led to death by opportunistic infections. Second, the social disruption and dismal conditions caused by a cascading breakdown of social systems brought mass migration, overcrowding, poor sanitation, poor water quality and waste disposal, increased vermin, and unburied dead. All of these factors are closely associated with the increased spread of infectious disease. Social disruption Despite the organised and sometimes violent civil unrest immediately before the famine, there was no organised rioting when the famine took hold. However, the crisis overwhelmed the provision of health care and key supplies: food relief and medical rehabilitation were supplied too late, whilst medical facilities across the province were utterly insufficient for the task at hand. A long-standing system of rural patronage, in which peasants relied on large landowners to supply subsistence in times of crisis, collapsed as patrons exhausted their own resources and abandoned the peasants. Families also disintegrated, with cases of abandonment, child-selling, prostitution, and sexual exploitation. Lines of small children begging stretched for miles outside cities; at night, children could be heard "crying bitterly and coughing terribly ... in the pouring monsoon rain ... stark naked, homeless, motherless, fatherless and friendless. Their sole possession was an empty tin". A schoolteacher in Mahisadal witnessed "children picking and eating undigested grains out of a beggar's diarrheal discharge". Author Freda Bedi wrote that it was "not just the problem of rice and the availability of rice. It was the problem of society in fragments". Population displacement The famine fell hardest on the rural poor. As the distress continued, families adopted increasingly desperate means for survival. First, they reduced their food intake and began to sell jewellery, ornaments, and smaller items of personal property. As expenses for food or burials became more urgent, the items sold became larger and less replaceable. Eventually, families disintegrated; men sold their small farms and left home to look for work or to join the army, and women and children became homeless migrants, often travelling to Calcutta or another large city in search of organised relief: In Calcutta, evidence of the famine was "... mainly in the form of masses of rural destitutes trekking into the city and dying on the streets". Estimates of the number of the sick who flocked to Calcutta ranged between 100,000 and 150,000. Once they left their rural villages in search of food, their outlook for survival was grim: "Many died by the roadside – witness