Health officials link deaths to the ferocious heatwave gripping northern Bihar state since May, rejecting recent reports that claimed the disease was caused by eating lychees.
The death toll due to suspected Acute Encephalitis Syndrome (AES) or "brain fever" in the Indian state of Bihar mounted to 136 on Friday, the state health department said.
The total number of AES-afflicted children said to be under treatment has reached 600 in 16 districts of the state. The maximum number of deaths was reported from Muzaffarpur district – 117.
The epidemic has sparked a debate over growing inequality in India and focused attention on a free health care scheme for the poor – known as "Modicare" after Prime Minister Narendra Modi – eight months after it's launch.
The precise causes of AES, which killed more than 350 people in Bihar in 2014, are not known but a majority of medical professionals say it is linked to a ferocious heatwave that has gripped Bihar for the last month.
Five-year-old Soni Khatun was playing in the midday sun last week when she began to vomit and lose feeling in her hands. Her mother, a poor labourer living in rural India, borrowed money to take her to the hospital.
Five hours later, Soni was dead.
"I still see her in my dreams," said Soni's mother Sahana Khatun of Bihar. "I can't accept she is gone."
The deaths were preventable, doctors said if poor families had access to good food, clean water and better medical care in Muzaffarpur district, 80 km from the state capital Patna.
VIDEO: The stench of urine, chlorine, vomit and death fills the main hospital in Muzaffarpur in eastern India, the epicenter of a mystery brain fever outbreak that has killed over 100 children since June 1 pic.twitter.com/2ihM2xFyZT— AFP news agency (@AFP) June 21, 2019
Lychees not the cause - doctors
Health professionals rejected recent reports that claimed the disease was caused by lychees.
Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur, though many families said their children had not eaten them in recent weeks.
Head of the department of pediatrics at SKMCH Gopal Shankar Sahni blamed the weather conditions for the outbreak.
"Hot and extreme weather conditions were the reasons behind the deaths and not lychees as claimed," he said.
The victims come from poor families who often suffer from malnutrition and dehydration.
If caught quickly, AES patients can often recover with simple rehydration treatment, doctors said, but delayed care can lead to convulsions and eventual death.
"It is a preventable disease," said Dr Chaitanya Kumar at the district's Kejriwal Maternity Hospital, one of two treating young AES patients.
"Glucose and providing meals to some of the poorest districts – these are not expensive things."
India has world-class hospitals in major cities like New Delhi and Mumbai, but rural facilities like those in Muzaffarpur are overstretched, doctors say.
The 600-bed Sri Krishna Medical College Hospital in Muzaffarpur has more than 900 patients, a third of them children with AES.
At least 93 AES patients have died at the facility since the outbreak began.
Stray goats roam over rubbish and rubble on the hospital grounds. The building has frequent power cuts and the stench of urine lingers in the hallways.
The hospital evicted a group of sick inmates from a ward to accommodate the surge in AES patients, but at times there are still two or three children assigned to one bed.
"It is incredibly difficult to be a doctor in a place like this," said Ravikant Singh, a volunteer doctor from Mumbai who was giving rehydration solutions to patients at the hospital.
Other doctors said they felt powerless.
"I can't do anything. It is the social conditions that have to change," said Rajkumar Goenka, secretary of the trust that operates Kejriwal hospital.
"The government – state and national – has to do something," he added.
Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, or too short for their age, according to government data.
In Marwan, a village of thatched huts where many residents belong to one of the lowest rungs in India's caste system, some children have swollen stomachs – a common sign of malnutrition.
Residents said they were unaware of Ayushman Bharat, the programme known as 'Modicare' launched in 2018 to give India's poorest free access to private healthcare.
Nand Lal Mandhji, 61, whose four-year-old granddaughter died from AES, said the family was given a flyer about the scheme during a hospital visit in May. The family is illiterate and the programme was not explained to them, he said.
"They gave us something but we didn't understand what it meant," he said, clutching the flyer with Modi's image.
Eight families in Marwan with sick relatives said they had never heard of Modicare, and did not receive warnings from authorities about the dangers of AES.
"No one comes here. Not politicians, health workers, no one," said Soni's mother.