In a related incident, about 50 students of a government middle school in Madhubani district fell ill after eating food under the midday meal scheme.
The food was served to children of Navtolia Middle School, Bisfi, about 22 km from Madhubani, amid allegations by the students that a dead lizard was found in the meal.
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'The oil used to cook the vegetables was foul-smelling. Doctors found the presence of organic phosphorus in the food and vomit. It means the children were poisoned,' Bihar education minister P K Shahi told reporters in Patna.
Shahi did not rule out foul play and said investigations will determine whether the poisoning was accidental or deliberate.
As the tragedy sparked a political blame game, Shahi also alleged a political conspiracy against the state government.
'Principal Meena Kumari's husband is close to a political leader,' he said.
Shahi suspected the poisoning to be caused by insecticides in vegetable or rice.
Union HRD Minister Pallam Raju said an FIR has already been lodged against the school principal.
The 'food has turned killer', screamed a woman whose two sons were among the victims, as a pall of gloom hung over Dandaman village.
While 16 children, aged below 10 years and studying in Class I to V, had died in Chhapra itself, four others were declared dead on arrival at Patna Medical College Hospital (PMCH) late last night. Two died at the hospital this morning, official and PMCH sources said.
Twenty five others are under medical supervision in PMCH, Superintendent of PMCH Amarkant Jha Azad said.
There were emotional scenes as children, their limbs dangling and heads drooping to one side, were brought to a hospital.
The tragedy took place at the government primary school in Dahrmasati Gandawan village at Mashrakh block, about 25 km from Chhapra and 60 km from Patna yesterday.
Police said that during the violent protests three police vehicles were damaged by agitators during a bandh call in Saran district over the deaths.