Citizenship—the status of belonging to a nation state—provides people with the right to have rights. Citizenship is closely associated with health and wellbeing, as it provides people with access to healthcare and welfare. Being stateless therefore also denotes a state of ill health.
The Government of India, under the BJP (a Hindu Nationalist party), is committed to implementing an unprecedented system that demands proof of citizenship in three phases.
It has recently passed an amendment to the Citizenship Act 1955, the Citizenship Amendment Act 2019 (CAA).  This provides an expedited route to citizenship for migrants of six groups of religious minorities (Hindu, Sikh, Buddhist, Jain, Parsi, and Christian) from three neighbouring countries. This excludes Muslims, and this goes against the secular nature of the Indian Constitution.
The government has proposed setting up a National Population Register (NPR) which lists all the people living in the country, whether they are citizens or not.
It has also proposed a nationwide National Register of Citizens (NRC), under which all Indian citizens must prove their citizenship with documentary evidence.
The Citizenship Amendment Act, the National Population Register , and the National Register of Citizens have ostensibly been set up to root out illegal immigrants. However, many citizens fear that these proposals are a move to disenfranchise Muslim citizens.
Against this backdrop, there have been nationwide protests in India with 31 people reported dead as a result of the protests.
The National Register of Citizens has been carried out in Assam in North Eastern India at enormous cost. It has taken a toll on the mental and physical health of citizens, and the burden of registration has led to impoverishment of many.  People have been denied citizenship due to even minor differences in spelling of names in different documents.
The Assam National Register of Citizens published last year excluded 19,06,657 persons.  The excluded people will have to go through a long and expensive process of appeals. If they cannot prove their citizenship, they will be placed in detention centres. Those excluded from the register are predominantly poorer people without documents to establish their citizenship.
There are 988 persons detained in six detention centres in Assam.  The legal status of detainees regarding their rights and entitlements is unclear. Detainees have been put into prisons along with other people awaiting trial and prisoners. Families have been separated with men and women kept in separate prisons. They are not entitled to parole or the use of telephones, nor are they allowed to work while in prison in a complete suspension of their fundamental rights. There have been 28 reported deaths in the detention centres. 
The processes of National Register of Citizens and detention have unsurprisingly led to enormous mental trauma resulting in suicides and deaths. [6,7] A member of the National Human Rights Commission (NHRC) team who visited those in detention spoke of the “environment of intense, permanent sadness…. It was as though everyone was in mourning” 
Similar findings have been reported among refugees on Nauru island off the coast of Australia where long incarceration has led to mental trauma exacerbated by separation from family members, suicidal thoughts, and suicidal attempts. 
It is the poorer citizens, those who are internally displaced, migrants, homeless people, people who have been trafficked into the country, and indigenous communities with insufficient documentation who may be excluded from the National Register of Citizens.
The experience of implementing the National Register of Citizens in Assam shows that a substantial number of people have been rendered stateless, with adverse consequences for their health. The implementation of the National Register of Citizens and the National Population Register across the country can render people stateless in a selective and discriminatory manner. We call upon the medical fraternity to be alert to the danger of a public health emergency as a consequence of this exercise. We further call upon the government to repeal the Citizenship Amendment Act 2019 and stop the nationwide implementation of the National Population Register and National Register of Citizens immediately.
Anand Zachariah, Professor of Medicine, Christian Medical College, Vellore, India.
Ramani Atkuri, Independent public health physician.
Amar Jesani, Independent research and training consultant, Bioethics and Public Health and Editor, Indian Journal of Medical Ethics.
- The Gazette of India. The Citizenship (Ammendment) Act, 2019 No. 47 (12th December, 2019) Available from: http://egazette.nic.in/WriteReadData/2019/214646.pdf
- Rights & Risks Analysis Group (RRAG). The Economic Cost of Draft NRC: Poor Made Extremely Poor August 27, 2019 Available from: http://www.rightsrisks.org/press-release/the-economic-cost-of-draft-nrc-poor-made-extremely-poor/
- Office of State Coordinator of NRC, Assam. Publication of final NRC on August 31, 2019 Available from: https://www.livelaw.in/pdf_upload/pdf_upload-363869.pdf
- India Today. NRC and story of how Assam got detention centres for foreigners December 27, 2019 Available from: https://www.indiatoday.in/india/story/nrc-story-how-assam-got-detention-centres-for-foreigners-1631835-2019-12-27
- The Telegraph. 28 deaths in Assam’s detention camps, minister tells Rajya Sabha 27 November 2019 Available from: https://www.telegraphindia.com/india/28-deaths-in-assam-s-detention-camps-minister-tells-rajya-sabha/cid/1722471
- National Human Rights Commission. Report on NHRC Mission to Assam’s Detention Centres from 22 to 24 January, 2018 Available from: https://avaazpress.s3.amazonaws.com/NHRC%20Report%20Assam%20Detention%20Centres%2026%203%202018.pdf
- The Hindu Businessline. Why Bobbydul is not in school December 27, 2019 Available from: https://www.thehindubusinessline.com/blink/cover/stories-from-assams-detention-centres/article30411699.ece
- Medecins Sans Frontieres. Indefinite Despair: The tragic mental health consequences of offshore processing on Nauru. Medecins Sans Frontieres mental health project, Nauru. December 2018 Available from: https://www.msf.org.au/sites/default/files/attachments/indefinite_despair_4.pdf