Lives literally depend on the current Indian election. At a 100-bed government-run hospital in the city of Jaunpur, goats roam the corridors. Used syringes and vomit dot the floors. Walls are stained red where visitors chewed tobacco and spat it out.
The radiology department in a hospital that serves up to 2,000 patients a day in India's northern state of Uttar Pradesh closed three years ago. There weren't enough doctors. Windows are cracked, blood supplies are low, and ceiling fans don't work in temperatures reaching 38 degrees Celsius.
"I'm sure patients have died because we don't have the right type of blood to give them," said Alok Mani Tripathi, 28, a hospital doctor who plans to vote for the first time in elections that conclude on May 16. He's supporting opposition candidate Narendra Modi's Bharatiya Janata Party (BJP) over Prime Minister Manmohan Singh's Congress, along with two regional parties that dominate politics in the state.
"We have been let down by everyone," he said in the Shaheed Uma Nath Singh District Hospital's transfusion unit. Blotches of congealed blood mark the hospital's walls. "Modi is the only person who can turn the state around," Tripathi said.
In a state that holds the key to power in India and has one of the lowest turnout rates, dissatisfied residents such as Tripathi are critical to Modi's aspirations to become prime minister. The BJP leader is betting his message of economic development set against the government's failings will unlock voter apathy and trump caste-based allegiances that shape the political contours of one of India's poorest states.
Uttar Pradesh, where child mortality rates rival sub-Saharan Africa, is home to 200 million people and sends 80 of the nation's 545 lawmakers to parliament, more than any other area. Voting will start today in the state, one of nine rounds throughout the country that began on April 7 and will end on May 12. The results of the election will be announced four days later.
The BJP has never formed a national government without winning the most seats in Uttar Pradesh, and it took at least 29 of the state's constituencies in the three times it held power.
At the last election in 2009, a quarter of the seats in Uttar Pradesh were won by a victory margin of less than three per cent.
That isn't lost on Modi. He appointed one of his most trusted lieutenants to wage the BJP's campaign there and will contest the election in the state's constituency of Varanasi, one of Hinduism's holiest cities.
"Unless we do well here we have no future," said Sanjay Bharadwaj, a BJP leader in Uttar Pradesh, where about 48 per cent of voters cast a ballot in the last election, lower than the national average of 58 per cent. "UP is critical to our game plan for coming to power."
Most encouraging for Modi are forecasts that the BJP is eating into support for the two regional caste-based parties that have held power in the state for the past 15 years.
The parties together have won the most seats in the last three parliamentary elections.
On a hot mid-March day, he stood on the footpath outside the Shaheed Uma Nath Singh District Hospital, where the body of his son-in-law had just been dumped by medical staff and covered with a blue sheet. His daughter, distraught in a bright red sari, sat on the floor wailing over her dead husband.
Yadav said he called an ambulance when his son-in-law started experiencing chest pain, but it didn't arrive. After waiting for about two hours, he paid a taxi to take them 25 kilometres on a pothole-filled road to the hospital.
They arrived too late for doctors to save him. Medical staff told Yadav there were no ambulances to take the body back home to his village of Sarhana.
"Our hospital maintains a higher standard compared to hospitals in adjoining districts," Bhasker Rai, chief medical superintendent of the hospital, said when asked about the incident. "The standard may not have been satisfactory because we lacked staff on that particular day due to holidays."
In Sarhana, mud-brick homes cluster around a broken well. None have toilets or running water, and only a few of them have electricity. "If Modi is for development then I will vote for him," Yadav said. "In past elections politicians promised they would help us, but until now nothing has happened."
Development topped the concerns of Uttar Pradesh voters in a poll by CNN-IBN television channels, followed by rising prices and corruption.
Two years ago the state had the most murder cases in the country, according to the National Crime Records Bureau, and United Nations data shows a person born in the state will on average live 14 years fewer than in the southern state of Kerala.
"Uttar Pradesh is the black hole of India," said Surjit Singh Bhalla, chairman of Oxus Research and Investments in New Delhi and a former World Bank economist. "When people see Modi they think, 'This guy offers me the chance of a better life.'''
India's economy has expanded on average 7.9 per cent annually over the past decade, while Uttar Pradesh has grown at 6.6 per cent. While the state is home to a sixth of India's 1.2 billion people, it only captured 0.2 per cent of the total foreign investment into India in the last 14 years, according to the Ministry of Commerce and Industry.
At campaign speeches in Uttar Pradesh, Modi has touted his economic stewardship as governor over the past 13 years of Gujarat, one of India's most prosperous states. At a March 2 rally attended by half a million people in the state capital, Lucknow, he contrasted Uttar Pradesh's near-daily electricity cuts with a more reliable supply in Gujarat.
Abhishek Manu Singhvi, a spokesman for Congress, said voters wouldn't be duped by Modi. ''It shows how seriously they insult the intelligence of the people of India," he said.
To get out the vote, the BJP is also tapping the grass-roots network of the Rashtriya Swayamsevak Sangh (RSS), a Hindu nationalist group to which Modi has belonged. Opponents say the group has fuelled religious conflict with Muslims.
Krishna Pratap Singh, the BJP candidate in Jaunpur, has met RSS activists and on March 19 he visited a local Hindu shrine wearing a bright, saffron-coloured scarf that had the names of Hindu gods written on it. Uttar Pradesh holds about a fifth of India's Muslims, who constitute about 13 per cent of India's population, according to the 2001 census.
"At the top level they talk about development and at the lower level they talk about communal issues," said Sandeep Shastri, the pro-vice-chancellor of Jain University in Bangalore, who carries out opinion polls for India's top television channels. "The BJP is trying to divide voters along religious lines to overcome the web of caste-based polling that has dominated past elections in Uttar Pradesh."
Police this week filed a hate speech complaint against Amit Shah, a key Modi aide who is heading the BJP's campaign in Uttar Pradesh, for telling a Hindu crowd that a vote for the party would be tantamount to "revenge" for religious riots in the state, according to Arvind Pundir, an official at a Shamli police station.
The town is near where about 50 people died in clashes between Hindus and Muslims last year.
Shah's statement wasn't a call to violence and wasn't intended to cause discord between communities, Nirmala Sitharaman, a BJP spokeswoman, said. She rejected complaints that the party was exploiting communal divisions to win votes.
But infighting threatens to undermine the party's chances in Uttar Pradesh.
At the hospital in Jaunpur, Tripathi is the only person on duty at the blood bank. He talks about how corruption, crime cartels and caste-based politics shape life in Uttar Pradesh.
"We change governments from time to time but nothing else seems to change," said Tripathi. "It has always been like this. Maybe if Modi comes this time it will be different."