BARAMULLA, India – The biting cold seeped through the cracks of the health facility in Tangmarg in northern Kashmir as 23-year-old Madiha* wrapped her shawl tighter around her shoulders. She had barely stepped inside when the lights flickered—and then went out.

A tense silence fell over the dimly lit corridor before the deep, guttural roar of the backup diesel generator filled the air. Thick, acrid smoke curled into the room, stinging her nose and leaving a metallic taste on her tongue. Patients huddled together, their breath visible in the freezing air, while nurses rushed around under the weak glow of emergency lights.

Madiha’s experience is an everyday crisis for health facilities across Kashmir, the northernmost region of India bordering Pakistan – a predominantly Muslim region that is part of disputed territory with Pakistan.

Across the region, hospitals battle chronic electricity shortages that have increased reliance on polluting diesel generators that spew toxic emissions into already pollution-choked air. Poor waste management in rural hospitals compounds problems.

These systemic failures, which get worsen every winter, not only cripple healthcare services but also fuel respiratory illnesses and waterborne diseases, turning hospitals from places of healing into sources of environmental and public health hazards.

Climate change reduces hydropower 

“We rely on diesel generators, but they often fail,” said a doctor who asked not to be named, at a hospital in Baramulla where daily power cuts often stretch beyond five hours, leaving critical patients in distress.

“For patients with respiratory illnesses, the fumes and the lack of consistent oxygen supply make it unbearable.”

Some 112 Primary Health Centers (PHCs) and 710 sub-centers across the territory of Jammu and Kashmir (J&K) operate without electricity, according to official data. 

But the situation on the ground is far worse, according to residents who report frequent and prolonged blackouts that force hospitals to depend on diesel generators. 

J&K’s electricity derives from hydropower, and a combination of climate change and neglect has reduced the region’s supply – particularly in winter where lower rainfall, drier conditions and glaciers freezing dramatically reduce water levels in rivers.

During the winter of 2024, hydropower generation plummeted by 65% to a mere 250 MW – a stark decline from the region’s capacity of 1,140 MW. The shortfall left hospitals scrambling to keep the lights on, often at the cost of public health.

“We have endured power outages lasting up to eight hours. This is particularly dangerous for healthcare,” said policy expert Abrar Dar, speaking to Health Policy Watch in Srinagar. “Generators have a load limit, and exceeding that capacity can disrupt critical medical services.”

Dar also pointed out the stark disparity in electricity access across India. “I often stay in Delhi, where 24/7 power is a given. Why don’t we have the same in Jammu and Kashmir?”

Despite spending ₹55,254 crore (over $6,3 million) on power purchases over the last decade, the region continues to face chronic shortages. 

While only 3.8% of healthcare facilities in India lack electricity, the number is 10.7% in Kashmir, highlighting central government neglect and the region’s severe healthcare infrastructure crisis.

Kashmir sells hydropower 

For rural Kashmiris, power shortages are a harsh, generational reality. Ishtiyaq Wani, 64, has lived with it his entire life.

“For 60 years, I’ve heard on the radio how fast the world is moving,” Wani said. “Decades ago, I heard about people going to the moon, yet despite Kashmir having its own hydropower projects, we still have to beg for electricity.”

Kashmir’s 13 hydropower projects have generated 48,808 million units (MU) of energy over the last decade. But during the bleak winter months, the regional power utility, Jammu and Kashmir State Power Development Corporation (JKSPDC), is forced to buy electricity from private companies.

It has been unable to recoup these costs from consumers so JKSPDC is forced to sell up to half the electricity it generates in the summer to private companies to recover its winter costs.

“J&K has vast hydropower potential, but most of our electricity is sent to the national grid or sold to other states,” explained social activist Muhjeeb Wani from Budgam. 

The central government’s refusal to fund three major hydropower projects – Kiru, Ratle, and Kwar – in the 2025-26 financial year has further delayed much-needed infrastructure.

Diesel generators worsen air pollution

Diesel generators, used as a lifeline during blackouts, are also major contributor to air pollution including black carbon, further endangering public health.

“Thousands die each year from pollution, yet despite having our own hydropower projects, we continue to suffer from electricity shortages,” said Mukhtar*, a 24-year-old from North Kashmir, frustration evident in his voice. “Hospitals, which are supposed to heal people, are instead worsening the climate crisis.”

According to the World Health Organization, air pollution-related death rates in India are approximately 140 per 100,000 people. Reports suggest that 10,000 people die each year in J&K due to PM2.5 exposure.

Beyond electricity shortages, improper medical waste disposal poses another health hazard. Many rural hospitals dump hazardous biomedical waste in open areas, contaminating drinking water and farmland.

“Hospital waste is thrown into streams, and we’re forced to drink polluted water,” said Mukhtar.

A 2019–2020 Jammu and Kashmir government report found that only 35.6% of the 1,518.91 metric tons of solid waste generated daily was treated. Although this figure improved to 63.1% by 2020–21, over 500 tons of garbage remain untreated every day. 

Last September and October, Kashmir reported over 130 cases of Hepatitis, highlighting a growing public health crisis. 

“Water pollution has multiple causes, but hospital waste should never be dumped in open areas,” Dr Shazaib Mir told Health Policy Watch. “It must be safely disposed of, or incinerated. Waterborne diseases claim millions of lives every year.”

In a 2017 study of 500 households in North Kashmir, a third of the 3,185 individuals surveyed suffered from waterborne diseases, including diarrhea, Hepatitis A and gastrointestinal infections. 

“These illnesses are only part of the struggle,” says Mukhtar. “In winter, Kashmir’s crumbling healthcare system collides with another deadly reality—impassable roads.”

In winter, healthcare is a challenge

On paper, J&K has a network of government-run hospitals and health centers. But in reality, harsh winters between November and February turn medical emergencies into life-or-death struggles.

“If an emergency strikes in winter, we have no choice but to carry the patient on our shoulders, walking for eight kilometers,” says Nasreena*, a heart patient from Nilsar, a remote town in Kashmir.

“We locals have somehow adapted to these challenges, but what if a tourist has a medical emergency? What will they do?” 

A record 2.95 million tourists visited J&K in 2024. In critical cases, patients have to walk over eight kilometers for proper care, which can turn fatal in sub-zero temperatures.

On 10 March, a helicopter landed in Tulail, a snowbound village, to rescue 27 stranded passengers including a pregnant woman in urgent need of medical attention. But such interventions are rare.

For most Kashmiris, winter isolation means making treacherous journeys on foot, often with tragic consequences. In Baramulla, 54-year-old Mumtaza* suffered a heart attack one freezing night. With no ambulance and no accessible roads, her family carried her for six kilometers through knee-deep snow. By the time they reached the hospital, she had passed away.

“My aunt could have survived if help had reached us,” says her niece, Mehnaaz*. “Instead, we walked for hours, and she died on the way.”

Official data states that 11.5% of healthcare facilities in Jammu and Kashmir remain inaccessible by all-weather roads, but locals insist the reality is far worse. Without urgent investment in road infrastructure and emergency transport, more lives will continue to be lost—not just to illness, but to the sheer inability to reach medical care in time.

Starved of investment

At the heart of Kashmir’s healthcare crisis is a severe lack of investment in infrastructure. While India has steadily increased healthcare spending in other regions in recent years, development in Jammu & Kashmir continues to lag, with underfunded hospitals, poor road networks, and an unreliable electricity supply exacerbating the situation.

According to the National Health Profile 2023, India spends only 2.5% of its GDP on healthcare, one of the lowest rates of major economies 

This chronic underfunding is reflected in the state of health infrastructure, where rural health facilities lack electricity, medical equipment, and essential drugs. 

The situation is worse in J&K, where there was a slight dip in the health budget allocation for 2024-25, according to the Jammu and Kashmir Economic Survey (from ₹8,362.28 crore in 2023-24 to ₹8,333.45 crore).

The healthcare sector’s struggles are also reflected in the shortage of health workers. J&K faced a shortfall of 700 doctors and specialists at Primary Health Centers (PHCs) and Community Health Centers (CHCs) in 2022-23, according to a health ministry report. In many remote areas, a single doctor is responsible for thousands of patients, making access to timely medical care nearly impossible.

For Kashmiris, these systemic failures translate into daily struggles – from mothers giving birth in candle-lit rooms to elderly patients gasping for air in smoke-filled wards, and families carrying their sick along snowbound mountain trails. 

Experts warn that without a significant increase in healthcare investment, improved road connectivity, and a reliable power supply, thousands more will continue to bear the brunt of a broken system – year after year.

*Some patients asked not to be identified by their full names.

Image Credits: Arsalan Bukhari.