COVID Foreign Aid: Why Life-Saving Supplies Are Stuck in Red Tape

The Union Health Ministry is yet to respond to questions raised by the media, or offer any transparent dashboard.

Image used for representational purposes.

(Photo: Kamran Akhter / The Quint)

A week since India allowed a shift in policy — after nearly 16 years — to allow foreign assistance, to battle the second deadly COVID surge, sharp criticism has emerged over the Centre’s handling of the relief material being flown in from friendly countries.

At the heart of the criticism lies concern over the distribution of critical foreign relief assistance — including critical care equipment — being a ‘black hole’, with little or no accountability and transparency on the part of the Modi government.

The death toll in the past week alone has gone up from 2,04,832 (29 April 2021) to 2,22,408 (4 May 2021) — with choked hospitals and clinics, especially across the Delhi-NCR region, resorting to SOS messages frequently on social media to replenish oxygen supplies. This, even as the media reported that nearly 300 tonnes of emergency COVID-19 supplies were stuck in bureaucratic red tape for days at the airport.

Foreign Relief Sent to India

The foreign relief material supplies as of 3 May stand at:

• 1,676 oxygen concentrators
• 965 ventilators
• 1,799 oxygen cylinders
• 1,36,000 vials of Remdesivir
• 210 pulse oximeters
• 8,84,000 rapid diagnostic test kits
• over 9 lakh N-95 face masks, among others

These include:

• 8 oxygen generators, 28 ventilators, 200 electric syringe pumps from France
• some 495 oxygen concentrators and 200 ventilators from UK
• 120 ventilators from Germany
• 20 large oxygen concentrators, 75 ventilators, 150 bedside monitors and 2,00,000 packs of Favipiravir from Russia
• 423 oxygen cylinders with regulators (200 Size D, 223 Size H), 210 pulse oximeters, 184,000 Abbott Rapid Diagnostic Test Kits, and a million N-95 face masks from the US

These are among other shipments from the afore-mentioned and other countries.

When Did Foreign Aid Stock Start Getting Clearance in Delhi?

The international shipments are received at the International Airport in Delhi in the presence of the embassy officials and envoys along with officials from NITI Aayog, the Ministry of External Affairs, the Indian Red Cross, the Health Ministry and Customs.

A government press statement on 5 May clarified:

“For all consignments received via MEA and coming as donations from foreign countries, the consignee is the Indian Red Cross Society. Upon receipt of the papers outlined in the process flow chart, IRCS issues the necessary certificates immediately to HLL for processing customs and regulatory clearances at airports. IRCS also ensures liaison with MoHFW and HLL so that delays are reduced and quick turnarounds are achieved.”

“In case of consignments arriving at military airports, or big items like oxygen plants, Dept of Military Affairs (DMA) assists HLL,” it further added.

Contrary to the government’s claims that the distribution of some 300 tons of supply began immediately after their arrival, it is now clear through media reports, that the stocks started getting cleared up only 3 May onwards after a meeting hosted by NITI Aayog with state officials.

A critical gap of more than 5 days, in which several lives could have been saved which were lost due to shortage of oxygen, as the equipments stayed in the warehouse.

No Clarity On Nodal Officers Or Agencies Handling Foreign Aid Supplies in States

It was on that 3 May meeting when state governments were requested “to immediately appoint Nodal Officers so that entities desirous of importing COVID relief material for free distribution may approach them for certification,” NITI Aayog tweeted. Even a key decision towards ad hoc exemption from IGST on imports of specified COVID-19 relief material donated from abroad was announced only on 3 May.

The Central Board of Indirect Taxes and Customs clarified that ‘no such consignment’ (of 3000 oxygen concentrators) was “presently” pending with Customs authorities, only once the warehouses had started to be cleared up following media furore.

Sources from private agencies involved with the aid distribution process, though, underlined that there is still no clarity about the nodal officers or agencies handling the supplies in states — a request made by central authorities as late as 3 May; distribution based on specific requests made by state governments to state government and private hospitals, and the timeline of distribution.

The government, in a press release on Tuesday, stated that some 40 lakh 24 different categories of items — including major equipment like BiPAP machines, oxygen (oxygen concentrators, cylinders, PSA oxygen plants, pulse oximeters), PPE (coveralls, N-95 masks and gowns), drugs (Flaviparivir and Remdesivir) — have been distributed to 86 institutions in different states.

It later revised it to 38 institutions across 31 states in an updated press release.

No Clear Answers on Distribution, Allocation to State Govts, Centre’s Action Plan

As per the government’s own list, some of the hospitals that have received supplies include LHMC, Safdarjung, RML, AIIMS, DRDO, ITBP, NITRD and two in Moti Nagar and Pooth Kalan in Delhi — essentially hospitals under the Central government. PGI Chandigarh, AIIMS and DRDO hospitals in different states, JIPMER Puducherry; Railways; ICMR; CGHS hospitals are among the other beneficiaries as mentioned in the list, with no notable hospitals in some of the worst-affected states like Maharashtra, though included in the list of beneficiary states.

But answers are not forthcoming so far — on the exact nature of distribution, any allocation proposed so far to state governments, private hospitals and smaller clinics gasping for breath; requests received by foreign missions from NGOs and states and the Centre’s plan to act on them.

“Do I know what resources are being allocated and since when? I do not know, simply because there is no transparency from GOI,” says Priyanka Chaturvedi, Rajya Sabha MP and Deputy Leader of the Shiv Sena. She added:

“When you have 1,26,000 vials of Remdesivir lying there from 25 April, some as part of USAID, why has it not gone to the critical areas? Why was it not identified that as soon as these come from the Indian Red Cross and HLL, why was the Health Ministry taking one week to put SOPs in place? When time is of criticality you cannot take one week to put these in place. It is absolutely unforgivable that it took you so long to decide.”

What States Are Claiming About Central Assistance

A highly-placed official in the Andhra Pradesh government stated that as of 4 May late evening, no central assistance had reached the state which has made specific requests for O2 concentrators and oxygen delivery equipments (bipaps, tubes, valves, ventilators, N95 masks) and more importantly, increased vaccine dosages.

An official said, on condition of anonymity, pointing to the sizeable diaspora from AP and Telangana which could have been leveraged in this crisis:

“We have not received any foreign aid supplies on ground yet. Have not seen anything coming to Andhra Pradesh so far. We have, in fact, now directly started reaching out to foreign organisations to bypass the Centre.”

The Andhra Pradesh Cabinet has meanwhile decided to import cryogenic tanks through Singapore.

Speaking from New York, Mukesh Aghi, President and CEO of the non-profit USISPF (US-India Strategic Partnership Forum) also underlined that while they are shipping all relief assistance under the aegis of the Red Cross, they are exploring NGOs and local partners with ‘strong distribution networks on the ground’, to be able to send out some shipments of relief supplies directly to states requesting for the same.

The USISPF has so far shipped 1,000 oxygen concentrators to India with a commitment to send 25,000 more in May.

In some cases like oxygen concentrators from Germany, the equipments have been delivered to RML, Safdarjung hospitals in Delhi and AIIMS Jhajjhar. While in the case of 8 large oxygen generation plants from France, that require a 15 square metre room in a hospital to supply the needs of 250 hospital beds, the embassy facilitated liaising with local distributors of the French manufacturers and the hospitals where the units were installed in a week’s time.

“If allocations have not even moved, it is criminal,” said an individual working closely with USAID, adding that though mum officially, the aid agency is ‘cagey’ about who are the eventual recipients.

‘Would be Good to Have One Centralised System’

Asked about any tracking website for the assistance being sent through US taxpayers’ money to India, the State Department Deputy Spokesperson Jalina Porter struck a measured tone last week. “As far as a specific website when it comes to tracking is concerned, we have nothing to read out or announce at this time.”

Porter said on 4 May:

“I’ll just repeat that the United States has provided more than USD 100 million in assistance to India through the US Agency for International Development. Now, when it comes to distribution, it was actually at the request of the Government of India that USAID provided these urgently-needed supplies to the Indian Red Cross, and that was just to ensure that they’re reaching those who are most in need and as fast as possible. So, for anything beyond that, we’d have to refer you to the Government of India.”

“Setting up structure and organisation is always challenging, and coordination is important,” said the envoy of a donor country posted in Delhi.

The ambassador added:

“Think ahead, take stock of what you have. Would be good to have one centralised system to receive and distribute foreign aid.”

The Union Health Ministry — which is the decision-making authority on the allocations — is yet to respond to specific queries raised by the media, or offer any transparent dashboard. For now, more questions than answers remain.

“It is a critical point — the lack of transparency, growing black marketing — these are issues important for the reputation of India,” stressed a foreign envoy.

(Smita Sharma is an independent journalist and tweets at @Smita_Sharma. This is a report and analysis. The views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)