Hospitals have an indispensable role in providing medical care to those with more serious or special health problems. In this regard, the team gathered information primarily in Amdavad city, focussing attention on the role of public hospitals. It obtained various kinds of information through discussions with camp inmates who had accessed hospital services, interviews of staff and patients in hospitals, and discussions with doctors working in various hospitals.

Amdavad is characterised by a fairly large number of government hospitals, both run by the Amdavad Municipal Corporation (L G Hospital , V S Hospital, and Shardaben Hospital) and two civil hospitals run by the state government.

Public hospitals have been working under a constant threat of violence against Muslim patients within the precincts of the hospital. There have been instances of mobs attacking hospitals, preventing injured persons from entering their gates, and even moving around in the wards, terrorising and even attacking patients and relatives. There is no indication that the government has made serious efforts to protect the health services, and maintain people's access to them. Despite this pressure, health professionals in the hospitals have functioned neutrally, providing treatment without discrimination on the basis of community. This is commendable.

On the whole, comments from almost all sources, including the camp inmates, indicated that individual doctors working in hospitals have worked strenuously, often around the clock, to deal with the large number of violence victims. This needs to be placed on record, and the efforts of many committed doctors, nurses and hospital staff to provide care to victims in a demanding situation needs to be appreciated.

However, there have been many larger forces at work, which have been responsible for restricting the effectiveness of hospitals in providing care especially to the minority community. The sanctity of hospitals as humanitarian spaces, where everyone should be able to receive treatment without fear, has been violated. In some situations, doctors are even pressurised or threatened for making efforts to treat minority patients. Based on the various interactions and observations, the team identified the following issues concerning public hospitals during this crisis.

Religion-wise segregation of hospitals
A senior medical consultant from a municipal hospital, told the team that, informally, both hospital authorities and the common people have to some extent segregated hospitals according to the religion of patients to whom they generally provide services. He said that there was an unwritten guideline that patients of the 'other' religion should be transferred to a 'safer' hospital.

Such segregation, which has become accentuated during the recent violence, is partly related to the geographical location of hospitals and the ghettoisation within the city. This has contributed to the public perception of each hospital as being the preserve of patients of certain communities. Hospitals which are located in Hindu majority areas are not so frequently accessed by Muslim patients and vice versa.

On the whole, there is an impression among camp inmates that Vadilal Sarabhai hospital is a comparatively 'safe' hospital for Muslims. Muslims have not accessed certain other hospitals as frequently during the violence from fear of attack by Hindu mobs. There was a case in the L.G. Hospital during the 1992 communal violence, when a Muslim burns patient admitted in the hospital was thrown off the roof of the hospital. ('In Ahmedabad, even hospitals are divided along communal lines', The Times of India, Mumbai edition, April 8, 2002). The memory of that event inhibited many patients from going there.

It is also important to comment that several ad hoc measures, that have been taken to deal with emergency situations (segregating hospitals and patients on the basis of community, giving sympathetic leave to staff belonging to the minority community) may threaten the secular character of health institutions and lead to accentuation of polarisation within the profession. However, it must be noted that the responsibility of ensuring safety of patients and staff in the hospitals lies with the agencies such as the police, which have clearly been party to the violence themselves. It is apparent that while the hospitals have largely been non-discriminatory, they have been unable to mobilise support to protect their non-partisan and humanitarian role.

Mobs creating terror and Muslim patients being unable to access hospitals
Patients, hospital staff and doctors - all told the team of large mobs, usually of the majority community, gathering in front of some hospitals or in hospital compounds, especially during the initial days after the outbreak of violence. The mobs intimidated Muslims trying to bring new patients to the hospital. Such threats sometimes forced patients to retreat from the hospital gates.

After the initial incidents, hospital authorities started providing security staff outside the hospital and even in some of the wards. This is not always sufficient.

Lack of access to hospitals was a problem encountered at various levels, even before patients could reach the hospitals.

In an abnormal situation, where there is a threat to people's safety and movement, the barriers to access to the institution has much worse repercussions. By depending on people to come to them for treatment, the services do not reach those who need them the most.

Threat of violence to patients within hospitals
The team also received reports of individuals and groups of 50 to 100 people, sometimes armed, circulating in certain hospital wards. These groups would talk in violent language about people of the other community, and create an atmosphere of fear. Even more serious, both patients and staff reported incidents of attempts to inflict violence upon patients within the hospital. Although such incidents were probably uncommon, the fact that they could occur is a serious matter, concerning the security of patients in the hospital.

There were many reports of violence by probable outsiders entering wards and attempting to harm patients.

Another issue regarding hospitals related to the premature discharge of Muslim patients in certain instances. While such decisions were apparently taken in order to ensure the safety of patients, they confirmed that even doctors perceived that patients and their attendants were not entirely secure within hospitals. The appropriate action by the authorities in such a situation would have been to ensure adequate security, rather than discharging patients.

We are grateful to the camp inmates, organisers and the volunteers working in the relief camps for all the information they shared with us.

We would like to thank friends Sandhya Srinivasan, Nandita Bhatla and Ranjan De for their help in the process of editing, layout, cover design and final production of the report.