India's coronavirus response ignores its slumdwellers, all 65 million of them

Until recently, Covid-19 was a wealthy man's disease in India, prevalent mainly in those with travel histories abroad and their contacts.

Now, as the South Asian nation inches closer to the community transmission stage, reports of Covid-19 infections and casualties have started emerging from its poorest pockets - the slums. There is no space for social distancing in these settlements, or enough clean water to wash hands, let alone the privilege of working from home. There is a history of infectious diseases, poor access to healthcare, and a risk of infecting millions.

Home to about one-third of the world's poorest, over 65 million in India - or one in six - reside in slums, which are "unfit for human inhabitation." Up to 53 million of these residents live below the poverty line, spending less than $14 for a family each month. Their homes are characterised by poor sanitation, overcrowding and unhealthy living conditions. And the world's biggest coronavirus lockdown is hardly proving to be a saviour for these residents.

Announced with four hours' notice, the nationwide lockdown announced in late March barely lent any consideration to the country's poor, who, according to an Oxford study, are at "high risk" from the coronavirus pandemic, owing to lack of access to clean drinking water, under-nutrition and a lack of clean cooking fuel.

Prime Minister Narendra Modi's government has announced direct cash transfers and food security measures for the poor in light of the pandemic. However, reports claim that the help has hardly reached its beneficiaries. Indian-American economist and Nobel laureate Abhijit Banerjee recently stated that India needs to be "much more generous" and has not done "anything close to enough" to provide relief to the poor, who have been adversely impacted by the countrywide lockdown.

There is no space for social distancing in these settlements, or enough clean water to wash hands, let alone the privilege of working from home

"The lockdown [in India] has already disproportionately hurt marginalised communities due to loss of livelihood and lack of food, shelter, health, and other basic needs," Human Rights Watch noted recently. "Indian authorities need to urgently adopt measures to protect the country's poorest and most vulnerable people if Covid-19 containment and relief measures prove inadequate."

So, why are slums more challenging in the fight against the novel pathogen?

Simply because the dynamics of disease play out differently for the rich and poor, and regular precautions that apply to the affluent are rendered impractical in cramped slum clusters.

The World Health Organisation (WHO), for instance, has advocated social distancing to combat the spread of coronavirus. Billions around the world are under lockdown. However, maintaining physical or social distance in India's densely inhabited slums is hardly practical.

Read more: 'We will treat only Hindus': Indian doctor 'turns away' Muslim patients amid coronavirus pandemic

With a population of 1.3 billion, India is the second most populous country on earth. According to World Bank data for 2018, the country has a population density of 455 people per square kilometre, as opposed to 148 in China, 275 in the United Kingdom, and 36 in the United States. India's slums fare much worse.

Asia's largest slum, Dharavi in Mumbai, for instance, houses 277,136 people per square kilometre. The slum cluster has already become a major hotspot of Covid-19 outbreak in India, having reported 733 positive cases and 21 deaths as of 7 May. Similar hotspots have also emerged in other major Indian cities, such as Pune, Bengaluru, Ahmedabad and Kolkata.

Another important recommendation of the WHO is washing hands frequently. However, in India's slums, there is limited access to safe water and private toilets. Most of the 100-square-feet homes in Mumbai's slums, for instance, do not have sanitation and water facilities. Residents often crowd around community toilets - one toilet for 1440 people in Dharavi - 78 percent of which lack water supply.

Drinking water is often contaminated, making the population vulnerable to water-borne diseases like diarrhoea, cholera, jaundice and typhoid. This water poverty makes it impossible for slum dwellers to wash hands to evade the novel coronavirus.

"Despite the lockdown, people still queue up outside the community toilets," Mohammed Ansari, says a 21-year-old leather artisan residing in Dharavi. "Most of us do not have masks, and tie handkerchiefs around our mouths instead. Many have tested positive here, and there is a constant fear of contracting the virus. But we're more worried about our wages. Our families depend on us."

Asia's largest slum, Dharavi in Mumbai, for instance, houses 277,136 people per square kilometre

The pandemic has caused millions around the world to start working from home. This is hardly an option for India's slum dwellers. Mostly migrants, who move to urban centres in search of employment, most slum residents find work in the country's robust informal economy as labourers in manufacturing units, or as construction workers, domestic help and auto rickshaw and cab drivers. They do not have employment benefits such as paid leave, insurance or safety equipment.

Such workers live hand to mouth, relying on daily wages for their expenses - averaging about a dollar a day. 'Work from home' could mean no food on the table for days, and exposure to other pressing problems like hunger and malnutrition. When India announced a national lockdown to contain the pandemic, urban migrants started walking hundreds of miles to get home. At least 22 died on the road. 

Sanitation is another major issue, which makes slum clusters further vulnerable to infectious diseases. Often located near drains, an estimated 31 percent of slums in India have no drainage system, and 27 percent have no garbage disposal arrangements.

Such living conditions lead to many non-communicable diseases like malnutrition and diabetes as well as infectious diseases such as dengue fever. Poor access to formal health infrastructure further aggravates the situation.

When India announced a national lockdown to contain the pandemic, urban migrants started walking hundreds of miles to get home

According to a study published by the Washington-based Brookings Institution on Covid-19 in Mumbai's slums, such settlements have a number of disadvantages built into their fabric, and are witnessing a high number of Covid-19 infections, which makes these areas and their residents "far more vulnerable" than other urban clusters.

The study also pointed to the "obvious limitations of the strategies that have widely and successfully been used elsewhere to combat the pandemic."

The Covid-19 crisis may prove fatal for those in India's slum clusters, and the state needs to adopt alternative administrative measures to prevent the pandemic from further exacerbating their vulnerability. These include immediate access to clean water supply, providing masks, organising mobile toilets to avoid crowding near community washrooms, free and large scale Covid-19 testing, provision of quarantine facilities, and easy and affordable access to food and public health care.

India is already home to widespread socio-economic health inequities, and the state must act before the novel pathogen deepens the divide.

Puja Changoiwala is an award-winning journalist and author based in Mumbai. She writes about the intersections of gender, crime, social justice, human rights and technology in India.

Follow her on twitter: @cpuja.

Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab.