by Maryam Khan

Being a heterogeneous country, India has numerous states which holds a charisma and significance of their own. And so Bihar, one of the states of India, is prominent for a plethora of reasons. Be it its famous Litti-Choka; it’s swaggery Bhojpuri language and songs, the pre-eminent Nalanda University, sheer number of IAS aspirants, orsome prestigious people like Aryabhatta,a mathematician who invented the digit zero, Gautam Buddha who got enlightenment here, Shatrughan Sinha who delivered a classic dialogue “Khaaamoshhh” and so forth. But apart from this, Bihar is also known for its illiteracy, poverty, unemployment, malnourishment, etc that’s why WHY BIHAR IS BECOMING A ZONE OF DEATH?


Since June, Bihar came into the possession of public eye and media interest.

But WHY?

According to some reports, it’s stated that a lot of children, probably more than 200, died in Bihar due to the outbreak of a threatening epidemic, known as Acute Encephalitis Syndrome (AES). Muzaffarpur being it’s epicentre; Vaishali, Sheohar and Eastern Champaran Districts are also hardly smacked with it.

Muzaffarpur, which is famous for the cultivation of Litchis, is not facing this epidemic for the first time. Such outbreaks have happened annually during summer months in the same districts since 1995.Children between the age of 1 to 15 are terribly affected, particularly children who are malnourished.Locally known as Chamki Fever, it’s a neurological condition, which includes convulsions, high fever, headache, bodyache, vomitings, mental disorientation as it’s symptoms, which leads to coma and death.

According to CNN Report, two hospitals in the region itself had more than 400 children complaining of fever, dizziness and delirium. “Between 2008 and 2014, there has been more than 44,000 cases and nearly 6,000 deaths from encephalitis in India, especially in UP and Bihar, according to a research paper published in The Indian Journal of Medical Research (IJMS) in 2017”.


Acute Encephalitis Syndrome, also known as Japanese Encephalitis (as it occurred first in Japan), is a mosquito-borne disease which is primarily spread by the Culex Mosquito and Japanese Encephalitis Virus. It’s host are mainly animals, but Humans can also be it’s victim if they’re living in a close proximity with these animals or Mosquito itself.It causes neurological problems like headaches or meningitis (inflammation of the brain tissue). Other symptoms are fever, neck stiffness , paralysis , seizures, tremors , disorientation and lack of coordination . If left untreated , this can cause permanent damage to nervous system or death .

But According to Prof. Doctor Kishore Kumar, Chairman and Managing Director of Cloudnine Hospitals, the breakout that is happening in Bihar right now is something called acute encephalitis syndrome .An encephalopathy is a damage , disease , or malfunction in the brain, ranging in symptoms that are mild (like memory loss or subtle personality changes) to severe (like dementia, seizures, coma, or even death). In a case of acute encephalitis syndrome (AES) however, there is no bacteria or virus involved.There are different types of encephalopathy. In the present case, the encephalopathy is associated with hypoglycaemia (low blood sugar level) and hence is calledhypoglycaemic encephalopathy. Unlike hypoglycaemic encephalopathy, encephalitis does not cause low blood sugar level.


Dr. T. Jacob John, an epidemiologist at the Christian Medical College in Vellore who investigated the disease during its outbreak in 2012, 2013 and 2014 in Muzaffarpur suspected and confirmed, a toxin found in litchi fruit that was responsible for causing hypoglycaemic encephalopathy. In 2017, an India-U.S. team confirmed the role of the toxin called methylene cyclopropyl glycine (MCPG).

  • SincePoverty and Famineiscommon and widespread in Bihar, it’s very much near to impossible for some families to eat every meal in a day. Children usually suffer from Malnourishment and Undernourishment in such a situation. Since Muzaffarpur is a hub of the cultivation of Litchis, people satisfy their hunger with Litchis, which are present in an abundance. Most of the children who are falling ill are from the familiescamping in orchards to harvest the fruits. These children tend to collect and eat the fruits that have fallen on the ground.Being undernourished, eating Litchis hardly affects them as:- First, there’s not enough food for them; Secondly, being undernourished, their bodies are not having enough body fats or glucose which the body requires, and eating Litchis aggravates it by lowering the little amount of glucose which they had in their body, which leads to hypoglycaemia encephalopathy.


Children have particularly low blood sugar level/low glucose and less body fat, as compared to adults.  So when they sleep without eating dinner, their body relies on the reserves of glycogen in the liver which is released by it and maintains the sugar level. Liver, the organ in our body is also responsible for the breakdown of body fats. And glucose, which is the main currency of energy in the body is stored in the form of glycogen in the liver.

        But in the case of UNDERNOURISHED CHILDREN, glucose is present in a very much low quantityand is inadequate. Not only this, even the glycogen reserves are next to meagre.  It’s normal for blood sugar level to dip after several hours of no food intake. Now undernourished children, who had gone to sleep without having a meal at night,develops Hypoglycaemia. The brain now obviously is in the need of normal or say average level of glucose in the blood, which is lacking in them. The liver, which is already deprived of its glycogen reserves, also fails to supply the need. So fatty acid oxidation , i.e the alternate pathway of glucose synthesis , is turned on. That pathway is blocked by MCPG ( toxin found in the Litchis).

This leads to drowsiness, disorientation and even unconsciousness. When the toxin stops the fatty acid conversion into glucose midway, amino acids are released which are toxic to brain cells. Brain cells stats to swell resulting in brain oedema ,it is caused by amino acid .As a result, children may suffer from convulsions, deepening coma and even death.

That’s why many group of medical experts believes that the consumption of Litchi is a contributing factor in making Bihar a death zone for children.


Parents who lost their children due to this epidemic are feeling terrible and are greatly affected by their loss. For parents, it was disheartening to see their children in pain infront of them. They were hopeless, and didn’t knew what to do so that they can help out their children and lessen their pain. Lack of doctors, medical facilities, and support from the government officials made them feel resentful and enraged. But even as the number of patients grew, experts and doctors were unsure what could be at the heart of the disease. And without knowing the root cause, it was impossible for the doctors to cure them.Children squeezed together on narrow beds meant for one,were shivering and full of agony. Frantic nurses and overwhelmed doctors who were trying hard to deal with the massive outbreak of encephalitis, miserably failed.  Indeed, it was a moment of despair.


Doctor Kafeel Khan, who was earlier in Gorakhpur was blamed by the government for the deaths of 70 kids suffering from encephalitisand also due to lack of oxygen. He spent more than seven months in jail for this accusation. Later, the government admitted to have failed to provide the hospital with oxygen cylinders on time.Now Khan, along with other medical professionalstravelled to Muzaffarpur in the worst-affected regions, to meet the patients; checking the symptoms and recommending them to go for a check-up and get tested. Despite of being his license cancelled by the government, he didn’t stopped from serving the people. What a brave man he is. He truly deserves some respect.

  • I’d suggest that the government and the healthcare department should make people aware about this epidemic, and it’s symptoms and consequences.The families living in that area should also make sure that their children don’t skip meals, and doesn’t eat Litchis in abundance. Also government should make sure that they provide the victims enough facilities and treatment, provide them enough meals, provide them with the best of their ability.


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