An ophthalmologist’s response to the humanitarian crisis in Kashmir

Kashmir has been in a state of turmoil ever since the partition of India in 1947. Even now, as we celebrate our 75^th anniversary of independence, parts of Kashmir struggle to have their basic necessities met in terms of health, safety, and well-being. The people of Kashmir are viciously caught between the crossfires of the extremist factions and counter-terrorist forces. Common people suffer the brunt of the conflict for no fault of their own.

In 2016, violent protests broke out in the valley after the demise of Burhan Wani, a militant commander of Hizbul Mujahideen.[1,2] In order to quell the unrest, the security forces enforced a strict curfew and some of the violators were wounded by the pellet guns. They had to be taken to hospitals and required immediate treatment. I still remember that time quite vividly. Borderless World Foundation, a Pune-based non-profit, had approached me, requesting my help to treat the victims who had suffered pellet eye injuries. As someone in the position to help them, I knew what I had to do at once. My response came from my heart without considering any obstacles that could be in my way. It was a calling which I just simply could not ignore. They were in pain, and they needed me. And I had to be there for them. As a medical practitioner and caregiver, my consent to be there and help was instinctual. It was a reminder for me that as doctors, every patient, no matter who they are, are there for us to serve—a soul whose pain and suffering we can alleviate.

“It doesn’t matter which side of the political aisle you’re on, every ophthalmologist will agree our mission is protecting sight.” — Ravi Goel, MD

I gathered a team of two doctors who were equally willing to travel to Kashmir during such a precarious time: Syed Asghar Hussain of Optimus Maqbool Hospital in Chennai and Kenshuk Marwah from New Delhi. We rescheduled our prior patient appointments in our practices and left for Kashmir, which at that time was brimming with political strife, demonstrations, curfew, and violence. All of it was laid bare in front of us. In spite of it, we established our camp at the Shri Maharaja Hari Singh (SMHS) Hospital in Srinagar [Fig. 1]. There, we found out that almost 210 casualties with eye injuries caused by pellet guns were clamoring to receive treatment.

Figure 1.

Prof. Dr. S Natarajan with Shri Maharaja Hari Singh (SMHS) Hospital staff and volunteer doctors

The local doctors had undertaken primary repair in 184 cases to restore the anatomy but a large number of them required the removal of pellets lodged inside the eye.[3] The overwhelming need for attention did not intimidate us. It only spurred us to act and take charge of the situation. Three-fourth of them had suffered open globe injuries while the remaining had closed eye injuries. We performed many emergency primary repairs and interventions one after another without having a moment of rest. These victims of pellet injuries were young, many in their teens. They had an entire life ahead of them. The heart-breaking sight of children as young as 10 on the hospital beds moved me to my core. These injuries were going to permanently change their lives forever. I just thought about how best I could serve them at that moment and continued with my surgeries. A large number of patients were waiting for medical attention, so it took hours and hours of dedicated work. By the end of the fifth day, we had performed about 100 surgeries.[4] However, the sad reality of my experience was that despite expeditious management and surgeries, the visual prognosis of the patients remained poor and the final best-corrected visual acuity despite treatment was counting fingers or worse in majority of cases, except few recovered good visual acuity. Many of them had central corneal injury, Macular Injury and Optic Nerve Injury.

Despite our security forces doing their best to contain collateral damage, such instances do occur—a particularly painful reality for many individuals. While political narratives woven around the issues of Kashmir drive us toward hate and apathy, when I think of the people of Kashmir and remember them, I only see pain and suffering. As human beings, that connects us with them. As citizens of this country, it is our responsibility to restore a sense of brotherhood and humanity. And as doctors and by willingly working to alleviate that pain and suffering, we can be at the forefront of it.

When I reflect on the time I spent in Kashmir and the assistance I offered to those victims of violence, I realize that the task in front of me was not just to restore the vision of many patients who were admitted to that hospital but also to bring hope to countless others. It was to show that we, as individuals and as a nation, care about them. It was to show that they matter to us. As a doctor, and as an ophthalmologist, how do I respond to a humanitarian crisis? The answer is simple: selflessly.

I take this opportunity to thank Dr. Tariq Quereshi, Head of the Department of Ophthalmology, all the Doctors and Staff, Shri Maharaja Hari Singh (SMHS) Hospital, Srinagar, Kashmir and Borderless World Foundation for their unconditional support during my five visits to Kashmir in 2016.

A special graphic image of a pellet intraocular foreign body created by Prasanna Venkatesh Ramesh, Trichy, Tamil Nadu, India and S Natarajan, Mumbai, Maharashtra, India

About the author

Prof. Dr. S. Natarajan

Prof. Dr. S. Natarajan is a Senior Vitreoretinal Surgeon practicing since 1984. He is a Padmashri awardee by the President of India and a recipient if the state award by the Govt. of Jammu and Kashmir for his meritorious public service. He is a charter member of the Retina Hall of Fame, one among 100 vitreoretinal surgeons. He is currently the President of the Tele-Ophthalmology Society of India and Asia Pacific Ophthalmic Trauma Society. He is the Worldwide Secretary General of Global Eye Genetics Consortium, Trustee, International Council of Ophthalmology and Board Member, International Society of Ocular Trauma. He is a Guinness World Record holder for screening the maximum number of Diabetic Retinopathy cases in Asia’s largest urban slum in Dharavi, Mumbai, where in 8 hours 649 patients were screened. He has done over 60,000 vitreoretinal surgeries. He has delivered over 2,500 invited guest lectures all over the world, authored 4 books and over 100 peer-reviewed articles. He was the President of the All India Ophthalmological Society and the Editor of Indian Journal of Ophthalmology. His passion for caring for patients of trauma is well-known and that took him to Kashmir when the need for an expert was acute.