No end in sight for Bihar’s AIIMS row
PM Modi's claim of a new AIIMS in Darbhanga sparked controversy as the state government and Union health minister traded blame over the delay in construction
On August 13, virtually addressing the Panchayati Raj Parishad in West Bengal, Prime Minister Narendra Modi spoke of his government’s achievements in the health care space over the past nine years. In that period, he said, Bihar, Jharkhand, West Bengal and Odisha have collectively seen the creation of 31 new medical colleges, while the North East had seen a doubling in the number of such institutions. “For better health facilities, from Guwahati in Assam to Kalyani in West Bengal, from Deoghar in Jharkhand to Darbhanga in Bihar, new AIIMS(All India Institute of Medical Sciences) have been opened with the planning that people do not have to travel hundreds of kilometres for treatment,” the Prime Minister said.
Within hours, a political controversy erupted in Bihar. For there is no functional AIIMS Darbhanga, land earmarked for its construction caught in a never-ending eight-year battle between the state and the union government.
Bihar deputy chief minister Tejashwi Yadav, the state health minister -- his RJD is one of the principal players in the national opposition grouping, Indian National Developmental Inclusive Alliance(INDIA) -- accused the Prime Minister of a “white lie”. “What kind of invisible development politics is this where the ministry of health has not yet finalised the site for AIIMS and the respected Prime Minister is saying that AIIMS has been opened there?,” Yadav tweeted.
The Union Health Minister Mansukh Mandaviya responded quickly and said that permission for AIIMS Darbhanga was first given on September 15, 2020 and land was allocated for the project in November 2021. “After this, you came to the government and changed this location on April 3, 2023 because of politics,” Mandaviya posted on X(formerly known as Twitter).
Yadav said that much of the period Mandaviya was describing referred to a time when the NDA, of which the BJP was a part, was at the helm in the state, before Nitish Kumar shifted allegiances and formed government with the RJD on August 9, 2022. He added that the Union health ministry had not yet given approval to the new site the state had proposed despite a conversation between him and Mandaviya and a formal letter dated June 2022, where he listed the advantages of the new site. CHECK ALL DATES
Either way, as the apportioning of blame continues, at the new proposed site where the state government wants the AIIMS to be set up, just off the Ekmi-Shobhan bypass, there is not one brick of a building that has been raised; only a waterlogged chunk of undulating land.
What is the controversy?
The establishment of an AIIMS in Darbhanga, 140 kilometres north-east of the capital Patna, has been a long standing demand in Bihar, serviced as it is by just the state run Darbhanga Medical College Hospital (DMCH) that has 1030 beds. This hospital caters to the medical needs of people in north Bihar. There is no super-speciality hospital in the region, with a plan to set one up at DMCH, initiated in December 2016, still not finalised. For specialized treatment in nephrology, cardiology, cardio-thoracic or vascular surgery , the only option is a trip to Patna.
Government documents seen by HT show that then Union Health Minister JP Nadda first wrote to the Bihar Chief Minister on June 8, 2015, requesting him to identify at least three locations, around 200 acres each, to set up Bihar’s second AIIMS. The one in Patna that has 1176 beds was established in September 2012.
The state government then received four reminders from the Union government between December 10, 2015 and April 12, 2017 . In between, the documents show, the Bihar government wrote to the Union Health Ministry on August 3, 2016 and March 19, 2017, asking for the centre to identify land for AIIMS, “on its own”.
Then Union Health Secretary Preeti Sudan then wrote to the then Bihar chief secretary Anjani Kumar Singh on February 2, 2018 referring to the multiple letters written by the Union Health Minister and said that if no reply was received in 15 days, the proposal to set up an AIIMS in Darbhanga may well be shelved.
Still, very little moved for three years.
Eventually on November 3, 2021, the state cabinet approved the handing over of 200 acres of land on the existing campus of the state’s Darbhanga Medical College and Hospital in November 2021, 15 months after the union cabinet approved the project, at an estimated cost of ₹1264 crore.
But a month later, on December 16, 2021, Chief Minister Nitish Kumar told journalists in Darbhanga that the state government would only part with 150 acres for AIIMS, and retain 77 acres for the further development of DMCH. In September 2022, the state government first handed over 81 acres of land on the DMCH campus.
But in January 2023, there was another volte face, when Chief Minister Nitish Kumar announced that the project would be shifted to a more accessible location. On April 3, this more accessible location was revealed, when Bihar’s additional chief secretary (health) wrote to the Union, telling them that alternative land had been earmarked near the Ekmi-Shobhan bypass.
The BJP MP from Darbhanga, Gopal Jee Thakur said, “The state government had demolished doctor’s quarters, shifted banks and government offices and spent funds up to ₹13 crore on earth filing work at the earlier proposed site on DMCH campus. They even transferred 81 acres to the Centre for construction work. How then did it shift the location to Shobhan?” asked Thakur.
Thakur said that the primary problem was the government’s inability to remove encroachments from DMCH land. “Out of the total 300 acres, only 227 acres is currently under the possession of DMCH”, he said.
The Expert Committee Report
But even the new plot of land has now come under question. In April, the union government sent a five-member expert committee to survey this location proposed by the state government, and in a letter on May 26, union health secretary Rajesh Bhushan rejected it, enumerating challenges with the site including that it was low-lying, needed extensive earth filling, had engineering challenges and posed potential water-logging issues. Members of the team said that the plot would require a reinforced foundation because of the black soil that lay beneath, which expands in the rain and contracts in the summer.
“Multi-storied construction across Darbhanga is challenging from the point of view of an earthquake — the district comes under the highest seismic zone 5 — and the cost of construction at the proposed location will be much higher,” said an expert on the team that comprised two structural engineers, an architect, a representative from a construction firm, and a coordinator from the ministry of health and family welfare (MoH&FW).
“At Shobhan, land filling and compaction have to be done layer-by-layer -- filling up one-foot of earth and then compacting and stabilising it, before refilling again. This will take a lot of time and require stringent monitoring because if compaction and soil stabilisation is not done properly, it will lead to maintenance issues,” one expert from Indian Institute of Technology (IIT) said, asking not to be named.
A third expert said that the construction at the site was “possible”, but was extremely challenging and would require heavy expenditure. “Construction of a hospital should be done at the natural soil level so that its maintenance cost is low. We must look for flat land that has good soil properties so as to reduce eventual running costs,” he said.
Professor LB Roy, a soil expert and former head of the department of civil engineering at National Institute of Technology (NIT), Patna, said the properties of the soil, on which the new site is located was less than ideal from a construction point of view. “Though the soil texture cannot be changed, it can be improved by various methods. Under-reamed piling(a process that uses cast-in concrete piles) is the only solution to bind the soil. The tentative cost of under-reamed piling will be 1.5 times higher than normal piling, and will require specialised worksmanship.”
The argument for the new location
Sanjay Kumar Jha, Bihar’s minister of information, public relations and water resources development said that the decision to change venue had little to do with encroachment, and said that there were clear reasons for the shift. First, he said, Shobhan offers a greenfield area, close to the city, the East-West corridor and the Darbhanga airport, enhancing its accessibility. “This aligns with the construction norms for new AIIMS, and helps in city expansion with allied development in the outskirts of the city. Plans for the development and expansion of DMCH are intact,” Jha said.
Jha said that the argument of the soil quality and topography that are being raised about Shobhan would exist anywhere in the state, with the entire district lbeing ow-lying. “The central team which inspected DMCH in December 2019 had said that it too was low-lying. We had done soil filing at DMCH as well. For Shobhan, the state government has allocated ₹309 crore for the purposes of land filling and the construction of a boundary wall.”
He also said that procuring soil for filling was “no big deal.” We will fetch it from the Khiroi river nearby. This is not the centre’s concern,” Jha said.
The minister said that the state government was prepared to give 150 acres of land free of cost to the Centre for the AIIMS at Shobhan and was also prepared to bear the cost of land filling. “We have already shared the burden of expenditure and the Centre has only to bear its construction cost. Their refusal is nothing but an attempt to discredit the Bihar government.”
That is where the impasse now stands, with no resolution in sight. The centre insists on an alternate site instead of the new site; the Bihar government insists on its new site. On August 14, in the latest in the line of letter exchanges, deputy Chief Minister Tejashwi Yadav wrote to Mandaviya again, saying the state government had sanctioned ₹3115 crore for the renovation of DMCH and as such, there was no land available now for the proposed AIIMS at the campus. He said that the Shibhan site would provide better connectivity to patients from north Bihar, Mithilanchal and even Nepal. “Having the DMCH and the AIIMS as two separate institutions will also help in the development of two specialised hospitals in the region,” Yadav wrote.
In the meanwhile, the site for the new AIIMS still has not a brick raised, mosquitoes breeding in a pool of stagnant water.
