The dusty roads out of Surat are choked with every manner of vehicle. Everyone leaving the city is masked against this airborne, invisible killer. The poor, using handkerchiefs bandit-style, are crammed inside and on top of careening buses. Others flee on camel carts, while richer Indians zoom past them in their cars, entire families wearing gas masks or surgical masks. In the back seat of a car, one bored child in a surgical mask taps away at his Game Boy, oblivious to the panic around him.
Despite pleas for people to remain in Surat, a city of more than 1.5 milion, a huge exodus is under way. Surat is on the main road and rail arteries connecting Delhi and the cities of Rajasthan with the industrial capital of Bombay. The obvious danger is that infected refugees will spread the disease far and wide across India.
Already, there are signs of this happening, with outbreaks of pneumonic plague detected in other districts of Gujarat. Hospitals in Bombay and Delhi are also on alert.
At Surat's railway station, there is hardly a free inch on the platforms, as thousands jostle to scramble aboard the next train out. The weary station manager, S C Shukla, a gas mask dangling around his neck, said that yesterday more than 100,000 people had fled the city by rail. 'They shouldn't leave. There's a strong possibility that they'll take the plague to other places, but we can't stop them,' Mr Shukla said. 'Everybody wants to save their own life.'
Thus fate seems to mock this country every time Indians allow themselves the luxury of thinking that life may improve. Until the plague outbreak, Surat was one of India's fastest- growing cities. Virtually all of the world's small diamonds and other gems are cut by workmen here in tiny, cramped sweatshops. Its textile mills and factories attracted labourers from all over the country.
But now several hundred thousand of these workers have abandoned town, running from this variety of plague which can be caught from a cough or sneeze. Unless detected and treated with antibiotics in time, it is invariably fatal - and death can strike within just 24 hours.
Surat's lanes are empty, save for beggars and slum dwellers who have nowhere else to go. I saw about 40 people clustered around a coach, which one slum colony had chartered to drive them out of town. Women masked in handkerchiefs huddled beside their metal trunks as the men haggled over the price. It didn't look as though they would return to Surat for a long time.
As Dr D N Shah, medical superintendent of the Civil Hospital, where more than 200 cases of pneumonic plague are being treated, said: 'I shudder to think what the magnitude of this epidemic will be after migrant workers reach their villages.'
Down on Ved Road, a shanty town built alongside a torrential open sewer, where more than 20 have died so far, men and women queued beside a shuttered shop front where a social worker was handing out tetracycline. The social worker did not have too many capsules, and two armed police stood guard in case he ran out and the crowd turned angry. A mob ransacked one chemist on Friday after exhausting its stocks.
Pneumonic plague is a more virulent form of bubonic plague - the Black Death - which is spread by rat fleas. The authorities are anxiously trying to exterminate Surat's millions of rats. At the railway station and around the slums, men in grotesque plastic masks - presumably after medical supplies of masks ran out, people went to the novelty shops - were sprinkling poison.
It is a dangerous, horrible task, one that few city workers are willing to do; absenteeism is running at more than 70 per cent. Without them, there is nobody to kill the rats nor to clear away the rubbish and dead animals. Surat was deluged by heavy rains a fortnight ago and more than 1,000 cattle were drowned. The stench of their bloated carcasses is everywhere on the roads leading into town.
The number of lives scythed down for sure by the plague is unknown. A single crematorium in Surat, the Ashwin Kumar, has burnt more than 60 plague corpses in recent days. The government in Delhi, which is downplaying the epidemic to avoid needless panic, claims that only 44 people have died in Surat. The true toll is probably closer to 200.
How this epidemic surfaced is a mystery to medical specialists. Having been free of plague for nearly 30 years, India is now beseiged by it. In all, hospitals in Gujarat and neighbouring Maharashtra state, where the bubonic infection has erupted, have nearly 900 plague patients.
It is known that forest rats in central India carried plague-ridden fleas. The suggestion is that last year's Maharashtra earthquake - which killed nearly 30,000 people - may have driven out the forest rats. In swarms of thousands, the rodents descended on the villages.
Many of Surat's labourers come from this poverty-stricken region of central Maharashtra, and doctors are guessing that the plague fleas may have been carried by migrant workers from the earthquake zone. In Surat's foul slums, where more than half the city's inhabitants live, the disease transformed from bubonic plague into the more infectious and even deadlier pneumonic variety.
The question for India now must be how much worse - and widespread - the outbreak will become.
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