His collar bone and ribs protrude out rudely. Muscles seem to have left his arms long ago. The gentle layer of fat has vanished off his face, the cheekbones and chin starkly jutting out. As his mother helps him wear a shirt, each vertebrate is clearly seen on his back. The hips simply don't exist. Skin and bones- that's all there is to him.
One look at 15-year-old Santosh Singh and the tell-tale signs of malnutrition seem obvious. Doctors are the only ones who can diagnose it. However, no doctors have visited him yet.
On May 15, Santosh underwent a major surgery as he suffered from abdominal tuberculosis. His intensities had all knotted up and an operation was necessary. Two weeks later when he was discharged on May 29, all hell broke loose as flash floods ravaged the Himalayas.
The Singh family lives in the mountain village of Pinola Ghat, less than 20 kms from the town of Joshimath in Uttarakhand's Chamoli district. They had to abandon their homes after the flood as the land along the river has weakened and could collapse any moment. The waters of Alaknanda river washed away their agricultural land too. Homeless, they now live in a government tent.
Their new home now is a government provided tent. A million flies move in and out, making their way from the tent to a make shift stable for their mules. Some first squat on the dung littered all over, and then the uncovered dry chapattis, onions and potatoes. Santosh's post-operative wound still hasn't healed, the risk of infection is only obvious.
"Since the floods, our difficulties have increased. Problem is where do we get the medicines from? The government has given us rations, but what about medicines? We used to feed him fruits, eggs and vegetables as per the doctor's advice. How can we get that now?" his mother Maisuri Devi explains sitting on the ground.
On the only bed in the tent, Santosh and his father Laxman both squeeze in together, sharing one blanket.
"Not one doctor has come," Laxman replies entering into a bout of heavy cough. "I'm unwell also. I have this horrible cough and fever for the past three months."
Earning just Rs 4000 a month, the disaster snatched away his livelihood. Santosh urgently needs a nutritious diet and roof to rest and recuperate. But their destitution is too severe to afford this.
Though the village is easily accessible, and the government has provided them with rations and compensation, what's strange is that government doctors have still not reached them- a fact indicating that the shortfall of doctors in the state is serious.
It was only the visit of the NGO, Save the Children, which highlighted this family's dire situation. "The living conditions are not right. The tent is dirty and there is a horse stable right beside and that could infect him. On the face of it, it does look like a case of malnutrition. He needs urgent medical attention," advises Avinash Singh, Programme Coordinator, Save the Children.