The term ‘shawarma death’ is once again in the news, with the death of a 16-year-old girl and hospitalisation of at least 40 other students due to suspected food poisoning from an eatery in Kerala’s Kasaragod. This is not the first time that the shawarma, a popular Levantine dish, has come into focus in the state for the wrong reasons. The term ‘shawarma death’ stuck in 2012 when a 21-year-old youth died after reportedly eating a shawarma, despite officials clarifying that no trace of food poisoning was found in his body after medical examination.
The death of 16-year-old Devananda in Kasaragod has once again triggered the collective memory, leading to social media being filled with misinformation. Food safety officials, however, point out that shawarma is not the only food item that can cause food poisoning, and that any item prepared in an unhygienic condition or stored improperly can lead to infections.
“Organisms form in decaying or old food items and release toxins, which becomes the reason for food poisoning. Chances of this happening are high during summer, as the food will decompose sooner in the heat. When we keep food in the freezer or in low temperatures, the functioning of the organisms will be limited, thereby preventing any contamination,” explains Dr Sudeep, Superintendent of the Government Medical College Hospital, Kannur.
Devananda died on May 1, and 49 others were hospitalised, due to suspected food poisoning after the children ate from a food outlet named Ideal Food Point at Neeleswaram in Kasaragod. “As a preliminary enquiry found that all of them had eaten shawarma, the food item has come under the scanner. However, there are others who ate the shawarma and did not fall sick. So we need to conduct a full enquiry to arrive at a conclusion,” said John Vijayakumar, Assistant Commissioner of Food Safety, Kasaragod.
Shawarma is made by cutting meat into thin slices and placing it on a rotating rotisserie to slow-cook it in the heat. The meat is then cut into pieces and served along with a bread of choice (kuboos, rumali roti, etc), mayonnaise and pickled vegetables. Shawarma is a popular street food in Middle Eastern countries, especially Turkey and Egypt.
According to the ‘Safety and Quality of Meat and Poultry Guide Note’ released by the Food Safety and Standards Authority of India (FSSAI), meat should be stored at 4 ºC for short term storage and at -18 ºC or below for long term storage. Meat under normal chilling conditions (0 – 4 ºC) of storage shall be consumed within two to four days. Frozen meat stored at -18 ºC or below must preferably be consumed within 10 to 12 months. Meat and poultry foods must be cooked to a safe minimum internal temperature of 75 °C to destroy any harmful bacteria.
In July of 2012, following the death of 21-year-old Sachin Roy Mathew reportedly after eating a shawarma in Thiruvananthapuram, multiple raids were conducted across the state and the sale of the food item was banned in Kochi temporarily. However, officials had later clarified that no trace of food poisoning was found in Sachin’s body during the medical examination, adding that he might have felt uneasy due to some other reasons. Later in October that year, a boy was hospitalised in Changanassery with food poisoning symptoms, following which hotels and restaurants demanded a ban on the food item.
Dr Sudeep explains that there are two kinds of problems that might arise from eating stale food. “Organisms enter the food item and produce toxins in it. If a person eats this, symptoms start immediately. In the second case, bacteria might start functioning inside the body after someone eats the food. In this case, the symptoms start around 12 hours after eating,” he said. He pointed out that all the children in Kasaragod started showing symptoms around 12 hours after eating the shawarma, so they were able to ascertain that it was a bacterial infection. Besides, the children had diarrhoea, stomach pain, vomit, fever – all of which are gastrointestinal symptoms caused due to bacteria, he added.
“Severe dehydration caused by extreme diarrhoea can lead to death, but chances of that happening in Kerala is extremely low. This is because people are aware and usually get medical help immediately. Apart from this, the toxins caused by bacteria can enter the bloodstream and affect other vital organs. For instance, it can affect the heart, causing myocarditis (inflammation of the middle layer of the heart wall). It can also affect the brain and cause encephalopathy (a damage or disease that affects the brain),” Dr Sudeep elaborated. He said that the cause of Devananda’s death can be determined only after getting all the reports. However, all the children admitted to the hospital have recovered, he added.
On May 4, District Medical Officer (DMO) Dr AV Ramdas said that the severe food poisoning was caused by a bacterium called shigella. Shigella infection is more serious than regular food poisoning, he said. The primary symptom for this is diarrhoea, which can be accompanied by stomach pain, fever, vomiting, etc. It can be fatal for children below the age of five or those with low immunity, he said. In case of symptoms like stomach pain, diarrhoea, fever, headache or vomiting, immediate medical attention should be provided.
According to John Vijayakumar, the initial enquiry had shown that all of the sick children had consumed shawarma, but some did not fall sick. “Initially we had thought that it was the shawarma that caused the illness. But we have appointed two officials to conduct an inquiry and submit a report. Only after that can we finalise the cause of food poisoning,” the food safety official said, adding that only 36 children were hospitalised.
“Our analysis will include lab reports of the food samples, doctors’ report on the children and the deceased person, a forensic sample report from the police’s side, as well as Devananda’s postmortem report to get the whole picture,” he said.
John further stated that the department’s responsibility was not only to conduct routine raids, but also to follow the existing cases, do the paperwork, and act upon the complaints received directly, via mail, text messages and through the media. “All eateries cannot be inspected every month because we are short staffed. We need five officers for Kasaragod district, but we only have three. We do our best with the resources available to us,” he said.
Regarding the safety measures that should be followed in restaurants, John said that special care should be taken while handling meat. “Most meats can only be used for hours, and not days. Especially in the case of shawarma, all of the ingredients involved are sensitive. The mayonnaise should be prepared at room temperature and used within a maximum of two hours.”
Mohankumar, a food safety officer from Tamil Nadu, pointed out that leftovers are often stored for the next day in the street food business. “This becomes problematic when the food is not stored at a low temperature, especially in summer. The meat should be stored at around -18 ºC for not more than 24 hours,” he says, adding that the food they have to seize most often is fish, followed by chicken. The meat’s colour shows us how old it is, he said. Another official said that the food is often stored in unsafe cooler boxes, instead of freezers.
Speaking about the general safety measures that have to be adhered to in restaurants, Kerala Hotel and Restaurant Association working president C Bijulal said the association has instructed its members to buy and store all ingredients in hygienic places. “The workers are subjected to medical tests every six months and the water is also tested every six months. In addition, we ask our members to strictly follow all the FSSAI rules,” he said.
Extra care should be taken when it comes to Arabian food, because the cuisine is from another country and Kerala has a completely different climate and environment, Bijulal pointed out. “We have to hire workers who know how to deal with such food items properly. Also, mayonnaise is made from raw eggs, and it has to be prepared and served fresh. It can be dangerous if we don’t do all this,” he added.
The shawarma burner, which is almost always placed outside the eateries, is said to be another reason for the possible contamination of the food item. In an earlier interview, a Joint Commissioner (Enforcement) had explained to TNM the reason behind the placing of the burner. “The burner emits heat of at least 300 ºC, which will make the entire room hot. This is why the burner is always placed outside the eatery. But unlike foreign countries, where pollution is lower, the situation in Kerala is different. The emissions from vehicles and the dust in the air are all sure to contaminate any food prepared in an open space. It is because of this that we made glass compartments mandatory, to protect the burners from outside contamination,” he said.
Dr Sudeep provided some general tips to be cautious about the food we consume. “We have to follow general hygiene when handling food at home. In case we are storing food, keep it in the fridge as soon as it is cooked. Raw food should be maintained at a lower temperature, and all items should be covered. Be vigilant of what you are eating. Besides, it is necessary for all hotels and eateries to follow rules and regulations,” he said.