Inside the opthalmology ward of Srinagar’s Shri Maharaja Hari Singh Hospital, are dozens of young men, some minors.

Some wear black sunglasses, others have bandages over one eye or thick strips of gauze across both.

Several were in obvious pain, twisting and turning in their beds. Others lay motionless as harried relatives fan them.

These patients are the latest victims of so-called non-lethal pellet guns that security forces have been using to control protests in Kashmir since 2010.

When fired, the metal pellets disperse in a deadly spray, indiscriminately hitting anything in its path. In Kashmir, the cartridges being used to quell recent protests are said to contain between 300 and 600 pellets each.

At least 50 people have been killed in clashes between security forces and protestors in the violence that broke out after Hizbul Mujahideen commander Burhan Wani was killed in an encounter on July 8.

According to figures issued by the government, at least 2,400 people have been injured since the protests first started. Of these, over 600 have been hit by pellets, with 210 suffering eye injuries. At least three persons, including 14-year-old Insha Malik, have completely lost their eyesight, while 23 persons have lost vision in one eye.

A 2014 study of 20 pellet victims with eye injuries in Kashmir showed that 33% of them did not regain their vision.

The victims

The victims of pellet injuries in the opthalmology ward of the Shri Maharaja Hari Singh Hospital include those who participated in protests as well as those who did not.

Faraz (name changed) was hit in downtown Srinagar while hurling stones at security forces a week ago. A pellet was lodged in the cornea of his left eye.

As he did not have the strength to speak, his friend Bashir (name changed) narrated what happened. He said that the 20-year-old was barely 50 metres from an armoured vehicle when security personnel fired a pellet shot from it. “He fell on his knees before he got up and ran into the alley blood, oozing from his left eye,” said Bashir.

Another patient, a minor, said he was on his way for tuition classes when he was hit. Listening to music on a mobile phone, he turned away when asked further questions.

Mushtaq (name changed), 21, has lost vision in his left eye and is “struggling to gain vision in his right eye”, according to a doctor at the hospital. Mushtaq said that he was returning home after purchasing rations when security forces fired at him. “I couldn’t see anything after I heard the shots fired,” he said.

Chances of recovery

Those who have eye injuries caused by pellets undergo a three-stage treatment procedure. The first involves clearing and saving the globe of the eye by removing any pellets. The second is geared towards prevention of infection as pellets often hit the eye after ricocheting from the ground or other contaminated surfaces. The third stage concerns visual recovery and may require multiple surgeries depending on the extent of damage to the eye.

A doctor at the Shri Maharaja Hari Singh Hospital, who did not wish to be identified, said that the hospital had about 200 eye injury patients admitted at present, of which 76 had undergone a secondary surgery to restore their vision.

Visiting eye surgeon, Dr S Natarajan, who has performed marathon surgeries on 40 such patients at the hospital, was hesitant to comment on how many of them will actually be able to see again.

“It will take at least six weeks to a year for us to know the outcome of the surgeries we did,” said Natarajan, who runs an eye hospital in Mumbai.

Another doctor at the hospital, who also wished to remain anonymous, agreed that it was “too early to say” whether the victims would regain their vision.

“A lot of patients still need surgeries and visual recovery depends on how the patients’ eyes respond to treatment,” said the doctor. “Some regain vision at three weeks and some take longer than six weeks. There is no deadline exceeding which the patient might go blind.”

A study by ophthalmologists at the Sher-i-Kashmir Institute of Medical Sciences in Bemina, Srinagar, which was published in the African Journal of Trauma in 2014, found that one-third of victims of pellet injuries did not regain their vision.

The doctors had studied 20 patients who had undergone surgical intervention for pellet injuries to the eye at the Bemina hospital between January 2010 and September 2013. While there was an improvement in vision in 65% of the cases following surgery, the condition of the rest of the patients remained unchanged, said the study.

Eye surgeons said that in cases of such trauma, it is rare for patients to regain normal vision. There will always be some deficit and they may have what doctors like to call “near normal vision”.

‘Dedicated eye hospital needed’

Dr Natarajan, who arrived in Srinagar last week after he read a message on a WhatsAapp group urging retina surgeons help save the vision of pellet victims in Kashmir, met Chief Minister Mehbooba Mufti and urged her to establish a dedicated eye hospital where doctors can be trained to operate on eye injuries.

“We have to do our best,” he said. “These are youngsters, teenagers and children. We can’t let them go blind.”

He added that if the situation did not change, Kashmir would need more operation theatres and doctors to operate on the injured.

Shotguns to stay

The use of pellet guns, or pump-action guns, by security forces for crowd control in Jammu and Kashmir has been widely criticised. The government has set up a seven-member team to look for alternatives to these weapons.

However, the Central Reserve Police Force, which aids the Jammu and Kashmir police in controlling protestors, has indicated that it will continue with these shotguns for the lack of a better alternative.

Central Reserve Police Force director general K Durga Prasad told The Hindu: “We have asked our jawans to aim low so that when fired, it only hits the lower part of the body. We have got to know that many people have lost their vision due to pellet injuries, and we are looking into these reports.”

The reluctance of security forces to give up pellet guns as a crowd control measure could have to do with its ability to incapacitate its victims. The Times of India quoted a police official in a report as saying that pellet guns were an efficient form of crowd control as “the long recovery time keeps the injured busy and incapacitates them from going back to stone-pelting.”

‘Doctors don’t take sides’

Trauma surgeries are not new for specialists like Natarajan, but he said that he had never operated on so many pellet injury cases in such a short time.

The doctor said that he received flak from his colleagues for volunteering to work at a Kashmir hospital. “My colleagues also want me to serve the Army,” he said. “I have tried to establish contact and offered my services even to the Army.”

He added: “Doctors don’t take sides.”

This article was first published on Scroll.in and has been reproduced with permission. It was published on Dawn.com on Aug 6, 2016.