CALCUTTA, Sept. 29—Large numbers of East Pakistani refugee children are dying every day front malnutrition and the diseases that accompany it, and tens of thousands are seriously malnourished and facing death.

Accurate mortality figures are not available because officials in the Indian refugee camps do not keep them separately for children, but spot check of several camps by this correspondent makes it clear that the deaths of children in the critical group, ages 1 to 8, number at least in the hundreds every day. Some foreign relief officials believe the toll is even higher.

“Thousands are dying,” said Alan Leather, an experienced field worker for Oxfam, the British‐based relief organization, “and I think tens of thousands will die unless a large‐scale child‐feeding program is begun immediately.”

New Program Approved

Such a program, called Operation Lifeline, has just been approved by the Indian Government — after two months of hesitancy and bureaucratic wrangling. Its effectiveness will depend on how quickly it is put into full operation, and many observers think this will take one or two months.

The pitiful scenes of suffering children are the same in all the teeming camps that house most of the nine million Bengalis who have so far fled to India to escape the Pakistan Government's six‐month ‐ old military repression in East Pakistan.

Infants lie dying on cots in sweltering makeshift field hospitals, their skin stretched taut across their wasted frames. Their numbed mothers stand over them, fanning them with cloth or cardboard, or trying to put some food in their mouths, which they immediately vomit.

“Will he live?” a visitor asked about one such skeletal child less than two months old, who was too weak to move or cry. “There is no chance,” said an Indian nurse. The mother's eyes agreed.

Malnutrition Widespread

Many of the children were malnourished when they arrived in India, for malnutrition is widespread even in normal times in East Pakistan, just as it is in the Indian border states into which the refugees have poured.

But the degree of malnutrition in the camps—aggravated by overcrowding, poor sanitation, fouled water and the weakened condition of the refugees after their long trek— is much worse than that usually seen on the subcontinent.

A field report by a team from the prestigious All India Institute of Medical Sciences found that nearly 50 per cent of the refugee children under the age of 5 are suffering from “moderately severe or advanced malnutrition,” caused by protein and vitamin deficiencies.

The malnutrition is almost always accompanied by other infections and diseases, such as diarrhea, dysentery and bronchial pneumonia, it said. Many of the children are wasted by three or four diseases at once.

The report said: “Even minor infections would tip the, scales in such deprived children, and unless urgent remedial measures are taken, substantial loss of infant and child population may occur quite apart from developmental retardation that is bound to afflict this group widely.”

Report 2 Months Old

Though the report is largely credited with prodding the Indian Government into action, it was handed to the Government over two months ago. The report said that there were 300,000 children “at the edge of a precipice [where] any acute infection can prove fatal in a majority of them.” Calling for an emergency program of supplementary feeding with proteins and calories, the report said that “time is of the essence.”

Other nutrition experts have also used the figure of 300,000 children in danger, and that was when the refugee population was considerably smaller.

At present, with about 30,000 new refugees crossing into India every day, there are about 1.7 million children younger than 8 years, and these are only the ones in the camps. Nearly one‐third of the nine million refugees are living outside camps with friends and relatives.

In addition, the camp population includes more than 500,000 pregnant and breast‐feeding mothers, who also need supplementary feeding.

2‐Part Program

The Operation Lifeline pro gram for these more than two million sufferers, which was recommended by the Medical Institute report, will have two distinct parts.

The first, which is called Alpha and is designed to be largely preventive, aims to set up. 1,000 or more feeding stations in the camps to provide milk powder and high‐protein foods for the bulk of the critical group “as a measure for preventing those children who are in the early stages of nutritional deprivation and are beginning to falter, from getting into graver forms of malnutrition.” Some Alpha stations have already opened.

The second part, which is not yet functioning, is a curative program for the hard cases. It is designed to handle about 125,000 children. The goal is to set up 500 nutritional therapy centers as adjuncts to camp hospitals, where seriously malnourished children will receive intensive, in‐patient care for as long as one or two months as a life saving operation.

UNICEF to help

The supplies for the entire program will be provided by UNICEF, which will buy them with foreign relief funds donated through the United. Nations. But the project will be run by others—Alpha, by the Indian Red Cross with the help of voluntary relief agencies, and Beta, by the Indian Government's Ministry of Rehabilitation.

Wrangling between the ministry of Rehabilitation and the Health Ministry over which should run Beta was one of the reasons for the delay in the program.

The major reason for the delay, however, was the Government's reluctance to launch such a comprehensive supplementary feeding program only for the refugees, when the local population—though not quite as ravaged—was suffering from similar problems.

When the situation in the refugee camps worsened; largely because of the monsoon floods, the pressure on the Government mounted and it finally approved the program. Relief officials are said to have assured the Government that seriously malnourished local children will not be turned away from the Beta centers.

The Indian state of West Bengal, which has absorbed about 7 million of the 9 million refugees, is a year‐round disaster area on its own—the home of perhaps India's deepest poverty.

Tensions Increase

Local people have already been complaining loudly about the amount of the refugees free food rations, which arc more than most of West Bengal's poor can afford to buy. Tensions seem to be growing between local residents and the refugees.

For example, although there are not enough doctors to handle all the medical problems in the refugee camps, there are proportionately even fewer for some of the people in the backward areas of West Bengal and the other border states.

The infant mortality rate in these areas is almost as high as that in the camps. In some West Bengal districts one‐quarter of the children die before they reach the age of 5.

The problem in the refugee camps may be worse than it seems. Whatever statistics exist —and they are meager—come from the camp hospitals. But many infants are dying in the dark of their flimsy huts, and their parents do not report the deaths, for to do so would be to lose one food ration.

Also, it is a tradition among Bengali villagers that when a child falls ill with fever or diarrhea, he is given a thin mixture of sago and barley water and all solid food withheld—which is tantamount to giving a malnourished child less food at a time when he desperately needs more.

The misery in the camps may deepen when winter arrives. At least three million blankets are needed, and only a few have arrived.

Also, if food shortages worsen inside East Pakistan, the refugee influx may increase. Officials expect that, with East Pakistan's border districts largely emptied by the earlier refugee flow, most of the new refugees will be coming from the interior and that after traveling the longer distances, they will arrive in an even weaker condition than the nine million who preceded them.

Most of the refugees who have been coining across the border for the last several weeks are from districts in the interior.

“A lot of them arrive in an irreversible state—a condition of complete collapse.” said a doctor in a children's ward at a camp near Calcutta, “There's nothing we can do for them.”