Trigger warning: This article contains references to suicide and some people might find it disturbing.

The trees and fields around Palamner were lush green. The road that linked the town, in Andhra Pradesh’s Chittoor district, to the village of Jeedimakulapalle, was lined with sweeping fields growing a variety of pulses, groundnuts, sugarcane and rice.

Despite the plentiful yield around, a sense of gloom lay over the house of Raghav Reddy, who lives in Jeedimakulapalle.

The 54-year-old had been a farmer all his life, but stopped farming two years ago, and now just grows a few vegetables on his field, for his family’s consumption. He has since converted a small room in his house into a shop, from which he sells food items, like chips and biscuits, and other household products. Next to that is a bigger room, with a cupboard, on top of which rested a portrait of his son, with a garland hung around it.

“After his death, we stopped farming,” Raghav said when I met him in mid-May.

He pointed to a bed in the corner of the room, and said, “That is where my son was lying down before we rushed him to the hospital.”

Raghav’s son B Bhaskar Reddy, who worked in Chennai, visited his parents on January 3, 2021. The parents said that Bhaskar had studied hard and done well in his career, securing a good job at a manufacturing company. The company had sent him to South Korea for a training programme, his parents recounted with pride. Raghav showed me Bhaskar’s office identity card, issued by his company.

On the morning of his visit, Bhaskar spoke to his parents, and even interacted with the neighbours – overall, he seemed to be in a pleasant mood. As the day progressed, however, he became agitated, his mother Shanthamma recalled. He snapped at her and suddenly talked about dying.

This took Shanthamma by shock, but she explained that Bhaskar was quite hot-tempered and would argue frequently – so she just assumed he was angry about something. Raghav was not at home, and Shanthamma stepped out of the room where her son was, to tend to some work. A few minutes later, when she returned, she saw that a bottle of green liquid had spilled on the floor – her son stood next to it. She realised that he had consumed some of the liquid.

Reasoning that the bottle contained some kind of pesticide, she called out for help. Within 15 minutes, they were at the Palamaner government hospital. Raghav carried the bottle of the liquid with him to show it to the doctors. On the way to the hospital, the parents assured each other that their son would be fine, since he had only consumed a small portion of the liquid. Bhaskar was still able to stand up, and was speaking properly, so his parents were sure that doctors could help him.

But the minute the doctor at the hospital looked at the label on the bottle, he told the parents plainly, “He is not going to survive.”

The parents protested and explained that their son had not consumed much of the substance at all. “But the doctor said that it didn’t matter, and that there was almost no chance that he would survive,” Raghav said.

The parents didn’t give up. They rushed Bhaskar to Chittoor government hospital. By then, Bhaskar was beginning to feel severe pain in his joints, and was unable to walk. But he was still fully aware of his surroundings and was speaking properly – so, his parents held onto hope.

But at the district hospital too, doctors told the family the same thing: Bhaskar wasn’t going to survive.

Next, the family rushed him to the Christian Medical College in Vellore, around 70 km away. The parents assured the doctor there again that Bhaskar had only taken a small sip of the product.

“Whether it is a whole glass or a teaspoon, death is certain,” the doctor told them.

The parents learnt that the substance Bhaskar had consumed was called paraquat. It was the first time they had heard about the toxic chemical, used as a herbicide. As farmers, they had never used it in their field, the couple said.

Raghav recounted that his son pleaded with him to save his life. “He told us that it did not matter how much the treatment costs, and that he would pay it all back to us after he recovered, but to somehow find a way to save his life,” he said. “But the doctors said there was simply nothing that they could do.”

For a few hours after he consumed the substance, Bhaskar was still able to interact normally with everyone. But after a while, the effects of the poison started to manifest. “He would cry in pain and they had to hold him down,” Shanthamma said, through tears. “It is not something anyone should witness.”

The couple had tried for years to have a child after losing a daughter at birth. “He was born to us after visiting many temples for years,” Raghav said. “We waited so long for a child.”

On Saturday afternoon, Bhaskar slipped into a coma, and the following evening, he passed away.

If you have suicidal feelings, please consider seeking help through the helplines and resources listed here.

Paraquat is the common name for paraquat dichloride, which is used by farmers across the world, and is a non-selective weedicide – that is, it kills all vegetation it comes into contact with.

The substance falls under a category of organic compounds known as viologens, and was first produced commercially in the 1960s. Farmers spray the weedicide on plots of land prior to cultivation and the weeds die within a few days. The chemical becomes inactivated on contact with the soil, so new crops are not impacted.

Paraquat is not only used to get rid of weeds before sowing takes place. Dileep Kumar AD, researcher and member of the Pesticides Action Network explained that it is also used to kill vegetation on the sides of roads, in schools, and any other area that needed to be cleared of weeds. “It is used everywhere,” he said. He added that paraquat did not just contaminate soil, but also posed a risk when it evaporated and remained in the air.

Like many pesticides, it is toxic to those who come in contact with it. What sets it apart from other commonly used weedicides is its lethality – even ingesting small amounts can cause death.

Further, unlike most other common pesticides, paraquat has no antidote. Thus, even if someone who consumes it reaches a hospital, there is no treatment that can be administered to them.

“Paraquat is a rapidly acting, non-selective herbicide,” said Anand Zachariah, the head of the general medicine unit dealing with toxicology at CMC Vellore, which sees paraquat poisoning patients from across Tamil Nadu and Andhra Pradesh, most from agricultural backgrounds.

He added, “In my experience as a toxicology expert, paraquat is the most lethal poison I have encountered.”

Once ingested, the substance is absorbed into the bloodstream, through which it reaches organs such as the kidneys, liver and lungs. Inside the body, it produces oxygen free radicals, which are unstable molecules that damage cells they come into contact with and can kill them.

This results in prolonged injury after consumption, usually leading to death, which can occur in anywhere between a few days and a few weeks.

Shanthamma and Raghav Reddy, who live in Andhra Pradesh’s Chittoor district, lost their son Bhaskar in January 2021. Bhaskar died by suicide after consuming paraquat. Photo: Johanna Deeksha

A study done in CMC Vellore, which looked at six years of data on patients who suffered poisoning with paraquat with suicidal intent, revealed that 80.9% of the patients died in the course of the hospital admission. A very small number, who had consumed low doses of the poison, were discharged alive, but suffered grave organ injuries and lived with the possibility that their conditions would worsen in future.

Paraquat poisoning “is virtually untreatable, with a distressing end,” said Zachariah.

Some patients who consume extremely small quantities and survive develop lung complications long after being discharged from hospitals in a stable condition. Long-term exposure and inhalation can cause severe health issues, and several studies have shown a link between paraquat and Parkinson’s. In the United States, as of March 2022, over 2,000 lawsuits have been filed by individuals affected by Parkinson’s against paraquat manufacturing companies for their role in causing their disease.

The substance is not only dangerous to those who consume it. Kumar said that paraquat remains in the soil even after the weeds die. Paraquat’s “half-life”, or the time it takes for a certain quantity of a pesticide to break down and reduce by half, is six years.

Paraquat is banned in 58 countries across the world. These include several countries in the European Union, the United Kingdom, the United Arab Emirates, China and several African countries. (Though Switzerland and China have banned paraquat, Syngenta, a Chinese-owned company headquartered in Switzerland is the biggest producer of the herbicide.)

In India, however, paraquat remains widely available across the country, despite years of calls from doctors and activists to ban it. “Without a doubt, paraquat should be banned in India,” Zachariah said.

Zachariah was among more than 30 senior faculty of CMC Vellore who wrote a letter citing data from their experience with the compound to the chief ministers of Tamil Nadu and Andhra Pradesh. “As medical professionals with the responsibility of saving lives, we need to bring to your attention the gravity of this problem,” the letter read. “In the interest of thepublic, we request the state government to take necessary action to stop the sales of paraquat by suspending sale license.” They have not received a response yet.

Like with Bhaskar, Afreen Begum, too, asked her family to save her after she consumed paraquat.

Begum, whose family asked that she and they be identified by pseudonyms, was only 20 years old in 2021, when the incident took place. She had been married a few months earlier and was four months pregnant. On the day she drank paraquat, she had come to her parents’ home, in an agitated state. “She had had a fight with her husband,” her brother Rizwan said.

The family, who also live in Chittoor district, are farmers and rear cattle. They used paraquat on a regular basis as a weed killer.

“She suddenly grabbed the bottle and took a sip,” her mother recalled.

Her family rushed her to the Chittoor government hospital. “I told the doctor it did not matter how much it cost, that he had to save her,” her father recalled. “He told us that we could pay him ten lakh, but it still would not be enough to save my daughter.”

Rizwan recalled, “She told us to try and save her.”

When the doctors assured the family that there was absolutely nothing they could do to save Begum, they decided to take her back home. “But just as we took the last turn to our house, she passed away,” her father said, pointing to the road outside.

Since paraquat is largely used in agriculture, it is typically those from farming families, and thus relatively underprivileged sections of society, who consume the substance with the intention of harming themselves.

Many who consume it do so impulsively, without understanding the extent of the damage their bodies will suffer. They are often misled by the fact that several other pesticides, such as certain organophosphates and carbamates, have antidotes, and that patients who consume them can survive after a few days of treatment.

“People don’t know that there is no cure,” Bhaskar Reddy’s mother, Shanthamma said. “If they knew that, they would not consume it.”

The Reddy family believes paraquat should be banned in India. “They should shut down that company that produces it,” Shanthamma said.

CMC Vellore sees cases from around Tamil Nadu and Andhra Pradesh of patients who have consumed paraquat. There is no antidote that doctors can administer in such cases. Photo: Wikimedia Commons

But not all bereaved families hold this view.

Begum’s two older brothers and her parents live on the same plot of land where the incident occurred. Despite the tragedy it wrought on their lives, they continue to use paraquat to this day, forced by the economic constraints they face.

Rizwan explained, “If we have to arrange labour to pull out the weeds, we need to hire at least 30 people, and still it would take days. But with paraquat, we don’t need to hire anyone and it’s a two-day job. As farmers, we are in real need of something like paraquat.”

Begum’s other brother, Ameer, noted, “The weeds dry up within two days, and then all we have to do is carry it and throw it away.”

Rizwan lifted some dry grass off the ground and showed it to me. “This is what happens to the plant,” he said. “The doctor said that once you consume paraquat, your insides also dry up this way.”

When I told him that even extended exposure can have serious health impacts, Rizwan agreed that that could be true. “When I’m spraying it also, half my leg is soaked in the chemical,” he said.

Yet, Rizwan doesn’t think that paraquat should be banned, and insisted that the chemical was only sold to farmers. However, Bhaskar Reddy’s story makes clear that this isn’t the case. His mother Shanthamma guessed that he may have got the substance from a shop near their house.

Raghav, Bhaskar’s father, said, “How is anyone supposed to know that even small amounts can kill?”

Experts argue that the continued wide availability of paraquat is a result of a stark absence of political will to protect the lives of those most at risk from it. “The fact that there is no antidote for paraquat should have caught everyone’s attention,” said Jayakumar C, director of Pesticide Action Network.

He added, “The constitution gives you the right to good quality health, but the government is also allowing the production of a chemical with no antidote. There is a serious fundamental flaw in the way we are doing things.”

Even states that have taken some steps towards banning the substance have failed to do so in the long term.

In Kerala, for instance, paraquat was banned in 2011. The ban was put in place following a much-publicised campaign against the use of the pesticide endosulfan, which had been used widely for more than 20 years in the district of Kasargod, leaving hundreds of families with serious health issues that resulted from exposure to it. These ranged from severe congenital deformities and bodily disabilities to reproductive problems, mental retardation and even death. The campaign against endosulfan resulted in a 2001 ban in Kerala on aerial spraying, and a total ban of the substance in 2010.

Kumar noted that on the heels of this ban, the government also decided to ban 14 other pesticides the following year, one of which was paraquat.

Pesticide manufacturing companies such as FMC India and United Phosphorus Limited, along with pesticide manufacturing associations and several estate owners, primarily cardamom growers, filed petitions in the Kerala High Court, demanding that the ban be revoked. They argued that under the Indian Insecticide Act, 1968, a state government can only ban a pesticide for an initial 60 days, and then an additional 30 days.

In February 2022, the court accepted their arguments, and revoked the ban.

Activists were dismayed. Kumar noted that though under the law only the Central government is allowed to ban a pesticide permanently, “Since agriculture is a state subject, the state should be allowed to ban these products for the benefit of public health.” He added that “on a purely technical basis, the ban was lifted without taking into consideration any of the health implications that it would cause. There was no risk assessment of adverse effects of the herbicide.”

If ingested, paraquat is absorbed into the bloodstream, and reaches organs such as the kidneys, liver and lungs. In the body, it produces oxygen free radicals, which damage and can kill cells. Photo: Johanna Deeksha

Jayakumar C, the director of Pesticides Action Network said that when the ban was ordered in 2011, there was also more political will among leaders in Kerala. He noted that current political leaders in the state were less inclined to fight against the demand for paraquat to be brought back into the market.

“Earlier there was more discussion on public health and opinion,” he said. “Things have changed now and these industries have managed to remove all the obstacles that prevent them from functioning,”

For now, there are no regulations against the use of paraquat in India, and it remains widely used in Kerala and other states. According to a 2015 study by Dileep Kumar, the Central Insecticide Board and Registration Committee has approved paraquat for use in nine crops. But the study found that the use of the substance in six states extended far beyond these nine crops, to 25 crops.

Kumar noted that the herbicide is sold as “moderately hazardous” even though it is lethal, and there is inadequate monitoring of its sale. “During the study, we found that there were several brands producing paraquat,” he said. “Even for medicines you need a prescription but for paraquat, you don’t need one.”

He added, “ Even children can buy it and nobody would stop them.”

The 2015 study also found that often farmers are not sold the products in the proper containers. “Farmers buy and use paraquat in an unsafe manner,” it stated. “It was found that paraquat is sold in plastic carry bags to farmers who demand 100 ml or 200 ml of the product. Neither the retailers recommend personal protective measures while handling paraquat nor do the farmers adopt them.” The study also noted that when the substance “is sold in plastic carry bags the risk of exposure and poisoning is higher through spillage, inhalation as well as contact.”

Kumar said that farmers are not advised to wear protective equipment like gloves and masks while handling paraquat – in any case, he explained, they often don’t have access to such equipment. Even if they could access it, he added, it still would not be feasible for Indian farmers to use it because they worked in tropical conditions. “We all saw how uncomfortable it was for people to use their personal protective equipment during Covid,” he said. “This is also the same.”

Farmers also usually lack access to information about the product. Under the Insecticides Act, it is mandatory for hazardous insecticides and herbicides to mention all their components, and detail rules for their usage on the cover of their containers. But Kumar pointed out that this information is almost always in English. “How many farmers will even be able to follow what the containers say?” he said. “And even if they were able to read it, there is no way they can comprehend such language.”

Kavitha Kuruganti, an activist who works for farmer’s rights and sustainable agriculture, said that four years ago, when she and a few other activists petitioned the Supreme Court to ban pesticides that are banned in other countries, paraquat was banned in 34 countries. “And now that number has reached 58,” she said.

Research suggests that bans are effective at curbing these deaths by suicide. A study from Taiwan revealed that after paraquat was banned in the country in 2018, it saw a 58% reduction in the paraquat suicide rate, and a concomitant 37% drop in the overall pesticide suicide rate, largely due to the ban. In South Korea, a study conducted after the substance was banned in 2011, found that in the following two years, pesticide suicide deaths per 100,000 halved from 5.26 to 2.67.

“So many Asian and African countries have banned it, “ Kuruganti said. “Why is India allowing it to be sold? There is simply no justification.”

Kuruganti also pointed out that insufficient attention was being paid to the long-term effects of paraquat. Though studies have shown that long-term exposure to the substance increases the risk of Parkinson’s disease, Syngenta, the top global producer of paraquat, has maintained that there isn’t enough evidence to prove the link. In early June, an article in The Guardian revealed that the company had been using “tactics to sponsor sympathetic scientific papers and mislead regulators about unfavourable research” on the substance.

In her investigation, the journalist Carey Gillam found: “Those documents showed that Syngenta was aware decades ago of evidence that exposure to paraquat could impair the central nervous system, triggering tremors and other symptoms in experimental animals similar to those suffered by people with Parkinson’s.”

In response, the company stated, “not one peer-reviewed scientific publication has established a causal connection between paraquat and Parkinson’s disease.”

A Guardian investigation found that Syngenta had been using “tactics to sponsor sympathetic scientific papers and mislead regulators about unfavourable research” on the substance. Photo: Wikimedia Commons

For now, in India, paraquat is not even among the pesticides that are being considered for a ban, or that are being phased out. In 2013, the ministry of agriculture constituted the Anupam Verma committee to review 66 pesticides that had either been banned, withdrawn or restricted in other countries, but which continued to be registered for use in India. In 2015, after deliberation, the committee recommended that 13 of the pesticides be banned, and that six be phased out by 2020. The following year, the government implemented the ban on the 13 pesticides, and issued a recommendation on phasing out the other six that the committee had listed.

Meanwhile, the Verma committee also recommended that the remaining 27 pesticides could continue to be used, but that they be reviewed again in 2018 – paraquat was among them. “There are just a lot of people lobbying for paraquat to stay in the market,” Kuruganti said.

In 2018, the SK Malhotra committee examined the 27 pesticides whose use had been permitted, and recommended that they all be banned.

After pesticide companies raised objections to this, the government set up the TP Rajendran committee in 2021, to re-examine the matter. The same year, the committee recommended that only three of the 27 be banned. In 2023, the government issued orders to ban these three pesticides – paraquat was not among them.

Kuruganti explained that there were sufficient alternatives that could allow farmers to avoid using paraquat – among these was live mulching, which is a method whereby a cover crop is interplanted or undersown with a main crop in order to suppress weeds. Further, she said, the government needed to ensure that more research was conducted on the management of weeds. “Weeds can be managed in various non-chemical ways,” she said. “And where required the government can set up NREGA-like schemes to subsidise labour in agriculture.”

Though farmers like Rizwan worry that they cannot manage without the use of paraquat, a study done by Aastha Sethi from the University of Edinburgh’s Centre For Pesticide Suicide Prevention, conducted while paraquat was banned in Kerala, revealed that crop yields were not affected when paraquat was not used. Another 2022 study covered 11 countries where paraquat was banned, and found that nine did not see any decline in crop yields. In fact, the study found that in several other countries, such as Senegal and Mauritania, crop yields increased after the ban.

The results of these and other similar studies indicate that paraquat can be phased out without adversely affecting farmers.

Kuruganti argued that such progress was being stymied by those who benefited from the sale of paraquat. “Because people are profiteering from the sales of these pesticides and herbicides, nobody wants to take on the responsibility of spreading this awareness among the farmers,” she said.

In 2019, four doctors at the Veer Surendra Sai Institute of Medical Sciences and Research in the city of Sambalpur, Odisha, went on a two-day hunger strike to demand a ban on paraquat. “Over the last four years, there have been at least 400 cases of paraquat poisoning that we have seen at our hospital, and five or six people who survive,” said Dr Shankar Ramchandani, the seniormost doctor among the protestors. “Or they go home in a really terrible condition and die later.”

Ramchandani, who was earlier a student at the institute, and in 2014 joined as a staff member, said he initiated the strike after feeling frustrated for years by what he was seeing in the hospital. “Once, the wife of a patient offered me all her ornaments and begged me to somehow save her husband, and I had to tell her there was absolutely nothing I could do,” the doctor recalled. “In another incident, a 14-year-old child ingested paraquat after underperforming in his exams. His father also begged me to somehow save him.”

After the doctors went on strike, the Odisha government decided that there would be restricted sale in the state, and that the subsidy provided to farmers for its purchase would be cancelled.

“But I have not noticed much impact of this restriction,” Ramchandani said. “People are still sold paraquat without much monitoring. Our fight is not over until paraquat is banned.”

Like the doctors of CMC Vellore, Ramchandani and his colleagues also wrote many letters, to the Odisha government, seeking a ban on the sale of paraquat. Ramchandani said that though he was a doctor and not an activist, he still believed it was important for him to launch the strike. “I have taken the Hippocratic oath to treat the sick the best I can,” he said. “And because there is no antidote to paraquat I am unable to fulfil that obligation. So if not me, who will go out and protest against the sale of paraquat?”

Christianez Dennis is a resident doctor at CMC Vellore.

This reporting is made possible with support from Report for the World, an initiative of The GroundTruth Project.