In India, soldiers are revered as the guardians of the Republic, their sacrifices often invoked in speeches and ceremonies. Yet once they hang up their boots and uniforms folded away, many veterans find themselves fighting a different kind of battle—the frontline has shifted from border posts to hospital corridors, where elderly servicemen and their families wait for care that too often never arrives.
At the heart of this struggle lies the Ex-Servicemen Contributory Health Scheme (ECHS), India’s flagship programme for veterans’ healthcare. Established in 2003, the ECHS was conceived as a covenant between the state and its soldiers, promising comprehensive medical cover for retirees and their dependents. Nearly five million beneficiaries are enrolled, served through a network of polyclinics and empanelled private hospitals. For a country that celebrates its military as an institution of honour, the ECHS was meant to embody dignity and gratitude in practical form. Two decades later, that promise is fraying.
A System on the Brink
The evidence of collapse is visible across India. In Kerala, hospitals in key districts, such as Kannur and Kozhikode, have stopped accepting ECHS patients, citing unpaid dues of crores of rupees and package rates that have been frozen for over a decade. In one case, a leading super-speciality hospital owed the equivalent of several million US dollars. Veterans who had already contributed significant sums at retirement and faced monthly deductions from their pensions suddenly found themselves paying out of pocket for critical care.
Reports have emerged of patients being turned away after hours, seriously ill veterans denied admission with the excuse of “no beds available,” and prescribed medicines substituted with whatever limited stock ECHS polyclinics had on hand. In Goa, similar stories surfaced as recently as mid-2025. Veterans’ associations in the area complained of long waiting times and poor service quality at government-designated hospitals. The complaints escalated to Defence Minister Rajnath Singh, prompting an unusual intervention from both central and state leaders. But even these high-level assurances have yet to deliver systemic change.
The result is a bitter irony: men who once fought on the country’s frontlines now find themselves abandoned in their hour of need—not by an adversary, but by institutional neglect.
Structural Failures
The reasons for this collapse are structural rather than incidental. The most pressing is financial. Hospitals say reimbursement rates have not been updated since 2014, making it commercially unviable to provide modern treatments under the scheme. Compounding this are chronic delays in settling dues, which leave hospitals with crippling arrears. Faced with these pressures, many simply exit the system.
Polyclinics, designed as the first line of healthcare delivery under ECHS, are themselves overwhelmed. They are understaffed, often lack diagnostic equipment, and struggle to maintain basic stocks of essential medicines. Veterans regularly report being sent away with prescriptions unfilled or supplied with substitute drugs that disrupt continuity of care. Bureaucratic red tape adds to the frustration: repeated demands for documents such as Aadhaar identity cards, pension details, and bank records turn even a routine consultation into a bureaucratic ordeal.
What emerges is a picture of a system caught between outdated financial structures, inadequate infrastructure, and slow-moving central authority—a combination that transforms a welfare promise into a daily humiliation.
The Human and Strategic Costs
The collapse of veteran healthcare is not just a welfare issue—it has wider social and strategic consequences. India’s military is one of the largest in the world, and the treatment of its veterans carries weight both within the forces and in broader society. Neglect corrodes morale. Soldiers currently in service watch how their predecessors are treated and draw their own conclusions about what awaits them after retirement.
For many veterans, particularly those from rural or lower-income backgrounds, the ECHS is their only access to affordable healthcare. Its failure pushes families into debt or leaves conditions untreated, exacerbating social vulnerability. The psychological impact is profound: to serve in uniform is to accept risk on behalf of the state, yet the state now appears absent when these individuals are most vulnerable.
There are also implications for India’s global ambitions. As New Delhi projects itself as a rising power and a net security provider in the Indo-Pacific, its inability to care for its own veterans exposes a dissonance. Nations that aspire to leadership in the international order are expected to uphold a robust social contract with those who serve in uniform.
How Other Nations Treat Their Veterans
Globally, the challenges of veterans’ healthcare are well recognised. The United States Veterans Affairs system, despite its well-documented bureaucratic hurdles, commands dedicated infrastructure and budgetary protection. The United Kingdom integrates veteran care into its National Health Service, with special provisions in place for service-related injuries and mental health issues. Even smaller nations under security threat, such as Israel or South Korea, prioritise veterans’ healthcare as part of broader national resilience.
The ECHS system’s current failures stand in stark contrast to this. Despite its size, the scheme suffers from chronic underfunding, outdated systems, and a lack of political urgency. For a country that spends billions annually on modernising its armed forces, the inability to ensure basic medical dignity for retired soldiers is jarring.
Restoring the Covenant
Reform of the ECHS cannot be delayed. Clearing the mountain of unpaid hospital bills and revising reimbursement rates is a crucial first step in restoring credibility. Polyclinics require investment in infrastructure and staffing to function as effective hubs of care, rather than mere bureaucratic checkpoints. Digital platforms could reduce redundant paperwork and allow for faster approvals, sparing veterans the ordeal of navigating an opaque system.
Rural veterans—who make up a significant portion of the community—require mobile healthcare units and greater integration with India’s AYUSH services to ensure they are not left behind. Beyond treatment, a preventive approach is necessary. Establishing a research and monitoring wing within ECHS could help track health trends among ageing veterans and anticipate emerging needs.
But above all, what is required is political will. Reforming the scheme cannot be left to procedural tinkering; it must be treated as a national priority. For India’s veterans, healthcare is not a privilege or charity. It is a debt owed by a grateful state to those who bore arms in its defence.
A Test of India’s Maturity
India is at a moment where its global role is expanding and its economic clout is growing. Yet the treatment of its veterans reveals the gap between ambition and responsibility. To allow elderly soldiers to languish in hospital queues is not just a policy failure; it is a moral one.
A rising power is judged not only by the strength of its military or the size of its economy but also by how it treats those who once stood guard for the nation. Honouring that covenant with its veterans is a test of India’s democratic maturity—and one it cannot afford to fail.