Why hundreds sleep outside AIIMS at night

On November 2, Arvind arrived at the All India Institute of Medical Sciences (AIIMS), New Delhi, from Uttar Pradesh’s Firozabad with his father. Fifteen days and several tests later, doctors told him he had blood cancer. For Arvind, renting a room in the national capital was out of the question.

When The Tribune met him at the underpass right outside India’s largest Central Government’s tertiary care hospital, he said, “I checked the rest house, but can’t afford to pay every day. The doctor said my treatment may cost around Rs 3 lakh and I’ve already spent Rs 70,000.”

So, the underpass outside Gate No 1 of AIIMS Metro Station is where he will stay put for the next six months.

Arvind, who has many other AIIMS patients for company, says they all sit on pavements during the day, eat outside and return to the underpass to sleep at night.

For hundreds of patients navigating healthcare at AIIMS, the underpass outside the facility turns into an impromptu shelter every night.

The grey-tiled walkway is always lined with people from states like Bihar, Uttar Pradesh and Jharkhand, their attendants in tow.

Until security personnel throw water to disperse them from public land, families spread thin sheets on the floor, some curling around their bags, others sitting upright, guarding medical documents and belongings.

The air is cold, space cramped and exhaustion palpable.

Day in and day out, AIIMS continues to draw millions due to its specialised care at nominal costs, and the burden at its outpatient facilities is only growing.

Dr Nirupam Madan, Medical Superintendent, said as a whole, AIIMS sees an average Outpatient Department (OPD) footfall of around 15,000 patients per day. She explained that the New Rajkumari Amrit Kaur (RAK) OPD block, which started in July 2020, alone accounts for roughly half of this number, with an average daily footfall of 7,000-7,500 patients, which can rise to 8,000 on Monday and Thursday.

Around 60% of the patients come from poorer states such as Bihar and Uttar Pradesh.

Morning queues outside AIIMS, especially for first-time OPD visitors, often stretch 200 metres or more, as people clutch referral slips and Aadhaar cards, hoping for just a few minutes with a doctor.

The numbers and the sight of patients shivering along the Ring Road at night pushed AIIMS to create Ashray, a night shelter that can accommodate 300-500 people. Started in December last year, Ashray is jointly managed by the Central Reserve Police Force (CRPF) and AIIMS. It remains a rare shelter facility for needy patients in any public tertiary care hospital in the country.

Six CRPF personnel are permanently deployed at Ashray, with a Patient Care Coordinator and a Patient Care Manager and AIIMS security stepping in when the rush increases. Between 9 pm and 11 pm, five electric shuttles make nearly 20 trips to ferry patients from Gates 1 and 6 to the shelter.

The shuttle coordinator explains that around 150 tokens are distributed every night.

To avoid overstay, Ashray only facilitates an overnight halt. No one is allowed in after 11 pm and at around 4 am, before the sun rises, patients from Ashray are dropped off at the OPD. This cycle continues every day.

Inside Ashray, long tents, covered in dark weatherproof material and held up by metal frames, are packed with mattresses placed edge to edge. Blankets, bags and water bottles are tucked beside each person. Fire extinguishers sit at the entrances, cables snake across the ground and floodlights keep the space bright through the night. Toilets and drinking water are available nearby.

Large tents can hold 150 people each, smaller ones fit around 12. On weekdays, 300-400 people stay there, on Sunday, the number rises to nearly 700 as patients arrive early for heavy OPD days like Monday. Chronic patients are assigned two separate tents.

“We try to never turn away a patient,” a CRPF constable managing the shelter said. Food from AIIMS kitchens arrives at 10 pm and is distributed on a first-in basis.

To accommodate the huge crowd of attendants who come with patients, often in numbers more than two, AIIMS operates three more rest houses on campus, with a combined capacity of around 950-1,000. Two rest houses are run by AIIMS and one is operated in collaboration with Power Grid and an NGO. Rooms cost Rs 10-25 per day.

The allotment is based on recommendations from treating doctors. Stays can be renewed weekly, but high demand means long waiting lists. “We have digitised the allotment process so that families can track their status,” Dr Madan explained.

Asked how much more capacity is required to meet the overwhelming demand, Dr Madan noted, “India is a country of 1.42 billion people, and everyone wants to come to AIIMS, New Delhi,” she said, adding that there is no straightforward answer.

She also pointed out that although several new AIIMS have been set up, health remains a state subject and many states still struggle with both the quality and quantity of healthcare services.

“Some southern states have performed well...they have better purchasing power, but northern states require much more public support,” she said.

New AIIMS hospitals, she said, are tertiary-care centres and typically such institutions take nearly a decade to develop fully. “While the hope is that these hospitals will eventually ease the load on AIIMS Delhi, that has not happened yet,” she added.

Meanwhile, the crowd outside AIIMS fails to settle. Those coming for OPD consultations still spill onto pavements, footpaths and the metro underpass.

Many are aware of Ashray, but can’t reach it in time, or prefer to sleep closer to the hospital gates, where queues begin forming before dusk.

Shamim from Rampur, Uttar Pradesh, sat on a pale cloth inside the underpass as his young daughter slept against his shoulder. His wife was in the emergency ward. “My wife and daughter are inside. I’m waiting here because we can’t go home. The underpass feels safer than the pavement,” he said.

Further down, 55-year-old Bhuran Paswan from Madhubani, Bihar, waited for his thyroid test the next day. “The test is scheduled for tomorrow. I’ll stay here till then,” he said, keeping his bag between his feet so it is not kicked in the crowd.

The clock showed 11 at night, outside Gate No 1 of AIIMS, Pankaj from Mathura sat with his wife and nine-year-old son. After suffering chest pain, he had visited the cardiology OPD earlier and was briefly admitted before being discharged around 9 pm.

“There’s no bus back home at this hour. We’ll stay here through the night and leave in the morning,” he said, folding his arms against the cold.