In June, one-year-old Sahil caught a fever and developed a rash all over his body. A month later, he was dead, mostly likely from a measles-malaria outbreak that ripped through Madhya Pradesh’s Balaghat district.Sahil’s 12-year-old sister Lamnin fell ill with similar symptoms and died a day later at their home in Bondari village.As Scroll reported in the first part of this series, at least 25 children from the Baiga and Gond tribes have died since May in this remote Adivasi habitation in Madhya Pradesh. For two months, the outbreak went undetected because of the complete absence of a healthcare system in the area.Measles is a disease that can be prevented through vaccination. India added the measles vaccine to its universal immunisation programme in 1985.But four decades later, in the villages of Balaghat, we found that immunisation drives against measles existed only on paper.“Why should I lie?”Sahil’s father Samaroo Dhurwey said that neither Sahil nor Lamlin had been vaccinated against measles.Dhurwey told Scroll that none of his seven children had ever been immunised against any disease. His eldest daughter is married, and the youngest is five years old.But the records maintained in the Kohnimod anganwadi in Bondari village show that Sahil last received one dose of the measles vaccine on April 21 this year, along with a Vitamin A injection and the pneumococcal vaccine.After the death of two of his children, Dhurwey alleged that he was asked by a local health worker to say that both had been vaccinated. “Par mein jhoot kyu bolu,” he said. “But why should I lie?”When we spoke to Lalita Dhurwey, the anganwadi worker, she said she had joined the post in May and did not know about the entry against Sahil’s name. However, she admitted the health department had not carried out any vaccination rounds since she began work.Kapil Yadav, a teacher at a primary school that stands next to the anganwadi, told Scroll that for months he “kept insisting” that the health department vaccinate the schoolchildren”. “But the anganwadi or health department did not carry out routine immunisation properly here,” he said.Experts Scroll spoke to said the low levels of vaccination allowed the measles virus to spread like wildfire in the region. In the Birsa block of Balaghat, which saw many of the deaths, there has been no recorded measles outbreak in the last two decades.That’s not all. As Scroll found out, the outbreak became deadlier for the children because many of them were malnourished. Moreover, the government’s take-home rations for children aged under six years had recently stopped, compounding the crisis.Sukchand Dhurwey's daughter was severely underweight when she died. Credit: Tabassum Barnagarwala.Poor vaccination coverageThree weeks after Sahil and Lamnin’s deaths, three-year-old Priti died in the neighbouring village of Kundekasa.She had symptoms similar to the other deceased children – high fever, rashes on her body and whitish spots in the mouth, which were suggestive of a measles infection.The register kept at the local anganwadi shows that Priti received her first dose of measles vaccine in December 2023.The first dose of the vaccine is given to babies between the age of nine and twelve months and the second dose at 16-24 months.She was one of the lucky few. The vaccination register listed 15 children – and 11 had missed their first measles shot.Priti missed her second dose, which can affect a child’s long-term immunity against the virus.She died on July 22. The cause of her death is “unknown”.Soon after her death, the administration began mass surveillance in villages in the Birsa block. Until then, the health department was unaware of a measles outbreak.In 2025, the health ministry set a target for elimination of measles by 2026 through 100% immunisation. India, however, has not met that deadline. We recorded 26,332 measles cases in the first half of 2026. Before this, India missed deadlines to eliminate measles in 2015, 2020 and 2023.Data from the ministry shows that till 2025, 92.2% of children in India received both doses against the measles virus.In Balaghat, the coverage is much lower. According to the latest round of National Family Health Survey, 81.3% children have received both the measles shots.In Birsa, where the outbreak began, the Adivasi villages have even lower vaccination coverage. According to a team from the World Health Organisation that surveyed 177 children in the Birsa block this August, 80% had received their first measles vaccine and 70% their second.But our investigation revealed that vaccination coverage was far worse than those figures suggest.We visited families of seven deceased children to check their vaccination status. Parents of six children said they had never been inoculated against any disease. One parent said her child had been administered at least two vaccines, but was not sure for which disease.Congress MLA Sanjay Uikey asserted that “none of the deceased children were fully vaccinated against measles”. Scroll could not verify this claim.In Bondari village, Sukhwati bai, a helper at the local anganwadi, claimed parents refuse immunisation even if there is a camp held. Sukhwati herself did not get her eight children vaccinated. Her son Roop Lal, aged 16, died on August 10.But Budhan Singh who lives in the same village said nobody from the health department held regular camps or visited them to explain the need for vaccines and their benefits. Singh’s four children have not received any vaccine, he claimed. “The health workers are coming now after all these deaths,” he said.Data from the health department shows that officials conducted a ‘catch-up’ round of measles vaccination – administering 10,481 doses till August 28 – after the outbreak was discovered.The vaccination officer, Dr Paresh Uplap, was removed from his post as the deaths were discovered. He was also removed from the post of the chief medical health officer in Balaghat.Uplap admitted that “measles vaccination coverage could improve in Birsa” but maintained that measles alone did not kill at this scale. “The high number of deaths that happened here were because these children had other health issues,” he said.Sukhwati bai, a helper at the local anganwadi, said there is great resistance to immunisation. Credit: Tabassum Barnagarwala.‘On paper, malaria was under control’Balaghat is a malaria-endemic zone. In 2024, the containment zone of 40 villages where the outbreak took a toll recorded 697 malaria cases. In 2025, there were 492 cases. Strikingly, this year in just one month, from July end to August end, the villages recorded 404 malaria cases. Two senior officials from the Balaghat health department told Scroll they believe there has been “massive under-reporting in malaria cases” over the past few years. “As a result, several necessary measures under the malaria programme were not taken,” one official said.“Until the outbreak began, on paper the malaria situation looked under control,” the official said.Mosquito nets were not distributed by the government this year in four villages that Scroll visited. In several villages, spraying and fogging insecticides to kill mosquitoes was delayed. Sunder Markam, a contractual worker, said he was appointed to conduct fogging in affected villages from August 12 after a jump in malaria cases. In Kundekasa village, where four-year-old Arvind Dhurwey died of malaria, sarpanch Parshuram Dhurwey said the health department did not undertake any preventive measures to control the mosquito spread till July end. “All these fogging teams have come after the deaths began to increase,” he said.The other factorExperts say one more factor explains the fatalities in the area – malnutrition.When the measles outbreak hit villages here, along with a sharp rise in malaria infections, malnourished children got seriously ill. Many caught both diseases. Of the 150 children admitted in a primary health centre in Bithli village in Balaghat since July, medical officer Dr Saurabh Uikey counted over 50 as underweight. “Malnourishment makes recovery difficult,” he said. “Children are susceptible to even the smallest of infections and can die of preventable diseases.”Virologist Shahid Jameel agreed. He told Scroll that malaria can “weaken the immunity system” and malnourishment can “compound the severity of the underlying health conditions”.Every third child aged under five is underweight in Balaghat, data from the National Family Health Survey-6 shows. But the data recorded by Balaghat’s Women and Child Development department officials appeared to be seriously undercounting the levels of malnourishment, Scroll found on the ground. For example, in three anganwadis we visited, only five of 127 children were recorded as severely acute malnourished children – that is one in every 25 children. There was no record of moderate acute malnourished children even though several children were shockingly underweight. Professor Vijay Nema, from the National Institute for Tribal Health Research, who visited Balaghat to investigate the outbreak, said that they found severely malnourished children during their field visits. “We do not need to measure their arm circumference to know that. They clearly looked undernourished,” he said. He added: “A vaccine may not fully work on severely malnourished children.”In Bondari village, three-year-old Priyanka Dhurwey had been vaccinated against measles, her father Sukhchand said. She was one of the few children who had reached a hospital facility after falling sick with suspected measles symptoms. But Priyanka died within two days of hospitalisation. In official records, her cause of death is “severe acute malnutrition, severe respiratory distress, severe anaemia, shock and respiratory failure”. When Priyanka died on August 13, she weighed 4 kg. “That’s the weight of a two-month old baby,” said Rajaram Chandrawanshi, district early intervention officer. A child her age should ideally weigh between 11 kg and 15 kg. Priyanka was not even listed as a malnourished child in the anganwadi’s register.A failing ration programmeAccording to anganwadi workers in the villages, children’s nutrition was adversely affected recently when the government has stopped supplying take-home rations. Until March, children aged three or less received free food from the state government’s Women and Child Development department. The take-home-rations – rice, dal, soybean – were given to maintain a basic nutritional diet in children.The aid stopped five months ago after the Madhya Pradesh government failed to pay the agencies supplying the food.“The last supply came in March. That stock lasted till April,” said Kundekasa’s anganwadi worker Mamta Yadav.Sukhchand, Priyanka’s father, said in the last few months, after the rations stopped, “she had become very weak”. “Anganwadi food helps many poor families in this region. We have been telling our supervisors to make some alternative arrangements,” said Suhadra Yadav, an anganwadi worker in Matla village. Devendra Sundriyal, assistant director in the women and child development department, did not respond to Scroll’s calls and texts, asking about take-home rations not being delivered and the poor record-keeping at the anganwadi.Local residents claim that malnourishment is a failure of multiple government departments, not just the Women and Child Development. Mansaram Meravi, member of the local Zilla Parishad, said several tribal residents have not been able to avail forest resources and land rights under the Forest Rights Act, 2006, which affected their traditional source of nutrition.The Baiga tribe traditionally relies on forest produce – they gather elephant foot yam, pihri or edible mushroom, and tubers from the forest to cook and eat. “Several are not allowed to gather forest produce,” said Meravi. “Their movement in the forest is now heavily controlled by the government.”