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A pandemic in unequal India

If the coronavirus pandemic lashes India with the severity that many public health experts dread, it will not be just the middle class who will be affected. India’s impoverished millions are likely to overwhelmingly bear the brunt of the catastrophic suffering which will inevitably ensue.

Written by Harsh Mander, leading scholar and human rights worker who heads the Centre for Equity Studies (CES) in Delhi, India. Athena has a longstanding partnership with CES, related to improving the health of homeless populations. Harsh defended his PhD on 'Vulnerable Populations and Policy Development in India: Designing State Interventions for Ending Hunger, Urban Homelessness, Destitution and Targeted Violence' in 2019 at the Athena Institute. Another PhD on this topic is currently being worked on by Harry Coleman who is looking at understanding and improving the health of inadequately housed groups in India.

The privileged Indian has been comfortable for too long with a comprehensive range of some of the most unconscionable inequalities in the planet. But with the pandemic, each of these fractures can decimate the survival probabilities and fragile livelihoods of those at the lower depths of this teeming country.

It is common knowledge that the virus has no cure so far, and only its spread can be prevented. The measures adopted by the government to stymie its progress were first to introduce a work from home measure, to wash one’s hands frequently, and physical distancing; and then a crushing unprecedented nation-wide lockdown for 21 days, that began March 24 midnight.

Does the government expect them to voluntarily starve and let their children die before their eyes to prevent the spread of the infection?

Deepening a social divide Public health experts are divided about whether this extreme measure was absolutely necessary and indeed implementable. It should have been abundantly clear that a total lockdown was possible only for the rich and the middle-class with assured incomes during the lockdown, homes with spaces for distancing, health insurance and running water supply. Then how can we justify the choice of this strategy which might protect the middle classes, but which throws the dispossessed, who lack these, to both hunger and infection?

When ordering the lockdown, did the Union government not remember the large majority of Indians: the millions of informal workers and destitute people who would have no work if they stayed home, many of them circular migrants, estimated at 100 million? These include casual daily-wage workers who search for work every day; those who do not have employers who would pay them if they miss work even to prevent infection; self-employed people such as rag-pickers, rickshaw pullers and street vendors; and people forced to survive by alms.

Many among them are people whose earnings each day barely suffice to enable them to eat and feed their families. Does the government expect them to voluntarily starve and let their children die before their eyes to prevent the spread of the infection? This crisis of hunger is even more dire for older people without caregivers, and persons with disability, who would be forced to die hungry because the state assures them little or no social security.

Governments also seem to be in similar amnesia about hundreds of thousands of children, women and men in every city who have no home to stay back in: for whom the only home is the pavement or the dirt patches under bridges.

How is social distancing feasible for large extended families who crowd into narrow single rooms in slums and working-class tenements?

Ground realities Recorded messages on our phones urge us to wash our hands regularly. We forget, however, that millions of Indians live in shanties without water supply, and they buy a pot of water, sometimes for a fifth of their day’s earnings (irregular incomes which are further decimated by the coronavirus lockdown). Regular cleanliness is a remote luxury entirely beyond their means.

We are also advised ‘social distancing’ (physical distancing) and ‘self-isolation’. How is this feasible for large extended families who crowd into narrow single rooms in slums and working-class tenements? Have we spared a thought for homeless people who have no option except to sleep in overcrowded unsanitary government shelters, which are veritable breeding centres for every deadly infection? For destitute people in beggars’ homes? Indeed, prisoners in our notoriously overcrowded jails? And I cannot forget those confined to detention centres in Assam, which are jails within jails.

The gaps in health care And then consider the capacity of the health system to deal with the pandemic if (or when) it actually submerges India. India’s investments in public health are among the lowest in the world, and most cities lack any kind of public primary health services. A Jan Swasthya Abhiyan estimate is that a district hospital serving a population of two million may have to serve 20,000 patients, but they are bereft of the beds, personnel and resources to do this. Few have a single ventilator. India’s rich and middle-classes have opted out of public health completely, leaving the poor with unconscionably meagre services. The irony is that a pandemic has been brought into India by people who can afford plane tickets, but while they will buy private health services, the virus will devastate the poor who they infect and who have little access to health care.

The Union government has announced a package, including monthly 5 kg extra grain, women Pradhan Mantri Jan Dhan Yojana holders will get ₹500 per month for next three months through direct transfer, three months’ pension in advance to nearly three-crore widows, senior citizens and the differently-abled and ₹2,000 for farmers under the Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) scheme. If you and I were told that we have to survive on just two days’ salary and 5 kg grain a month, with no health insurance, how would the future look?

And with these prospects, millions of migrants stranded in cities are desperately dodging the police and hunger as they trudge hundreds of miles, sometimes with small children, to a place which they call home. You cannot blame them: In their situation, without food and work, fearing a disease which can kill you, where would you want to be? This mass migration is estimated by some to be of the scale of Partition. With this, the lockdown has entirely failed and is now pointless.

What must be done Most of the official strategies place the responsibility on the citizen — rather than the state — to fight the pandemic. The state has done too little in the window of recent months it got before the pandemic reached India for expanding greatly its health infrastructure for testing and treatment. This also includes planning massive operations for food and work, security for the large mass of the poor, for safe and sanitised transportation of the poor to their homes, and for special protection for the aged, the disabled, children without care and the destitute.

India has lived too long with inequalities which should be intolerable.

For two months, every household in the informal economy, rural and urban, should be given the equivalent of 25 days’ minimum wages a month until the lockdown continues, and for two months beyond this. Pensions must be doubled and home-delivered in cash. There should be free water tankers in large numbers supplying water in slum shanties throughout the working days. Governments must double Public Distribution System (PDS) entitlements, which includes protein-rich pulses, and distribute these free at doorsteps. In addition, for homeless children and adults, and single migrants, it is urgent to supply cooked food to all who seek it, and to deliver packed food to the aged and the disabled in their homes using the services of community youth volunteers.

To ensure jails are safer, all prison undertrial prisoners, except those charged with the gravest crimes, should be released. Likewise, all those convicted for petty crimes. All residents of beggars’ homes, women’s rescue centres and detention centres should be freed forthwith.

India must immediately commit its long-delayed 3% GDP of public spending on health services, with the focus on free and universal primary and secondary health care. But since the need is immediate, Indian authorities should follow the example of Spain and New Zealand and nationalise private health care. In particular, an ordinance should be passed immediately no patient should be turned away or charged in any private hospital for diagnosis or treatment of symptoms which could be of coronavirus.

India has lived too long with inequalities which should be intolerable. While one part of the population enjoys work and nutritional security, health insurance and housing of globally acceptable standards, others survive at the edge of unprotected and uncertain work, abysmal housing without clean water and sanitation, and no assured public health-care. May we use the moment of this pandemic — the gravest crisis India and the world have faced in many decades — to resolve to correct this in the post-corona India. Can we at least now make our country more kind, just and equal?

Learn more about our partnership with the Centre of Equity Studies through this blogpost by Nicole and Pävi.

More articles by Harsh Mander:

State’s measures to fight coronavirus are stripping the poor of dignity and hope

"The Indian government found it fit to charter planes with medical staff to fly in migrants from other countries. But it felt no responsibility at all to the millions of migrants stranded without work and food in every corner of the country."

Solidarity is a potent weapon against pandemic, prejudice weakens us all

"Public health experts differ about whether such a harsh and comprehensive a lockdown was advisable in India. But assuming it was, it was designed and implemented entirely bereft of empathy and compassion."

Covid-19 crisis calls for universal delivery of food and cash transfers by the state

"In these dire circumstances, it is essential for the state to directly provide the basic means of survival to anyone who needs it. This must be in both cash and kind."

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