Many of them die or become permanently disabled failing to secure one of the 36 proper ICU beds in Bangladesh, which is by far shorter than the minimum required number of 500.

According to experts, Bangladesh needs at least 500 beds with 'limited' ICU facilities at all district hospitals and specialised ICU beds at all tertiary hospitals like in Dhaka city.

Usually, one per cent of total beds in general hospitals are earmarked for the ICU, but in reality this standard frequently remains unmet in most hospitals.

The situation is exacerbated by the rising number of patients seeking admission to ICU units. Patients at private clinics, most of which lack such facilities, are frequently referred to hospitals for intensive care, but most are turned away.

Recently, a young man with critical head injuries suffered in a road accident was first taken to a private hospital in Dhanmondi where his condition was stabilised. But ICU beds in the hospital were already full and authorities were forced to refer the patient to another Dhanmondi hospital.

But the man was out of luck there too -- all ICU beds there were also full. Frustrated, relatives took him to Dhaka Medical College Hospital (DMCH) where they waited for an ICU bed while he was admitted to the general ward. But several days passed and no beds were available. The man died in the general ward without proper treatment.

The Department of Anaesthesia, Analgesia and Intensive Care Medicine of the BSMMU (Bangabandhu Sheikh Mujib Medical University) revealed in a study that during the 1994-2002 period, 1,154 critically ill patients had to be turned away due to shortage of ICU beds.

The same study revealed that ICU patient mortality rate in the city's four leading hospitals is also very high -- 52 percent at the DMCH, 45 percent at the BSMMUH, 39 percent at Birdem (Bangladesh Institute of Research and Rehabilitation in Diabetics, Endoctrine and Metabolic Disorders) and 28 percent at Bangladesh Medical College Hospital.

A Daily Star investigation found that only a few hospitals in the city have general and multidisciplinary ICUs. They are: the DMCH, the BSMMUH, Ibrahim Memorial Hospital popularly known as Birdem, Bangladesh Medical College Hospital, Central Hospital, Millennium Hospital, Holy Family Red Crescent Hospital, Sikder Women's Medical College and Hospital, the National Heart Foundation, National Institute of Cardiovascular Diseases and Institute of Chest Diseases and Hospital.

Some state-owned general hospitals in the city like Shaheed Suhrawardy Hospital, Mitford Hospital and National Hospital have no ICU and most of their patients are referred to the DMCH, the only general hospital with free ICU facilities.

Professor Waheduddin Mahmud, head of ICU at the DMCH, said, "Every day we are forced to refuse admission to two to three critically ill patients simply because we do not have enough beds. Ideally, the eight-bed multidisciplinary ICU at the DMCH is perfect. But the problem is it is the only free ICU in the country, so you can imagine the pressure on us."

The other problem is many patients are inappropriately referred to the ICU who undergo procedures for which admission to an ICU may not be crucial. Besides, some others are unnecessarily admitted to ICU after operation.

Professor KM Iqbal, chairman of the Department of Anaesthesia, Analgesia and Intensive Care Medicine at the BSMMUH said, "Often, patients who do not qualify for intensive care are sent to the ICU and occupy the beds for months and we have to turn deserving patients away."

Terminally ill patients who have practically no chance of survival, including those with cerebral vascular disease commonly known as brain stroke, are often inappropriately referred to the ICU, Iqbal said.

He said patients with Guillenbarre Syndrome (GBS), trauma head injury and respiratory failure have very good chance of recovery, but only if ICU beds could be freed up in time.

"This is a common practice and a major problem," said a senior anaesthesiologist of Birdem.

Some anaesthesiologists cited costs of ICU facilities that averages Tk 4,000 a day and with full use of ventilator support and relevant drugs hits Tk 12,000 a day as prohibitive.