Faris Kallayi

Dusk was falling fast on Osmania General Hospital (OGH) as a thermal fogger disinfected the premises. The machine operator covers every nook and corner and enters the waiting area in front of the Quli Qutb Shah block unannounced. As the fog engulfs, Akif Baig gets up from the cement bench and makes his way out. Baig’s mother is admitted here with seizures and heart and kidney infections. She has had this condition for three years. 

Before coming here, his mother was admitted for a few days at a private hospital that he did not want to name. It cost them Rs 18,000 to 22,000 per day, he said after a quick calculation. That represented almost a month’s pay for Baig, who works as a cashier at Flipkart’s warehouse. And “We are people with a monthly salary of Rs 20,000 to 25,000,” he says. 

Twenty-three-year-old Baig’s story is also the story of most Hyderabadis who live in the Old City area. For many like him, government-run hospitals are the only care they can afford.

A 2021 survey by Hyderabad-based Helping Hands Foundation (HHF) of 7200 households across 20 plus urban slums in the Old City found that 70% of the inhabitants do not have access to good and affordable healthcare.

A fruit vendor stacking mangoes near Charminar / Photograph by Faris Kallayi

“We are going in a minus”

Established by Muhammed Quli Qutb Shah in 1591 around the iconic Charminar, the Old City of Hyderabad has been inhabited for 432 years. 

Fast forward to 2023, Old City still carries its charm, markets are busy, and tourists flock to the many historical monuments in the area. The nine-year-old state of Telangana has incorporated Charminar in its emblem. 

But gone are the times of prosperity. Population has increased exponentially. Residential areas have become crowded.  

The demographic data specific to the Old City is not available. An HHF rough estimate says there are 25 lakh Muslims in the area, making it a predominant presence.

Residents say all the successive governments have failed the people of Old City. The “government never did anything” in the last 75 years, said senior community leader and trustee of Badshahi Ashurkhana Mir Abbas Ali Moosvi.

Moosvi pointed to “the triangle of hospitals” established during Nizam’s rule: Osmania General Hospital, Government Nizamia General Hospital (Unani) and Modern Government Maternity Hospital, Petlaburj. These three hospitals remain major healthcare providers in the Old City. 

Syed Ali Zaidi, an accountant turned hospital administrator of the Hyderabad-based Get Well Clinic Charitable Society (GWCCF), echoed a similar concern. The Old City has always been ignored in terms of development, health, and education. “We are going in a minus,” he says. 

Dr Amir Ullah Khan, a development economist and Research Director of the Centre for Development Policy and Practice (CDPP), flagged the weak municipal structure as the major problem. Municipal activities are limited to daily cleaning and sanitation. 

Read the in-depth interview of G. Sudhir, Chairman, Commission of Inquiry on Status of Muslims of Telangana

When asked about the government’s neglect, he says, “The government has not made any hospitals anywhere. [It] hasn’t invested in healthcare anywhere.” The situation of public healthcare across the state is the same. The new city has a lot of private hospitals, while in the Old City, that are also fewer.  

“Public health[care] is non-existent,” Dr Khan says.

A Varied Picture

In one and a half dozen interviews across the Old City area, a varied picture of public healthcare emerged. 

Mohammed Miraaj, a resident of Tolichowki, was spotted in the corridor outside a mostly empty ward of Golconda Area Hospital (GAH). His infant was born without a urinal hole. He expressed his satisfaction with the facilities and treatment as he got into the auto, waiting for them to rush to Niloufer Hospital for further consultations. The doctors at GAH had advised the family to see specialists at Niloufer Hospital.

However, “irregularity of doctors” and “unfriendly staff” are major problems at GAH, Mohammed Firdous Khan, a 53-year-old resident of Bada Bazar in Golconda, said. He runs a soft drinks shop in front of Golconda Fort, where he caters to touristy customers. 

“The whole circle is bad. No public has confidence in your hospital,” he says. The government needs to wake up and “inspect” the cracks and flaws by “sending people disguised as patients,” he added.

Dudukula Fayaz, 28, a daily wager, criticised the delay in treatment while attending to his nephew at the hospital in Petlaburj. 

Mohammed Shafi, 23, a fruit vendor from Mughalpura, complained about lack of hygiene and rampant bribes in the hospitals. 

Even so, many residents praised the quality of healthcare provided in OGH. Mohammed Aijaz Khan, 56, an attar vendor near Afzal Gunj Masjid, pointed to the affordability of healthcare in government hospitals. He recently had to take his daughter to the hospital for an emergency.

“In other [private] hospitals, there would be expenses of thousands of rupees,” he says.

Faiz Muhammed Khan, 58, who lives a few blocks away from GAH, was at the hospital to get relief for heartburn. The bed facility and hygiene have improved in the last eight years, he certified. He comes here for all his medical needs. 

“[We] don’t have money; where will we go?” he asks. 

Minority Within a Minority 

Muslim women are a minority within a minority. 

The Government of Telangana instituted a Commission of Inquiry headed by retired IAS officer G. Sudhir in 2015 to look into the status of Muslims in the state. Sudhir Commission’s 2016 report on the socio-economic and educational conditions of the Muslim community states that Muslim women are slightly better than other socio-religious communities in terms of health. “Unlike women from other communities, Muslim women are better treated at home and have better health outcomes,” the report states.

Read the in-depth interview of G. Sudhir, Chairman, Commission of Inquiry on Status of Muslims of Telangana

However, this advantage doesn’t seem to last too long. According to the report, “Their disadvantages grow as they grow older and are subject to the interface between gender and community within the Indian social, political and economic context.”

Vantage spoke with poet turned social activist Jameela Nishat. She founded Shaheen Women’s Resource and Welfare Association in 2002 and has been working with the women of Old City ever since. 

“Shaheen’s work started with the caged bird,” she says, recollecting the drawing one girl made in a competition conducted by the organisation.

Based out of their office in Sultan Shahi, Shaheen’s primary focus is women from the slum areas that constitute a big part of the Old City. 

Nishat flagged the absence of public hospitals in the area. “In the Old City, there is no proper hospital. After the [Afzal Gunj, Nayapul, and Puranapul] bridge crossing, there is no government hospital at all. We have only healthcare centres,” she says. 

However, Mujtaba Hasan Askari, founder of HHF, outlined three reasons for poor health: First, two-thirds of Old City is urban slums. Second, the socio-economic condition of the community is poor as education levels and enrolment in higher education are significantly low. Third, lack of employment and economic opportunities beset the area with no industrial or service growth. An additional burden is posed by sedentary and nocturnal lifestyle, poor dietary habits, illiteracy, lack of awareness about health, and a significant number of chronic non-communicable diseases such as diabetes and obesity. These factors collectively cause “an economic-financial-health distress.”

“All these become a deadly concoction for poor health,” Askari says.

Charitable organisations, like HHF and GWCCF, are doing considerable work in the healthcare of the Old City. Despite impressive initiatives, it is a small sector. “All charitable [hospitals] put together, they can reach only five percent [of the population],” Dr Amir Ullah Khan says.

Need for Government Presence

In the 2023 budget, the Telangana government announced the construction of nine new medical colleges and allocated 5% of its total expenditure towards health. However, it still stands less than the 6.3% average health spend by other states. Extension of Basti Dawakhanas and starting more Palle Dawakhanas are certainly a welcome boon. 

Basti Dawakhanas are health centres that cater to the poor in urban settings. Palle Dawakhanas are small rural health centres attached to PHCs. 

The requirement today is that “The government should be providing quality services at the doorstep,” Askari says. The consultation time of doctors needs to increase, and there is a need for more nurses and paramedics. He says in the current scenario that, “The human resource component is missing.” 

Dr Amir Ullah Khan emphasised on having “a very significant government presence” where small hospitals are established close to large slums in order to take care of out-patients. There is a dire need for more health workers in hospitals. Most importantly, government hospitals need to start diagnostic centres and provide more medicines since they constitute almost 50% of the expenses. These measures can significantly reduce out-of-pocket costs, he said.

Doctors at Old City hospitals often point to increased caseload due to overcrowding and lack of screening at the primary level.

Vantage contacted three senior health officials from the Government of Telangana: Health Secretary Syed Ali Murtaza Rizvi, Special Secretary Soni Bala Devi, and Public Health Director Dr G. Srinivas Rao. None of them were available for comment despite multiple attempts. This piece will be updated when they respond. 

This article was published on 26 April, 2023.