Malnourishment by design

While analyses of the devastating floods in Pakistan and cholera pandemics in India focus on climate change and the lack of adequate sanitation, the overarching impact of colonialism and poor governmental policies cannot be ignored.

As Alberta announces plans to erect a statue commemorating the legacy of Winston Churchill, it bears reminding that his ethnocentric policies are believed to have led to the Bengal Famine of 1943, not local drought, crop failure or overpopulation. The Bengal Famine – in what was then a province of British India but is now Bangladesh, the Indian province of West Bengal and the eastern portion of India –  illustrates the detrimental impact of colonial policies on nutrition and chronic disease impacting millions of people.

The partition of India was one of the most catastrophic upheavals in human history. The Indian Independence Act 1947 was voted upon by British parliamentarians, creating two countries out of the single British colony. These two countries, India and Pakistan (East, now Bangladesh, and West Pakistan, now Pakistan), were separated by arbitrary lines drawn by Lord Radcliffe. During partition and the mass transfers of Muslims, Hindus and Sikhs, more than 14 million people were displaced and almost 2 million people died or went missing. Beyond this, British colonization itself had a tremendous role to play in the malnutrition and poverty we see today across Pakistan, India and Bangladesh – three countries, which combined, house nearly one quarter of the Earth’s population.

The extraction of goods from colonized countries like India financed the industrialization of Western Europe and British settler colonies. As the extraction intensified over 200 years, the per capita consumption of grains among colonized Indians decreased significantly. Many famines have historically been attributed to droughts and crop failure. However, the Bengal famine in 1943 is largely recognized to be anthropogenic, or man-made. Bengal’s economy was predominantly agricultural in the 1940s. While the historical focus has been on crop shortfall in late 1942 (as per the “food availability decline” theory), grain shortage due to damage from a cyclone and crop disease was not the sole cause of the famine.

The inability to import and access domestic rice, coupled with prioritized distribution and war-time inflation, transformed a food shortage into famine and death.

Due to British wartime policies and fear of a Japanese invasion during the Japanese occupation of Burma, John Herbert, then Governor of Bengal, issued a directive in March 1942 for all “surplus” unmilled rice and other foods in Bengal to be removed or destroyed. This was coupled with confiscation of tens of thousands of boats by the British army, authorized by “British denial policies.” While done to deny transport to the invading Japanese army, the destruction of rural boats led to a disruption of the livelihoods of Bengal’s fishermen as well as a dissolution of existing transport and market systems for the movement of rice.

British financing of military efforts led to war-time inflation – a deliberate colonial policy implemented by Churchill in which more money was printed for military expenditure. A “Foodstuffs scheme” also was concocted by the Bengal Chamber of Commerce (composed of primarily British-owned firms) in which food was preferentially distributed to “higher priority individuals,” including the war industries, the military and civil servants. In other words, food was stripped away from the poor to provision troops.

The inability to import and access domestic rice, coupled with prioritized distribution and war-time inflation, transformed a food shortage into catastrophic famine and death.

By November 1943, deaths by starvation peaked and disease overtook as the main cause of mortality. As is the case across all famines, starvation, resultant malnutrition and opportunistic infections spiraled in a vicious cycle. There is substantial evidence that protein energy malnutrition (PEM) leads to reduced functional T cell counts, reduced serum complement activity and increased undifferentiated lymphocytes that all increase the risk of respiratory infections, malaria, TB and infectious diarrhea. Malaria and diarrheal illnesses thus took hold in Bengal, which was already stripped of social infrastructure and struggling with overcrowding and poor sanitation.

The Bengal famine is an important example of how large-scale imperial policies can directly and catastrophically influence the nutrition and overall health of a nation. In medical training, we are taught about the unequivocal link between public health policies and local disease burden but, at a broader level, national policies have the power to veer a nation off course. We need look no further than our own backyard, where the Government of Canada approved nutritional experiments on Indigenous children in residential schools. Deliberate malnourishment has been employed as a weapon across human history.

Approximately 3 million deaths have been attributed to the Bengal Famine of 1943. On this 75th year post-partition, it is worth remembering that Churchill once maintained that “the famine was their own fault for breeding like rabbits.” But it is the undernourished peoples of South Asian countries who shoulder the legacy of their predecessors. They faced colonial attitudes and policies, now recognized as powerful social determinants of health, that led to mass hunger and preventable diseases.