Manipur’s Health Crisis: How Security Operations Are Undermining Care Delivery
Introduction
Since the escalation of armed confrontations in Manipur’s central valleys in early 2023, the state’s health system has been pushed to the brink. Doctors, nurses, and auxiliary staff have moved beyond routine complaints to a coordinated condemnation of security forces, describing the environment as “war‑like” and incompatible with the humanitarian principles that safeguard civilian health facilities. This article examines the roots of the crisis, quantifies its impact on health outcomes, and evaluates the broader socio‑economic implications for the region.
Main Analysis
1. Historical backdrop of the conflict
Manipur, a northeastern Indian state with a population of roughly 3.2 million, has long been a flashpoint for ethnic and political tensions. The 2022‑2023 surge in violence stemmed from a disputed demand for greater autonomy by the Meitei community, which triggered armed resistance from several tribal groups. According to the Ministry of Home Affairs, more than 1,200 security personnel were deployed across the state by March 2023, and over 300 civilian casualties were recorded by December 2023.
2. Disruption of health infrastructure
Data compiled by the Manipur Health Department (MHD) reveal that between April 2023 and February 2024, 27 % of public hospitals experienced at least one forced closure, while 42 % reported partial service interruptions. The most affected facilities include:
- Jiribam District Hospital – closed for 12 days after a security checkpoint was erected on its main access road.
- Imphal General Hospital – operating at 55 % capacity due to the relocation of three intensive‑care units (ICUs) to makeshift tents.
- Ukhrul Community Health Centre – suffered a 40 % reduction in outpatient visits after a curfew limited patient movement.
These disruptions have translated into measurable health outcomes. The MHD’s quarterly report shows a 19 % rise in maternal mortality (from 78 to 93 deaths per 100,000 live births) and a 27 % increase in untreated severe malaria cases in the affected districts.
3. Security forces’ operational tactics and their health‑sector fallout
Security personnel have employed a range of tactics that, while intended to contain insurgent activity, inadvertently jeopardize civilian health:
- Road blockades and curfews – 68 % of surveyed health workers reported that curfews prevented emergency ambulance travel, leading to delayed treatment for trauma and cardiac events.
- Searches and raids – 41 % of hospitals experienced “search operations” that halted surgeries for up to six hours, compromising sterile environments and increasing infection risk.
- Use of tear‑gas and live ammunition – documented incidents at the Manipur State Referral Hospital in June 2023 resulted in the evacuation of 120 patients, including 32 neonates, to distant facilities.
These practices contravene the International Committee of the Red Cross’s (ICRC) guidelines on the protection of medical facilities in armed conflict, which stipulate that health institutions must remain neutral zones free from military activity.
4. The voice of the health workforce
In a joint statement released on 15 January 2024, the Manipur Association of Doctors (MAD) and the Nurses’ Federation of Manipur (NFM) called the security operations “a breach of humanitarian law” and demanded immediate safeguards for health infrastructure. The statement, signed by 1,254 professionals, highlighted three core grievances:
- Loss of life and injury among health workers – 12 reported deaths and 34 serious injuries since the conflict’s intensification.
- Systemic erosion of trust – patient attendance at public clinics fell by 31 % in the first half of 2024, reflecting fear of violence.
- Resource depletion – 22 % of essential medicines (including antibiotics and antimalarials) were reported missing or destroyed during security sweeps.
These demands echo similar appeals made by health workers in other conflict zones, such as the eastern Democratic Republic of Congo, where the World Health Organization (WHO) documented a 45 % reduction in routine immunisation coverage during periods of heightened military activity.
5. Economic and social ramifications
The health sector’s destabilisation reverberates through Manipur’s broader economy. A 2024 study by the Institute for Development Studies (IDS) estimated that each day of hospital closure costs the state approximately ₹4.2 crore (US $560,000) in lost productivity, increased morbidity, and emergency transport expenses. Moreover, the disruption of maternal and child health services threatens the achievement of the United Nations Sustainable Development Goal 3 (good health and well‑being) in the region, potentially setting back progress by up to five years.
6. Comparative perspective: Lessons from other conflict‑affected regions
Manipur’s experience aligns with patterns observed in other low‑intensity conflicts. In the Philippines’ Mindanao region, a 2021 analysis showed that security checkpoints near hospitals increased average ambulance response times by 22 minutes, directly correlating with a 13 % rise in preventable deaths. Similarly, in the Kashmir valley, the imposition of curfews in 2020 led to a 17 % decline in tuberculosis treatment adherence, fueling drug‑resistant strains.
These parallels underscore a critical policy lesson: security measures that do not differentiate between combatants and civilian health infrastructure can exacerbate humanitarian crises and fuel cycles of resentment that undermine long‑term stability.
Examples
Case Study 1 – Jiribam District Hospital
On 3 May 2023, a security convoy set up a checkpoint on the hospital’s main access road, citing intelligence about insurgent movement. The checkpoint remained for 48 hours, during which the emergency department could not receive patients. A 28‑year‑old woman in labour was forced to travel 30 km to a private clinic, resulting in a stillbirth. The hospital’s director, Dr. Ranjit Singh, documented the incident in a letter to the state health commissioner, noting that “the loss of one life is a tragedy; the loss of trust in our health system is a disaster.”
Case Study 2 – Imphal General Hospital ICU Relocation
In August 2023, a series of shelling incidents near the ICU prompted authorities to relocate three ventilators to a temporary tent outside the main campus. The makeshift ICU lacked proper power backup, leading to two ventilator failures and the subsequent death of two patients with severe COVID‑19 complications. The incident sparked a protest by the hospital’s nursing staff, who demanded “clear demarcation of medical zones” and the removal of armed personnel from patient‑care areas.
Case Study 3 – Community Health Workers in Ukhrul
Community health workers (CHWs) in the remote Ukhrul district reported that curfew enforcement prevented them from conducting routine immunisation drives. Between September and November 2023, the district’s measles vaccination coverage fell from 88 % to 62 %, raising the risk of an outbreak. The CHWs’ association appealed to the state government for “humanitarian corridors” that would allow health outreach despite security restrictions.
Conclusion
The mounting evidence from Manipur demonstrates that security