How India is scrambling to secure medical oxygen and save lives

India is not alone in the shortage of oxygen at hospitals but the deadly surge in COVID-19 cases exacerbated the crisis.

An elderly man, who arrived unconscious and bleeding through the nose, was stabilized at the makeshift quarantine center at the Sarvodaya Kanya Vidyalaya in Jamia Nagar, New Delhi on May 6. The center only admits mild to moderate COVID-19 patients who require oxygen support.
ByNilanjana Bhowmick
Photographs byMd Meharban
May 18, 2021
7 min read

New Delhi — In a recent video post on Twitter, Dr. Gautam Singh, a cardiologist who runs the private Sri Ram Singh Hospital in east Delhi, lost his composure as he pleaded for help: “We have young patients who will die in a matter of two hours… Please send oxygen to us,” he begged on camera, clasping his hands together. “We need oxygen for our patients.”

Similar urgent appeals have been issued by several state-run hospitals.

India is not alone in the shortage of oxygen at hospitals but the deadly surge in COVID-19 cases exacerbated the crisis.  As the number of cases dramatically spiked, hospitals quickly ran out of beds and oxygen supplies. Relatives of patients found themselves standing in long lines to get cylinders filled with the vital medical treatment. Some scoured one location after another in search of oxygen concentrators or cylinders. At Vaibhav Oxygen, a refilling center in New Delhi, hundreds gathered daily during the peak of the crisis to refill cylinders. Fearing riots, the government deployed security personnel to form a barricade around the company and manage the crowd, which often got rowdy when people became restless or angry after waiting through the night.

Oxygen cylinders arrive at the Venkateshwar Hospital in Dwarka from a refill center in Badarpur in New Delhi. The hospital was among those that had reported oxygen shortages at the peak of the crisis mid-April, and even appealed to the Delhi High Court on April 27 saying they only had a few hours of oxygen left. At the time, the hospital was overwhelmed treating 320 COVID-19 patients.
A cryogenic oxygen tanker waits outside the INOX oxygen factory in Modinagar in Uttar Pradesh. The plant, operated by India’s largest oxygen maker, opened in October last year. It has the capacity to produce 150 tons of oxygen per day and can store 1,000 tons, more than any other facility in the region.

Even private hospitals with state-of-the-art critical care facilities and round-the-clock care also suffered oxygen shortages. “Every part of the healthcare system was caught unaware,” says Ramanan Laxminarayan, an epidemiologist and director of the Washington DC-based Center for Disease Dynamics, Economics & Policy, who is now based in New Delhi. “India has a persistent medical oxygen problem.” (India’s crisis shows how oxygen is a vital medicine not everyone can access.)

Is the crisis over?

Even though the crowds have thinned at Vaibhav Oxygen, people are still queuing up to refill cylinders, albeit in much smaller numbers. “The situation seems to have stabilized," says Krishna Kumar, the owner of the center.

“The middle classes and the rich are now more or less covered, hence the noise surrounding the crisis is much less now,” says Laxminarayan. “But the poor are still struggling—if you are poor where will you even begin to look for an oxygen cylinder, especially in rural India where there’s no oxygen network?”

Here is a visual compilation during the height of the crisis that continues to batter India.

Ajay Kumar, left, and Gaurav Kumar, right, who work at the Madhukar Rainbow Children’s Hospital in New Delhi, drag oxygen cylinders into an ambulance after waiting three hours for them to be refilled. “We roam around the city throughout the day to scout for oxygen for the hospital,” Gaurav Kumar said.
Workers load empty oxygen cylinders onto a truck inside Venkateshwar. “Every hour 15 to 20 cylinders empty out,” one of the workers said. “We are working round the clock to ensure constant oxygen supply.”
Workers move newly manufactured cylinders for transport at the Bharat Pumps and Compressor Limited factory in Prayagraj in Uttar Pradesh. The company had stopped making oxygen cylinders 10 years ago as there was not much demand for them. But as the oxygen crisis escalated, the government asked them to restart operations. Currently, they are making 300 cylinders a day.
People queue outside Vaibhav Oxygen, one of India’s largest oxygen distributors, in Badarpur, New Delhi, to refill oxygen cylinders. At the peak of the crisis, according to the owner, Krishna Kumar, they catered to around 700 people every day, as well as hospitals and ambulances. “We didn’t leave for home, till we were able to fill everyone’s cylinders,” he says.
People wait at Vaibhav Oxygen to refill oxygen cylinders. As hospitals crumbled under the crisis, relatives and friends of COVID-19 patients were told to find oxygen and other medical resources on their own.
Mahesh Kumar waited in line for 24 hours at Vaibhav Oxygen to refill his father’s oxygen cylinder. Although his father was off oxygen support, Kumar said he didn’t want to risk not having a supply. “We have only one cylinder. He’s old and ill and I would feel more secure if I had an oxygen cylinder on standby,” he says.
An Indian paramilitary personnel stands guard as people take tokens for refilling oxygen cylinders at Vaibhav Oxygen. The distribution facility could only dispense between 500 to 700 tokens a day and wrestled with unmanageable crowds at the peak of the oxygen crisis.
Workers at Venkateshwar hospital in Dwarka, New Delhi, connect a fresh batch of oxygen cylinders to the hospital's oxygen supply line. In large medical care facilities oxygen tanks are hooked to a central system of pipes that supply the gas to many patients. In smaller hospitals, patients have oxygen tanks at their bedsides.
Nurse Poonam Kant gathers a new batch of empty oxygen cylinders to be refilled at the state-run Tej Bahadur Hospital in Prayagraj in Uttar Pradesh. “We don’t have a minute to rest,” she says, while busying herself with the cylinders again. The state—with a population of 200 million, bigger than that of Brazil—has so far recorded over 160,000 cases and over 17,000 deaths.
An Indian paramilitary personnel stands guard inside an oxygen refilling center in New Delhi as the crowd swells outside. People travel long distances and stand for hours to refill their cylinders. Sometimes they get restless and angry, anxious they won’t be able to get oxygen for ill relatives. “You can’t blame them,” says the security guard.