On Sunday morning a week ago Raymond Cournoyer, a young French- Canadian who is Oxfam’s field director in Bengal, received a message whose implications appalled him. It came from Mother Theresa, the Indian nun whose work for the poor in Calcutta has become a legend, and who had sent a medical team to work with refugees from East Pakistan in Krishnanagar, 70 miles north of Calcutta on the border between the two Bengals.

“Please send saline water,” the message said, “there is an outbreak of cholera in the camp.” Cholera has been endemic in Bengal for at least a century. About 2,000 people die of it every year in Calcutta. But in normal times, for reasons which health experts do not fully understood, it remains epidemiologically stable. What Mother Theresa’s message meant was that this precarious stability had been shattered at the most dangerous possible moment. Swarming in crowded “camps” many of them no more than pathetic squatters’ settlements without sanitation, with polluted water and no medical help, the five million refugees who have crossed from East Pakistan into India were appallingly vulnerable to a disease which is spread by waterborne bacteria. Once cholera appeared in the camps, last weekend, an epidemic was a certainty: a tragedy of almost unimaginable dimensions was, and remains, a possibility.

Cholera causes such violent diarrhea and vomiting that death can result from sheer dehydration. That is where the saline water comes in: the vomiting is too bad for liquids to be swallowed, so dehydration must be prevented by intravenous injections of saline solution. If this treatment is administered quickly, even without supporting antibiotics a healthy person has a chance of shaking off the disease.

Within an hour after they got Mother Theresa’s message, Cournoyer and his helpers managed to buy 350 bottles of saline water in Calcutta, and load them on to a truck for Krishnanagar. Some idea of the statistical inadequacy of the efforts is conceived by the fact that the next day Dr. Abedin, the West Bengal health minister, said that 1,000 bottles of saline water were needed every day, and that 800 were being received.

SHORTAGE OF FOOD, DRUGS AND VACCINE

By Monday, the West Bengal director of health, Dr. Sahar was talking about a “massive” epidemic in Nadia district, which includes Krishnanagar. Three hundred and fifty people were officially reported to have died of cholera there over the weekend. On Tuesday, the official cholera death count for the whole of Bengal had risen to 900, and by Wednesday to 1,300. And these figures only covered deaths in the camps. Roughly half of the refugees are not in camps yet, and when cholera breaks out in camps, thousands of people panic and leave, taking the disease with them.

Geographically the infection has spread in a way which tends to confirm the Indian government’s contention that it is spreading outward from inside East Pakistan. By Wednesday, Unicef had received reports of outbreaks of cholera in Assam and Tripura, the Indian states, on the far side of East Bengal, separated from Nadia district by the entire breadth of Pakistan territory. By Thursday, Oxfam had received an inquiry from the West Bengal authorities asking what proportion it could meet an order for four million doses of cholera vaccine. And by Friday the government of India was asking Catholic Relief Services in Geneva for eighty tons of various drugs, while the Oxfam office in Calcutta was telexing to Oxford for a whole planeload of saline solution.

Cholera can only be cured with saline injections and antibiotics, if it is caught in time, and if hygienic conditions can be brought up to a safe minimum standard, it can also be partly controlled by vaccination, which is about 60 per cent effective. The process of mass vaccination can moreover be greatly speeded up by using the new jet injection, vaccine gun, manufactured by Schuco International which enables a medical worker to vaccinate 400 people an hour, roughly as many as a doctor could inject in a day without the machine.

Huge quantities of medical equipment are now being sent out to Bengal. Relief workers are all too well aware that, big as the quantities sound, they are too little, and may come too late. For example, some 30 jet injection machines are now on their way; that is substantially less than one machine to each ten camps. Most of the available stock of anti-cholera vaccine held by British manufacturers was flown out yesterday: it comes to 903,000 doses. That is less than one dose between every four refugees; and the refugees, of course, are no longer the only people in Bengal who are in danger of catching cholera.

The Indian authorities have made valiant efforts to provide an acceptable minimum ration for all the refugees. It is not copious: it costs about one rupee, or a little less than a shilling, per refugee per day. Approximately 55 paise (cents) goes to rice and dhal - lentil paste - and the rest goes on cooking oil, fuel, and utensils. Many of the refugees have not eaten for five or six days by the time they cross the frontier; for starving people, these rations are a minimum, but for Bengalis, they are enough. There have already been incidents where Indians gave complained that the Government is giving the refugees more than the Indians have themselves.

Before the refugees get their first rations, they must be registered. The Indian Government therefore has a fairly precise idea of how many refugees there are, and of where they are. One of the most serious factors hampering relief work is the fact that the refugees are spread out along the whole perimeter of East Pakistan, which winds more than a thousand miles from the Ganges Delta below Calcutta, almost up to the Himalayan foothills, round through the hills of Assam, over remote, sparsely populated country with one of the world’s heaviest rainfalls, and down to the Bay of Bengal again on the Burmese frontier.

The refugees are fairly evenly spread out along this frontier. Late last week, taking the districts and states clockwise, the Indians had counted 420,000 in the 24-Pargana district, south-east; in the north 450,000 in Nadia; only 140,000 in Murshidabad , where the Ganges is the frontier and hard to cross; 300,000 in Malda; and 1,200,000 in the flat plains of West Dinajpur district. In Cooch Behar, to the north of East Pakistan, there were at least 700,000 refugees; in Assam some 300,000 - 17,000 as far away as the Himalayan hill station of Darjeeling; over 450,000 in Meghalaya; and in the extreme south-east Indian state of Tripura, which only had 1,500,000 people of its own before the influx arrived, there are 700,000 refugees in more than five hundred camps.
That come to a total of 4,660,000 refugees: a minimum total, since some wealthier people have managed to get to Calcutta or to smaller towns without needing to register in order to get rations. Others may be wandering uncounted, through the countryside.

And refugees are now pouring in at an estimated 100,000 a day. Yet even this staggering total may represent no more than half of the problem. Many Western relief officials are convinced that the exodus will not stop until the last Hindu has left East Pakistan. And there were ten million Hindus in East Bengal before the present emigration begun.

There have been three distinguishable waves of refugees since the crisis began in East Pakistan. The first influx arrived immediately after March 25, the day the Hindu (as well as Bengali) auxiliary forces mutinied in East Pakistan and the West Pakistan army moved in. Significantly, this first wave included some Muslims. The second wave came across the frontier at the end of the first week in May; and the third began growing last weekend. In both cases, the refugees were overwhelmingly Hindus. The refugees show every sign of fear and panic. The Sunday Times arranged for large numbers of refugees to be interviewed by Bengali-speaking reporters of the Hindustan Standard.

NEW DANGERS AS THE MONSOON APPROACHES

The paper’s managing editor, Mr. Aveek Sarkar, concluded that the refugees brought with them “cruel memories of a revolution that failed” - the attempt to establish an independent Bangladesh - and also of a “reign of terror” instituted by the Pakistan army. Worse, the Indian reporters uncovered what they call “disturbing evidence that part of the massacre may even have been deliberate.” “What makes the allegation of a systematic anti-Hindu campaign more plausible,” Mr. Sarkar writes, “is that the army in no way prevented the refuges from crossing the border into India. Part of the cruelty may have been unleashed in order to force Hindus to seek refuge.”

Two examples give the flavour of the repeated stories the reporters were told. Sarat Das, aged 80, said that one day his 40-year-old son, a cobbler in Jessore, did not come home from work. He was told his son had been shot dead. Sudharani Ghose said that her husband was called away from their home by Muslim League volunteers and shot dead in the road. Such stories cannot be corroborated. But they do at the very least suggest that the refugees came in fear, and will not go back to East Bengal so long as the Pakistan army remains in control. One refugee in the camp was asked why he didn’t go back: “I go back only when it’s Bangladesh,” he replied. There is no doubt he spoke for a majority of the refugees.

It is hard to escape the conclusion that the Indian government - which officially regards them as temporary “evacuees” rather than refugees - has got its head in the sand. It is already faced with the almost insuperable administrative, economic and political problems represented by five million refugees. And there is a possibility of up to another five million refugees crossing the frontier. But if the Indian government’s attitude is unrealistic, it is certainly understandable. It is not its fault that the refugees have arrived. They came because of what has happened inside East Pakistan, and that means primarily because of what the government and the army of Pakistan have done.

Then, too, the Indian government is under strong pressure from several directions to get rid of the refugees if it can. There have already been incidents in which the local Indian population has objected vehemently to refugees trying to find work. West Bengal politicians are alarmed at the fertile soil which the refugee camps will make for the Naxalite revolutionaries; and there are already signs of Naxalite activity; including political murder, in the camps.

The Indian government has made great efforts to cope with the influx, given its limited resources, and so have the state governments. The government of Tripura state, especially, has acted with great vigour: it has started work on 26 permanent camps. The Indian government has, for example, employed a private contractor to haul food in a fleet of trucks from the railhead to the Tripura frontier. A large number of private agencies besides Oxfam are active in one way or another: the West Bengal red Cross, Unicef, War on Want, the Save the Children Fund, Catholic Relief Services, the Christian Agency for Social Aid, Christian Aid, CARE, and - not least - the churches. But most private agency officials would probably endorse Raymond Cournoyer’s vehement insistences that “what the private agencies are doing is a drop in the bucket.” The agencies’ contributions are measured in terms of three doctors here, four there, when hundreds are needed of programmes that feed tens of thousands of people when millions are hungry.

Unfortunately, the world’s governments have not been in a hurry to form a human chain themselves. More than three week ago, U Thant made an urgent appeal for special contributions to the United Nations refugee committee. So far, according to the UN, only four countries have made or pledged contributions. Britain gave an initial contribution of £1 million shortly after the appeal. The United States has given $2.5 million of which $500,000 is already with the UN committee. Canada has pledged $2 million worth of foodstuffs and medical supplies, and West Germany has pledged DM 1 million for a start. None of the other 150 odd UN member countries has so far responded - though to be fair Sweden, for example, has made a contribution through the Red Cross instead.

“Once the monsoon comes in earnest”, Raymond Cournoyer says, “you can’t expect people to stay out in the open for two days.” And hundreds of thousands are sleeping in the open. Only half of the refuges are in camps. Probably only the Indian army would have the organized manpower and material on hand to build shelters before the monsoon reaches its peak for the numbers involved. And because of the tense international situation the Indian army is otherwise deployed; guarding the frontier. Unless cholera is under control by the time the monsoon comes, the epidemic will grow; flooding and a rise in the water table will spread the bacteria more rapidly. And the monsoon will bring a new danger with it: typhoid. Only small quantities of anti-typhoid serum have been sent out. Nor will the monsoon bring the end of Bengal’s troubles. For East Pakistan’s rice crop should have been sown before the monsoon. Reports suggest that because of the fighting and the subsequent exodus, hundreds of thousands of farmers planted no rice this spring. There is an obvious danger that after conquest, slaughter and death, famine will visit East Bengal as the Fourth Horseman.

The relief workers are haunted by a more immediate danger. Calcutta lies in the path of the cholera epidemic. A city of no-one-knows how many million - perhaps eight this year, perhaps 12 by the end of the decade. Three quarters of the city lacks sewers or running water. Great tracts of it flood with every monsoon. The Indian government is desperately worried about cholera getting into the city. Already there are 30,000 refugees in a camp almost at the end of the runway at Dum Dum airport. And there is another refugee colony, several thousand strong, even farther into the city near the northern shanty-towns.

“Personally,” says Brigadier Michael Blackman, the Oxfam disaster operation officer, who has just come back from the city, “I think if cholera gets to Calcutta, God help us. It could be like the Great Plague” of London.” “We know what cholera is,” says Raymond Cournoyer, “C’est un feu de foret” (it’s a forest fire). “There are no terms strong enough to say how dangerous it is, if it once caught hold in the area around Calcutta, the whole population of both the Bengals might be decimated.” There are about 110 million people in the two Bengals. That is three per cent of the human race.