It's happening again.

In early September, a cluster of unexplained child deaths in a small town in Madhya Pradesh sent local health workers scrambling.

At least 19 victims - aged one to six - had died within weeks of taking a common cough syrup. Officials tested everything from drinking water to mosquitoes before the truth emerged: their kidneys had failed.

Weeks later, a state laboratory in the southern city of Chennai confirmed the worst. The syrup in question contained 48.6% diethylene glycol, a toxic industrial solvent that should never be found in medicine. Kidney failure is common after consuming this poisonous alcohol.

The horror wasn't confined to Madhya Pradesh. In neighbouring Rajasthan state, the deaths of two young children, allegedly after consuming a locally-made Dextromethorphan syrup - a cough suppressant unsafe for very young children - sparked outrage and a government investigation.

For India, this brought a grim sense of déjà vu.

Over the years, diethylene glycol in Indian-made cough syrups has claimed dozens of young lives. In 2023, Indian syrups tainted with diethylene glycol were linked to the deaths of 70 children in The Gambia and 18 in Uzbekistan.

Between December 2019 and January 2020, at least 12 children under five died in Jammu in Indian-administered Kashmir allegedly from cough syrup, with activists suggesting the number of casualties might have been higher. In the past, there's also been abuse of cough syrups containing codeine, a mild opioid that can produce euphoria in high doses and lead to dependence, and is not advised for young children.

Each time regulators promise reform, contaminated syrups reappear - reflecting a fragmented drug market and, critics allege, a weak regulatory system struggling to oversee hundreds of low-cost, often unapproved syrups........

© BBC