by Md Motiar Rahman:

HEALTH is a fundamental right, rooted in the belief that access to health care and a healthy environment is essential for a dignified and fulfilling life. This right is recognised globally through frameworks such as the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights, emphasising that everyone is entitled to the highest attainable standard of physical and mental well-being. Constitutions in many countries and legal systems, such as those in South Africa, Brazil and India, have enshrined health as a core right, obliging governments to provide an equitable access to health care services, clean water, sanitation and nutrition.

While health is not explicitly recognised as a fundamental right in Bangladesh’s constitution, it is acknowledged as a state responsibility under the directive principles of state policy. Article 15(a) mandates the state to ensure the provision of basic necessities, including food, clothing, shelter, education and medical care while Article 16 emphasises improving public health, particularly in rural areas. Article 18(1) emphasises the state’s duty to improve public health and enhance nutrition for its citizens.

To attain, maintain and improve physical and mental health, it is imperative to have a sustainable and robust healthcare system covering a wide range of medical and preventive care. These services include primary care, specialised treatment, emergency interventions and public health initiatives to prevent diseases and promote a healthy way of life. A well-functioning healthcare system ensures accessibility, affordability and equity, addressing the needs of all population segments, particularly vulnerable groups. Effective healthcare delivery relies on skilled professionals, adequate infrastructure and efficient policies prioritising quality and inclusivity. Public health campaigns, advancements in medical technology and collaboration between governmental and non-governmental entities play pivotal roles in enhancing healthcare services, ultimately contributing to the overall socio-economic development of a nation.

Bangladesh’s healthcare system has significantly improved health indicators, including reduction in child and maternal mortality, near-universal vaccination and expanded rural healthcare through community clinics. Non-governmental organisations and effective family planning have also contributed to success. However, challenges such as urban-rural disparities, under-funding, staff shortage, skilled human resources, insufficient structural facilities, corruption and a growing burden of non-communicable diseases persist. Rising healthcare costs and the absence of insurance further strain the system.

With all these limitations, there have been incidents of violence against medical practitioners in Bangladesh, often spurred by perceived negligence or unmet expectations, exposing systemic flaws in health care. Issues such as treatment delays, misdiagnosis, poor communication and inadequate service quality have eroded trust between patients and providers, leading to frequent conflicts. These attacks, driven by disappointment and weaknesses in infrastructure, legal protections and public perceptions, have tarnished the once-noble profession. The growing violence harms healthcare professionals’ morale, disrupts patient care and fosters fear in medical institutions. In response to escalating violence against medical practitioners, they often suspend services, resuming only under the protection of law enforcement or with formal assurances from authorities. Addressing this crisis demands systemic reforms, better communication, legal safeguards and strategies to improve patient satisfaction.

In recent days, the tragic death of Abhijit Halder, a former student of Dr Mahbubur Rahman Mollah College on Demra Road at Jatrabari in Dhaka, on November 18, has overshadowed other incidents attributed to alleged negligence at Dhaka National Medical College and Hospital on Johnson Road in Old Town, triggering a cascade of significant and far-reaching societal repercussions. The death reportedly from dengue fever, sparked protests among his peers at the college, who accused medical staff of negligence. The protests quickly turned violent, leading to vandalism at the hospital and confrontations with rival student groups. Tension escalated further when students from nearby Government Shaheed Suhrawardy College and Kabi Nazrul Government College mobilised against Mollah College students, culminating in coordinated vandalism on November 26. Witnesses described hundreds of attackers, armed with makeshift weapons, storming the Mollah College campus, resulting in numerous injuries and significant property damage.

This event exposed critical issues of alleged medical negligence and its far-reaching societal repercussions. The dynamics behind the broader involvement of students from multiple institutions remain unclear, further complicating the turmoil and pointing to unresolved grievances and institutional rivalries. The death of Abhijit Halder underscores the complex issues that defy straightforward interpretation, instead demanding thorough exploratory research.

Starting from November 18, students of Dr Mahbubur Rahman Mollah College approached the medical college authorities over several days to resolve the crisis. However, they were unable to achieve the desired outcome. In cases involving allegations of medical negligence, it is imperative for hospital authorities to conduct thorough and transparent investigations of the circumstances of the death, identifying any lapses by attending physicians and publicly sharing the findings. These incidents underscore the pressing need for greater accountability and transparency within the healthcare system to minimise the recurrence of such events to an acceptable level. The hospital should establish a dedicated team with a well-defined system in place to address and resolve conflicts effectively. This team should be equipped to intervene in cases of alleged negligence or any form of casualty, ensuring timely mitigation and improved conflict resolution. Moreover, physicians in every emergency department must respond promptly to accident victims and terminally ill patients, leaving no room for delays, negligence or lapses in care. Strengthening patient safety protocols and fostering trust within communities should remain a top priority.

This event highlights the fragility of both formal and informal security frameworks within educational institutions, the shortcomings in conflict de-escalation strategies and the communication gaps that intensify such crises. Educational institutions should establish and enforce a disciplinary code of conduct, overseen by an internal committee. Additionally, a management committee should be tasked with implementing proactive, dialogue-driven programmes in schools and colleges to foster understanding and prevent conflicts.

Systemic reforms in crisis management with law enforcement are imperative, along with enhancing their capacity to prevent and manage crises effectively, ensuring public safety, and minimizing the recurrence of similar incidents. Despite being under significant pressure, the police reportedly sought to de-escalate the conflict through negotiation, leading to the closure of Dr Mahbubur Rahman Mollah College on the day a large crowd paraded through Dhaka’s streets and marched towards the college. Overwhelmed by the sheer number of people, the police refrained from using non-lethal or lethal means, citing concerns that any such action could lead to an uncontrollable situation, severely damaging the police’s public image and undermining the ethos of law enforcement. It is noteworthy that Gen Z effectively mobilised students from other colleges, including Shaheed Suhrawardy College and Kabi Nazrul Islam College, through social networks that operate largely beyond the reach of law enforcement oversight.

The death of Abhijit Halder exposed deep discord and divisions among students who had previously united under a common platform, leveraging social networks to play a pivotal role in the July-August uprising against the regime of Sheikh Hasina. This rift culminated in a violent confrontation when a large group of students, primarily from Shaheed Suhrawardy College and Kabi Nazrul Islam College, armed with improvised weapons marched seven kilometres to Dr Mahbubur Rahman Mollah College. They vandalised the institution, looted portable items and left behind widespread destruction and chaos. The damage, as reported by the authorities, amounted to Tk 50 crore that could have been better used to establish a robust diagnostic facility.

The critical shortcomings in Bangladesh’s healthcare system such as a shortage of specialists, inadequate infrastructure, declining quality of care in public hospitals and systemic issues like misdiagnoses, unprofessional behaviour and insufficient consultation times have eroded public trust and severely impacted patients’ psychological well-being. These failings have fuelled a surge in medical tourism, with many Bangladeshis seeking treatment in countries such as India, Thailand, Singapore and Malaysia, drawn by perceptions of superior care and advanced technology. This trend not only tarnishes the reputation of local health care but also drains an estimated $4–5 billion annually from the foreign exchange reserve, with nearly a half spent in India, which has seen an 83 per cent increase in Bangladeshi patients over three years.

Indian health care, though perceived as cost-effective, often charges international patients up to three times the fees paid by domestic patients. Additionally, payment options are limited to cash in dollars or card transactions, both of which are subject to fluctuating exchange rates. Popular hospitals in cities such as Delhi, Mumbai and Bangalore vary in quality. The visa process in Bangladesh has faced criticism for being slow, time-consuming and overly cumbersome. Additionally, the discourteous behaviour of some staff has further exacerbated the disappointment of applicants. On arrival in India, patients encounter additional hurdles such as unnecessary airport protocols. The recent fall of Sheikh Hasina has further strained Bangladesh-India relations, leading the Indian government to suspend all visas, including medical visas, while some organisations in India have refused services to Bangladeshi visitors. As a result, Bangladeshi patients are increasingly seeking treatment options in countries such as Thailand and Singapore.

India’s visa restrictions on Bangladeshis, though disruptive to medical travel, offer a unique opportunity, a blessing in disguise, for Bangladesh to reform its healthcare system and move towards self-reliance. By addressing systemic flaws through investments in advanced technologies, specialist training and improved service delivery, Bangladesh can enhance quality, efficiency and trust in its healthcare services. Tackling issues such as unprofessional behaviour, unnecessary procedures and poor physician-patient communication is essential, alongside increased public funding, policy reforms and fostering public-private partnerships that prioritise community welfare. Initiatives such as global accreditation, telemedicine and health information systems can further elevate standards and expand access. These measures would not only restore trust and retain patients but also reduce economic losses and dependency on foreign medical services.

Dhaka has seen a notable growth in medical facilities, including medical colleges, hospitals and diagnostic centres, aimed at delivering advanced healthcare services. By prioritising improvements in infrastructure, modern technology integration and digital platforms, Bangladesh can move towards self-reliance in health care. A key strength is the success of its pharmaceutical industry, which meets 98 per cent of domestic medicine demand and exports cost-effective generic drugs to over 151 countries. This global recognition bolsters the healthcare sector, saves foreign currency and ensures accessible, high-quality treatment for patients, positioning Bangladesh as a significant player on the international pharmaceutical market. During the Covid outbreak, Bangladesh demonstrated remarkable resilience and self-reliance by combating independently and delivering extraordinary healthcare services without external assistance.

Bangladesh’s healthcare system, despite a notable progress in areas such as maternal health and rural accessibility, remains marred by systemic issues such as inadequate funding, insufficient infrastructure and declining trust in public hospitals. The death of Abhijit Halder and others underscores the pressing need for accountability, transparency and systemic reforms to address patient-provider conflicts and broader institutional deficiencies. While rising medical tourism reflects a lack of confidence in local services, it also signals an opportunity for transformative healthcare reforms. By investing in infrastructure, technology, and human capital and fostering public-private partnerships, Bangladesh can enhance its healthcare delivery and restore public trust. Sustainable reforms in this direction will not only reduce dependence on foreign medical services but also bolster the nation’s economy and health outcomes.

Dr Md Motiar Rahman is a retired deputy inspector general.