Tussles between patient party and the healthcare professionals, ranging from verbal spat to even assaulting the healthcare professionals are not uncommon in India, including Manipur.The recent conflict in Manipur between patient party and healthcare professionals has exposed deep fractures in the doctor-patient relationship at many healthcare centers of Manipur, especially at the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) and Regional Institute of Medical Sciences (RIMS) in Imphal.
What Sparked the recent conflict in RIMS?
There are two incidences that has sparked the recent public outrage, or so to say, how the patient party allegedly blaming the healthcare professionals for their negligence to save valuable lives. The trigger incident appears to be as a 50-year-old man, Yambem Sanjoy, died shortly after being discharged from RIMS. His death led to a mob assault on the attending doctor and vandalism of hospital property.
Second Tragedy: During the chaos, a 35-year-old woman, Chingshubam Ongbi Manju, died from childbirth complications in the ICU. Her family and local groups then assaulted another doctor, escalating tensions
Healthcare Workers’ Response
When discussed with one of the senior practitioners/professionals at JNIMS who don’t want to be named, argues that, “is there any doctors who wants to take his/her patient’s life?”. He claimed that they tried their best to save any lives, irrespective of the patient’s background in term of religion, caste, creed, gender, and so on. As per the opinion of the concern physician, “many lives lost not only in Manipur, but also lost lives in the Western and developed countries too, even if their health infrastructures are supported by skilful doctors and medical facilities with advance technology”.
No doubt, he also admits that there is always a black sheep within any professional sector, including medical professionals, but as he opines, “condemning the entire medical fraternity would be less fruitful”. He implored that targeting and seeing all the doctors to be murderer is very unfortunate. He also opines that many doctors are thinking about leaving Manipur or leave their professions for all, fearing for their safety and the securities of their family members.
Such things stem from the continuous exposure to violence, abuse, and the threat of it leads to burnout, anxiety, and “compassion fatigue” among healthcare workers. This mental state can inadvertently affect their interaction with patients, creating a vicious cycle of disconnection and mistrust.
As such, it is suggested that institutional mental health support, counseling services, and de-briefing sessions for staff following critical incidents may be in place. Protecting their psychological well-being is essential for maintaining a compassionate workforce.
As the aftermath of the assault on healthcare professionals at RIMS recently, the healthcare system in Manipur came in limbo for a while, ultimately terrorising the entire poor and helpless patients. There were strike action follows, as doctors, nurses, and staff at RIMS launched a 24-hour strike, suspending all services including emergency care, outpatient departments, and surgeries. They demanded justice and protection. They also demand medical associations called for the arrest of those responsible for the assaults and urged the government to ensure a safe working environment for healthcare professionals
Public Reaction and Ethical Debate
Following the unfortunate incidences, there follows civil society criticism. Groups like the Youth Forum for Protection of Human Rights criticized the strike, citing alleged medical negligence and the deaths of five patients in recent weeks.
Some commentators also reflect on ethical manifestations. Commentators emphasized the need for compassionate communication between doctors and grieving families. Emotional disconnects, lack of transparency, and perceived indifference can fuel mistrust and violence
Underlying Issues
The antagonistic and confrontational situation between the patient party and the medical professionals may premised on two major issues, namely, a) systemic stress, and b) the breakdown of trust.
While the report published on the website of the Director of Health Services, Government of Manipur, all the doctors rendering service in the State (Public+ Private) the doctor population ratio of the State is quite good at around 1 doctor per 1635 population. This actually doesn’t meet the criteria of WHO’s standard of 1:1000 doctor-patient ratio. Well, the report also says that the ratio is without accounting the AYUSH doctors in the State. Unfortunately, their (supposedly) healthy picture apparently does not reflect on the ground in practical sense, as most of the patient, particularly the poor, invariably tried to hit the road for either RIMS or JNIMS. Ultimately, many healthcare professionals argue that doctors and nurse operate under immense pressure, often with limited resources and high patient loads.
On the other hand, it is an observable fact that the patient parties also have less options with them, as the Sub-centers, Primary Health Centers, Community health Centers, and District Hospital are most non-functional and less effective (even if equipped with optimum amount of medical facilities), which is in contrast to the health care systems in Kerala. This ultimately lack trust among the people. If fact, this issue is becoming an issue of cultural question that stems from widespread corruption and dishonesty of the bureaucratic and political leaders of the state – Manipur.
What makes Kerala’s primary health centers (PHCs) “effective”?
First, Kerala’s healthcare system is premised on decentralization, where local bodies (Panchayats) have significant control over health centers, ensuring local accountability.
Second, it is all about staffing. As per Dr V.K. Paul, member (health) of the NITI Aayog, says, Kerala has fewer vacancies for staff nurses at primary health centres (PHCs) and community health centres, and medical officers at PHCs – important for immediate medical intervention (ThePrint, 2018). Further, Kerala PHCs are reliably staffed with doctors and nurses, which builds community trust.
Third, Kerala have a very strong preventive care system. A strong focus on public health and preventive care reduces the burden on tertiary hospitals.
Explicitly state that for Manipur to emulate this, it requires political will to empower local governance in health and a strategic focus on revitalizing PHCs and CHCs, not just pouring resources into RIMS and JNIMS.
In fact, the failure is often not just of individual doctors but of hospital administration and protocols too. One may raise questions like, what is the role of the Medical Superintendent or Hospital Director in such crises? Why there was absence of a swift, institutional response—a designated spokesperson? These things are a clear protocol for handling adverse events, and immediate engagement with aggrieved families. Lacking such things often escalates isolated incidents into full-blown conflicts.
Accordingly, families, meanwhile, face emotional trauma and expect accountability. The absence of clear communication and empathy during medical crises can turn grief into confrontation. This was exactly what has happened in the recent crisis in RIMS, where the concern authorities allegedly disowned their responsibilities, fleeing and escape the site, keeping quiet and haven’t clarifies either through press conferences or promptly tried to pacify through peaceful dialogues with the grieving party.
The “Third Space” of Media and Social Media:
The role of media in shaping public perception is crucial but underplayed. In the immediate aftermath of a tragic incident, sensationalist media reporting and the rapid spread of misinformation on social media can inflame public sentiment, create mob mentality, and make rational dialogue impossible. This puts immense pressure on healthcare institutions before all facts are known.
As such, it is recommended that healthcare institutions and professional bodies need a proactive media and communication strategy. They should be trained to communicate with empathy and transparency during crises to counter misinformation and manage public expectations.
Path Forward
A multi-pronged approach is essential to break this cycle of violence and mistrust. To prevent such tragedies from recurrence, one may ponder on transparent communication about risks and prognosis, provided that the institutional safeguards are in place. In fact, Hospitals must establish robust crisis communication protocols and dedicated Patient Relations Offices to ensure transparent, empathetic, and timely dialogue with families, especially during adverse events. One must not neglect the cultural sensitivity and emotional support for grieving families.
On the other hand, legal accountability for violence against healthcare workers and destructions of public property should also be there. The psychological safety of healthcare workers is paramount. Institutions must provide mental health support to staff to prevent burnout and compassion fatigue, ensuring they can continue to provide empathetic care.
While violence against healthcare workers must face swift legal consequences, a parallel, accessible system for addressing patient grievances through medical arbitration and mediation should be promoted to provide a fair and faster recourse than the courts.
A significant factor in the trust deficit is the perceived lack of a fair, accessible mechanism for addressing medical negligence. The current options—approaching the courts or the Medical Council of India (now National Medical Commission)—are slow, expensive, and adversarial.
It may also suggest that the concern authority may introduce the concept of strengthening medical indemnity insurance and promoting mediation and arbitration as faster, less confrontational alternatives for resolving disputes. This provides a legitimate path for patients seeking justice without resorting to violence.
One may also propose that hospitals have a dedicated “Medico-Legal Cell” or “Patient Relations Office” that acts as a buffer and a communication channel between clinicians and families, especially when a patient’s condition deteriorates or death occurs.
Healthcare institutions must also proactively engage with the media and civil society to manage narratives, counter misinformation, and build public awareness about the challenges and limitations of medical science.
This case is a sobering reminder that healthcare is not just clinical—it’s deeply human. Healing requires trust, and trust demands empathy on both sides.
Lastly, the concern authorities may look into the success stories from the states like, Kerala, which may be applied and implemented, if necessary. Mention may be made here that Kerala’s healthcare system is widely admired both within India and internationally for its inclusive, efficient, and people-centered approach.
For such things to apply in Manipur, systemic strengthening is very vital. The government must genuinely commit to decentralizing healthcare. Learning from Kerala, the focus should be on making Sub-centers, PHCs, and CHCs functional and trustworthy, which will reduce the overwhelming burden on tertiary centers like RIMS and JNIMS. It is from the empirical experience that most of the peoples of Kerala would visit the sub-center, or primary health centers before directly heading to the main hospitals. If the lower healthcare centers deemed necessary to refer the patient to higher centers or main hospital for further examinations, they do so accordingly. This reflects how effective are the healthcare centers in this state, and how these things have developed as a culture in Kerala. Unfortunately, such culture is hardly visible in Manipur. Kerala’s model proves that healthcare excellence isn’t just about money—it’s about vision, equity, and community engagement.
The writer has a PhD. from University of Deusto, Bilbao, Spain. He may be contacted at rameshningthoujam@gmail.com
