Until a few months ago, Raj*, a resident doctor working at the Regional Institute of Medical Sciences (RIMS) in Imphal, had no experience working with bullet wounds. In the second week of the ethnic violence that broke out in Manipur in May this year, he was confronted with treating a patient who suffered a rifle bullet wound in his leg. “I remember this case vividly. Only senior staff had any experience in treating rifle bullet injuries,” recalls Raj. “The textbooks can only prepare you so much for a situation like this,” he says. “Whenever we got information about a firing incident, the entire staff would be on standby, and there have been patients coming in every other day. There were days when 20 arrived in just this one hospital. We were in the hospital around the clock,” says Raj.
The ethnic violence in Manipur has claimed at least 150 lives and injured more than 1,000 people ever since clashes broke out between the tribal Kuki and non-tribal Meitei community on May 3. The state is now divided by assumptive boundaries that keep the Kukis concentrated in the hills and Meiteis in the valley. Intense gunfire has been reported for over three months along the foothills where civilian ‘volunteers’ are camped with guns in bunkers. After the separation, doctors say, the wounds observed are mainly bullet wounds shot from a distance.
TNM visited four hospitals where the injured are being treated and found that doctors are grappling not only with wounds “they have never seen before” but also with the tensions between the two communities and a slew of mental health problems.
Doctors say that in the first week of the violence in early May, many deaths recorded were mob attacks against civilians. “Initially, we came across blunt force injuries indicating an unequal fight. Kukis who resided deep in the valley in Imphal and Meiteis who resided in the hills in Churachandpur were attacked by mobs, dragged out from cars and bikes, and beaten with iron rods and bats,” says a doctor at the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) in Imphal. “But after a few days, the cases we came across were gunshot and blast injuries,” says Raj. The hospitals in Imphal are one or two hours away from the conflict zone.
The ongoing violence has led to claims and counterclaims from the Kuki and the Meitei sides, with ‘volunteers’ telling reporters that they are using licensed single-barrel guns or pellet shotguns.
JNIMS Hospital/ By Bhuvan Malik
But doctors like Raj dismiss the idea that only licensed single-barrel guns and pellet guns are being used in the violence. “Our unit has dealt with six rifle bullet injuries. We can tell clearly as the shotgun pellets are spherical and all-metal while the rifle bullets are shaped like a tear-drop. Rifle bullets penetrate much deeper than a pellet wound, sometimes piercing straight through,” says Raj.
Apart from treating headshots, Raj says that his unit has come across three cases of gunshots to the genitalia, including one case of a woman. “The three patients survived, but it was clear that the attackers’ intention was not just to kill but to inflict hurt,” Raj says. At the height of the violence in May, the hospitals were severely understaffed after other northeastern states decided to evacuate the students studying in Manipur. With a depleted staff, the doctors at RIMS put together a plan to deal with the stream of incoming patients.
Alongside dealing with conflict injuries, doctors said they had to navigate the tensions between the two communities at the hospital before the exchange of the Kuki and Meitei populations took place in May. “There were several Kuki patients admitted here (in Imphal), and even though doctors know they have to maintain neutrality in these situations and consider anyone injured to be a patient in need, there were other Meitei staff members who were uncomfortable since the families of Kuki victims would also be in the hospital,” says a doctor at RIMS.
RIMS Hospital/ By Bhuvan Malik
After the first round of the violence subsided, central forces carried out a ‘repatriation’ exercise in Manipur — Kukis stuck in Imphal were moved to the hills, and Meiteis to the valley. The exchange was projected as a peace initiative, but in effect, it turned the contentious border areas between the valley and the hills into conflict zones. At the time of the exchange, Meitei doctors in the hills were shifted to the valley, while Kuki doctors in the valley were shifted to the hills.
This left the lone major hospital in the hill district of Churachandpur cut off from Imphal, where it would receive resources during normal times. The hospital currently has 38 dead bodies and has treated 328 injuries since the conflict began. “We have three surgeons who are tending to the injured and who are on standby whenever required. Usually, the patients are coming in late at night since firing mostly takes place after dark,” says Siam, a technical assistant in the hospital. When TNM visited the hospital, Siam was tending to two persons seriously injured by a blast in Pholjang village on the frontlines of the conflict.
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Raj Medicity/ By Bhuvan Malik
He says the biggest concern is stocking up on essential medicines since there is no more contact with Imphal. “We are getting essential medicines from Assam and Mizoram. The main concern is the lack of dialysis consumables,” says Siam. The main private hospitals - Raj Medicity and Shija Hospitals and Research Institute, apart from the two government hospitals – RIMS and JNIMS, are all located in Imphal. “Imphal is one hour away, but it could not be further away at the moment,” says Siam.
Doctors at the hospital also said they have come across gruesome wounds inflicted by high-grade weapons in the conflict. “In one case, we recovered a two-inch mortar from the Kangwai area. We have also come across wounds from sniper rifles,” says Dr Tinglonglei Thangluai, Medical Superintendent of the hospital.
Three months after the start of the conflict, doctors in both Imphal and Churachandpur say that while the number of injured persons at the hospital has reduced, the number of patients walking into the psychiatry department has steadily increased. “In June and July, we had a lot of cases of young children and those older than 50 reporting headiness, shortness of breath, and other symptoms consistent with anxiety,” says a psychiatrist.
The doctor says that most people who go through a traumatic event – defined in clinical terms as an episode of threatened death, serious injury, or sexual violence – experience a period of symptoms that include nightmares, anxieties or headaches but recover later. A smaller number develop long-term distress or post-traumatic stress disorder. “We have no evidence of long-term distress yet. But it is becoming clear that even after the armed conflict subsides, we expect this stream of patients to continue for a long time,” says the psychiatrist.
"We are seeing signs of PTSD. On Friday, a 17-year-old woman came to our unit. She was in one of the frontline conflict areas and said she cannot sleep because she fears the conflict reaching her village. She's also dealing with the stress of her BA exam. There is a possibility that many of the cases I am seeing can develop into long-term distress," the doctor says.
*Name changed to protect identity.
Manipur Dispatches: Our reporters Prajwal Bhat, Haritha John and Bhuvan Malik are in Manipur to provide you with in-depth ground reports that delve into the heart of the matter, highlighting the real issues underlying the current conflict. If you believe that human rights violations in a distant land should be a topic of conversation in this part of India, support our intrepid truth-seeking mission. Contribute here.