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NEW DELHI - Hundreds of thousands of patients in India unnecessarily experience excruciating pain, Human Rights Watch said in a report today. Restrictive drug regulations, lack of training for health care workers, and poorly integrated care result in needless suffering for patients because they cannot get inexpensive and effective pain medications.
The 102-page report, "Unbearable Pain: India's Obligation to Ensure Palliative Care," found that many major cancer hospitals in India do not provide patients with morphine, despite the fact that more than 70 percent of their patients are incurable and likely to require pain treatment and palliative care. Health centers offering services to people living with HIV similarly do not have morphine or doctors trained to prescribe it.
"India's health care system abandons so many patients to severe pain," said Diederik Lohman, senior health and human rights researcher at Human Rights Watch. "They are left to suffer; many told us that their pain was so bad they would prefer to die."
Severe pain is a common symptom among cancer patients, particularly during the last stages of the disease. It is estimated that more than 1 million advanced cancer patients in India experience severe pain in any given year. In addition, many other patients, including those with HIV, TB, or other infections or illness, may face acute or chronic severe pain.
The report identified three key obstacles to improving the availability of pain treatment and palliative care:
"India is one of the world's largest legal producers of opium, the raw material for morphine," Lohman said. "But almost all of it is exported while hundreds of thousands - if not millions - of Indians suffer needlessly."
The report focuses specifically on the availability of pain treatment for cancer patients. It says that, based on official morphine consumption reports, fewer than 4 percent of patients with advanced cancer have access to appropriate pain treatment. The report also says that increased government funding for cancer has not emphasized palliative care.
"The Indian government deserves credit for investing in regional cancer centers and increasing funds for cancer control," Lohman said. "But without specific efforts to ensure that all cancer hospitals can treat pain and offer palliative care, these funds will do little to relieve the suffering for patients with advanced, incurable cancer."
The report is the first by an international human rights organization to examine access to pain relief medicines from a rights perspective. Human Rights Watch believes that governments have an obligation to ensure that essential medicines, including morphine, are available to patients and that health care workers receive adequate training in their use. The report says that the failure by the Indian government to fulfill this obligation violates the right to health.
Human Rights Watch further argues that the government's failure to ensure that cancer hospitals offer pain treatment may violate the prohibition against torture and cruel, inhuman and degrading treatment because of the widespread nature and severity of the suffering it causes. Human Rights Watch says that much of this suffering could be prevented with relatively basic and inexpensive steps.
Selected Quotes from Patients
"It felt as if someone was pricking me with needles. I just kept crying [throughout the night]. With that pain you think death is the only solution."
- Priya, Hyderabad, a woman with breast cancer
"My leg would burn like a chili on your tongue. The pain was so severe I felt like dying. I was very scared. I felt that it would be better to die than to have to bear this pain. [I thought], just remove the leg, then it will be alright. Just get rid of the leg so I'll be free of pain."
- Dilawar Joshi, Hyderabad, a Nepali man with a bone tumor
"I would sleep maybe an hour and a half per night. I could take any number of sleeping pills [without effect]. With morphine, I can relax. This place [the palliative care unit] is heaven-sent..."
- Shruti Sharma, Hyderabad, a breast cancer patient
"I had pain in my back and both legs. My legs twisted into an abnormal position. My legs would turn inside and my toes up. It was a pricking pain that was excruciating. I could not sleep as the pain was particularly bad at night."
- Pillai, Trivandrum, a patient with spinal TB and HIV
"I developed severe pain all over the abdomen and in the area of my genitals. It was a continuous, throbbing pain that radiated to the back. It made me very irritable and frustrated. I went back to the doctor three or four times to say that I had pain and wasn't getting any relief. I would get new medicines but they would still provide no relief."
- Kamala Kanwar, Jaipur, patient with cervical cancer
Human Rights Watch is one of the world's leading independent organizations dedicated to defending and protecting human rights. By focusing international attention where human rights are violated, we give voice to the oppressed and hold oppressors accountable for their crimes. Our rigorous, objective investigations and strategic, targeted advocacy build intense pressure for action and raise the cost of human rights abuse. For 30 years, Human Rights Watch has worked tenaciously to lay the legal and moral groundwork for deep-rooted change and has fought to bring greater justice and security to people around the world.
"There must be accountability for this administration's dangerous disregard for our national security," said one Democratic congressman and former military prosecutor.
U.S. National Security Adviser Mike Waltz and members of his staff have created at least 20 group chats on the encrypted messaging app Signal to coordinate official work on sensitive policy issues around the world, four people who were added to such groups told Politico.
Waltz was already under fire for a group chat about the U.S. bombing Yemen when the report broke. Politico's Dasha Burns wrote on Wednesday that "none of the four individuals said they were aware of whether any classified information was shared, but all said that posts in group chats did include sensitive details of national security work."
The anonymous sources told Politico that the group chats involved policy issues involving China, Ukraine, Gaza, the Middle East, Europe, and Africa. One of them said, "It was commonplace to stand up chats on any given national security topic," one of the four sources told the outlet.
The Politico article comes a day after The Washington Postreported that Waltz and other members of President Donald Trump's National Security Council conducted official government business via their personal Gmail accounts, which are far less secure than Signal chats.
The fresh revelations also come as "Signalgate"—in which Waltz, Defense Secretary Pete Hegseth, and other top Trump administration officials added a journalist to a Signal group chat about plans to bomb Yemen—still smolders.
Calls for Waltz's resignation or firing, which were already numerous in the wake of Signalgate, mounted Wednesday.
Resign.
[image or embed]
— Senator Ed Markey ( @markey.senate.gov) April 2, 2025 at 2:26 PM
"Waltz must resign. Hegseth must resign," Rep. Ted Lieu (D-Calif.), a member of the House Foreign Affairs Committee, said on the social media site Bluesky. "There must be accountability for this administration's dangerous disregard for our national security."
Referring to the Signal group chats, Rep. Jimmy Gomez (D-Calif.) asked on the social media site X, "How many more are there?"
"Even Trump allies say this doesn't pass the smell test," he added. "National Security Adviser Waltz and Pete Hegseth need to be fired."
"He's taking a sledgehammer to the economy and pursuing unpopular, reckless trade policies that will do nothing to benefit workers and only serve to increase costs for consumers," warned one expert.
After U.S. President Donald Trump announced long-anticipated sweeping tariffs at the White House Rose Garden on Wednesday, economists, labor leaders, American lawmakers, and other critics reiterated that the move will negatively impact people worldwide.
The president revealed that on April 5, he will impose a 10% tariff on all imported goods and additional penalties for dozens of countries, including major trading partners—ignoring warnings that, as Jeffrey Sachs wrote in a Common Dreams opinion piece, his "tariffs will fail to close the trade and budget deficits, raise prices, and make America and the world poorer."
Trump's related executive order states that he finds "that underlying conditions, including a lack of reciprocity in our bilateral trade relationships, disparate tariff rates and nontariff barriers, and U.S. trading partners' economic policies that suppress domestic wages and consumption, as indicated by large and persistent annual U.S. goods trade deficits, constitute an unusual and extraordinary threat to the national security and economy of the United States."
The order adds that the "threat has its source in whole or substantial part outside the United States in the domestic economic policies of key trading partners and structural imbalances in the global trading system," and declares a national emergency.
NBC Newsreported Wednesday that "global markets reacted sharply and swiftly... with investors fleeing U.S. stock indexes and companies that rely on global supply chains seeing their stocks plummet." The outlet noted that Dan Ives, an analyst at the investment firm Wedbush Securities, wrote, "President Trump just finished his tariff speech at the White House and we would characterize this slate of tariffs as 'worse than the worst case scenario' the street was fearing."
Trump framed this step in his trade war as "liberation day" and claimed that the duties are "reciprocal," but economists pushed back. Justin Wolfers at the University of Michigan said: "Trump announces his tariffs, which are (somehow?) related to the trade barriers other countries are imposing on the U.S. But... THE NUMBERS HE'S PRESENTING BEAR NO RELATION TO REALITY. It would be absurd to call these reciprocal tariffs. They're grievances."
Groundwork Collaborative executive director Lindsay Owens
said in a statement that "Americans have one simple request of President Trump: lower prices. Instead of answering the call, he's taking a sledgehammer to the economy and pursuing unpopular, reckless trade policies that will do nothing to benefit workers and only serve to increase costs for consumers."
"But Trump doesn't care about what happens to working families, as long as his billionaire donors and advisers are happy," she continued. "Republicans are already
chomping at the bit to use any potential tariff revenue to fund their next massive billionaire tax break."
Kobie Christian, a spokesperson for the national campaign Unrig Our Economy, similarly concluded that "there is no other way to say it—this is an out-of-touch policy designed by a billionaire and for billionaires."
"Virtually no one will benefit from these Republican-backed tariffs—except for the ultrawealthy who will get yet another tax break, paid for by working families," Christian added. "Small business owners will be forced to raise their prices to keep their businesses afloat, and Americans will have to pay even more for everyday goods. These tariffs could even push the economy into a recession. American workers need lower costs, not more tariffs and billionaire handouts."
American Economic Liberties Project's Rethink Trade director, Lori Wallach, declared that "the businesses that profiteered from our old broken trade system should pay for the necessary transition to more balanced trade, not American workers and consumers. President Trump must take immediate action to stop corporations from using the pretext of these tariffs to price gouge the very Americans already slammed by decades of bad trade policy and corporate greed."
Wallach was among those who pointed out that tariffs can be a vital tool. She explained that "Trump's announcement goes much broader, but tariffs against mercantilist countries like China, Germany, Korea, Taiwan, and Japan to counter systemic trade abuses can help restore America's capacity to produce more of the critical products needed for American families to be healthy and safe and for our country to be more resilient and secure."
"But to deliver more American production and good jobs, the goal must be to balance trade, not equalize tariff rates, and tariffs must be consistent," she stressed. "Tariffs must be accompanied by other industrial policies like tax credits to build demand for U.S.-made goods, incentives for investment in new production capacity and bans on stock buybacks, and easier union formation so gains go to wages, not just profits."
The only thing being liberated today is money from the bank accounts of hard-working Americans.
— Robert Reich ( @rbreich.bsky.social) April 2, 2025 at 5:21 PM
Liz Shuler, president of the AFL-CIO, the nation's largest federation of unions, also said that "the strategic use of tariffs can be an effective tool to support our industries and protect jobs at home. But they must be accompanied by policies that invest in our manufacturing base and a strong commitment to promoting workers' fundamental right to organize trade unions and bargain collectively."
"Unfortunately, the Trump administration's attacks on trade union workers' rights at home, gutting of the government agency that works to discourage the outsourcing of American jobs, and efforts to erode critical investments in U.S. manufacturing take us backward," she asserted. "We will continue to fight for trade policy that prioritizes the interests of working people without causing unnecessary economic pain for America's working families."
Some congressional Democrats shared similar criticism. Michigan Congresswoman Debbie Dingell said that "when used strategically, tariffs are a critical tool to bring back jobs and support American workers and industries," but "I'm concerned about the chaotic and immediate implementation of these wide-reaching tariffs."
U.S. Rep. Jimmy Gomez (D-Calif.)
wrote on social media that "Trump's dumb tariffs are going to drive up costs for real working people. Like the dad who is trying to save money by fixing his car at home. Those parts from AutoZone are made somewhere else and the prices will go up!"
As the White House circulated a multipage sheet of targeted countries, Gomez and Rep. Sean Casten (D-Ill.) were among those who noticed that Russia—which is waging a yearslong war on Ukraine—is absent from the list.
Meanwhile, as critics including Aaron Reichlin-Melnick at the American Immigration Council highlighted, the list included the Australian territory of the Heard Island and McDonald Islands—even though the islands are "completely uninhabited."
"Population zero. I guess we're going to tariff the seagulls?" quipped Reichlin-Melnick. "It kind of feels like a White House intern went through Wikipedia's list of countries and just generated this list off of that with no further research."
Organizer Max Berger
wrote on Bluesky Wednesday, "I like how no one knows whether the president of the United States is going to tank the global economy because he's a fucking idiot—or if he's just doing a bit."
"Trump is clearly comfortable weaponizing Social Security for political purposes, and we fear that this is only the beginning," said one critic.
The top Democrat on the U.S. House Oversight Committee on Wednesday led calls for the resignation of acting Social Security Administration Commissioner Leland Dudek following the revelation of internal emails confirming that the SSA canceled contracts with the state of Maine as political payback after Democratic Gov. Janet Mills publicly defied President Donald Trump in support of transgender student athletes.
The emails—which were obtained by House Oversight Committee Ranking Member Gerry Connolly (D-Va.)—show that Dudek ordered the cancellation of enumeration at birth and electronic death registration contracts with Maine, even though SSAd subordinates warned that such action "would result in improper payments and potential for identity theft."
"These emails confirm that the Trump administration is intentionally creating waste and the opportunity for fraud."
Dudek—who is leading the SSA while the Senate considers Trump's nomination of financial services executive Frank Bisignano—replied to the staffer: "Please cancel the contracts. While our improper payments will go up, and fraudsters may compromise identities, no money will go from the public trust to a petulant child."
He was referring to Mills, who stood up to Trump in February after the president threatened to suspend federal funding for Maine unless the state banned transgender girls and women from participating on female scholastic sports teams.
The termination of the enumeration at birth contract briefly forced Maine parents to register their newborns for a Social Security number at a Social Security office, rather than checking a box on a form at the hospital as is customary, before the SSA reversed its decision.
Connolly sent Dudek a letter demanding that he "resign immediately" and submit to a transcribed interview with House Oversight Committee Democrats. Connolly wrote that Dudek "ordered these contracts terminated" as "direct retaliation" for Mills' defiance, "even though you knew that doing so would increase improper payments and create opportunities for fraudsters."
Government accountability advocates also condemned Dudek's actions.
"These emails confirm that the Trump administration is intentionally creating waste and the opportunity for fraud—in this case, to punish Maine Gov. Janet Mills for not bowing down to Donald Trump," Social Security Works president Nancy Altman told Common Dreams.
"The people actually punished by these actions were exhausted new parents in Maine, forced to drag their newborns to overcrowded Social Security offices in the middle of a measles outbreak," she continued. "Thankfully, the Trump administration had to quickly reverse course after massive public outrage. But Trump is clearly comfortable weaponizing Social Security for political purposes, and we fear that this is only the beginning."
"Once again, we see Team Trump resorting to revenge to set domestic policy."
Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare, told Common Dreams that "it does not surprise us at all that this administration would weaponize Social Security against anyone who disagrees with or challenges President Trump."
"It's one of the concerns that we have with Elon Musk and [the Department of Government Efficiency] having access to everyone's personal data without any defensible explanation for why they need it," he continued. "We and the American people have legitimate worries, not only that this information will be vulnerable to hackers, but also that it could intentionally be misused as a weapon against anyone who publicly disagrees with Trump."
"The fact that the acting commissioner himself publicly admitted that he didn't really understand the Maine contract, but canceled it anyway, proves that this administration is making reckless changes that affect real people for no legitimate reason," Richtman added. "Once again, we see Team Trump resorting to revenge to set domestic policy."
The revelation of Dudek's emails comes amid SSA turmoil caused by the termination of thousands of agency personnel in what Trump, Musk, and other Republicans claim is an effort to reduce waste and fraud. Musk—who recently referred to Social Security as the the "biggest Ponzi scheme of all time"—has proposed the elimination of up to 50% of SSA's workforce and has said that up to $700 billion could be cut from programs including Social Security, Medicare, and Medicaid.