being rather hollow, as the administration swung into belated activity.   

On July 3, a public health emergency was declared by the directorate of health and family welfare services of Puducherry. Sec 144 (2) of the CrPC was announced as well, but then later withdrawn. The PWD minister claimed that the health emergency declaration was a precautionary measure, adopted so as to create awareness among the people so that symptomatic patients could get early treatment. After a high level review meeting held in Karaikal, the minister declared what should have been obvious from the beginning, that the outbreak was due to contamination of water, as a result of sewage leaking into piped water supply, and absence of proper filtration or even chlorination. People tapping into water from unhygienic sources were also mentioned as possible sources of infection!


The ministers and officials who have urged the people not to panic, are also accountable for the suffering and distress and expenses that people have had to undergo. There have been a number of continuing deficiencies in public health measures related to the provision of safe drinking water and sanitation, and in the functioning of the primary health centres and epidemic prevention measures. Organisations like the Pondicherry Science Forum that have been working on health issues consistently have raised serious questions which have come to the fore at this time :  A major concern is how such an outbreak could take place despite Puducherry union territory’s better health infrastructure and traditions of healthcare? The failure is a sorry reflection on the current governance.

Moreover, it is also a grim reminder that the government has learnt very little from the covid pandemic. It is clear that despite the pandemic not yet being completely spent, the Integrated Disease Surveillance Program (IDSP), whose whole purpose is to provide early warnings and thereby prevent epidemics, is not functioning well.

That cholera, a disease of the past, has re-emerged in such a form is particularly dangerous. The people of Puducherry should know what has happened with the recent outbreak and whether at least this time the necessary lessons have been learnt and corrective measures implemented.

In such a context, the PSF has called for a public enquiry commission with experts who can conduct a study and assess the reasons for the recent outbreak of ADD and Cholera in Karaikal region of Puducherry. It has also proposed that it is time for Puducherry to have a public health law.


The CPI(M) has blamed the negligence of the government for the cholera outbreak in Karaikal. Party secretary, Rajangam, issued a statement accusing the UT government of laxity in taking timely action, as a result of which the outbreak of cholera and diarrhoeal disease had affected and led to hospitalisation of hundreds of people in the region after consumption of highly contaminated water.

The CPI(M) statement also points out that it has been a year since the ruling NR Congress-BJP coalition government took charge in the union territory promising several welfare schemes. But it is an unfortunate reality that the administration has failed to deliver on many fronts. The epidemic in Karaikal illustrated the failure of the administration to provide even safe drinking water in the region.  It is high time for the authorities to realise that the outbreak in Karaikal was caused by the dependence on antiquated water supply and sewerage systems. The Party has demanded that the government should urgently modernise the water distribution and sewerage infrastructure in the region.

The incident should also serve as an eye opener for the administration in addressing water quality issues elsewhere, including in Puducherry, where several areas have reported brownish water. Studies have shown that while the total dissolved solids dissolved in the drinking water used by the general public should not exceed 300 ppm, there are areas in Puducherry where this has reached 3000 ppm.  

The CPI(M) has called on the government to immediately carryout inspections of reservoir tanks and distribution networks and replace the outdated pipelines to ensure safe drinking water to the public.

Another aspect that must cause deep worry is that the earliest and worst affected areas were the ones in which the poor and marginalised sections reside. Hence, it is not enough that the government plans for sewarage facilities in well-to-do areas. The government’s neglect of the living conditions of the urban poor is a major cause for the scale of the epidemic. As we learnt from the pandemic, no one, not even the elite are safe, unless everyone is safe.

The CPI(M) also observes with concern that the absence of elected local bodies for over 10 years has undermined democratic functioning, such that local problems acquire crisis proportions before they come to the notice of the administration. The local body elections should be conducted without any further delay.

The following demands are being set forth for immediate action:

  1. Constitute a proper public enquiry commission with leading Indian experts in public health and urban planning to investigate the causes of the outbreak, the reasons for the failure to contain the epidemic and make recommendations for preventing future epidemics
  2. Strengthen panchayats, municipal bodies and the PHED departments and ensure adequate funding to ensure that every residential area, irrespective of its legal status, has water and sanitation systems that meet the minimum acceptable standards in a time bound manner.
  3. Strengthen residents welfare associations and village health committees across all areas, to oversee safe drinking water and safe sanitation and sewage systems in every residential area, and ensure all measures required for achieving ‘healthy neighborhoods.’
  4. Undertake regular area-wise water quality testing quarterly and monitoring of sewage systems and make this data available on the public domain. Similarly, morbidity and mortality reports from IDSP and other sources like death registration should also be made available on the public domain.
  5. Enact a public health law similar to other states and right to health law similar to best practices at the international level to ensure that there is an adequate legal framework to assure health security for the common people.