“I had an Ayushman card, yet I was denied free treatment. I spent nearly Rs.3 lakh, but even then I couldn’t save my daughter,” recalls Rajesh Yaduvanshi, his voice quivering with grief. “All I can remember now is her voice. She had just begun to form sentences, much faster than most children her age.” He works as a security guard in Nagpur, Maharashtra, while his family resides in the Parasia municipality of Madhya Pradesh’s Chhindwara district.
On September 14, his two-year-old daughter, Jayesha, was admitted to a local clinic run by Dr Praveen Soni. “She had been suffering from pain and fever. After receiving treatment, we returned home. Her pain subsided, but on September 20, the fever returned. From September 20 to 22, she was admitted to Dr Soni’s clinic—[he is] a government paediatrician who also operated a private practice—where tests confirmed she had typhoid. After two to three days of treatment, she had some relief and was discharged again,” Rajesh told Frontline. “On September 23 and 24, her fever returned, accompanied by severe breathing difficulties. On September 25, we took her to a different doctor in Chhindwara. The treatment continued until 2 am. After reviewing her reports, the doctor informed us that her kidneys had stopped functioning and advised us to take her to Nagpur immediately. We reached Nagpur around 6 am and admitted my daughter to a private hospital,” he said.
Overwhelmed by the mounting bills at the private hospital, Rajesh was forced to move Jayesha to a government facility, where she remained from September 28 to October 7, when Jayesha succumbed to acute kidney failure.
Since early September, 24 children from Madhya Pradesh—the majority from Chhindwara, with others from the neighbouring districts of Betul and Pandhurna—and Rajasthan have died. Three more children remain in critical condition in Nagpur. Most of the victims come from tribal communities and lower-income families.
The killer drug
The culprit in these cases? A cough syrup. Manufactured by the Tamil Nadu–based Sresan Pharmaceutical, the medicine was marketed under the name Coldrif. Tests revealed that the syrup contained diethylene glycol (DEG), a toxic industrial solvent that can prove fatal, triggering acute kidney failure when ingested.
Many syrups, particularly those containing paracetamol like Coldrif, employ propylene glycol as a solvent. This compound also serves industrial purposes: as an antifreeze, heat-transfer fluid, and emulsifier, among others. Consequently, two distinct grades of this raw material exist: an industrial grade, which may contain elevated levels of DEG; and a pharmaceutical grade, where contaminant levels must remain strictly within permissible limits. DEG, or even ethylene glycol, can infiltrate syrups either when industrial-grade propylene glycol is utilised in production or when companies neglect to rigorously test raw materials for contaminants before use.
On October 1, as reports of child deaths linked to cough syrups dominated the headlines, Tamil Nadu’s Drugs Control Department raided Sresan Pharmaceuticals’ facility in Kancheepuram, Tamil Nadu. The inspection uncovered 39 critical and 325 major non-compliances under the Revised Schedule M (Good Manufacturing Practices) and Schedule L1 (Good Laboratory Practices) of the Drugs Rules, 1945.
Also Read | A strong dose
Officials documented unhygienic conditions, leaking equipment, and the use of non-pharmaceutical-grade raw materials, including propylene glycol contaminated with DEG. Laboratory tests on a batch of Coldrif syrup manufactured at the facility (Batch No. SR-13) revealed 48.6 per cent weight by volume of DEG, which is nearly 500 times above the permissible limits of the toxic substance linked to acute kidney failure. The facility’s licence was due to expire in 2026.
History of DEG poisoning
India, regrettably, has a history of multiple incidents of DEG poisoning. In 1998, 33 children died after consuming a syrup contaminated with DEG. In 2020, 17 children died in Ramnagar, Jammu and Kashmir. Beyond India, around 70 children succumbed in The Gambia in 2022, while another 17 lost their lives in Uzbekistan. Both international incidents were linked to cough syrups manufactured by facilities in Haryana and Uttar Pradesh.
Several States, including Delhi, Tamil Nadu, and Kerala, have now banned the sale of Coldrif. The WHO has also voiced concerns over gaps in India’s drug safety regulations. India’s drug regulator has flagged three contaminated cough syrups—Coldrif (Sresan Pharmaceuticals), Respifresh (Rednex Pharmaceuticals), and ReLife (Shape Pharma)—and forwarded the findings to the WHO.
Shivani Thakre, 24, the mother of a child who died after consuming Coldrif cough syrup, in Parasia municipality of Madhya Pradesh’s Chhindwara district, on October 9. A photograph of her deceased child is in the background.
| Photo Credit:
PRIYANSHU SINGH/REUTERS
The first cases of child deaths linked to cough syrup came to light as early as September 3, yet it was only on September 16—nearly a fortnight later—that the Madhya Pradesh government launched a survey in the Parasia block of Chhindwara district. What began as a handful of unexplained cases of kidney failure among children quickly escalated into one of the gravest public health crises in the State’s history.
Kavita Jham, a social worker from Chhindwara associated with the NGO Jan Swasthya Abhiyan India (JSAI), has been tirelessly coordinating with parents and doctors, both in Nagpur and Chhindwara, since the tragedy. Speaking to Frontline, Jham highlighted the systemic flaws in the healthcare infrastructure that contributed to the tragic deaths. “I have been working in the sector since 2008. Setting aside the COVID era, this is the single largest tragedy I have seen. The medical infrastructure is in a shambles. Chhindwara does not have a single dialysis unit, forcing parents to travel 150 kilometres to Nagpur for treatment,” she said. “Junnardeo Hospital, the largest government facility in the district, does not even have a paediatric specialist. There is no dedicated children’s hospital, and this has been the case for around 15 years,” she said.
“If the government says ‘Jan Jan Swasthya’ [health for all], then why isn’t it reaching the public?” she asked. Jham alleged that parents were often denied access to their children after they are admitted, receiving only the child’s body in the end. She gave the example of a child named Hanutiya, admitted in the neighbouring district of Betul, who is also a relative of Rajesh Yaduvanshi.
Amulya Nidhi, JSAI national convenor, said: “This is not an isolated incident. Over the past few years, the situation has been deteriorating steadily, with the healthcare system in a pathetic state. If you examine the broader health indicators, the crisis is extensive: malnutrition and other endemic issues persist. In the last three months alone, there have been alarming episodes: in Indore, for instance, two children died in a government hospital after severe lacerations caused by rat bites,” he said.
The JSAI has written to Madhya Pradesh Chief Minister Mohan Yadav urging his immediate intervention and an impartial investigation into the regulatory failures that precipitated this tragedy. The organisation has also demanded a comprehensive audit of drug quality and a judicial inquiry to safeguard against future incidents and to hold those at fault accountable.
Issues flagged by CAG
The Comptroller and Auditor General of India, in its November 2024 report, highlighted Madhya Pradesh’s failure to submit annual drug plans, delays in tenders, shortages of essential medicines in hospitals, and the presence of 263 types of expired drugs in Chhindwara and facilities in other areas, underscoring significant deficiencies in drug management.
Similar findings were presented in the Madhya Pradesh Assembly, revealing that 138 of 229 drug samples tested in government laboratories between April 2021 and June 2025 were deemed “substandard”.
The JSAI has also written to the Union Health Minister urging that the State’s Food and Drug Administration (FDA) be strengthened, the number of drug inspectors to be increased, and the implementation of the recommendations of the 2003 Mashelkar Committee report.
“The onus of this tragedy does not rest solely on private hospitals. This time, many children were taken to government facilities where they were prescribed Coldrif syrup. Why did they seek care in government hospitals? Because of free medical services and the Sardar Vallabhbhai Patel Nishulk Aushadhi Vitran Yojana, which provides free medicines. The government must act decisively and fulfil its responsibilities. It needs to immediately prohibit all adulterated cough syrups,” Nidhi told Frontline.
The government is now talking about random quality sampling of all drugs. “But who authorised the approval in the first place,” asked Nidhi. The issue transcends one State and involves multiple jurisdictions. The central drug administration authority [Central Drugs Standard Control Organisation] issues licences for drugs and the ministries are responsible for ensuring both licensing and quality verification. Once a drug reaches a State, such as Madhya Pradesh, the State Drug Controller, the Madhya Pradesh Food and Drug Administration, and the highest authority, the Commissioner, bear collective responsibility for the distribution of these medicines— whether to pharmacies, private hospitals, government facilities, or elsewhere. Accountability lies squarely with them,” said Nidhi.
On October 5, the authorities constituted a Special Investigation Team (SIT) to probe the cough syrup deaths. Led by an Assistant Commissioner of Police from Madhya Pradesh, the SIT raided the manufacturer’s factory near Chennai on October 8. Ranganathan Govindan, the owner of Sresan Pharmaceutical, the company that produced the contaminated cough syrup, has been arrested and placed in 10-day judicial remand by a Chhindwara court. The Madhya Pradesh government has also suspended two drug inspectors in Chhindwara and Jabalpur, along with a Deputy Controller of the FDA, while transferring the Controller.
Ranganathan Govindan, owner of Sresan Pharmaceutical, which manufactured Coldrif, being taken to a court in Chhindwara, on October 10.
| Photo Credit:
PTI
Dr Soni, the government paediatrician who also operated a private clinic, was taken into custody and is now under judicial remand. Dr Soni, who had prescribed Coldrif to several children, has been charged with negligence causing death. The FIR against him also names the syrup manufacturer. An inquiry into Dr Soni—who was suspended within hours of the FIR—concluded that his negligence had caused “irreparable harm” and “tarnished the department’s reputation”.
Speaking to the media, Dr Soni said he had prescribed the syrup to children over several days as part of routine primary care. “The syrup is not a one-day treatment. I have been prescribing medicines from this company for over 10 years. It’s incorrect to suggest that a primary doctor determines the formulation; we receive sealed, ready-to-use medicines,” he said.
Protests against Soni’s arrest
The country’s medical fraternity has rallied against Dr Soni’s arrest. Nearly 8,500 doctors in government hospitals across Madhya Pradesh staged protests, condemning the action and demanding his release.
The Federation of All India Medical Association has written a letter to the Union Health Ministry expressing concern over the glaring gaps in drug regulation. The association urged the government to release Dr Soni immediately and emphasised that any disciplinary or legal action should be undertaken only after a thorough investigation is concluded.
Similarly, the Tamil Nadu chapter of the Indian Medical Association (IMA) condemned the arrest of Dr Soni. Dr S. Karthick Prabhu, secretary of the IMA’s Tamil Nadu chapter, stressed that the doctor had not endorsed the product and the issue pointed to regulatory failures. “The arrest of the doctor is unjustified. It is the manufacturer’s responsibility to ensure the quality of the drug,” he said.
Dr R.V. Asokan, former national president of the IMA, observed that the contamination was rooted in greed and profit. “Pharmaceutical-grade propylene glycol and glycerine are costly, so they must have substituted them with an industrial-grade solvent. When a substance is replaced with a non-active or unapproved ingredient, it constitutes a spurious drug under our definition, and that is precisely what triggered this tragedy. There is no way for a doctor prescribing an approved drug to ascertain whether it is contaminated or not. When a medicine is approved and overseen by a regulatory authority, we prescribe it in good faith,” he said.
Mariama Kuyateh, 30, with a picture of her late son Musa, who died from acute kidney failure, in Banjul, The Gambia on October 10, 2022. The WHO said cough syrup produced by India-based Maiden Pharmaceuticals could be responsible for the deaths of 66 Gambian children, most under five years old.
| Photo Credit:
MILAN BERCKMANS/AFP
Back in 2022, when child deaths linked to cough syrups occurred in The Gambia and Uzbekistan, the government was compelled to mandate the testing of all syrup batches intended for export at Central or State drug-testing laboratories.
Experts, however, questioned why only export-bound drugs were being scrutinised. “Setting aside export drugs, everything released into the Indian market suffers from the same gaps in approval and monitoring. Fewer than 1 per cent of drugs are tested for quality or impurities, and that too at random. Indian citizens are consequently exposed to significant risk, much of which goes unreported or undetected. Although a pharmacovigilance system exists, with a dedicated department to monitor drug safety, its reach on a national scale is minimal and woefully inadequate for India’s size,” Dr Asokan told Frontline.
“A critical regulatory gap emerged due to a policy shift in the early 1990s. Until then, drug approvals were solely under the jurisdiction of the Central government. However, the authority was later devolved to State governments. Consequently, many pharmaceutical companies established operations in States such as Uttarakhand, where regulatory oversight, infrastructure, and human resources for testing and approval remain severely inadequate. This decentralisation, coupled with weak monitoring, has enabled manufacturers to obtain approvals with relative ease.”
Dr Asokan further criticised the arrest of Dr Soni, dismissing it as a mere gimmick designed to divert public attention from the core issue and allow those truly responsible to evade accountability. “You’ve imprisoned the doctor without even granting bail. The judiciary, too, is complicit; they’re culpable because they’ve failed to recognise the absence of a prima facie case. The doctor had no role in this tragedy, yet the courts have overlooked that fact. The Drug Controller is equally culpable. Has that been acknowledged? Where is the accountability in this system? Are they not public servants? Are they not meant to be accountable? Which Drug Controller has resigned? Which Minister has shouldered responsibility? Has the Minister even addressed the issue adequately? What explains this silence when 23 [the toll rose to 24 subsequently] children have died across multiple States?”
Also Read | Behind the Indian cough syrup that killed many in Gambia and Uzbekistan
According to Dr Asokan, there is a certain apathy in the response of the Chief Minister and the government. He said this had long been an issue, and pointed out that the BJP has been in power in Madhya Pradesh for nearly two decades. He referred to the disturbing videos showing rats inside a neonatal care unit in Indore, where infants were bitten and subsequently died from the injuries. “It’s just bizarre,” he said, “such things happen only in movies!”
In a video that went viral, responding during a press conference to a journalist who asks about the deaths of children after consuming cough syrup, Madhya Pradesh Chief Minister Mohan Yadav can be heard saying, “Yeh kal ki baat hai. Kal ki baat aaj mat karo” (That is yesterday’s news. Don’t bring it up today.)
Jaivardhan Singh, a Congress MLA and former Cabinet Minister of Madhya Pradesh, was sharply critical. “The Chief Minister’s comments reveal complete insensitivity. To put it bluntly, it reflects the arrogance that power breeds, the arrogance of position. For him, this is evidently not a significant matter. His casual attitude exposes his mindset and demonstrates his callous outlook towards such critical issues and the healthcare sector as a whole,” Singh told Frontline. He added that the Congress intends to raise the matter in the Assembly and press for the Health Minister’s resignation.
“Where does the buck stop? Why are those in Bhopal getting away scot-free? Why is not a single official in Bhopal being held to account? Why are they not being removed? Why are the senior officers in the health department not being pursued? That will be our principal contention.”
For Rajesh Yaduvanshi, life will never be the same again. “Nothing can bring back my daughter. In a few weeks, everyone will forget what happened, just as they forgot the children in Indore who died from rat bites. I spent lakhs, but still couldn’t save her. Money will come back, but how will I move on?”
