Akram Sidiqui
In the mosaic of North India’s distinguished healthcare institutions, the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) stands as a sentinel of advanced medical care, offering critical support to hundreds of thousands of patients each month.
Situated in the heart of Srinagar, SKIMS has long established itself as the premier tertiary care center for Jammu and Kashmir.
Or simply a beacon for those in need of specialized interventions and advanced diagnostics.
Despite its praiseworthy role, SKIMS is frequently subject to public scrutiny and is often criticized for lapses that stem less from negligence and more from the overwhelming demand placed upon it. The reality is that SKIMS, though robust in its infrastructure and manpower, cannot singularly shoulder the burden of critical care for the entire Union Territory. The systemic inadequacies across district and sub-district hospitals render it a default destination for referrals, even when many cases could—and should—be managed at the local level.
What lies beneath this referral cascade is a far graver concern: the absence of basic critical care infrastructure in peripheral regions. In remote districts such as Kupwara, Bandipora, and Poonch, hospitals may possess physical structures and personnel, but are critically deficient in lifesaving equipment. Ventilators, the cornerstone of intensive care, are either absent, non-functional, or unusable due to inconsistent power supply and lack of trained staff. These areas face not a shortage of compassion, but of clinical capacity.
A report published on May 4, 2025, in a local daily revealed the grim distribution of ventilators in the UT. While over 2,000 ventilators have been procured, only 1,747 are operational, and those are concentrated in a few urban centers. Districts with high patient loads and poor transport connectivity are left with no functional ventilatory support. In Bandipora and Kupwara, not a single operational ventilator is available, placing patients in severe respiratory distress at significant risk of mortality.
The standard guidelines recommended by the World Health Organization (WHO) suggest that every district hospital with a capacity of 200–300 beds should be equipped with 5–10 ventilators. Sub-district hospitals with 100–200 beds should have at least 3–5. The current state of affairs in J&K falls alarmingly short of these benchmarks. While on the other hand , many ventilators remain idle, not due to mechanical fault, but because of lack of technical training among healthcare workers or absence of biomedical engineers for maintenance. Moreover, erratic power supply in remote districts makes even functioning ventilators practically unusable.
Consequently, patients with manageable conditions, such as Acute Respiratory Distress Syndrome (ARDS), sepsis-induced respiratory failure, exacerbations of chronic obstructive pulmonary disease (COPD), or trauma-related complications, are indiscriminately referred to SKIMS, further burdening an already strained system. SKIMS, with around 100 ventilators, often operates at maximum capacity, leaving critical patients waiting for intensive care unit (ICU) beds in emergency holding areas or general wards.
The disparity between public and private healthcare is stark. In Srinagar and Jammu, private tertiary centers are equipped with functional ICUs, adequate human resources, and modern monitoring systems, accessible only to those who can afford them. Meanwhile, government hospitals in rural areas struggle to maintain oxygen pipelines, let alone advanced ventilatory support. For the economically disadvantaged, this gap in access is not just inequity, it is a clinical emergency.
Nonetheless, recent developments provide cautious optimism. Through initiatives under the PM Cares Fund, new equipment is being procured, skill development programs are being rolled out, and digital accountability mechanisms are under discussion. SKIMS itself is undergoing infrastructural expansion, and there is growing recognition of the need for decentralized critical care.
However, time remains the most critical factor. For patients in Kupwara and Bandipora, progress on paper offers no solace when a child in respiratory failure requires immediate mechanical ventilation. The window for life-saving intervention is narrow, and systemic delays often turn treatable conditions into fatalities.
To rectify this imbalance, a multi-pronged approach is essential, for that robust training programs for medical officers, nurses, and paramedics in ventilator use and critical care protocols.
Deployment of biomedical engineers in each district hospital to ensure timely maintenance of equipment.
Investment in infrastructure, including reliable power supply and oxygen generation units.
Telemedicine support systems to assist peripheral centers in decision-making during emergencies.
Let us no longer allow geography to dictate survival outcomes. The breath of a critically ill patient in Poonch or Kupwara is as sacred as one in Srinagar. Let ventilators not be symbols of privilege, but tools of equity. Let them function not only in well-lit ICUs, but also in the modest corners of our remote district hospitals.
For in the valley where life and nature entwine so intimately, may the rhythm of a ventilator must not become a rare privilege, but a right, a pulse of hope, accessible to one and all who dare to survive.
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