Protestors torched the administrative headquarters of Nepal, the palace of Singha Durbar. This was one of several public properties that were set alight. Credit: Barsha Shah/IPS
KATHMANDU, Sep 10 2025 (IPS) – Nepal entered into a new era of constitutional and political crisis after deadly protests by the deeply frustrated young generation (Gen-Z). Prime Minister KP Sharma Oli resigned on Tuesday after protests grew out of control.
Gen-Z protestors took to the streets on Monday, where the government used force. Security forces opened fire at youth protests against corruption, nepotism, and a social media ban. At least 19 people were killed on a single day. It’s one of the deadliest protest days in Nepal’s history. So far, at least 24 people have been confirmed to be dead during this ongoing unrest.
Protesters took to the streets after the government of Nepal banned most social media last week. Social media ban was the final straw, and on TikTok and Reddit, Gen-Z (13-28 years old) users organized peaceful protests, but they escalated. Now the Himalayan country with nearly 30 million people is facing uncertainty.
On Tuesday many of the government agencies and courthouses were set on fire. The country’s administrative headquarters and parliament house burned down. The homes of political leaders were also torched.
Initially reluctant, Oli resigned on Tuesday, citing “the extraordinary situation” in the country. He submitted his resignation to the President effectively immediately.
Later Tuesday, Nepal President Ramchandra Paudel issued a statement urging protestors to cooperate for a peaceful resolution.
“In a democracy, the demands raised by the citizens can be resolved through talks and dialogue, including Gen-Z representatives,” he said in a statement. Paudel urged Gen-Z representatives to “come to talk.”
Balen Shah, mayor of Kathmandu metropolitan city, who is seen as one of the possible leaders, also urged youth protestors to stop destroying public property and come to talk.
“Please gen Z, the country is in your hands; you are the ones who will be building. Whatever is being destroyed is ours; now return home,” he wrote on social media on Tuesday evening.
After the security situation got out of control, the Nepal Army deployed throughout the country from late evening on Tuesday. Army chief also urged protesters to come forward to talk with the president to find solutions.
After the rapidly escalating situation, international agencies, including the United Nations, issued their concerns.
Expressing deep concern over the deaths and destruction, UN human rights chief Volker Türk called on authorities and protesters to de-escalate the spiraling crisis. In a statement, Türk said he was “appalled by the escalating violence in Nepal that has resulted in multiple deaths and the injury of hundreds of mostly young protesters, as well as the widespread destruction of property.”
“I plead with security forces to exercise utmost restraint and avoid further such bloodshed and harm,” he said. “Violence is not the answer. Dialogue is the best and only way to address the concerns of the Nepalese people. It is important that the voices of young people are heard.”
The UN Secretary-General is also closely following the situation, according to his spokesperson. During Tuesday’s daily briefing in New York, Stéphane Dujarric said António Guterres was “very saddened by the loss of life” and reiterated his call for restraint to prevent further escalation.
“The authorities must comply with international human rights law, and protests must take place in a peaceful manner that respects life and property,” Dujarric said, noting the dramatic images emerging from Nepal.
The UN Country team in Nepal urges authorities to ensure that law enforcement responses remain proportionate and in line with international human rights standards.” UN Resident Coordinator Hanaa Singer-Hamdy described the situation as “so unlike Nepal.”
Nepal is known for its political insatiability and has seen more than a dozen governments since it transitioned to a republic after abolishing its monarchy. In 2008, after long protests and a decade-long Maoist war, Nepal transitioned into a republic and got its new construction in 2015.
One decade later, Nepal has again found itself in a political crisis.
Sep 5 2025 (IPS) – CIVICUS discusses recent protests in Angola with Florindo Chivucute, founder and executive director of Friends of Angola, a US-based civil society organisation established in 2014 that works to promote democracy, human rights and good governance in Angola.
The Angolan government’s 1 July decision to remove diesel subsidies, sharply pushing up public transport costs, triggered a series of protests. Angola is one of Africa’s biggest oil producers, but many have seen little benefit from its oil wealth and continue to live in poverty. People have taken to the streets in unprecedented numbers to demand an end to corruption and mismanagement, presenting the ruling party, in power for 50 years, with its biggest test. Security forces have responded to incidences of looting and vandalism with lethal violence. At least 30 people have been killed, 277 injured and over 1,500 arrested.
What triggered the protests?
Fuel subsidy cuts sparked the crisis. The protests began on 28 July, after the government’s decision to remove diesel subsidies immediately pushed up fuel prices. What started as a drivers’ strike in Luanda, the capital, quickly spread to other provinces and escalated into bigger protests.
The impact was devastating. For many families, even a small rise in fuel costs is crushing, because wages have been eroded by years of recession and currency devaluation. When transport costs rise, food prices and school fees rise too, leaving those already struggling unable to make ends meet.
But fuel was just the trigger. The unrest reflected much deeper frustrations, including high unemployment, particularly among young people, growing poverty and anger at corruption and mismanagement. People see public resources channelled into luxury spending and infrastructure deals benefiting a few powerful figures connected to the ruling People’s Movement for the Liberation of Angola (MPLA), while basic services and jobs are neglected. Combined with the immediate shock of higher fuel prices, these grievances fuelled widespread anger.
Why are people struggling in such a resource-rich country?
This is the irony at the heart of the crisis. Angola produces large quantities of oil, along with diamonds, yet most people don’t see the benefits. Mismanagement and entrenched corruption are central to the problem. Revenues from natural resources have too often been captured by networks close to political power and channelled abroad or invested in ways that don’t create jobs.
Angola’s dependence on fuel imports makes the situation worse. We don’t have sufficient domestic refining capacity. Instead of using oil revenues to build refineries and strengthen local industry, a system emerged in which those with political connections profited from importing refined products back into the country. This removed incentives to invest in local processing or agriculture. The result is a tiny wealthy elite and a large majority with very low wages and limited access to services.
What do these protests reveal about the government’s grip on power?
The protests have marked a turning point. The MPLA has dominated politics since independence in 1975, and large-scale protests are not common. The fact that so many people were willing to take to the streets, particularly in and around the capital, shows growing discontent with the government and ruling party.
The authorities’ reaction has been heavy-handed. Security forces have used teargas and live ammunition in some cases, and carried out numerous arrests, including of union leaders and journalists. In some areas protests were accompanied by looting and, tragically, by deadly clashes with security forces. Civil society has since called for investigations into the killings and for accountability for those responsible.
The government’s strategy risks backfiring. By responding with force and detentions, it risks creating a greater sense of mistrust and frustration, which could influence how people engage with political processes as we approach the 2027 election.
How is civil society organising and what challenges does it face?
Civil society – including church groups, trade unions and local associations — has mobilised quickly to call for accountability and transparency. New coalitions are forming; for example, groups such as the Bishops’ Conference of Angola and São Tomé and Príncipe’s Episcopal Commission for Justice and Peace, Friends of Angola, the Justice, Peace and Democracy Association and Pro Bono Angola are working with religious organisations to push for investigations into the killings and provide humanitarian support to families affected by the unrest.
But the environment is hostile. Funding for democracy and human rights work is scarce, so organisations struggle to pay staff or sustain programmes.
State surveillance creates another barrier. The state has invested heavily in surveillance infrastructure, and civil society organisations are often targeted by cyber intrusions and closely monitored. The legacy of communist authoritarian rule creates deep mistrust, which makes organising more difficult.
Language barriers limit international support. Much of the work happens in Portuguese, which limits reach to the wider international audience that often communicates in English, French or Spanish.
Additional restrictions threaten to further tighten civic space. Recent draconian measures include the 2024 National Security Bill and the Bill on the Crime of Vandalism of Public Goods and Services. In addition, the 2023 draft law on Non-Governmental Organizations, approved by presidential decree, imposed harsh regulations. These restrictive laws and policies undermine fundamental freedoms and, if fully implemented, risk worsening the already limited environment for civil society in Angola.
What would it take to address the underlying problems?
Strong political will is needed to tackle corruption and manage public finances transparently. This means opening up procurement and fiscal data, pursuing accountability for past abuses, and ensuring resource revenues are channelled into public priorities such as hospitals, local industry and schools. Investment in education, healthcare and small-scale agriculture would create jobs, strengthen livelihoods and reduce dependence on imports.
Institutional reform is equally vital. This means protecting property rights, improving the business environment so investment generates employment and strengthening an independent judiciary and electoral processes so people can seek change through democratic channels.
International partners have a role to play by supporting electoral transparency and demanding accountability from companies and governments that operate in Angola.
The 2027 election will offer a crucial test. The international community should pay close attention and support reforms that increase transparency and electoral integrity. Electoral reforms and the clear, public release of results at the local level would go a long way towards restoring confidence in democratic processes.
Elephants at the Kappukadu elephant rehabilitation center in Kottoor.
NEW DELHI, Sep 5 2025 (IPS) – In the early part of this year, two deaths in Kerala garnered major media attention. A farmer in Wayanad and a female plantation worker in Idukki were killed in two separate events, within a matter of a few days, by wild elephants.
Arikomban, another wild elephant, has become a media favorite recently due to his brushes with human settlements near his habitat. Named so because of his love for ari (rice), the elephant had been relocated from Kerala to Tamil Nadu in 2023 following constant protests from people who also claimed him to be ‘life-threatening.’ Kerala’s news outlets widely covered Arikomban’s relocation.
These aren’t one-off cases in Kerala, which has seen a spike in human–wildlife conflict, especially involving elephants.
According to a news report, 451 people have been killed in wildlife conflicts in the past five years alone in the state, with 102 of them caused by elephants.
However, wildlife biologists and environmentalists have been at odds with the narratives promoted by the media and society regarding what constitutes conflict.
“I think we shouldn’t be using the terminology ‘wildlife conflict’ itself. I would prefer addressing it as ‘negative wildlife interaction,’” says Dr. P.S. Easa, who holds a PhD on Elephant Ecology and Behavior and is a member of the National Board for Wildlife and the IUCN, Asian Elephant Specialist Group.
The conflict between wild animals and humans has been going on for centuries, and what we witness in the current era has been influenced by the transformation in the behavior of both these groups, as well as humans’ perception towards wildlife in general, he adds.
In Kerala’s social framework, the rising phenomenon of human–elephant conflict takes on a much deeper and more complex meaning than the broader topic of conflict with wildlife. Elephants have been an integral part of Kerala’s culture and tradition for centuries—domesticated not just for heavy labor but also as part of temple festivals. In the last few decades, machines have replaced elephants in much of the labor environment in the state, yet the land giants continue to be a part of the festival parades. Animal behavioral experts and activists have been consistently raising their voices against this practice in this century, citing the need to treat elephants as solely wild animals.
Easa refuses to even use the term “domesticated” for them.
“Captive elephants are the only right way to address them in this age and time,” he says.
In 2024 alone, there had been nine reported deaths in Kerala by such captive elephants. The Hindu reported six such deaths, including an elephant mahout, within the first two months of this year. Although there have been stricter rules and regulations in recent years on using captive elephants for temple festivals, they have mostly been restricted to paper. The religious nature of the festivals that these elephants are made to be a part of makes the topic even more sensitive, and political parties tend to stay away from addressing the issue.
Kerala’s elephant reserves have been categorized mainly into four regions, namely Wayanad, Nilambur, Anamudi, and Periyar. Periyar Reserve had the highest count of elephants, followed by the Anamudi Reserve. According to the Kerala Government’s Forest Statistics and the report of the ‘Wild Elephants Census of Kerala,’ the four reserves have a combined total extent of 11,199.049 sq. km., out of which only 1,576.339 sq. km. is assessed to be devoid of elephant population. According to a 2024 official assessment, Kerala had an elephant population of just under 1800, a decline of more than 100 from the previous year.
As Kerala’s elephant reserves border the neighboring states of Tamil Nadu and Karnataka, natural factors that affect the elephant population, like extreme drought and heavy, abrupt rainfall, influence the elephants’ migration across the states during the year.
In Kerala, particularly, shrinking forest habitats caused by deforestation and the increasing presence of human settlements in regions historically occupied by elephant populations, coupled with climate change and the invasive plant species erasing the elephants’ natural food sources, are some of the factors causing unnatural elephant migration, according to experts, and as a consequence, resulting in frequent interactions with humans.
The phrase “descent of wildlife into human settlements” itself is a misnomer, Eesa says.
“In almost all such cases, human settlements had crossed over to those places where the wildlife had existed peacefully before. Wayanad and Idukki are classic examples of this.”
“There was a report that I had come across a while ago—of an ‘elephant attack’ that happened in Sholayar Forest Reserve. Look at the irony of that news. It’s a forest reserve—the habitat belongs to the elephant, not the people who were driving through it. What I’m saying is, every time an elephant conflict is reported, you need to dissect all the circumstances surrounding it. Where—was it within the jungle or outside it? When was it, during the daytime or at night? And how? What were the circumstances leading up to the interaction?” he explains.
The drastic increase in food waste owing to tourism in Kerala has been another factor for wild animals encroaching into human spaces lately. Elephants, wild boars, and monkeys have been observed to have come to human settlements to feed on the food waste.
There is no one, foolproof method to resolve the human–elephant conflict, scientists opine. Easa points out that several techniques that had been fruitful in African countries proved ineffective when used in countries like Sri Lanka and Indonesia.
A mahout is seen riding a captive elephant. Kerala continues to make use of elephants for temple festivals and parades.
Wildlife biologist Sreedhar Vijayakrishnan, in an interview given to Mongabay in 2023, suggests five main long-term measures that will help mitigate human-elephant conflict. This includes initiating long-term studies to understand elephant movements and spatiotemporal patterns of conflict, which will help ascertain where and how interventions are required; tracking areas of elephant movement and identifying regions of intense use while installing alert lights at vantage points that can be triggered in case of elephant sightings; raising awareness among local populations to discourage feeding elephants or unwanted interactions; training local rapid response teams to prevent negative interactions and indiscriminate drives; and fitting satellite collars on elephants that frequently cause issues.
Kerala also has an elephant rehabilitation center established in Kottoor, Thiruvananthapuram, for rescuing, rehabilitating, and protecting both captive and wild elephants. The state, like other forest reserves in India, has historically chosen to turn many of the captured conflict-making elephants into ‘Kumkis’ (a Kumki elephant is a specially trained and domesticated elephant used in rescue operations and to train other wild elephants and manage wildlife conflict).
Apart from the above, one of the most effective measures that has been implemented in Kerala is through the Wayanad Elephant Conflict Mitigation Project by the Wildlife Trust of India (WTI). The project, first initiated in 2002–2003 by WTI, has evolved into a successful model for tackling human–elephant conflict in Kerala. The model has focused on relocating human settlements from places identified as ‘elephant corridors’ in the Wayanad district of Kerala. Wayanad, spanning a total of 2,131 sq. km., has an elephant reserve spread over 1,200 sq. km., with an elephant density of 0.25 elephants/sq. km.
Shajan M.A., a Senior Field Officer with WTI who handles the project currently, tells me, “Our method is to buy such sensitive land from the people, including both tribal and other communities, and relocate them to safer regions, away from wildlife conflict.” Ultimately, WTI hands over the purchased land to the Kerala Forest Department.
In regions like the Tirunelli–Kudrakote elephant corridor, the human–elephant conflict had escalated so much that it had resulted in several human deaths. For the communities, leaving a land they had occupied for decades and considered home is never easy, Shajan acknowledges. But of all the tried and tested methods to deal with the human–wildlife conflict, this approach has been the most effective in the long run, he points out.
Shajan also muses on the question of what exactly comprises a ‘conflict.’
“Conflict can hold different meanings. From a monkey stealing food from the house to a tiger or an elephant attack on a human, even leading to deaths, it’s all considered a human–wildlife conflict. Sadly, we, as a society, tend to be reactive once it transforms into a conflict and place the blame wholly on the wildlife.”
MONTEVIDEO, Uruguay, Sep 2 2025 (IPS) – In late June, thousands flooded the streets of Lomé, Togo’s capital, presenting the ruling dynasty with its biggest challenge in decades.
The catalyst was constitutional manoeuvring by President Faure Gnassingbé to maintain his grip on power. In March 2024, his government pushed through constitutional amendments that transformed Togo from a presidential to a parliamentary system. This created a new position, the President of the Council of Ministers – effectively Togo’s chief executive – elected by parliament rather than by popular vote, and with no term limits. Gnassingbé assumed this new role in May, making it abundantly clear the changes were only about keeping him in power indefinitely.
This constitutional manoeuvre was the latest episode in a 58-year family saga that began when Faure’s father, Gnassingbé Eyadéma, seized power in a 1967 coup. For 25 years, the elder Gnassingbé ruled over a one-party state, staging ritual elections that reached absurd heights in 1986 when he claimed re-election with close to 100 per cent of votes on an implausible 99 per cent turnout. Even after nominal multiparty democracy arrived in 1992, elections remained charades with predetermined outcomes, as opposition parties faced systematic obstacles that made fair competition impossible.
When Eyadéma died in 2005, the military simply appointed his son Faure as successor, despite the constitution mandating immediate elections. International pressure forced a hastily organised vote, but this followed the familiar script of violence, fraud and repression. The pattern repeated in 2010, 2015 and 2020, with each election offering a veneer of legitimacy for continued authoritarian rule – and eliciting successive waves of protest that were either violently repressed or pre-emptively suppressed.
Now, two decades after Faure took power, this latest constitutional gambit has triggered the most significant challenge to his rule. The constitutional changes designed to keep him in power have instead galvanised opposition, creating a focal point for decades of accumulated grievances.
The current protests differ from their predecessors by being overwhelmingly led by young people who’ve never known any other leaders than the Gnassingbés. Raised on promises of multiparty democracy, they’ve witnessed systematic electoral fraud to perpetuate a government wholly unresponsive to their needs. They connect their daily struggles with unemployment, power outages and crumbling infrastructure with the long-term denial of their democratic freedoms.
The arrest in May of a popular rapper and TikToker, Aamron – for posting a video calling for street protests to coincide with Gnassingbé’s birthday on 6 June – galvanised discontent, turning simmering frustration into organised resistance. Aamron’s detention sparked the formation of the 6 June Movement (M66), led by young artists, bloggers, diaspora-based activists and civil society figures who rely heavily on social media to coordinate protests, bypassing state-controlled channels.
The government’s response, however, has followed a familiar path of authoritarian crackdown. In late June, security forces killed at least seven people, including 15-year-old Jacques Koami Koutoglo, and they’ve also used teargas, beatings and mass arrests against protesters. The regime has detained journalists, forced deletion of protest footage and imposed internet shutdowns during protests. It has suspended international media outlets including France 24 and RFI for their protest coverage. it has even issued international arrest warrants for M66 leaders based abroad, accusing them of terrorism and subversion.
Protests have continued despite repression. The leadership of young people, less intimidated by the security apparatus and better connected through social media, has allowed for the diversification of opposition tactics, with activists shifting between street protests, legal challenges and international advocacy as circumstances dictate. The diaspora is also playing a role, with Togolese communities abroad organising solidarity protests and advocating with international organisations for sanctions against the Gnassingbé regime.
Significant obstacles however remain. Gnassingbé controls all levers of power, including security forces, the electoral commission and the Constitutional Court. For a democratic transition to result, international pressure would need to intensify, including the imposition of targeted sanctions on regime officials and their economic interests. Regional bodies, particularly the Economic Community of West African States, would need to act, including by threatening to suspend Togo until democratic reforms are implemented.
Whether these protests trigger democratic change or become yet another chapter in the history of repressed dissent will ultimately depend on the ability of pro-democracy forces to sustain pressure and whether the international community finally decides to act. Gnassingbé’s constitutional manoeuvre may prove to be his final act, not because it succeeded in keeping him in power, but because it awakened a new generation. Togo’s young people have discovered the power of collective action—and that could prove decisive.
As Israel escalates its attack on Gaza City, the UN moves to stop further violence and humanitarian violations by renewing UNIFIL’s mandate for the last time.
United Nations Secretary-General António Guterres at a press briefing on Israel’s plans to take over Gaza City. Credit: Jennifer Xin-Tsu Lin Levine/IPS
UNITED NATIONS, Aug 28 2025 (IPS) – Ahead of the Security Council meeting on the situation in the Middle East, United Nations Secretary-General António Guterres spoke to the press on the “unfolding tragedy that is Gaza,” calling Israel’s new plans to take over Gaza City with the military a “deadly escalation” and an “existential threat to the two-state solution.”
He warned that such a move could precipitate an unprecedented humanitarian catastrophe that imperiled any remaining prospects for negotiated peace.
The Secretary-General also reiterated his plea for an immediate ceasefire, emphasizing that capturing Gaza City would result in massive civilian casualties and widespread destruction—including severe impacts on the health sector already teetering on collapse.
At the daily press briefing, spokesperson for the Secretary-General Stéphane Dujarric reported on the displacement in Gaza since Israel’s most recent invasion, confirming the Secretary-General’s statements about refugees. UN experts report that the total number of people who have fled from north Gaza to south Gaza since August 14, when the Israeli invasion was announced, is 20,000.
The Secretary-General went on to address the most recent Israeli air strike on the Nasser Hospital in the southern Strip of Gaza, where at least 20 people were killed and 50 others were injured. Israel’s military defended the strike by asserting that it targeted a camera used by Hamas to surveil troop movements.
Dorothy Shea, United States ambassador to the United Nations, defended Israeli actions and urged condemnation of Hamas’ use of civilian facilities for military purposes. She also noted the Hamas members killed by the airstrike.
Prime Minister Benjamin Netanyahu issued a statement calling the strike a “tragic mishap” with no mention of a specific Hamas target. The Secretary-General called for an impartial investigation into these contrasting claims.
Although Netanyahu reaffirmed his respect for journalists on X, formerly known as Twitter, UNESCO reported at least 62 journalists and media workers killed in Palestine while working since October 2023. At least five journalists were killed in the Nasser air strike, according to World Health Organization Director Tedros Adhanom Gebreyesus.
At the Security Council meeting debating whether or not to renew the mandate for the United Nations Interim Force in Lebanon (UNIFIL), many representatives acknowledged Israel’s current military action and called UNIFIL’s work “vital” in maintaining borders, minimizing conflict and stabilizing tensions.
The representative for Algeria Amar Bendjama was critical of UNIFIL’s failures, but spoke in favor of the renewal. He said, “We must ask, has UNIFIL fulfilled its mandate? Clearly, the answer is no. Lebanese lines remain under Israeli occupation, and we regret that our proposal to include a clear reference to the 1949 general armistice agreement was not retained. Without ending Israel’s occupation of Arab lands, peace and stability in the region will remain elusive.”
UNIFIL was initially created in 1978 to oversee Israeli withdrawal from Lebanon. The mandate was adjusted and has played a significant role in maintaining Lebanese army control on the border between Lebanon and Israel rather than Hezbollah, a paramilitary organization, taking over. Critics, led by the United States, see the mandate as a waste of money that has helped Hezbollah consolidate power.
Dujarrac emphasized the necessity of all participating parties to respect UNIFIL’s mandate for it to successfully fulfill its promises.
The Council ultimately voted to renew UNIFIL’s mandate, with many members stressing that the mission continues to play an important role in preventing further escalation along the Israel-Lebanon border.
Guterres’s warnings on Gaza and the debate over UNIFIL underscored the overlapping crises in the region that face the Security Council.
As displacement in Gaza mounts and humanitarian needs continue to fester, UNIFIL’s renewal has bought time rather than answers for a region caught between humanitarian crisis and unresolved conflict.
A patient being checked for BP at Mann PHC. Credit: Rina Mukherji/IPS
MANN, India, Aug 26 2025 (IPS) – Generally thought to be diseases of the wealthier classes, non-communicable diseases (NCDs) like hypertension and diabetes are on the rise among India’s underprivileged working classes in semi-urban and rural sprawls.
Take the case of Mohan Ahire. A middle-aged gardener in Pune, Mohan never realized that the heaviness in his head was a symptom of hypertension. Last summer, a mid-morning visit to the market saw him fall unconscious on return. Upon regaining consciousness, his wife and sons discovered the paralysis on the right side of his body, leading doctors to diagnose it as a stroke.
Bahinabai Gaekwad, a 56-year-old sweeper in Mann village, was at work when she suddenly collapsed and died. Doctors from the Primary Health Centre (PHC) next door found that she had been suffering from undiagnosed hypertension for a long time. The ailment ultimately led to a fatal cardiac arrest.
The worst problem is that most patients from underprivileged sections are not aware of their health condition.
Praful Mahato, a migrant laborer from Balasore in Odisha, who is currently employed in a dhaba (roadside eatery) in Mann, a fast-industrializing rural outpost of Pune city, had been suffering from heaviness and dizzy spells for some time. But he attributed his symptons to long hours at work and resulting fatigue. A chance visit to a medical camp confirmed high blood pressure and diabetes. Since the last four months, medication has controlled his blood pressure and brought down his sugar level.
Jagdish Mondol, in his 50s, did not realize he had hypertension and diabetes until he needed to undergo a hernia operation at a government hospital in Bhadrak, Odisha. This was despite blurred vision and difficulty in walking. Thankfully, the operation got him to wake up to his health condition. Regular medication has now improved his blood pressure and sugar level.
Fortunately, some patients may seek help on their own. Lalita Parshuram Jadhav, a 40-year-old migrant construction worker from Yavatmal, is one such. “Since the last two years, I have been experiencing pain in my legs; it became quite acute over the past year,” she tells IPS. A medical check-up confirmed hypertension and high sugar levels.
India’s Hypertension and Diabetes Epidemic
The cases cited above exemplify the rising burden of India’s non-communicable disease (NCD) of Hypertension and Diabetes. Ranked among the top ten NCDs responsible for untimely deaths worldwide, these two diseases are interlinked. This means those with hypertension are also vulnerable to developing prediabetes and diabetes.
According to the World Health Organization (WHO), an estimated 1.28 billion adults in the 30-79 age group suffer from hypertension, with two-thirds of them living in low- and middle-income countries. Yet, only 21 percent of those affected have their hypertension under control, while around 46 percent of these remain unaware of their condition and remain undiagnosed and untreated.
Diabetes, notably, can be of two varieties. Type 1 Diabetes is a congenital condition, while Type 2 diabetes is a lifestyle disease that develops later in life. South Asians, Pacific Islanders, and Native Americans have a significantly higher risk of developing the disorder.
The International Diabetes Federation (IDF) recorded a dramatic increase in the number of people affected by Type 2 Diabetes globally since the 1990s, and since 2000, the rise has been dramatic. In India, there are an estimated 77 million people above the age of 18 years suffering from diabetes (type 2), while nearly 25 million are prediabetic (at a higher risk of developing diabetes in the future). Yet, more than 50 percent of these are unaware of their diabetic status.
In India, the prevalence of Diabetes rose from 7.1 percent in 2009 to 8.9 percent in 2019. Meanwhile, 25.2 million adults are estimated to have Impaired Glucose Tolerance (IGT), a prediabetic condition that is estimated to increase to 35.7 million in the year 2045. It is also estimated that approximately 43.9 million people suffering from diabetes remain undiagnosed and untreated in India, posing a major public health risk.
It is a matter of concern that most deaths from these diseases occur in the 30- to 70-year-old age group, posing a major economic loss.
In Mann, doctors at primary health centers (PHCs) are battling this scourge, with hypertension affecting around 28 percent of the population and 12 percent being diabetic. The scenario is similar to that at Mullaheera, in rural Haryana, located just outside the national capital region of Delhi.
Dr. Sona Deshmukh, from the People-to-People Foundation, which is collaborating with the Government of India on its Viksit Bharat @2047 initiative and the in-charge for the Pranaa Project, tells me, “Diabetes is common among the older population, but hypertension is rising among the youth.”
Dangers Posed by Hypertension and Diabetes
The problem with both Hypertension and Diabetes is socio-cultural, with most people viewing these diseases as benign. Yet, ignoring them can lead to paralytic strokes and ultimately, death.
Characterized by headaches, blurred vision, nosebleeds, buzzing in the ears, and chest pain, uncontrolled and untreated hypertension can lead to—
chest pain (also termed angina);
heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen.
heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs; and
sudden death due to irregular heartbeat.
This is because excessive blood pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can result in the complications listed above, besides bursting or blocking arteries that supply blood and oxygen to the brain, causing a stroke. It can also cause kidney damage, resulting in kidney failure.
In the case of Diabetes, the body is unable to either produce or use insulin effectively. While individuals with Type I diabetes have a congenital condition wherein the insulin-producing cells in the pancreas are attacked and destroyed, patients with Type II diabetes—which is a preventable lifestyle-related disease—either do not produce enough insulin or are unable to use insulin effectively for the body’s needs. Uncontrolled diabetes can lead to blindness and organ failures that affect the kidneys, heart, and nerves, ultimately leading to diabetic strokes and death.
Reasons Behind the Spurt
So, what are the reasons behind the spurt? Government Medical Officers Dr. Mayadevi Gujar and Dr. Vaishali Patil say, “The transition of many rural outposts into semi-urban industrialized zones has brought in lifestyle changes. Locals, who once partook of healthy home-cooked millets or cereals, now eat cheap, oily snacks from wayside kiosks cooked in reused palm oil. With more disposable income, workers lean towards sugary soft drinks and fast food, making them prone to diabetes. Addictions like tobacco and alcohol are on the rise. Tobacco-chewing remains common to both men and women in rural India.”
Additionally, with climate change affecting agricultural incomes in rural India, the younger generation is stressed with employment issues. These make a potent recipe for hypertension and diabetes.
Dr. Sundeep Salvi, a noted specialist in cardiovascular diseases, who heads the Pulmocare Research and Education (PURE) Foundation and has chaired the respiratory group for the Global Burden of Disease Study, adds, “Unlike in the past, people eat and sleep late, watch late-night television, drink endless cups of tea and coffee, and work late hours. Skipping meals is common, with little time for exercise. Sleep deprivation is a fallout of this. Stress and inadequate sleep are a deadly combination, feeding hypertension and diabetes.”
Salvi calls for hydration and good nutrition to stave off hypertension and diabetes. “Excess tea and coffee are harmful. Caffeine-present in tea and coffee-is a diuretic; it prevents hydration. A dehydrated constitution results in hypertension and diabetes, which, in turn, cause heart disease, stroke, kidney diseases, and eventually, death.”
He also views air pollution as a major risk.
“By air pollution, I am referring to both indoor and outdoor pollution. In rural areas, the burning of crop waste causes outdoor pollution. But indoor pollution in rural homes and urban slums is 5–10 times greater than outdoor pollution. High levels of particulate matter contribute to 20 percent of the global burden of diabetes, as well as hypertension.
Diabetologist and Director of the Diabetes Unit at Pune’s KEM Hospital Prof. Chittaranjan Yajnik, who has been working on this issue for over two decades, has an interesting take on the matter based on his findings.
Yajnik sees a direct correlation between vulnerability to diabetes and poor intrauterine growth.
“Poor intrauterine growth reflects in poor organ growth, especially of the infra-diaphragmatic organs (liver, pancreas, kidneys, and legs), reducing their capacity to perform adequately in later years. Such individuals, when faced with overnutrition and calories later in life, end up with prediabetes and diabetes.”
Yajnik’s research found that two-thirds of prediabetic girls and a third of the prediabetic boys were underweight at birth.
“These findings are suggestive of a ‘dual teratogenesis’ concept, which envisages a combination of undernutrition and overnutrition over a life course due to rapid socio-economic and nutritional transition…” This means intrauterine programming of diabetes needs to be supported in growth-retarded babies since metabolic abnormalities develop very early in life.
Yajnik certainly has a point, since anemia in expectant mothers and low birthweight babies is a major problem all over India. The National Family Health Surveys conducted over the years by the Government have shown a persistently high prevalence of fetal growth restriction in Indian babies. This phenomenon is linked to low birth weight in newborns, which is as high as 18.24 percent, according to the latest data.
The Solution
Recently, the Ministry of Health and Family Welfare (MOHFW) of the Government of India has implemented several schemes nationwide at the primary health level, starting with nutrition, medical care, and immunization for pregnant mothers while ensuring institutional delivery. Offspring are also extended comprehensive help for the 4 D’s (defects at birth, diseases, deficiencies, and developmental delays), immunization, supplementary nutrition, and WASH interventions. These continue through adolescence to prepare a healthy population for reproductive age.
Meanwhile, weekly wellness sessions have been introduced all over India. Deshmukh adds, “Regular screenings for hypertension and diabetes are done every few months for early detection and follow-up. Counselling sessions encourage people to adopt healthier lifestyles, while Yoga is being popularized through events like the International Yoga Day.”
These initiatives, one hopes, will arrest the epidemic.
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