The Telangana government affidavit of July 27 in the High Court declaring its intent to demolish the heritage block of the Osmania General Hospital (OGH) complex has reignited an old conflict between heritage conservationists and those backing public health rights. Over the years, the Telangana High Court has received several public interest litigation (PIL) petitions from representatives of both camps. The July 27 affidavit by the government was in response to these PILs.

The OGH is a vital, overburdened, public super-speciality hospital spread over 26 acres in Hyderabad. Its heritage block, completed in 1926, is a majestic river-front structure along the banks of the Musi river. The OGH has served the public healthcare needs of the State for nearly a century. More blocks were added behind the heritage structure in later years as the need arose to expand the hospital.

Also Read | India’s childhood diabetes problem stems from stigma and ignorance

In July 2020, following rainwater and sewage water inundation, the government announced its decision to permanently vacate the heritage structure, which housed the 400-bed inpatient ward. The demand to construct a new hospital was made from time to time but nothing happened. Some eight years ago Chief Minister K. Chandrashekar Rao, too, promised demolition of the old structure and a new hospital built there.

Osmania General Hospital in October 2021, when INTACH, Hyderabad chapter, held a press conference to discuss its structural condition assessment review of the over 100-year old heritage structure. An INTACH team has examined the heritage structure from roof to floor at least four times since 2015.
| Photo Credit:
RAMAKRISHNA G

The old building is deemed to be structurally weak and unsafe and the overall OGH infrastructure is considered inadequate to meet the needs of the population. Hence, the government wants to raze down the entire complex and build a new hospital. But heritage activists are demanding that the block be conserved and a new hospital built around it. The government does not see merit in that.

Integral part of Hyderabad

In its affidavit, the government stated that the hospital would need more than 1,800 beds. Besides, the complex would need residential quarters, parking area, and space for other accompanying services. This would require over 35 lakh square feet of area. To adhere to the Indian Public Health Standards and the National Building Code (2016) norms, the proposed new hospital requires at least 22.2 acres, as per the affidavit submitted by the Health Secretary, S.A.M. Rizvi.

The OGH complex includes a police station, a graveyard, and religious structures, which cannot be disturbed. The government insists that demolishing the heritage structure is the only way to get the required extent of land. According to government sources, if the heritage structure is left undisturbed, buildings constructed around it cannot be taller than it because of the existing regulations relating to heritage conservation.

While a new hospital is necessary, activists point out that Hyderabad could lose an integral part of its built heritage if the structure is demolished. They are prepared to fight to conserve the protected heritage structure.

A view of Osmania General Hospital when the process of shifting files and equipment from the old inpatient block was underway in July 2020.
| Photo Credit:
RAMAKRISHNA G

First established in 1866 as Afzalgunj Hospital, it was rechristened as Osmania General Hospital and relocated to its present 26-acre campus following the devastating floods of 1908. The construction was completed in 1926 and the hospital remained operational until July 2020, when the inpatient block was closed. It is one of the 150-odd notified heritage structures in the city and enjoys protection under Regulation 13 of the Zoning Regulations, 1981, of the Hyderabad Metropolitan Development Authority (HMDA). Over the years, public representatives have shifted their stand on whether conserving the heritage building is a priority or not. The July 27 affidavit was submitted after a unanimous decision by a committee comprising representatives of various government departments, MLAs and MPs.

Activists, however, point out that the government committee ignored the existing regulations while deliberating on the fate of the building. One of the petitioners, Lubna Sarwath, had approached the Telangana High Court to protect another heritage building, the over 150-year-old Irrum Manzil of Hyderabad, and got a ruling in her favour in 2019. She spoke to Frontline on the OGH issue.

Unviable for patients

“The government committee has MPs and MLAs in the name of ‘public representatives’ and government officials in the name of ‘experts’,” she said. “The government kept civil society members out of the so-called consultative meeting and the Heritage Conservation Committee guidelines, as ordained by the HMDA Act and Rules, were trampled upon,” Sarwath said.

A view of Osmania General Hospital showing broken patches in the ceiling.
| Photo Credit:
NAGARA GOPAL

Heritage activists allege that the government is citing space constraint as an excuse to justify the demolition of the heritage structure. Several hospitals in the city are running in much smaller areas with similar bed strength or facilities. “So, why can’t OGH?” asked Dr Iqbal Jaweed, an alumnus of Osmania Medical College, who has been in the forefront of the campaign to conserve the OGH heritage building. Speaking to Frontline, Dr Jaweed alleged that the inpatient block was closed in 2020 under the false pretext that it was unsafe. “At that time, water was oozing out of the manholes and the problem was rectified almost immediately. The roof is not leaking and there has been no damage due to rain and flooding since then,” he claimed.

He said that the departments housed in the heritage complex could be shifted to the 14 peripheral campuses of the OGH located across the city. “This would help conserve the magnificent, priceless, precious building. Demolishing it will be unfortunate and unforgivable,” Jaweed said.

Where the government and heritage activists disagree is on the structural viability of the building. While the government committee has called it unfit for hospital use, heritage activists who have surveyed it are confident it can be repaired and conserved for adaptive reuse.

A team of the Indian National Trust for Art and Cultural Heritage (INTACH) has examined the heritage structure from roof to floor at least four times since 2015. Its members say that the damage is superficial and not beyond repair. “Incompatible materials used to repair the building caused more harm and this needs to be addressed,” said S.P. Anchuri, a structural engineer associated with INTACH. Following one of their on-site studies that lasted over 15 days, INTACH released a detailed report in 2015 countering the government’s claim that the building was structurally unsafe.

“It can be used for hospital administration purposes. Or, it can house a museum,” said Anuradha Reddy of INTACH, adding that the building could survive for another 100 years or more if it was looked after scientifically.

Even heritage activists are not proposing the use of the heritage building for patients, saying it would be an unviable and unreasonable option.

Overloaded infrastructure

The OGH is a vital part of Telangana’s public health services. Conveniently located in terms of transport facilities, patients come to this referral hospital not only from the districts but from neighbouring States too. On busy days, it treats nearly 2,000 outpatients. The inpatient wards are usually overcrowded. The ICUs are, as usual, available only on a priority basis. The hospital also serves transplant patients, including those in need of liver transplant, which could cost ₹20-30 lakh in a private facility. It is also a training and teaching facility for nurses and undergraduate and postgraduate medical students.

When the OGH’s heritage structure was vacated in July 2020, other buildings, such as outpatient and super-speciality blocks, had to accommodate the patients, and this burdened the already overloaded infrastructure. Following the ad hoc arrangement, the overall capacity of OGH went down from over 1,300 to 1,100 beds. There was an interruption of services for nearly three months in 2020. “We rearranged everything gradually, but there has been no permanent resolution to the space constraint,” said B. Nagender, Superintendent of OGH. The staff said there was a shortage of beds, and services were routinely delayed and disrupted because of this.

A view of the in-patient block in July 2020 when it was flooded with sewage and rain water.
| Photo Credit:
RAMAKRISHNA G

On any given day, one can see dozens of patients in inpatient wards getting treated on the hospital floor. With patients’ bags and files scattered around, it is on the floor that follow-ups are done and drips administered. “We cannot turn down poor people. We send them back when possible, but they have to be kept somewhere when they can’t be asked to return the next day. At times, we find ourselves searching for our patients,” said a senior doctor who did not want to be named.

Everyday story

During a visit to one of the inpatient wards in August, Frontline found patients sheltering under beds too. Several said they would rather wait a day or two on the floor and get a bed than risk further delay.

A young patient being treated for epilepsy lay diagonally on the floor, covered in a bedsheet brought from home, while his head rested on the polythene bag containing his belongings. The staff had administered him a drip in this position. He had been waiting to get a bed for over 36 hours. Another patient sat in a wheelchair as his leg bled from an injury and haemophilia. He had been administered a drip and asked to wait. Such stories are endless.

Patients wait in long queues to consult doctors at Osmania General Hospital.
| Photo Credit:
NAGARA GOPAL

It is a severely compromised medical environment for poor people who cannot afford private treatment. Other blocks of the OGH, including the outpatient area, are poorly maintained too—the roof leaks at several spots, even outside the superintendent’s office. The bathrooms are barely usable. The attendants do not have adequate resting areas and sit wherever possible.

While this would be the story of most public hospitals in India, the Telangana government appears to be interested in fixing the problems by rebuilding the hospital. “The patients need proper care and comfort. This hospital was a luxury 100 years ago, with a general ward and common bathrooms. Now, demands and needs have evolved. We need more beds. Some patients need private and semi-private beds and attached bathrooms. One must also consider the growing requirements over the next 50 years or so,” said Nagender.

He refuted the idea of heritage activists that the heritage building can be adaptively reused for administrative purposes. “It occupies nearly three acres of land. What administrative work requires three acres?” he asked.

Also Read | Behind the Indian cough syrup that killed many in Gambia and Uzbekistan

The Healthcare Reforms Doctors Association (HRDA) supports the proposal to demolish the heritage structure and has filed a PIL. “Heritage activists think a building is more important than public health,” said Dr Mahesh Kumar of HRDA. However, according to the HRDA, the government too is not fully invested in speeding up the process of creating a new hospital, be it at this site or a new one. In a statement, it called the government’s proposal half-baked and half-hearted.

“The importance of the OGH heritage building is not in its use but in its continued existence,” said Sarwath, contradicting the view of the HRDA. “The structure is a crucial part of the identity of the people of Hyderabad and Telangana,” she added.

With heritage and public health being seen as mutually exclusive, when they need not be, a resolution to the issue might be difficult. It remains to be seen what the High Court decides.