India is under a public health emergency, with hotspots of the pandemic highly localised in certain cities, although it has impacted the life of all citizens across the country and livelihood of the informal sector. With those infected crossing the one-lakh-mark, Covid-19 really throws an insurmountable challenge before the country where health facilities are not geared to deal with it.
The slums in most cities have become hotbeds of the pandemic due to congestion, overcrowding, lack of proper sanitation and water supply. On the contrary, home quarantine, social distancing and regular handwashing have been highly recommended to prevent the spread of infection. Since the virus is contagious, use of separate toilets and bathrooms is recommended along with frequent handwashing with soap.
The pandemic has brought to the forefront the challenges urban India is facing with regard to home quarantine and social distancing given the dearth of adequate housing and basic amenities, with over 17% of the population living in slums. Given this scenario, it is important to analyse what percentage of households have a separate room, exclusive access to toilet and handwashing facilities to arrange complete isolation of patients.
The 2011 Census data shows that the problem of adequate housing is severe in metropolitan cities and slums, where 37.6% and 57% of the households reside in just one room respectively. Greater Mumbai, where the share of population living in slums is around 50%, has 64.7% of the households living in just one room. Highly dense slums makes the practise of social distancing challenging.
Exclusive access to basic amenities is not uniform across urban India. The recent round of the National Sample Survey on Drinking Water, Sanitation, Hygiene and Housing Condition in India, 2018, shows that a quarter of the urban population do not have exclusive access to bathroom and toilet facilities whereas only 57.5% households have exclusive access to a principal source of drinking water. These figures corroborate the fact that social distancing and handwashing are limited to affluent households, who are privileged to have exclusive access to basic amenities.
In contrast, poor households are constrained by poor availability of basic amenities. Lack of exclusive access to basic amenities poses further challenge. Also, half of the slum households have water supply outside premises, and a quarter depend on community toilets (Census 2011). The figures worsen in non-notified slums where about 70% of the households do not have exclusive access to drinking water.
Therefore, the risk of spread of the virus is high in such localities as is seen in Dharavi and slum clusters in other cities. The situation with regard to hygiene is really grim in slums where almost 60% of the households have basic amenities outside their premises or need to share the facilities with other households.
Handwashing Without Water
Only 56% of urban households wash hands with water and soap/detergent before meals. The figure drops to about 40% in slums. The availability of soap and water in latrines is around 60% in slums. Importantly, over 20% of slum-dwellers do not practise handwashing after defecation substituting their handwashing with ash/mud/sand.
In million-plus cities, the better off localities report the highest share of households who wash hands with soap before a meal. These households also report higher access to exclusive services as compared with non-metro cities. In India, exclusive access to basic amenities and hygiene practices are highly correlated with affordability, the inequality rising with regard to exclusive access to bathrooms and latrines.
Only about 40% of poor households go for handwashing with water and soap/detergent before meals. The Scheduled Tribes and Castes households face higher deprivation with regard to exclusive access to basic amenities, which limits their hygiene practices.
Possibly, the most ‘unheard’ section of society in the time of pandemic is the differently-abled population. Eight million differently-abled people reside in urban India with Urban Maharashtra reporting the highest share (Census 2011).
The pandemic has been most widespread in this State. Accessing basic amenities and maintaining minimum hygiene remain a challenge for these people, especially those living in slums.
Extreme congestion in low-income informal settlements stands in the way of home quarantine of suspected Covid-19 patients, especially in cities where government facilities for the same are not available. Coupled with this, lack of access to exclusive basic amenities compels households to share services. Also, lack of the habit of handwashing before and after meals and defecation are important challenges that need to be addressed if the guidelines of home quarantine, social distancing and regular hand washing need to be adhered to by the poor, in case of infection.
The challenge is serious in non-notified slums and squatters where coverage of services is still poor and households need to queue up for water or use community toilets or defecate in the open. Patients from such poor households living in slums while sharing basic amenities with other households, run the risk of community transmission. Provision of minimum standard of living with adequate living space and exclusive access to basic amenities is the sine qua non to addressing the pandemic, which currently seems a distant dream.
(Dr Debolina Kundu is Professor and Biswajit Kar is Research Associate, National Institute of Urban Affairs, New Delhi)
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