SOUTH CHINA SEA
1. Context
China and the Philippines said they have agreed to work on lowering tensions after a year of public and tense confrontations in the South China Sea between their ships that have raised concerns of armed engagement in the region
2. China's South China Sea Escalation
- Amid the global pandemic, China is intensifying its presence in the South China Sea, particularly focusing on the disputed Spratly Islands and Paracel Islands.
- This move has raised concerns among neighbouring countries, such as Vietnam and the Philippines, who also claim sovereignty over these territories.
- China has unilaterally renamed 80 islands and geographical features in the South China Sea, a controversial action that has drawn criticism from neighbouring nations.
- This renaming effort exacerbates the ongoing territorial dispute and has the potential to strain diplomatic relations in the Asia-Pacific region.
- The Spratly Islands dispute involves China, Taiwan, Vietnam, the Philippines, and Malaysia, all vying for control over this archipelago and its surrounding features.
- Although these islands are largely uninhabited, they are believed to harbour significant untapped natural resources.
- However, due to the dispute, exploration and resource assessment efforts remain limited.
3. Historical Background
- The discovery of oil near the Palawan coast in the 1970s further fueled territorial claims, even though some reports suggest limited oil and gas reserves in the region.
- This historical context underscores the complexity of the Spratly Islands dispute.
- The Paracel Islands dispute is equally complex, with China and Vietnam both laying historical claims to this archipelago.
- Historical texts from various periods, including colonial-era records, have been cited to support these conflicting claims.
- Tensions escalated in 1974 when China took control of the islands, sparking a prolonged dispute involving Vietnam and, later, Taiwan.
Image Source: Forbes4. Contemporary Developments
- Since 2012, China, Taiwan, and Vietnam have pursued various strategies to bolster their territorial claims, including constructing government buildings, promoting tourism, reclaiming land, and expanding military presence on these islands.
- China's recent establishment of new administrative districts in both the Spratly and Paracel Islands prompted the Chinese government to rename numerous geographical features.
- This move is reminiscent of a similar initiative in 1983 when China renamed 287 features in the disputed region.
- China's increased military activity and the creation of artificial islands for military and economic purposes in the South China Sea have raised concerns among neighbouring countries and Western powers.
- Recent incidents, such as the sinking of a Vietnamese fishing trawler near the Paracel Islands and the construction of Chinese research stations on disputed Philippine territory, have further inflamed tensions.
5.What is the dispute between the Philippines and China over the South China Sea?
- The dispute between the Philippines and China over the South China Sea primarily revolves around territorial claims, maritime boundaries, and access to resources.
- China claims a significant portion of the South China Sea, demarcated by what's known as the "nine-dash line," a boundary that encompasses about 90% of the sea, overlapping with claims by several other nations, including the Philippines.
- The Philippines contests China's claims, particularly in areas that fall within its Exclusive Economic Zone (EEZ) and territorial waters as defined by the United Nations Convention on the Law of the Sea (UNCLOS).
- Tensions escalated due to China's construction of artificial islands and military installations in disputed waters, which the Philippines and other neighboring countries view as a violation of their sovereignty and a threat to regional stability.
- The Philippines filed a case against China in 2013 with the Permanent Court of Arbitration (PCA) in The Hague, challenging the legality of China's claims based on UNCLOS.
- In 2016, the PCA ruled in favor of the Philippines, declaring that China's claims had no legal basis. However, China has consistently rejected the ruling, asserting historical rights over the South China Sea.
- Despite the ruling, the situation remains contentious, with ongoing diplomatic efforts and occasional confrontations between the two countries' vessels in the region
6.What is the nine-dash line?
- The nine-dash line is a demarcation line used by China to outline its territorial claims in the South China Sea. It's a U-shaped boundary that encompasses about 90% of the South China Sea, covering various islands, reefs, atolls, and waters.
- Originally, the nine-dash line was drawn by the Republic of China (ROC, now Taiwan) in the late 1940s to illustrate its territorial claims over the South China Sea. After the Chinese Civil War, when the Communist Party took control of mainland China in 1949, the People's Republic of China (PRC) continued to uphold this demarcation.
- However, the line's legal basis and specifics have been ambiguous. It has never been clearly defined, and China has not provided precise coordinates or explanations for its claim. The line overlaps with the exclusive economic zones (EEZs) and territorial waters of several Southeast Asian nations, including Vietnam, the Philippines, Malaysia, Brunei, and Taiwan. This has led to territorial disputes and heightened tensions in the region.
- The international community, including the United States and many other countries, does not recognize China's nine-dash line claim as valid under international law, particularly the United Nations Convention on the Law of the Sea (UNCLOS), which outlines maritime entitlements and territorial claims based on geographical features and historical rights.
7. Conclusion
- The South China Sea remains a highly volatile region, with the potential for further diplomatic tensions and military escalations.
- The ongoing territorial disputes, fueled by historical claims and concerns over natural resources, pose a significant challenge to stability in the Asia-Pacific region and require careful diplomatic efforts to find peaceful resolutions.
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For Prelims: South China Sea, Paracel Islands, Spratly Islands,
For Mains:
1. Discuss the historical background of the territorial disputes in the South China Sea. How have historical claims contributed to the complexity of the issue? (250 Words)
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Previous Year Questions
1. The South China Sea Dispute involves which of the following countries? (CDS GK 2019)
1. China
2. Vietnam
3. Malaysia
4. Indonesia
Select the correct answer using the code given below.
A. 1 and 4 B. 1 and 2 only C. 1, 2 and 3 D. 2, 3 and 4
Answer: C
2. Which one of the following statements best reflects the issue with Senkaku Islands, sometimes mentioned in the news? (UPSC CSE 2022)
A. It is generally believed that they are artificial islands made by a country around South China Sea.
B. China and Japan engage in maritime disputes over these islands in East China Sea.
C. A permanent American military base has been set up there to help Taiwan to increase its defence capabilities.
D. Though International Court of Justice declared them as no man's land, some South-East Asian countries claim them.
Answer: B
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Source: The Indian Express
EXCLUSIVE ECONOMIC ZONE (EEZ)
1. Context
China claims sovereignty over nearly all of the South China Sea, including the Second Thomas Shoal, based on historical records dating to the Xia dynasty, nearly 4,000 years ago. Beijing has illustrated its claim to the critical maritime area – a key sea transport route – with a vague, U-shaped “nine-dash line” that cuts into the exclusive economic zones, or EEZs, of Brunei, Indonesia, Malaysia, the Philippines, Taiwan and Vietnam.
2. Exclusive Economic Zone (EEZ)
An Exclusive Economic Zone (EEZ) is a maritime zone that extends beyond a country's territorial sea and is established by coastal nations according to the United Nations Convention on the Law of the Sea (UNCLOS). The EEZ provides a sovereign state with certain rights regarding the exploration and use of marine resources within that zone.
Key features of an EEZ include:
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Resource Rights: The coastal state has the exclusive rights to explore, exploit, conserve, and manage natural resources found in the waters, seabed, and subsoil within the EEZ. This includes resources like fish, oil, gas, and minerals.
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Sovereign Rights: The nation holds sovereign rights for the purpose of exploring, exploiting, conserving, and managing natural resources, both living (like fish) and non-living (such as oil and gas) within the EEZ.
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Jurisdiction: The coastal state has the authority to regulate various activities within the zone, including scientific research, environmental protection, and the construction of artificial islands or structures for economic purposes.
An EEZ typically extends up to 200 nautical miles (370 kilometers) from the coastline, but it can be modified based on specific geographical conditions or agreements between neighboring countries. It's important to note that while coastal states have rights within their EEZs, other nations have the freedom of navigation and overflight through these zones, as well as the right to lay submarine cables and pipelines in accordance with international law
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3.Rights of the country in the EEZ
Within their Exclusive Economic Zone (EEZ), countries have specific rights granted by international law, primarily defined by the United Nations Convention on the Law of the Sea (UNCLOS).
Some of these rights include:
- The coastal state has the exclusive right to explore and exploit natural resources, both living (like fish) and non-living (such as oil, gas, and minerals), within its EEZ
- Nations can conduct various economic activities, including fishing, mining, and the extraction of oil and gas, subject to their own regulations and in compliance with international agreements and environmental conservation principles
- Coastal states have the right to conduct scientific research and surveys related to marine ecosystems, resources, and environmental factors within their EEZ
- Countries are responsible for the conservation and management of the marine environment within their EEZ, ensuring that activities carried out do not harm the ecosystem or endanger marine life
- The coastal state has regulatory jurisdiction over the EEZ, allowing it to establish and enforce laws related to customs, immigration, sanitation, and other matters concerning economic activities and environmental protection within this zone
- Nations can construct artificial islands, installations, and structures for economic purposes within their EEZ, provided they comply with international regulations and environmental safeguards
- While coastal states have exclusive rights to the resources within their EEZ, other countries have the freedom of navigation and overflight through these zones for purposes like shipping, laying cables, and conducting military activities, as permitted by international law
4.Key Terms regarding EEZ
Territorial Waters
The territorial waters of a nation encompass all water regions under its authority, consisting of internal waters, the territorial sea, contiguous zone, the Exclusive Economic Zone (EEZ), and potentially extending to the continental shelf.
Territorial Sea
The territorial sea is a concept in international law that refers to the belt of coastal waters extending from a country's baseline (usually the low-water line along the coast) outwards for up to 12 nautical miles (22.2 kilometers), as recognized by the United Nations Convention on the Law of the Sea (UNCLOS)
Contiguous Zone
The contiguous zone is an area of water that extends beyond a country's territorial sea, stretching up to 24 nautical miles (44.4 kilometers) from the baseline. In this zone, a coastal state can exert limited control for the purpose of preventing or punishing infringements of its customs, fiscal, immigration, or sanitary regulations within its territory or territorial sea. While it allows for certain enforcement measures, it doesn't grant full sovereignty, unlike the territorial sea
5. India and Exclusive Economic Zone (EEZ)
- India has an Exclusive Economic Zone (EEZ) that extends up to 200 nautical miles (370 kilometers) from its coastline.
- Within this zone, India holds exclusive rights for exploring, exploiting, conserving, and managing natural resources, both living and non-living, such as fish, oil, gas, minerals, and other marine resources.
- The EEZ of India is significant, offering opportunities for economic activities like fishing, offshore energy exploration, scientific research, and environmental protection.
- India exercises jurisdictional control over this zone, regulating various activities and safeguarding the marine environment in accordance with international laws, including the United Nations Convention on the Law of the Sea (UNCLOS).
- Additionally, while India has exclusive rights to the resources within its EEZ, other nations have the freedom of navigation and overflight through these waters, respecting India's sovereign rights and complying with international laws and agreements.
5.Way forward
The vessel with 21 Indians and one Vietnamese crew managed to sail on its power after the attack and reached Mumbai on Monday escorted by the Indian Coast Guard Ship (INGS) Vikram. Upon arrival, a Navy Explosive Ordnance Disposal team carried out a preliminary assessment of Chem Pluto and analysis of the area of attack and debris found on the ship points towards a drone attack, the Navy said. “However, further forensic and technical analysis will be required to establish the vector of attack, including type and amount of explosive used,” it stated. A joint investigation by various agencies is also underway.
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For Prelims: Exclusive Economic Zone (EEZ), UNCLOS, Contigous Zone
For Mains: General Studies II - International Law and Governance regarding EEZ
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Previous Year Questions
1.With reference to the United Nations Convention on the Law of Sea, consider the following statements: (UPSC CSE 2022)
1. A coastal state has the right to establish the breadth of its territorial sea up to a limit not exceeding 12 nautical miles, measured from baseline determined in accordance with the convention.
2. Ships of all states, whether coastal or land-locked, enjoy the right of innocent passage through the territorial sea.
3. The Exclusive Economic zone shall not extend beyond 200 nautical miles from the baseline from which the breadth of the territorial sea is measured.
Which of the statements given above are correct?
A.1 and 2 only
B.2 and 3 only
C.1 and 3 only
D.1, 2 and 3
Answer (D)
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Source: The Hindu
COMPETITION COMMISSION OF INDIA
1. Context
Competition Commission of India, CCI’s mandate is broad, and encompasses the elimination of practices having adverse effects on competition, promotion and sustenance of competition, protection of consumer interests, and ensuring freedom of trade. It inquires into and takes action against any form of anti-competitive agreements between enterprises
2. Competition Commission of India
- The Competition Commission of India (CCI) is a regulatory authority established in India to promote and protect fair competition in the marketplace.
- It was established under the Competition Act, 2002, and became fully functional in 2009.
- The primary objective of the CCI is to prevent anti-competitive practices, ensure a level playing field for businesses, and promote consumer welfare
- The Competition Commission of India (within the Ministry of Corporate Affairs) has been established to enforce the competition law under the Competition Act, 2002.
- It should be noted that on the recommendations of Raghavan committee, the Monopolies and Restrictive Trade Practices Act, 1969 (MRTP Act) was repealed and replaced by the Competition Act, 2002
- The Commission consists of a Chairperson and not more than 6 Members appointed by the Central Government
- It is the statutory duty of the Commission to eliminate practices having an adverse effect on competition, promote and sustain competition, protect the interests of consumers and ensure freedom of trade carried on by other participants, in markets in India as provided in the Preamble as well as Section 18 of the Act.
- The Commission is also mandated to give its opinion on competition issues to government or statutory authority and to undertake competition advocacy for creating awareness of competition law.
- Advocacy is at the core of effective competition regulation. Competition Commission of India (CCI), which has been entrusted with implementation of law, has always believed in complementing robust enforcement with facilitative advocacy. It is a quasi-judicial body.
3. Key functions and responsibilities
Here are some key functions and responsibilities of the Competition Commission of India:
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Competition Advocacy: The CCI engages in advocacy and education activities to promote competition awareness among businesses, government agencies, and the public.
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Antitrust Enforcement: The CCI investigates and takes action against anti-competitive agreements, abuse of dominance by companies, and anti-competitive mergers and acquisitions. It can impose penalties and remedies on entities found to be in violation of competition laws.
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Merger Control: The CCI reviews and approves or disapproves mergers, acquisitions, and combinations that may have an adverse impact on competition in the Indian market. It assesses whether these transactions are likely to cause a substantial lessening of competition.
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Market Studies and Research: The CCI conducts studies and research to understand market dynamics, competition issues, and emerging trends. This information helps in formulating policies and recommendations to improve competition.
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Competition Advocacy: The commission engages in advocacy efforts to promote competition principles and practices among businesses, government agencies, and the public.
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Consumer Protection: While primarily focused on promoting competition, the CCI also indirectly promotes consumer welfare by ensuring that markets remain competitive and that consumers have choices and access to fair prices.
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Regulation of Anti-Competitive Practices: The CCI addresses practices such as price-fixing, bid rigging, and abuse of market power that can harm competition and consumers.
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Legal Proceedings: The CCI has the authority to conduct investigations, hold hearings, and pass orders. Its decisions can be appealed to higher courts in India.
4. What is the Competition Act?
- The Competition Act, 2002, as amended by the Competition (Amendment) Act, 2007, follows the philosophy of modern competition laws.
- The Act prohibits anti-competitive agreements, and abuse of dominant position by enterprises and regulates combinations (acquisition, acquiring of control and M&A), which causes or likely to cause an appreciable adverse effect on competition within India
- In accordance with the provisions of the Amendment Act, the Competition Commission of India and the Competition Appellate Tribunal have been established
- The government of India replaced Competition Appellate Tribunal (COMPAT) with the National Company Law Appellate Tribunal (NCLAT) in 2017
- The provisions of the Competition Act relating to anti-competitive agreements and abuse of dominant position were notified on May 20, 2009
| Competition is the best means of ensuring that the ‘Common Man’ or ‘Aam Aadmi’ has access to the broadest range of goods and services at the most competitive prices. With increased competition, producers will have maximum incentive to innovate and specialize. This would result in reduced costs and wider choice to consumers. A fair competition in market is essential to achieve this objective. Our goal is to create and sustain fair competition in the economy that will provide a ‘level playing field’ to the producers and make the markets work for the welfare of the consumers |
5. What is Cartelisation?
Cartels can be difficult to define. According to CCI, a “Cartel includes an association of producers, sellers, distributors, traders or service providers who, by agreement amongst themselves, limit, control or attempt to control the production, distribution, sale or price of, or, trade in goods or provision of services”
The International Competition Network, which is a global body dedicated to enforcing competition law, has a simpler definition. The three common components of a cartel are:
- an agreement;
- between competitors;
- to restrict competition.
6. Way forward
CCI needs to revisit its definition of ‘relevant market’. In the age of digital world, defining relevant market has been a tough task for regulators world-wide. Technological developments like Web 3.0, AI, IoT, Blockchain and issues like data protection and privacy, search bias, platform neutrality, confidentiality, etc, have created a need for a robust competition law. Such a law should meet the demands of the technological era we live in.
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For Prelims: Statutory board, Constitutional body
For Mains: 1.Discuss the role and functions of the Competition Commission of India (CCI) in promoting and ensuring fair competition in the Indian market
2.Examine the challenges and limitations faced by the Competition Commission of India (CCI) in effectively regulating and promoting competition in the digital economy
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Previous year Questions
1. Competition Commission of India is which kind of body? (RSMSSB Sanganak 2018)
A. Statutory body
B. Constitutional.
C. Single Member
D. Private
Answer (A)
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Source: indianexpress
WORLD TRADE ORGANISATION (WTO)
1. Context
Even as developed countries continue to flag concern over India’s food security programme for distorting global food prices, New Delhi is set to keep up the pressure for a permanent solution on public stockholding for food grains at the 13th ministerial conference of the World Trade Organization (WTO) next month in Abu Dhabi
2. World Trade Organisation (WTO)
- WTO is an international organization set up in 1995 by replacing the General Agreement on Trade and Tariffs (GATT) under the Marrakesh Agreement.
- It is the only global international organization dealing with international Trade between nations.
- Its HQ is located in Geneva, Switzerland.
- Currently, WTO has 164 members and India is a founding member of WTO.
- Currently, the head (Director-General) of WTO is Ngozi Okonjo-Iweala.
3. Objectives of WTO
- To formulate and implement rules for international trade.
- To provide a platform for negotiating and monitoring further trade liberalization.
- To provide a platform for the settlement of disputes.
- Providing assistance to the developing, least-developed, and low-income countries in transition to adjust to WTO rules and disciplines through technical cooperation and training.
- To cooperate with the other major economic institutions (like the UN, World Bank, IMF, etc.) involved in global economic management.
4. Important trade agreements of WTO
- Agreement on Agriculture (AoA),
- Agreement on TRIPS (Trade-Related Aspects of Intellectual Property Rights),
- Agreement on the Application of Sanitary and Phytosanitary Measures (SPS),
- Agreement on Technical Barriers to Trade (TBT),
- Agreement on Trade-Related Investment Measures (TRIMS),
- General Agreement on Trade in Services (GATS) etc.
5. Geoeconomic Shift and the Need for WTO Reforms
- Over 50 years ago, Richard Cooper argued that "trade policy is foreign policy," emphasizing the value of economic interdependence to deter security confrontation.
- Today, the world is characterized by heightened securitization of international economic relations and a shift towards geoeconomic considerations, challenging the belief in economic interdependence as a deterrent to security issues.
- The WTO, established to legalize and monitor economic interdependence, faces challenges due to unilateralism in international economic relations, particularly by developed countries like the US, who show little regard for WTO law.
- Economic policies such as industrial subsidies and local content requirements have resurfaced, forgotten WTO rules like security exceptions are gaining prominence, and efforts to weaken trade multilateralism in favor of external plurilateral alignments are being made.
- Jeffrey Schott argues that expecting the G20 countries, especially the developed ones, to reform the WTO for the better is naïve, as a weak WTO aligns with the US foreign policy objective of strategic rivalry with China.
- Schott suggests that middle powers like India, Indonesia, Brazil, and South Africa should take the lead in pushing for WTO reforms to address the current challenges.
- Developing countries should prioritize four critical areas for WTO reform, with special attention on preserving the principle of special and differential treatment (SDT), which provides special rights to developing countries and obligates developed countries to treat them more favorably.
6. Key Areas for WTO Reforms
Strengthening Special and Differential Treatment (SDT): Lawyers Vineet Hegde and Jan Wouters highlight that only 21% of SDT provisions in WTO agreements obligate developed countries to provide differential treatment to developing countries. Efforts should focus on giving more enforceability to SDT provisions.
Reviving the Appellate Body: The WTO's appellate body has been paralyzed since 2019 due to the US's indifference. Other G20 countries need to either convince the US to change its stance or revive the appellate body without US participation to restore the WTO's dispute settlement mechanism.
Balancing Consensus and Plurilateral Discussions: With consensus-based decision-making in the WTO proving slow, there has been a shift towards plurilateral discussions on specific issues. While plurilateral agreements offer opportunities for rule-making, there is a need to establish a multilateral governance framework that incorporates key principles of non-discrimination, transparency, and inclusivity.
Addressing Transparency Gap: The WTO lacks transparency in terms of notification requirements. Members have a poor record of notifying laws and regulations affecting trade, leading to increased trade costs, particularly for developing countries. Efforts should be made to improve compliance with notification obligations.
Importance of Trade Multilateralism: Despite current trends, trade multilateralism remains crucial for countries like India. India, as the G20 President, should collaborate with other nations to drive the WTO reforms agenda, promoting inclusive trade multilateralism.
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For Prelims: World Trade Organisation (WTO), General Agreement on Trade and Tariffs (GATT), Trade-Related Aspects of Intellectual Property Rights (TRIPS), and General Agreement on Trade in Services (GATS). For Mains: 1. Discuss the key areas for reforms in the World Trade Organization (WTO) and their significance for promoting inclusive trade multilateralism. (250 Words) |
Previous year Questions
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1. In the context of the affairs which of the following is the phrase "Special Safeguard Mechanisms" mentioned in the news frequently? (UPSC 2010) A. United Nations Environment Program B. World Trade Organization Agreement C. ASEAN-India D. Free Trade G-20 Summits Answer: B 2. Consider the following statements: (UPSC 2017) 1. India has ratified the Trade Facilitation Agreement (TFA) of the WTO 2. TFA is a part of WTO's Bali Ministerial Package of 2013 3. TFA came into force in January 2016 Which of the statements given above is/are correct? A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2 and 3 Answer: A 3. In the context of which of the following do you sometimes find the terms 'amber box, blue box, and green box' in the news? (UPSC 2016) A. WTO affairs B. SAARC affairs C. UNFCCC affairs D. India-EU negotiations on FTA Answer: A |
Source: The Indian Express
MEDICAL CARE IN INDIAN TRAINS
1. Context
The Indian Railways shoulders the monumental responsibility of transporting over 2.3 crore passengers daily, a figure nearly double the projected population of Uttarakhand in 2022. While the Balasore train accident in June 2023 underscored the imperative of rail safety, it primarily addressed accident-related concerns. However, given the substantial passenger throughput, another critical facet often overshadowed is the Railways' responsibility towards addressing medical emergencies.
2. Passenger Load and Rail Safety Concerns
- The Balasore incident emphasized accident-related safety, but the Indian Railways, with its vast passenger volume, grapples with a distinct safety challenge — medical emergencies. The magnitude of this challenge came to light in 2017 at the Katpadi Junction railway station in Vellore, Tamil Nadu, where 1,076 medical emergencies were reported. These ranged from trauma-related incidents to minor ailments and life-threatening conditions, requiring prompt attention.
- A quarter of the reported emergencies at Katpadi Junction were trauma-related, while the rest spanned a spectrum from common ailments like fever to critical conditions such as low blood sugar. Notably, almost 10% of emergencies reported at the station's emergency help desk, managed by the Christian Medical College (CMC) Vellore, demanded urgent, life-saving interventions.
- India witnesses a surge in non-communicable diseases, with diabetes and hypertension on the ascent. The recent years have seen a marked increase in deaths attributed to heart attacks, indicating a shifting health landscape. The pertinent question arises: Is the Indian Railways adequately equipped to address the escalating wave of medical emergencies, particularly those arising from these prevalent health conditions?
- The landscape of health emergencies in India is transforming, with non-communicable diseases taking center stage. As heart attacks and other critical conditions become more pervasive, the preparedness of the Indian Railways to handle the medical fallout of these health challenges comes under scrutiny.
- Given the changing health dynamics, it becomes imperative for the Indian Railways to enhance its preparedness for medical emergencies. This involves not only addressing trauma-related incidents but also developing a comprehensive approach to tackle a spectrum of health issues, from minor ailments to life-threatening conditions.
- To meet the evolving health demands of its vast passenger base, the Indian Railways must consider reinforcing its medical infrastructure. This includes upgrading emergency help desks, ensuring the availability of trained medical personnel, and equipping stations to handle a diverse range of medical emergencies.
- Collaborations with healthcare institutions, exemplified by the partnership with Christian Medical College (CMC) Vellore, can serve as a model for augmenting medical support. Such partnerships bring specialized medical expertise to the forefront, ensuring prompt and efficient responses to emergencies.
3. Evolution of Medical Care in Indian Railways
- The provision of medical care in the Indian Railways has undergone significant evolution, extending beyond addressing accident-related emergencies to encompass a broader spectrum of medical conditions. This evolution is marked by initiatives and interventions aimed at enhancing emergency healthcare services for passengers.
- In 1995, a crucial milestone was achieved with the introduction of the 'special first aid box' in long-distance superfast trains, specifically Shatabdi and Rajdhani. This specialized kit, comprising 49 items, was designated for use by a doctor traveling on the train. Subsequently, an enhanced version known as the 'augmented first aid box' with 58 items was introduced for specific long-distance trains.
- As a pilot project in November 1996, the Railways stationed a medical team on two long-distance trains, including a medical officer, a male nurse, and an attendant. Over the next four years, challenges emerged as the team was predominantly idle, addressing only minor ailments. The inadequacy of resources in moving trains resulted in the loss of critically ill passengers' lives, leading to the discontinuation of the service.
- To ensure healthcare accessibility, the Railways implemented a discount incentive in which doctors traveling on trains received a 10% discount if they volunteered to provide medical services en route. Despite these measures, instances like the unfortunate death of Netrapal Singh in 2004 highlighted persistent inadequacies.
- A petition filed in the Rajasthan High Court in 1996 gained momentum following Mr. Singh's demise, prompting judicial scrutiny of medical care provisions in trains and railway stations. The 2005 judgment revealed a lack of awareness contributing to the underutilization of medical teams. The court directed the reservation of four berths in long-distance trains for medical care and mandated medical teams for trains covering more than 500 km.
- In 2017, the Supreme Court intervened, directing the Railways to establish a committee comprising experts from the All India Institute of Medical Sciences (AIIMS), New Delhi. The committee's task was to recommend further measures for enhancing medical care provisions in the Railways.
- Based on the Supreme Court's directive and the committee's recommendations, the Railways committed to modifying the contents of first aid boxes. These modified boxes are now provided at all railway stations and in all passenger-carrying trains. Additionally, the Railways mandated first-aid training for railway staff, both at the time of joining and at three-year intervals. The committee also recommended a periodic review of service utilization every three years.
- The ongoing commitment to periodic reviews and continuous improvement underscores the Railways' dedication to enhancing healthcare services. The multifaceted approach involves infrastructure enhancement, staff training, and awareness initiatives to ensure the effectiveness of emergency medical care provisions.
4. Implementation Status of AIIMS Expert Committee Recommendations (2018)
- In 2018, the Minister of State in the Ministry of Railways responded to a Lok Sabha query, stating that all recommendations put forth by the AIIMS expert committee had been implemented. This suggests a commitment to improving medical care provisions based on the expert committee's insights.
- In 2021, the Railways took a significant step by introducing an integrated helpline number, 139, designed to handle various queries related to railway services, including medical assistance. This centralized helpline aimed to streamline communication and address passenger concerns efficiently.
- In February 2023, Union Minister of Railways Ashwini Vaishnaw conveyed to the Lok Sabha that deputing a doctor at every railway station was deemed unnecessary. However, by December of the same year, the minister asserted that all recommendations of the committee, including those potentially impacting medical services, had been implemented. This shift in perspective raises questions about the ongoing assessment of medical care needs.
- Despite official statements, as of the latest available information, passenger complaints on social media platforms, including X (formerly Twitter), continue to highlight dissatisfaction with medical services on trains. This ongoing feedback suggests a gap between official claims and passenger experiences.
- On December 23, 2023, while traveling from Delhi to Dehradun on a Vande Bharat Express, one of the authors, Parth Sharma, encountered a medical emergency. The train staff urgently sought a doctor's assistance for a passenger experiencing symptoms suggestive of a heart attack. This real-time incident underscores the critical importance of immediate medical intervention during emergencies.
- During the medical emergency, it was revealed that the emergency kit on the train was inadequate. Key deficiencies included the absence of a blood pressure monitor and a glucometer. Furthermore, critical medications, such as aspirin, were near expiry. A closer inspection suggested that the train might be using an outdated medical kit list from 1995 instead of an updated version from 2017.
- The incident on December 23, 2023, and the identified shortcomings in the emergency kit highlight the ongoing need for continuous evaluation and enhancement of medical care provisions on trains. This involves not only implementing recommendations but also ensuring that onboard medical resources are regularly updated and aligned with contemporary healthcare standards.
5. Evaluation of Existing Medical Kit Lists (Post-2017)
- According to K.P.P. Abhilash, the head of emergency medicine at CMC Vellore, the medical kit list from 2017 is deemed inadequate. Drawing insights from cases at the emergency care center in Katpadi Railway station, Dr. Abhilash and his team identified essential medical items that were lacking in the existing stock. These include personal protective equipment for healthcare providers and a pulse oximeter.
- Recognizing the transformative impact of recent advancements in point-of-care diagnostics, experts suggest the inclusion of portable ECG devices and rapid diagnostic kits in the onboard medical kits. This addition aims to enhance the ability to identify and promptly address conditions such as heart attacks during train journeys.
- An urgent measure is to ensure the widespread implementation of the updated 88-item medical kit list recommended by the AIIMS expert committee. This involves verifying the presence of the updated kit in all trains and raising awareness among passengers about the availability of these services. Regular inspections are crucial to maintaining the quality and completeness of onboard medical care resources.
- The Railways should institute a system to capture comprehensive data on the healthcare needs of individuals traveling on trains. This data-driven approach can serve as a foundation for informed policy decisions. Understanding the prevalent health conditions among passengers enables proactive planning and resource allocation to meet evolving medical requirements.
- Conducting periodic training sessions for onboard staff is essential to ensure they are well-equipped to handle medical emergencies effectively. Additionally, awareness programs for passengers can inform them about the available medical services, emergency protocols, and how to access assistance when needed.
- Collaborating with medical professionals, organizations, and research institutions can contribute valuable insights to continuously refine and update medical care provisions. The Railways can benefit from ongoing dialogues with experts in emergency medicine, public health, and medical device development.
- Establishing a culture of continuous improvement is crucial. Regular assessments, feedback loops, and responsiveness to evolving medical standards should be ingrained in the healthcare provision framework on trains. Embracing an iterative approach ensures that the system adapts to changing healthcare dynamics and emerging technologies.
6. The Way Forward
The Indian Railways still faces challenges in providing adequate medical care for its vast passenger base. While progress has been made, discrepancies and inadequacies persist. Embracing a data-driven, technology-enabled, and collaborative approach, with a commitment to continuous improvement, is crucial to ensure the well-being of millions traveling on this critical network.
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For Prelims: Indian Railways, AIIMS
For Mains:
1. Discuss the challenges faced by Indian Railways in providing adequate medical care for its vast passenger base, highlighting the evolving nature of health emergencies. (250 words)
2. Discuss the ethical implications of inadequate medical care provisions on Indian Railways, considering the potential consequences for passenger safety and well-being. (250 words)
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Source: The Hindu
GLOBAL SURGERY
1. Context
This focuses on equitable access to emergency and essential surgery. It encompasses a range of challenges including inaccessibility, disease burden, and economic burden
2.What is global surgery?
Global surgery aims to ensure fair access to critical and emergency surgical services. While its primary emphasis is on low- and middle-income countries (LMICs), it also addresses disparities in access within high-income countries (HICs), focusing on underserved populations. These essential and emergency surgical interventions encompass a range of procedures, including surgery, obstetrics, trauma, and anesthesia (SOTA). Despite minor variations, there is general agreement among various international organizations on approximately thirty procedures classified as emergency and essential surgery
Global surgery refers to the delivery of surgical care on a global scale, with a focus on addressing the surgical needs of underserved populations in low- and middle-income countries (LMICs). This field encompasses a broad range of surgical services, including preventive measures, emergency and essential surgical care, and rehabilitative services.
Key aspects of global surgery include:
- Many people around the world lack access to essential surgical services. Global surgery aims to improve accessibility to safe, timely, and affordable surgical care for all, especially in regions where such services are limited
- Surgical conditions contribute significantly to the global burden of disease. Global surgery initiatives aim to address conditions such as injuries, obstetric complications, infectious diseases requiring surgery, and non-communicable diseases through surgical interventions
- Efforts in global surgery often involve training local healthcare providers, strengthening healthcare systems, and building the capacity of local surgical teams. This helps ensure sustainable improvements in surgical care within communities
- Global surgery advocates for equity in healthcare, recognizing that access to surgical services is a fundamental component of comprehensive healthcare. It emphasizes the importance of social justice in addressing health disparities
- The field of global surgery also involves research to better understand the surgical needs of different populations, as well as advocacy to raise awareness and mobilize resources for improving surgical care globally
3. History of " Global Surgery"
- The year 2015 marked a pivotal moment, often referred to as the "Annus Mirabilis" or miracle year, for the global surgery field. It served as a turning point in recognizing the significance of surgical care on a global scale.
- A crucial catalyst for this shift was the Disease Control Priorities Network (DCPN) report on essential surgery, sponsored by the World Bank. This report emphasized the cost-effectiveness of emergency and essential surgical care, the benefits of scaling up surgical systems, and the substantial surgically preventable disease burden.
- Another key development in 2015 was the establishment of The Lancet Commission on Global Surgery (LCoGS). This commission brought together experts and stakeholders to assess the global status of surgical care access, define indicators for monitoring surgical care readiness, systemic capacity, and impact.
- It also contributed to the formulation of implementable strategies such as the national surgical, obstetrics, and anesthesia plan (NSOAP). A critical outcome of these efforts was the passage of the World Health Organization Declaration on Safe Surgery (WHO Resolution 68.15). This declaration underscored the necessity of a commitment to emergency and essential surgical systems for achieving universal health coverage
4. Concerns
- The challenges in global surgery are substantial, covering issues such as lack of accessibility, disease burden, and economic implications.
- According to the LCoGS, more than 70% of the global population, totaling five billion people, lack timely access to safe and affordable surgical care. Notably, 99% and 96% of individuals in low- and lower-middle-income countries (LLMICs), respectively, face access gaps, a stark contrast to the 24% in high-income countries (HICs), indicating a significant global disparity.
- Among these, over 1.6 billion people without access reside in South Asia, representing more than 98% of the region's population lacking access to safe and affordable SOTA care.
- The lack of access is closely linked to the disease burden. In 2010, surgically treatable conditions accounted for approximately 17 million deaths, surpassing the combined mortality burden of HIV/AIDS, tuberculosis, and malaria.
- The Global Surg Collaborative highlighted peri-operative mortality as the third most common cause of death, underscoring the impact of delayed care, unsafe surgeries, and limited surgical system capacity.
- The DCPN's comprehensive assessment revealed that scaling up surgical services at district hospitals in low- and middle-income countries (LMICs) could avert over 77 million surgically preventable Disability-Adjusted Life-Years (DALYs), constituting 3.5% of the total disease burden in these countries. South Asia had a higher DALY rate than the LMIC average, contributing significantly to surgically preventable burdens in neonatal and maternal diseases, congenital anomalies, digestive conditions, and injuries.
- The disease burden also carries an economic weight. The projected cumulative loss to GDP due to the lack of scaling up surgical care is estimated to be $20.7 trillion (in purchasing power parity terms) across 128 countries by 2030. Annually, the societal welfare loss is approximately $14.5 trillion for 175 countries, with South Asia accounting for around 7% of the global lost welfare
5.Addressing the Issue
- Despite the significant disease and economic burdens associated with it, surgery tends to be overlooked in international policies and health planning.
- The Lancet Commission on Global Surgery (LCoGS) observed that surgery accounted for less than 1% of all indicators mentioned in reports from influential organizations like the World Bank, World Health Organization (WHO), UNICEF, and others.
- This neglect extends to national policymaking, as evidenced by an analysis of National Health Strategic Plans from 43 African countries, where 19% did not mention surgery or surgical conditions at all, and 63% mentioned surgery only five times or less.
- A similar trend was noted in over 70 years of policymaking in India, with the most recent National Health Policy (2017) containing only two partial mentions of the term "surg." Even in the context of cancer control plans, India's new guidelines on non-communicable diseases (2023), which heavily focus on cancer, lack substantial references to surgery according to The Lancet Commission on Global Cancer Surgery.
- Although national health account data on funding for surgery is limited, data from sources like Developmental Assistance for Health (DAH) indicates a neglect in funding for surgery and related areas. DAH contributions to trauma care are less than $1 per Disability-Adjusted Life-Year (DALY) compared to $41 per DALY for HIV or $25 for tuberculosis.
- While U.S. charitable organizations and foundations have allocated millions to surgical care in low- and middle-income countries (LMICs), these funds are often directed towards specific diseases such as cleft palate, obstetric fistula, and ophthalmic issues, with minimal support for strengthening overall surgical systems in individual countries.
- For instance, of the $105 million spent by 470 U.S. foundations from 2003 to 2013, only $7.1 million and $1.7 million were allocated to the training of local surgical providers and infrastructure, respectively.
- Neglect is also evident in research, as shown by a bibliometric analysis revealing that in 2022, there were only 315 'global surgery' titles (1.5%) in the PubMed database compared to 21,453 'global health' titles.
- Research and funding are interconnected, with the National Institutes of Health (NIH), the largest healthcare research funder in the U.S., funding a significant number of large research projects, but only a fraction related to surgery, and even fewer focused on global surgery. The neglect observed in policy, financing, and research is interconnected, with each aspect influencing and reinforcing the others
6. Way forward
While the challenges in global surgery may seem formidable, they are surmountable. Research from the Lancet Commission on Global Surgery (LCoGS) and the Disease Control Priorities Network (DCPN) has demonstrated that emergency and essential surgical care not only proves to be cost-effective but also offers significant cost benefits. Over 30 low- and lower-middle-income countries (LLMICs) now possess subnational data on their surgical care indicators, with India being the most extensive contributor to this dataset. Several African nations have developed and put into practice National Surgical, Obstetric, and Anesthesia Plans (NSOAPs), showcasing robust political and policy commitment since 2015. In South Asia, Pakistan has established a National Surgical Care Vision, Nepal has initiated an NSOAP, and the Pradhan Mantri Jan Arogya Yojana has facilitated millions of surgeries at minimal or no cost for the bottom 40% of the Indian population. Addressing global surgery challenges requires a focus on research and innovation, policy emphasis, and sustained financial support
Source: The Hindu
