A Decade of Delays: AIIMS Darbhanga Remains on Paper as Only Gate Structure Draws Public Ire

Bihar's ambitious healthcare project struggles with land disputes, political differences, and slow execution despite ₹1,264 crore allocationNearly eleven years after its initial announcement and more than five years since Cabinet approval, the All India Institute of Medical Sciences (AIIMS) in Darbhanga remains largely an unfulfilled promise, with only a main gate structure standing on the 183 acre site a stark symbol that has recently drawn widespread criticism on social media platforms.The project, conceived to transform healthcare delivery in Bihar's Mithila region and surrounding areas, has become emblematic of bureaucratic delays and centre-state coordination challenges that have plagued infrastructure development in India's most populous states.The proposal for AIIMS Darbhanga was first announced by then-Finance Minister Arun Jaitley in the 2015-16 Union Budget as part of the government's commitment to establish "AIIMS-like" institutions across underserved states. The announcement came as part of a broader healthcare infrastructure expansion under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), launched in 2006 to address regional imbalances in tertiary healthcare availability.

The scheme's objective was unambiguous: to establish institutions of national importance that would provide quality tertiary healthcare, medical education, nursing education, and research facilities while creating a pool of trained medical professionals for deployment in primary and secondary healthcare facilities under the National Health Mission.

For Bihar, which already had one AIIMS in Patna operational since 2012, the Darbhanga facility represented an opportunity to serve the densely populated Mithila region, comprising districts like Darbhanga, Madhubani, Samastipur, and Sitamarhi, along with adjoining areas in Nepal and northeastern states. After nearly five years of deliberations and site surveys, the Union Cabinet, chaired by Prime Minister Narendra Modi, formally approved the establishment of AIIMS Darbhanga on September 15, 2020. The approval came with a budgetary allocation of ₹1,264 crore, fully funded by the Central government, with an initial timeline of 48 months for completion from the date of approval, suggesting the facility should have been operational by September 2024. The Cabinet approval outlined an ambitious scope: a 750-bed hospital including emergency and trauma beds, ICU facilities, AYUSH beds, private wards, and speciality and super-speciality departments. The infrastructure plan encompassed a medical college with 100 MBBS seats and 60 B.Sc. Nursing seats, along with 15-20 super-speciality departments. Additional facilities included an AYUSH block, auditorium, night shelter, guest house, hostels, and residential complexes for faculty and staff. The project was expected to generate employment for nearly 3,000 persons in various faculty and non-faculty positions, with indirect employment through ancillary services. Projections indicated the facility would serve approximately 2,000 outpatient department (OPD) patients daily and 1,000 inpatient department (IPD) patients monthly, catering to an estimated 8.5 crore people across the Mithila region, including 14 districts of Nepal and populations in northeastern states like Sikkim.

Despite Cabinet approval in September 2020, the project encountered its first major obstacle: land acquisition and site finalisation. The Bihar government initially proposed land at Shobhan village near Darbhanga, but the Central government's technical team rejected this location, citing flood vulnerability during preliminary surveys.

Political dynamics further complicated matters. In 2019, then-Chief Minister Nitish Kumar had proposed upgrading the existing Darbhanga Medical College and Hospital (DMCH) as the second AIIMS in Bihar, suggesting the use of approximately 200 acres of unused land at DMCH. However, after the formation of the Mahagathbandhan (Grand Alliance) government in Bihar, the proposed location was shifted to Shobhan village. The land dispute persisted for years, becoming a point of contention between the central and state governments. Following the return of the NDA coalition government in Bihar, the central government revisited and eventually approved the Shobhan bypass location. On February 12, 2024, a central team inspected the site and agreed to accept it for the proposed AIIMS construction. The formal land transfer occurred in phases. On August 12, 2024, Bihar's Health Department Special Secretary Shashank Shekhar Sinha submitted documents for 150.13 acres to AIIMS Darbhanga Executive Director Dr Madhwanand Kar, with assurances that the remaining 37.31 acres would follow shortly. The state government eventually transferred a total of 187 acres, of which approximately 93 acres would be utilised for the main AIIMS campus, with the remainder reserved for future expansion and ancillary facilities.

On September 7, 2024, Union Health Minister and BJP President J.P. Nadda visited the site and announced that construction would commence imminently, revising the project cost estimate to ₹2,000 crore. The Union government sought technical assistance from the Indian Institute of Technology, Delhi, for architectural and engineering support. On September 23, 2024, HSCC (India) Limited, a wholly-owned subsidiary of public sector construction company NBCC (India) Limited, was officially appointed as the executing agency by the Ministry of Health and Family Welfare. The contract, valued at ₹1,261 crore, stipulated that buildings would be constructed across an area exceeding 2.25 lakh square meters. The project timeline was revised to three years from the date of the foundation stone laying.

After sustained pressure from various quarters, including the Mithila Student Union's door-to-door brick collection campaign launched in August 2021 and multiple hunger strikes by local activists and political representatives, Prime Minister Narendra Modi finally laid the foundation stone for AIIMS Darbhanga on November 13, 2024, more than nine years after the initial announcement and over four years past the original Cabinet approval.

During the ceremony, which also saw the inauguration of development projects worth approximately ₹12,100 crore across Bihar, the Prime Minister emphasised the facility's role in transforming healthcare access in the region. However, on-ground progress has been minimal. According to a review conducted by Darbhanga Member of Parliament Dr Gopalji Thakur in mid-2025, the final design prepared by a consortium including experts from IIT Roorkee, IIT Delhi, AIIMS Patna, and architectural firms has been approved and submitted to the concerned departments. Construction of the boundary wall, stretching 5.3 kilometres at a cost of ₹37.82 crore, reportedly commenced on May 1, 2025. In December 2025, the project received mandatory environmental clearance, a prerequisite since the construction area exceeds 2.08 lakh square meters, placing it under Category 'B' of Environmental Impact Assessment rules. The clearance ensures compliance with waste management, water conservation, and environmental sustainability standards. The campus design includes approximately 1.03 lakh square meters of green area with 9,207 trees to be planted. Despite these procedural advances, visual evidence from the site reveals that the only substantial structure visible is the main gate, a reality that has triggered widespread criticism on social media platforms in recent days, with images and videos circulating showing the incomplete state of construction more than a decade after the project's announcement.

The prolonged delays have sparked significant political controversy. Opposition parties, particularly the Congress, have characterised the slow progress as emblematic of the BJP-led central government's failure to deliver on infrastructure promises in Bihar. Recent social media posts highlighting the solitary gate structure have been seized upon by critics to question the government's commitment to healthcare development in the state.

Dr Gopalji Thakur, the Darbhanga MP and a vocal advocate for the project, has attributed delays to political differences between the central and state governments during periods of non-NDA rule in Bihar. He maintains that the project has gained momentum following the NDA's return to power in the state, crediting Chief Minister Nitish Kumar for facilitating land acquisition.

Local activists and student organisations have maintained sustained pressure through various campaigns. The Mithila Student Union's innovative "ghar-ghar se intaa laenge, Darbhanga AIIMS banaenge" (we will collect bricks from every home to build AIIMS Darbhanga) campaign symbolised grassroots frustration with bureaucratic inertia. Hunger strikes by activists in September 2023 and by MP Gopalji Thakur in October 2023 highlighted the growing impatience among stakeholders.

According to available records, AIIMS Darbhanga has earned the dubious distinction of being the most delayed AIIMS construction in India. While other AIIMS announced in the same phase, including those in Kalyani (West Bengal), Deoghar (Jharkhand), and Guwahati (Assam), have either become operational or made substantial construction progress, Darbhanga continues to languish. This delay is particularly glaring given that AIIMS Patna, Bihar's first AIIMS, has been operational since 2012 and has demonstrated the transformative impact such institutions can have on regional healthcare delivery and medical education. The approved design envisions a comprehensive medical township spread across nearly 7.36 lakh square meters. In the first phase, approximately 4.81 lakh square meters will be developed, with the remainder reserved for future expansion. The tallest structures on campus will rise to 30 meters.

The project emphasises sustainability, with significant portions allocated to green spaces, rainwater harvesting systems, waste management facilities, and energy-efficient building designs. The campus layout has been strategically planned to ensure connectivity with major roads, railway stations, and Darbhanga airport, facilitating access for patients from distant locations.

Current official projections indicate that AIIMS Darbhanga is now expected to be completed by 2029, a significant extension from the original 2024 timeline envisioned during Cabinet approval. This nine-year construction period from foundation stone to completion represents a departure from the standard 48-month timeline mandated for AIIMS projects under PMSSY. The delay has tangible human costs. Each year of postponement represents thousands of patients who continue to travel long distances for tertiary care, hundreds of medical students denied quality education opportunities, and potential healthcare professionals not trained to serve in Bihar's underserved districts.

Despite the setbacks, stakeholders express cautious optimism that the project is finally on track. With environmental clearances secured, the executing agency in place, and boundary wall construction reportedly underway, the institutional framework for implementation appears more robust than at any previous stage. However, several challenges remain. The project must maintain construction momentum despite potential monsoon disruptions, given the region's vulnerability to flooding, the very concern that initially complicated site selection. Procurement of specialised medical equipment, recruitment of qualified faculty, and establishment of teaching protocols will require careful coordination in parallel with physical infrastructure development. The Central government's complete funding commitment, covering both construction and operational expenses, eliminates financial uncertainties that have plagued other state-level medical infrastructure projects. Yet, the Darbhanga experience underscores that financial allocation alone cannot overcome coordination challenges, land disputes, and political discontinuities that characterise large-scale infrastructure development in India's federal structure.

The AIIMS Darbhanga saga offers several lessons for healthcare infrastructure development in India. First, it highlights the critical importance of resolving land acquisition and site clearances before formal project announcements to avoid raising public expectations that subsequently go unmet for years. Second, it demonstrates how centre-state political differences can derail even nationally important projects with clear public health benefits. Third, it shows that sustained civil society pressure, through campaigns like the brick collection initiative, can be effective in keeping stalled projects on the political agenda.

For Bihar, a state with one of the highest population densities in India and significant healthcare infrastructure deficits, the operational commencement of AIIMS Darbhanga remains a crucial development priority. Until the facility begins serving patients and training medical professionals, the promise of equitable healthcare access in the Mithila region remains unfulfilled. As photographs of the solitary gate continue to circulate on social media, they serve as a stark reminder of the gap between policy announcements and ground-level implementation, a challenge that extends well beyond this single project to encompass India's broader infrastructure development aspirations.

SOURCES @: India Today, The CSR Journal, Hindustan Times, Times of India