Famine is seldom as multitudinous a cause of death as the disease that it engenders. When poor and homeless people are gathered together in millions subsistence can perhaps reach them, hurriedly erected tents can house them, but disease and especially a disease like cholera can spread rapidly and terribly through the crowds of already weakened people. Such conditions in West Bengal, where the daily flow of refugees coming across the border from East Pakistan is still about 100,000 a day, have pressed a cry for help from Dr. Abedin, the West Bengal Minister of Health.

When a degree of panic is added to the physical difficulties of coping with the refugees the morale of those trying to deal with the problem can easily be broken. That in itself makes the need for effective world assistance and aid the greater. Both the League of Red Cross Societies and the World Health Organization will be ready to respond when any appeal is made to them by the Indian Government.

Certainly cholera is endemic in both East and West Bengal. At this time of the year the incidence commonly reaches its peak. The cholera-infected refugees crossing the border are not therefore an extraordinary phenomenon except in their number. Moreover cholera is a disease that is neither infectious nor contagious.

It is carried by drinking water that has been infected by the excreta of those suffering from the disease. Unhappily these are precisely the conditions most likely to be found where a mass of refugees is inhabiting a hurriedly-erected tented camp, where sanitation is inadequate and where proper controls cannot be exercised.

It follows that if the sufferers from cholera can be separated and kept in isolation while uninfected water supplies are made available to the rest then the epidemic can be brought under control. To prevent the spread of cholera, it is not so much skilled medical attention that is necessary as welfare workers and adequate sanitation. Thus far the Indian Government has kept up with the demand for food and has available enough tents to set up temporary camps, It is the sudden and overwhelming demand for vaccines and other medical supplies that has brought a cry for help from Calcutta.

For the moment deaths among the many thousands affected by cholera are likely to be high. Semi-starved refugees living in temporary camps are unlikely to get the immediate medical attention without which they have small chances of surviving. In such conditions the death rate can go up to as high as eighty per cent. Only the healthier sufferers who get prompt medical attention are likely to be saved—and there will be few of them.

There may for a time be some conflict between saving the lives of those afflicted and the preventive efforts of trying to vaccinate as many as possible of those crossing the frontier. If supplies of vaccine are running short and if the flow of refugees does get worse then the Indian Government should ask for and should be given all the help it needs. In East Pakistan also cholera must be expected and may also be rampant. Fortunately Dacca is well equipped with a cholera research centre run by Seato where ample stocks of anti-cholera vaccine are held, but the political conditions remain very bad.

The best hope is that the flow of refugees will itself soon be tapering off. Such reports as are to be had from Dacca suggest that military operations have now stopped, though it is hard to be sure. Furthermore the onset of the monsoon rains will make movement very difficult even with short distances to the West Bengal border. The Pakistan Government insists that many of the refugees are simply its political opponents seeking refuge in India. If it is faced by 100,000 political opponents leaving every day that is a grim comment on the situation. The political and military crisis which created the refugee flight makes it hard to give aid to those who are still in East Bengal.