五月的一个凌晨三点左右，巴米塔·马卡姆（Bamita Markam）开始抽搐。
At about 3am one morning in May, Bamita Markam began convulsing.
这个三岁的孩子已经发了几天高烧，身上长满了红肿的疮。她的母亲库希拉（Koushila）起初带她去看医生，医生开了一些药膏。
The three-year-old had spent days with a high fever and angry red sores on her body. Her mother, Koushila, had first taken her to a doctor, who prescribed an ointment.
巴米塔似乎有所好转，但随后又病倒了。家人请来一位神医到马特拉村（Matla）的家中，给她喂了一些糖浆和药片。但都无济于事。天亮时，巴米塔已经离世。
Bamita seemed to recover, then became ill again. A faith healer, called to the house in Matla village, gave her syrups and tablets. Nothing worked. By dawn, Bamita was dead. "She cried a lot," Koushila recalls.
“她哭得很厉害，”库希拉回忆道，“她整晚都在抽搐。”家人曾试图喂她喝水。有一次，她呕吐出了鲜血。午后，他们将她埋葬在丛林中。
"She convulsed all night." The family tried to make her drink water. At one point she vomited blood. They buried her in a jungle after midday.
官员们表示，自五月以来，印度中央邦巴拉加特区（Balaghat）的一群偏远村庄记录了至少32名儿童死亡，巴米塔的死亡就是其中之一。受害者年龄从三四个月大的婴儿到18岁的青少年不等，大多数是拜加人（Baiga），这是印度75个“特别脆弱部落群体”之一。
Bamita's death was one of at least 32 child deaths recorded since May in a cluster of remote villages in Balaghat district in India's Madhya Pradesh state, officials say. The victims ranged from babies just three or four months old to an 18-year-old, and most were Baiga, one of India's 75 "particularly vulnerable tribal groups".
官员们将这些死亡原因主要归咎于麻疹和疟疾，并指出营养不良和治疗延误可能加剧了病情。
Officials attribute the deaths to mainly measles and malaria, possibly aggravated by malnutrition and delays in treatment.
他们认为，有8到10例死亡与麻疹有关，约10例与疟疾有关，还有几名儿童同时患有多种感染。每起死亡的确切原因尚不完全确定。
They believe eight to 10 deaths were associated with measles, roughly another 10 with malaria, with several children suffering more than one infection. The precise cause of every death is less certain.
自2013年以来一直代表该地区的桑杰·乌伊基（Sanjay Uikey）告诉我：“我从未见过这样的疫情。我父亲曾担任过两届议员，我也担任了三届，但我们两人都从未见过在如此短的时间内有这么多孩子死亡。”
"I have never seen an outbreak like this. My father was a two-term lawmaker, and I have served three terms, but neither of us has seen so many children die in such a short time," Sanjay Uikey, who has represented the area since 2013, told me.
但疾病只是问题的一部分。在巴拉加特偏远的森林地区，毛派叛乱曾在此扎根，前往医疗中心本身就是一项挑战。
But disease is only part of the story. In remote, forested parts of Balaghat, where Maoist insurgency once took root, reaching a health centre can be a challenge in itself.
在季风季节，地形会让这段路程变得更加艰难。稻田在红土地和低矮的森林山丘映衬下闪烁着光芒。狭窄的土路在田野和泥屋之间蜿蜒，在大雨中往往变得湿滑难行。
In the monsoon, the terrain can make that journey harder. Paddy fields glow against red earth and low, forested hills. Narrow dirt tracks wind between fields and mud homes, often becoming slippery and impassable in heavy rain.
乡村景色十分葱郁，但房屋却非常稀少。大多数巴伊加族（Baiga）的房屋墙壁由泥土砌成，结构简陋（使用粗糙的木材和竹材建造），屋顶覆盖着瓦片或茅草；为了防止雨水渗入，屋顶还用塑料材料进行了修补。
The countryside is lush, but the homes are sparse. Most Baiga houses have low mud walls, rough timber and bamboo, and tiled or thatched roofs patched with plastic against the rain.
有些房屋只能通过这些狭窄的小路才能到达。负责调查这些死亡事件的医生们不得不驾驶拖拉机在泥泞的路上艰难前行。在最近的一次访问中，我们花了近1.2英里（约1.2公里）的时间徒步上山，才抵达那些较为偏远的村庄。周围的丛林中散布着许多儿童的坟墓——这些孩子都死于疾病。
Some homes are accessible only by these tracks. Doctors investigating the deaths have travelled through the mud in tractors. On a recent visit, we walked nearly 2km (1.2 miles) uphill to reach some of the more remote homes. The surrounding jungle was dotted with the graves of children who had died.
最近的州立医院位于比尔萨（Birsa），拥有100张病床，距离这些村庄大约70公里远。对于没有交通工具的家庭来说，前往医院意味着要穿越泥泞的道路，或者只能依靠临时制作的竹制担架或摩托车；而这无疑会让他们损失一整天的收入。
The nearest state hospital, a 100-bed facility in Birsa, is about 70km away. For families without vehicles, reaching it can mean muddy tracks, a makeshift bamboo stretcher or a motorcycle - and a day's lost wages.
当巴米塔（Bamita）病重时，她的家人未能及时将她送往医院。当时正下着大雨，道路泥泞难行，他们根本无法将她转移出去。
When Bamita became seriously ill, the family did not get her to hospital. It was raining heavily. The tracks were muddy and slippery, and the family had no way of transporting her.
“如果当时我能把她送到医院，她或许还能活下来，”库希拉（Koushila）说道。
"If I was able to take her to hospital she might have lived," Koushila says.
她的另一个女儿安基塔（Ankita）一直追问姐姐的去向。这个六岁的小女孩被告知了一个在许多乡村中都常见的解释：“玛塔·阿·盖伊（Mata aa gayi）”——意思是“女神降临了”。
Her other daughter, Ankita, keeps asking what happened to her sister. The six-year-old has been told what many children in these villages are told: "Mata aa gayi" - the goddess has arrived.
在某些巴伊加族家庭看来，像水痘这样的疾病其实是“疾病女神”的降临，人们应该安抚这位女神而不是对患者进行治疗。因此，这些家庭会举行为期七到九天的仪式，为这位“疾病女神”沐浴，并献上清水和印楝叶。许多人相信，在仪式完成之前对患者进行治疗可能会导致其死亡。
For some Baiga families, some illnesses - like chicken pox - are seen as the arrival of a disease goddess, who must be appeased rather than treated. Families perform a seven to nine-day ritual of bathing and offering cool water and neem leaves to the local disease goddess. Many believe that treating the patient before the ritual is completed could cause death.
几周来，这些迷信观念一直影响着这些家庭对待生病儿童的方式。直到后来，死亡事件的规模才开始逐渐显现出来。
For weeks, such beliefs shaped how families responded to sick children. Then the scale of the deaths began to emerge.
7月21日，当地村委会的负责人帕尔舒拉姆·杜尔韦（Parshuram Dhurwey）得知邦达里村（Bondari village）有两名儿童死亡。第二天早上，他又听说又有一名儿童去世了。他立即联系了当地官员并前往现场查看情况。
On 21 July, Parshuram Dhurwey, a local village council chief, heard that two children in the same household in Bondari village had died. The next morning, he heard of another death. He called local officials and went to the area.
眼前的景象令人心碎：许多儿童都死于疾病，整个村庄陷入了绝望与悲痛之中。
They found a grim picture. "Every other child was sick," Dhurwey says.
“每隔一个孩子就生病了，”杜尔韦（Dhurwey）说。“他们发烧、出疹子。许多人营养不良。”当政府医疗官员尼米什·高塔姆（Nimish Gautam）抵达时，他发现孩子们严重脱水。他见到的第一个病例是一名十几岁的女孩，她已经发烧出疹好几天了，血糖看起来低得危险。她的家人拒绝让医疗队对她进行全面检查。
"They had fever, they had rashes. Many were undernourished." When government medical officer Nimish Gautam arrived, he found severely dehydrated children. The first case he saw was a teenage girl with several days of fever and rash, whose blood sugar appeared dangerously low. Her family refused to let the health team examine her properly.
“我们请来了警察劝说他们把她送到卫生中心。但家人仍然拒绝，”高塔姆告诉我。“他们说如果我们带她去治疗，她就会死。所以我们只能对她进行观察，最后她康复了。”杜尔韦说，在一个村子里，官员们强行进入民宅，将五名重病儿童送往医院。他们全都康复了。
"Police were brought in to persuade them to take her to a health centre. The family still refused," Gautam told me. "They said if we took her for treatment, she would die. So we kept her under observation, and she recovered." In one village, Dhurwey says, officials forcibly entered homes and took five seriously ill children to hospital. All recovered.
当疫情变得明显到足以引起地方当局注意时，孩子们其实已经死亡数周了。杜尔韦说，到9月时，他所在委员会管辖的四个村庄——阿多里（Adori）、昆德卡萨（Kundekasa）、邦达里（Bondari）和乌斯里（Usri）——已有10名年龄在18个月到14岁之间的儿童死亡。
By the time the outbreak became unmistakable to local authorities, children had already been dying for weeks. By September, Dhurwey says, 10 children aged about 18 months to 14 years had died across the four villages in his council - Adori, Kundekasa, Bondari and Usri.
这些症状惊人地相似，却又令人沮丧地缺乏特异性：发烧、皮疹、虚弱、脱水，在某些情况下还伴有癫痫发作。一些孩子在疑似麻疹和疟疾的同时，还患有疥疮、真菌感染或细菌性皮肤感染。在一个疟疾流行地区，发烧可能同时意味着多种疾病。
The symptoms were frighteningly similar and frustratingly non-specific: fever, rashes, weakness, dehydration and, in some cases, seizures. Some children had scabies, fungal infections or bacterial skin infections alongside suspected measles and malaria.
邦达里的萨尼拜（Sagnibai）在24小时内失去了两个孩子。她12岁的女儿拉姆宁（Lamnin）于6月26日去世。她一岁的儿子萨希尔（Sahil）在第二天也去世了。一位当地的治疗师告诉这家人，这是“玛塔”（Mata，意指天花或麻疹等被视为神灵惩罚的疾病）。他们也没有钱或交通工具带孩子去看医生。
In a district where malaria is endemic, fever could mean several things at once. Sagnibai of Bondari lost two children within 24 hours. Her daughter, Lamnin, 12, died on 26 June. Her one-year-old son, Sahil, died the following day. A local healer told the family it was Mata. They also had no money or vehicle to take the children to a doctor.
她的丈夫萨马鲁·杜尔韦（Samaroo Dhurwey）记得那些夜晚，孩子们的身子仿佛在“燃烧”。他们无法消化食物。他们最终死在了家里。
Her husband, Samaroo Dhurwey, remembers nights in which the children's bodies seemed to be "on fire". They could not digest food. They died at home.
马特拉（Matla）村的马哈辛·帕特（Mahasingh Parte）在两天内失去了两个孩子——一个六岁的女孩和一个四岁的男孩。这家人听从了一位信仰治疗师的指示。“他说不要带他们去医院，”帕特回忆道。
Mahasingh Parte of Matla village lost two children - a six-year-old girl and a four-year-old boy - within two days of each other. The family followed a faith healer's instructions. "He said don't take them to hospital," Parte recalls.
帕特是一名没有土地的农场工人，他说，在收入较好的日子里，他每天只能赚大约200卢比（约合2美元或1.58英镑）。在雨季，工作机会非常稀缺；尽管距离那里只有5公里远的地方就有一家小型初级卫生中心，但他从未去过那里。贫困和偏远的环境让他的孩子们面临极大的生存困境。
Parte is a landless farm labourer who earns about 200 rupees ($2; £1.58) on a good day, he said. Work is scarce in the monsoon, and although a small primary health centre is just 5km away, he had never been there. Poverty and remoteness had stacked the odds against his children.
随着死亡人数的不断增加，关于孩子们究竟为何会生病的问题变得越来越难以回答。
The question of what was making children sick became harder to answer as the deaths mounted.
印度医学研究委员会（ICMR）与国家部落健康研究所（NIRTH）联合开展的一项调查在8月7日对从受影响村庄采集的10个样本进行了检测：其中6个样本检测结果呈麻疹阳性，4个样本呈阴性。
An investigation by the ICMR-National Institute for Tribal Health Research (NIRTH) tested 10 samples collected from the affected villages on 7 August. Six tested positive for measles; four were negative.
麻疹具有高度传染性，患者会出现高烧、咳嗽、流鼻涕、眼睛发红和流泪等症状，随后还会出现皮疹。大多数孩子能够康复，但营养不良会大大增加麻疹的致命风险，使他们更容易患上肺炎、严重腹泻和脱水，以及脑部炎症。此外，麻疹还会削弱孩子的免疫系统，使他们更容易受到其他疾病的侵袭；疟疾则可能进一步加剧这种风险。
Measles is highly contagious, causing high fever, cough, runny nose and red, watery eyes, followed by a rash. Most children recover, but malnutrition can make measles far more dangerous, increasing the risk of pneumonia, severe diarrhoea and dehydration, and inflammation of the brain. The infection also weakens the immune system, leaving children vulnerable to other infections. Malaria can compound that risk.
不过医生们提醒说，疟疾并不一定是在麻疹之后发生的，而且并非所有的发烧和皮疹症状都一定是麻疹引起的——实际上，往往是多种疾病和健康问题共同作用的结果。
But doctors cautioned that malaria did not necessarily follow measles, and not every fever and rash was measles. Instead, several infections and vulnerabilities collided. "Sometimes there is no single factor behind the deaths," Gautam said.
“有时候，孩子的死亡并非由单一因素造成的，”高塔姆说：“这些孩子普遍营养不良，而且家里根本没有健康教育和卫生设施。”虽然巴伊加村并没有与现代社会完全隔绝：季节性的迁移会让村民们前往其他地区从事辣椒采摘等工作；孩子们会用智能手机观看视频，许多家庭也配备了太阳能供电的设备、银行账户，有些家庭甚至还能使用自来水。然而，营养不良现象仍然普遍存在，许多孩子的营养状况极差。最近因麻疹去世的一名5岁儿童体重仅有约5公斤。
"There are malnourished children and there's zero health education and hygiene at home." The Baiga villages are not entirely disconnected from modern India. Seasonal migration takes families to other states for chilli picking and other work. Children watch reels on smartphones, while many families have minimum single-bulb solar-powered electricity, bank accounts and, in some homes, piped water. Yet malnutrition remains widespread, with children often poorly fed. A five-year-old who died recently of measles weighed around 5kg.
高塔姆认为，营养不良的主要原因是早婚和过早生育——有些女孩在16或17岁时就成为了母亲，而此时她们的身体尚未发育完全。
Gautam believes malnutrition is driven by early marriage and motherhood, with some girls becoming mothers at 16 or 17, when their bodies are still developing.
怀孕间隔过短、早产和低出生体重等问题随之而来，而年轻母亲在母乳喂养和照顾孩子方面面临重重困难。饮食是另一个问题：许多家庭严重依赖米饭和扁豆汤，蛋白质摄入不足，饮食结构单一。对巴伊加族家庭的调查显示，普遍存在营养不良问题，且公共服务利用率低下，进一步加剧了这一状况。
Closely spaced pregnancies, premature births and low birth weight can follow, while young mothers struggle to breastfeed and care for their children. Diet is another problem: many families rely heavily on rice and lentil soup, with too little protein and dietary variety. Studies on Baiga households have found widespread nutritional deficiencies, compounded by poor uptake of public services.
纸面上的服务与实际情况之间存在巨大差距：在死亡病例开始出现数周后，政府才作出回应，而医疗团队在接触并说服家庭配合方面举步维艰。
The gap between services on paper and on the ground was stark: the state response came weeks after deaths began, while health teams struggled to reach and persuade families.
疫情被确认后，卫生工作者开始在受影响村庄进行挨家挨户的筛查。配备氧气、雾化器、吸引设备、疟疾检测试剂和药品的流动医疗单元，走访了20多个受影响村庄。
Once the outbreak was recognised, health workers began door-to-door screening in affected villages. Mobile medical units carrying oxygen, nebulisers, suction equipment, malaria tests and medicines visited more than 20 affected villages.
一名流动医生尼拉杰·夏尔马表示，团队每天常规接诊超过50名患者，其中约一半是儿童。他们每天进行10次以上的疟疾检测，有时每天能发现两例阳性病例。
One mobile doctor, Neeraj Sharma, says teams routinely saw more than 50 patients a day, about half of them children. They conducted 10 or more malaria tests daily, sometimes finding two positive cases a day.
据高塔姆介绍，最终有超过6200名患者——其中大多数是儿童——接受了居家治疗。超过630名患者被转诊至区医院。约600人已康复回家，目前仍有约30人住院治疗。
More than 6,200 patients - mostly children - were eventually treated at home, according to Gautam. More than 630 were referred to district hospitals. About 600 returned home, while around 30 remain admitted.
疫苗接种成为紧急应对措施。尽管官方记录显示某些地区的接种覆盖率达90%至95%，但卫生工作者发现，部分儿童没有接种记录，且一些家庭不愿为孩子接种疫苗。
Vaccination became an emergency response. Although official records suggested 90-95% coverage in some areas, health workers found children without records and families reluctant to vaccinate.
因此，当局向所有15岁以下的儿童提供麻疹-风疹（MR）疫苗，无论其是否有接种记录。高塔姆说，在比尔萨地区识别出的约4万名儿童中，约有2.7万人已接种疫苗。该地区共有180个村庄，其中约67个以巴伊加族为主，属于最脆弱的群体。
Authorities therefore offered the measles-rubella (MR) vaccine to all children under 15, regardless of recorded status. Of about 40,000 children identified in Birsa, roughly 27,000 had been vaccinated, Gautam said. Of the area's 180 villages, some 67 are predominantly Baiga and among the most vulnerable.
但疫苗接种只是儿童所需保护的一部分。关于基本营养和其他卫生服务是否真正惠及风险最高的人群，仍存在更广泛的疑问。
But vaccination is only one part of the protection children need. There are wider questions about whether basic nutrition and other health services are reaching those most at risk.
印度主计审计长2024年的一项审计发现，中央邦在分发旨在补充六个月至三岁儿童、孕妇和哺乳期母亲膳食的带回家口粮方面存在“严重违规行为”，包括受益人身份识别、生产、运输和分发环节的问题。
A 2024 audit by India's Comptroller and Auditor General found "serious irregularities" in Madhya Pradesh's distribution of take-home rations meant to supplement the diets of children aged six months to three years, pregnant women and lactating mothers, including problems with beneficiary identification, production, transport and distribution.
此次疫情现已平息。官员表示，最后一个儿童死亡病例发生在他们9月底评估前的两周多以前，同时团队仍在继续走访村庄。在昆德卡萨，一个曾经每天接诊约120名儿童的医疗营地，如今每天接诊不到10人。
The outbreak has now subsided. Officials say the last child death was more than two weeks before their late-September assessment, while teams continue visiting villages. In Kundekasa, a medical camp that once saw about 120 children a day was seeing fewer than 10.
回到马特拉，巴米塔的母亲谈起那个会要钱买零食、和妹妹一起玩耍、一有车靠近就跑进屋里的孩子，因为车辆让她害怕。
Back in Matla, Bamita's mother speaks about the child who would ask for money for snacks, play with her sister and run inside whenever cars approached because vehicles frightened her.
“我曾希望她能读书，有所成就。我从不后悔没有生男孩，”考希拉说。然后她看向幸存的妹妹安基塔。
"I had hope she'd study and make something of herself. I never regretted I didn't have a boy," Koushila says. Then she looks at Ankita, the surviving sister.
“我想再要几个孩子，”她说。“我觉得孤单。安基塔也孤单。她一直哭着找姐姐。”
"I want more kids," she says. "I feel alone. Ankita is alone. She keeps crying for her sister."