With 10 more pilgrims dying since Saturday, the death toll from natural causes during this year's Amarnath Yatra has risen to 98. Lack of acclimatization, high-altitude sickness, bogus health certificates and systemic failure could be among the causes, doctors say.
A crucial factor that could contribute to the deaths of pilgrims is the lack of acclimatization which is an absolute must before undertaking high-altitude expeditions, said Parvaiz Koul, head of medicine at the Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Jammu and Kashmir's only super-specialty hospital.
"Pilgrims just get up from Baltal and Pahalgam (the two base camps for the Yatra) and start the uphill trek without any proper acclimatization. To safely negotiate the high pressure gradient, one must acclimatize for at least three to four days," Koul told IANS.
"Acclimatization must be made compulsory for the pilgrims to avoid high altitude sickness and associated complications".
"I personally believe there is a systemic failure somewhere. It does not necessarily have to be in either Baltal or Pahalgam, although there is always scope for improvement of medical facilities provided to the pilgrims at these places," Koul said.
"We have been receiving cases of pulmonary oedema, cerebral oedema and myocardial infarction, which are all manifestations of high altitude sickness and can be causes for pilgrim mortality.
"We will have to remember a few basic facts before reaching reasonable conclusions. Medical fitness certificates have been made mandatory for every pilgrim, but bogus fitness certificates being obtained against monetary considerations by over-enthusiastic pilgrims remains a serious possibility.
"For example, we have been seeing patients with known histories of ailments that necessitate that the patient should not undertake the difficult high-altitude trek," Koul said.
Jammu and Kashmir Governor N.N. Vohra, who is also chairman of the Shri Amarnath Shrine Board (SASB) that manages the affairs of the Yatra, has been regularly visiting the base camps and other halting points of the Yatra to ensure that sufficient stocks of oxygen cylinders, oxymeters and other medical facilities are made available for the pilgrims.
Khurshid Iqbal, a senior cardiologist at SKIMS, said: "When 300,000 people assemble at a place in three or four weeks, there is always a natural reservoir of diseases among otherwise healthy people."
"These illnesses spread and can cause mortalities. Secondly, there are patients who hide their ailments while declaring facts for obtaining medical fitness certificates in order to undertake the Yatra," Iqbal added.
Renowned neurologist Sushil Razdan, who has performed the Yatra a number of times, told IANS: "Mahagunas top en route to the shrine (on the south Kashmir trek) is more than 14,000 feet high while the shrine is situated at 13,000 feet."
"At altitudes like these, people otherwise healthy get high altitude sicknesses which can vary from simple headaches, lethargy and disorientation to pulmonary or brain oedema.
"Those with cardio-vascular vulnerability are highly susceptible to these illnesses. Going from plains to high altitudes is always risky," Razdan said.
"Pilgrims undertaking the Kailash Mansarovar Yatra have to undergo strict medical checks and even then, fatalities occur among the pilgrims while the total number of pilgrims is not beyond a few thousand," he added.
Last year, 107 pilgrims had died due to natural causes during the Yatra. In 2010, 78 and in 2009, 42 pilgrims died due to natural causes.
About 750,000 pilgrims visited the cave shrine last year. The figure was 600,000 in 2010 and 450,000 in 2009. This year, 580,000 pilgrims have so far performed the Yatra.
Statistics reveal the overall mortality rate of pilgrims seems to have gradually increased over the years as the number of pilgrims has also increased.
Whether it is lack of proper acclimatization or bogus fitness certificates that are the culprits, the fact remains that pilgrims across age groups are among 98 who have died due to natural causes during this year's Yatra, which is definitely a reason for concern.
The Supreme Court had Monday expressed shock over the fact that 10 pilgrims had lost their lives the past three days.
"It is a very sad thing. Within three days, the toll has gone up from 87 to 97. We are worried that more people should not die," an apex court bench of Justice V.S. Chauhan and Justice Swatanter Kumar observed.
The court has also directed that medical facilities at the north Kashmir Baltal camp be augmented three times over what these presently are.
"At least in this session, no more deaths should take place," the apex court judges hoped, asking the state government to take help from other states to improve medical facilities for the pilgrims.
(Sheikh Qayoom can be contacted at firstname.lastname@example.org)