New Delhi & Pune: Sitting in the corner of a storeroom that he has turned into a home office in Madhu Vihar, an eastern district of India’s capital, Nawab Singh gazed at a wall opposite his wooden desk.
The grey wall was dusty and discoloured: remnants of brown sellotape were stuck all over the grey wall, which had A-4 sized splotches, where papers appeared to have been torn down.
“Jigyasa likes to draw, and I like to put all of them up here,” Singh, 33, explained, slowly looking away. “A few days ago, she tore them up.”
Her hair open, the ends of her loose, green track pants emblazoned with the word “love” in white capital letters, Jigyasa, 11, is Singh’s niece, a quiet and reserved child, the younger of his oldest brother’s two daughters.
Jigyasa, who said she would like to be a doctor, likes to paint, and the splotches on the wall were where she had once stuck her paintings, which she tore down, Singh said, as a result of recurring episodes of anger. He could not explain the outbursts. For the past year and a half, he said, the anger has come and gone.
Jigyasa’s older sister, almost as quiet, with her hair streamlined by a striking red hairband, is Purnima, 13. In April 2021, as a result of a tragedy that unfolded during the Covid-19 pandemic, Singh suddenly found he had become their sole guardian.
"Everything happened in a matter of 96 hours,” said Singh on a chilly December afternoon, his voice hushed. He feared his nieces would hear him and might relive those grim days that he wished for them to forget.
“First their father, and less than two days later, their mother died,” said Singh. “How do you tell two young children that, overnight, they have been orphaned? How do you have these conversations?”
Jigyasa and Purnima’s parents perished as two consecutive waves of the Covid-19 pandemic caused an unprecedented humanitarian crisis nationwide, causing food, hospital beds and oxygen shortages, as the death toll soared to one of the world’s highest, depending on whose data you consider.
Data Disputes, Lives Lost
On 5 May 2022, the World Health Organisation (WHO) estimated 4.7 million Indians had died of Covid-19 over 24 months, between 1 January 2020 and 31 December 2021. That was about 30.9% of the global death toll.
The WHO calculated the lives directly lost to the virus and “excess mortality”—the difference between deaths counted over a specific time period and expected numbers of deaths in the same time period. Within a day of the WHO report, the Indian government objected to the methodology and mathematical models used, stating that no more than 481,000 had died over 28 months, between 3 January 2020 and 6 May 2022. By 23 December 2022, the official government Covid-19 death toll was approximately half a million, with 530,690 fatalities.
There was a similar dispute over statistics of children orphaned by the pandemic in India.
On 24 February 2022, an United Kingdom-based, medical peer-reviewed journal, The Lancet Child & Adolescent Health, recorded over 5.2 million children who lost either one or both of their parents to Covid-19 across 21 nations in the world. The pandemic orphaned as many children in two years as HIV/AIDS did in ten, according to the study.
With the most affected age group ranging from 10 to 17 years old, the Lancet study said the highest rates of children orphaned were in Peru, South Africa, Mexico and India.
India was estimated to have approximately 1.9 million Covid-19 orphans or 36.54% of the global total. The ministry of women and child development on 2 March 2022 disputed this estimate as well in a press release.
Titled “Lancet Article Sophisticated Trickery Intended To Create Panic Among Citizens, Divorced From Truth And Ground Reality”, the ministry provided a state and union territory wise breakdown of children hit by the pandemic, as per the Bal Swaraj portal set-up in May 2021 by the National Commission for Protection of Child Rights (NCPCR).
According to government data, 153,827 children were either orphaned, with a single parent, or abandoned as of 15 February 2022, a number 12 times lesser than the Lancet estimate.
‘Both Children Knew Something Bad Had Happened’
Purnima and Jagyasa were two among 10,386 children, as recorded by government data, to have lost both parents to Covid-19.
“Both children knew something bad had happened,” said Singh. “While Purnima was one of the first people at home to know about their father’s demise, Jigyasa saw their mother struggling to breathe in front of her own eyes.”
Also infected with Covid-19 alongside her parents, Jigyasa was admitted in the same Covid ward as her mother, Snehlata, on 14 April 2021. Her father, Kunwar, was admitted in a ward a floor below them at a government hospital in central Delhi on the same day.
Less than 14 hours later, on April 15, Kunwar—a 39-year-old bookseller and the sole-breadwinner of the family—died.
At approximately 1 am on April 17, Snehlata, six-months pregnant, also died.
Since then, Singh, a newly-registered litigation lawyer, has been trying his best to spend as much time as possible with his nieces in their two-bedroom flat.
“They are both as quiet and talkative as one another,” he said, letting out a small laugh at the sight of Purnima and Jigyasa tip-toeing their way into the room with a tray of warm water.
The two sisters have held on to each other since the demise of their parents. Unable to sleep without one another, they are each other’s closest confidants.
Purnima, a dance-lover, is often regarded as the ‘grown-up’ by her extended family. More often than not, she is the first person to rush to her younger sister whenever the latter cries and shivers during nightmares in the middle of the night or expresses sudden bouts of anger.
Financial Benefits, But What Of Mental Health?
“They have received the government-mandated financial benefits, and, while it took time, local officials were helpful in ensuring adequate documentation was in place,” said Singh, explaining how government financial aid reached his nieces.
Under the Mukhyamantri Covid-19 Pariwar Aarthik Sahayata Yojna or the chief minister’s financial support scheme for families affected by Covid-19, launched by the Delhi government in July 2021, each death amounted to an ex-gratia of Rs 50,000. In the case of Purnima and Jigyasa, they received Rs 100,000 each due to the death of both their parents. They have each also been receiving Rs 2,500 every month.
“However,” said Singh, “nobody has called us to offer any kind of mental health or trauma-related counselling for either of them.”
On 29 May 2021, the government of Prime Minister Narendra Modi announced the PM CARES for Children scheme for those who lost their parents to Covid-19. Several state governments announced financial compensation, and the union government promised school scholarships and financial aid: a monthly stipend once the child turned 18 and a lump sum of Rs 10,00,000 once they turned 23.
The union government also extended a health insurance cover of Rs 500,000 under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana or the Prime Minister’s Public Health Scheme to its beneficiaries.
While this is the only union government programme that includes mental health services, it is only applicable to children who lost both their parents to the pandemic, according to information provided by the ministry of women and child development, which monitors the PM-CARES for children scheme.
“This scheme is also applicable for children who may have lost their only parent during the pandemic,” said R S Sharma, chief executive officer (CEO) of the National Health Authority, the apex body governing the health insurance scheme, told Article 14. However, children with single surviving parents cannot get aid under this provision.
A year after the health insurance programme was announced, the union government in May 2022 announced 4,345 beneficiaries among Covid orphans nationwide. This was less than 2.9% of the number of children who lost a parent or both recorded by the State in March 2022.
An Unknown Helpline
“The real impact of the Covid-19 pandemic shall be borne by the forthcoming generation,” Anurag Kundu, chairperson of the Delhi Commission for Protection of Child Rights (DCPCR) told Article 14.
“One of the most heart-wrenching calls we received was from a seven-year-old boy during the second wave of the pandemic,” said Kundu. “His father had died of Covid-19 right next to him, and he wanted to know the process of cremation.”
In April 2021, the DCPCR launched a helpline (+91-9311551393) for children facing Covid-related crises. Its team of counsellors and volunteers hoped to support children who may have lost either one or both of their parents to the virus, needed logistical guidance or suffered from anxiety and loneliness.
“While we do cater to grievance and distress calls, one of our primary aims of launching this helpline was to prevent further Covid-induced trauma amongst children,” Kundu said.
In 2022 alone, the facility recorded over 12,000 calls. Few were made by children.
Not many know of the helpline and its virtual counselling facilities, and there is a social stigma associated with seeking mental health support among Covid-affected households across New Delhi, said experts. The crisis is aggravated by insufficient formal knowledge of what children orphaned by the pandemic face.
“The pandemic has been a disaster in more ways than one,” former Supreme Court Judge, Justice Madan Lokur, observed in the DCPCR’s second issue of Children First: Journal on Children’s Lives, released in August 2022. “We still do not know the extent to which children have been traumatised.”
At a shelter home for girls in a northern district of Pune, Maharashtra, similar thoughts were evident.
“Be it the Juvenile Justice Act (2015), the National Policy for Children (2013), or any other child-care law in the world, institutionalisation is always the last resort,” said Col (retd) Mickie Uberoi, 66. “It is only when there is absolutely nobody else who can provide adequate care to a child that they are sent to such a home.”
After serving over 25 years in the Indian Army, Uberoi began a shelter home for girls in need of care and protection in an alley of Yerwada along with four retired army officers in April 2022. The home is known locally as ghar or home, and he is lovingly called ‘uncleji’.
‘We Could Not Even Say Goodbye’: A Daughter Recalls
K (identity withheld) and her two younger sisters walked through the ghar’s gates in May 2022. After moving from one relative’s house to the other over a year-and-a-half years, sometimes separated from one another, they finally found a place they could all call home.
They were the only Covid-orphans among the 26 children there.
“They died 10 days apart from one another,” K*, 15, recalled as she sat still on a swing in a small play-area outside the six-storey shelter home. “And we did not get chance to say goodbye to either of them.”
With her hair neatly oiled and braided in two parts, K tapped her feet up-and-down on an unseasonably warm late-November Pune evening. She smiled every time she heard someone call her “Kaju”, the name her mother used for her.
K’s mother, Laxmi, was on the fourth-stage of lung cancer when she coaxed her younger brother to tell her where her husband was.
“Even though she was too frail to speak, she would not take no for an answer,” said K. “She wanted to know where Baba was, and my uncle could not keep it from her anymore.”
Vijay, a 53-year-old security guard, had met with an accident on his scooter a few kilometres away from their home in Saswad on 5 November 2020. It is only when he was rushed to a large state-run hospital in Pune city that they realised that he was also infected with the Covid-19 virus.
Three days later, on 8 November, unknown to his family, Vijay. Ten days later on 18 November, bed-ridden and incapacitated, Laxmi died at their home, moments after she heard of his death.
According to their death certificates, both of them were infected with Covid-19. Neither knew.
Loss Of Memory, Bursts Of Rage
Over the next 18 months, the three sisters, aged 15, 9 and 5, moved three houses. After spending two months at their maternal uncle’s residence in Uruli Kanchan, they were sheltered separately by three different relatives across Pune.
“Just before we left our house in Saswad, I gathered all our family pictures with our parents and locked them up in boxes,” said K, an aspiring Indian Administrative Service (IAS) officer. “I did not want my sisters to be reminded of their loss every single day.”
Her younger siblings do not remember a lot about their parents or how they died. S, the youngest of the three, still believes that, one day, her parents will visit her bearing gifts—a cycle and a cake, specifically. Two years after their death, K finds herself struggling to block out flashbacks of her time with their parents. She struggles to prevent unexpected outbursts of rage.
According to the initial diagnosis of a psychologist in October 2022, K showed symptoms of what is called “situational anger”. In other words, she is triggered by situations that remind her of her parents or hinted at further abandonment.
A Helpline Is Flooded With Calls
“I must emphasise that the government of Maharashtra is extremely sensitive towards the needs of children orphaned by Covid-19,” said Susieben Shah, chairperson of the Maharashtra State Commission for Protection of Child Rights (MSCPCR). “We realise that the kind of loss they have faced cannot even be healed with time.”
On 20 March 2020, a centralised child-helpline (1098), officially called ‘CHILDLINE’, was expanded to receive calls from children in distress due to Covid-19.
Within the first 21 days of this expansion, CHILDLINE received as many as 460,000 calls. According to CHILDLINE’s records, the helpline, which runs day and night, has answered over 5.3 million and assisted or rescued 3,95,000 children.
CHILDLINE 1098 is the sole calling-facility available for children orphaned by Covid-19 in Maharashtra, the state with the second-highest population of Covid-orphans in the country.
In June 2021, the Maharashtra government set-up task forces and ward-level representatives across 35 districts. Their primary effort is to reach children either partially or completely orphaned by Covid-19 and to identify their educational, financial, nutrition and mental-health needs.
Rahul More, Maharashtra’s deputy commissioner for child welfare said his department had collaborated with “on-ground non-governmental organisations and medical facilities”, such as the Indian Psychiatric Society, to counsel children facing Covid-induced trauma statewide.
As of 23 November 2022, Maharashtra’s ministry of women and child development recorded 28,908 children orphaned by Covid-19. With 2.9% having lost both parents, only 40 children had institutionalised: 89.9% are now under the care of single mothers.
The Rise Of ‘Prolonged Grief Disorder’
“In what we believe to be almost a post-pandemic world, Covid-induced orphans and widowed women are two of the gravest yet most invisible communities in not just India, but nations around the world,” Susan Hillis, senior technical advisor on the Centers for Disease Control and Prevention (CDC) Covid-19 International Task Force, told Article 14.
According to their data, two of every three Covid-orphans worldwide are between 10 and 17. In India, 65% of the children who lost one or both parents were adolescents.
In 2020, the American Psychiatric Association created a new diagnosis called the “prolonged grief disorder (PGD)”, Hillis explained. “There are studies that suggest that children who experience the death of a parent or caregiver are significantly more likely to suffer from the psychiatric disorder that must sought counselling and professional help,” she said.
In normal circumstances, the three factors that increased the risk of a child suffering from PGD are: sudden death, not being able to participate in normal funeral rituals or lack of availability of “conventional psycho-social environments thereafter”, said Hillis.
“Any one of these instances can increase the risk of PGD,” said Hillis. “In the case of Covid-orphans—they bore all three factors, simultaneously,”
In September 2021, PGD was added to the diagnostic and statistical manual of mental disorders, a handbook of global mental health professionals from across the world.
The American Psychiatric Association study said some of the symptoms of PGD included intense emotional pain (such as anger, sorrow, bitterness) related to the death, avoidance of reminders that the person is dead, difficulty with their own reintegration (such as engaging with friends, pursuing interests, planning for the future) and extreme loneliness.
In addition to efficient state investment in robust mental health facilities, some of the most sustainable ways of helping children hit by Covid trauma are to train school teachers to deal with such trauma and to form “accessible on-ground grief support groups” for them, said Hillis.
Discovering More Orphans
In June 2020, Médecins Sans Frontières—a global humanitarian medical non-governmental organisation—began a mental health helpline in India. Operational in seven languages—Hindi, Tamil, Gujarati, Marathi, Assamese, Punjabi and English—trained counsellors provided one-on-one telephonic consultations for those facing any kind of Covid-induced distress.
“Even as adults, it is difficult to ask for help,” said Singh, the Delhi lawyer, looking over his shoulder at his nieces playing with one another in the small makeshift balcony behind his desk. “How do we expect children who have suffered their biggest loss in the most traumatic ways to?”
“They barely know what is happening to them,” said Singh, “let alone have the words to seek help for themselves.”
In March 2023, along with the rest of the world, India will complete three years of dealing with the Covid-19. Many have moved on, others struggle, especially orphaned children, who are still being discovered by the State.
“The number of orphans are being monitored and updated almost every single day,” said More, the Maharashtra official previously quoted. This is the case in New Delhi as well.
In other words, it still isn’t clear how many children lost either one or both of their parents to the pandemic. Experts said India has yet to comprehend the scale of loss, let alone figure out how to deliver trauma-related aid.
Most Orphaned Children Bereft Of Help
Recent research (here and here) indicates intent and consensus on the need to extend mental health facilities to orphaned children, especially since the second-wave of Covid-19 nationwide.
But with a majority of Covid orphans living outside the institutional framework, it is difficult to deliver such aid, even where it is available.
While there are central and state helplines that a caregiver or well-wisher may contact to seek help for a child, there is little engagement with such children in their existing communities and environments, such as anganwadis and schools.
“People say the pandemic is over,” said Singh. “But for such children, with their full lives ahead of them, it is just getting started.”
As he spoke, he smiled as he watched Purnima and Jigyasa run to the other room to get a new stack of her A4-sized drawings. They would, he hoped, soon fill his otherwise grey wall again.
*Name withheld on request
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(Oishika Neogi is an independent journalist based in New Delhi.)
Reporting for this story was made possible by the Medecins Sans Frontieres (MSF) Without Borders Media Fellowship. MSF, also known as Doctors Without Borders, works with journalists to encourage independent, impartial and neutral reporting on health and humanitarian crises.