Normal is not normal anymore, there is a new normal which the world is adapting after the rapid spread of novel coronavirus across longitude and latitude of the earth. The Coronavirus pandemic has changed everything. It has forced the mankind to flex and evolve, both in real-time and in the long-term. Physical and social distancing are buzzwords and an integral part of daily life. However, In India where unprecedented-paced urban sprawling already impedes intensification of complex urban issues including but not limited to land, water and sanitation and, 65 million people or 17 percent of urban population lives in informal settlements, social distancing is almost impossible with a population density of 200,000 people per square kilometer in slums like Dharavi in Mumbai neighborhood.
Urban slum population is more prone to deficiency of basic amenities like safe drinking water, sanitation, housing and health care services. According to National Family Health Survey-4 (NFHS-4, 2015-16) 4.6%, 3.4% and 8.4% of urban, rural and urban slum population respectively were using unimproved sanitation facilities and open defecation rate reported as 63.1% in urban slums.
Public health system in India has witnessed tremendous progress since the world’s first cholera pandemic outbreak in Kolkata in 1847 and the burden of mortalities during 1918 flu pandemic but due to complex and fairly unique Indian phenomenon of neighborhoods where the urban poor and middle class live together, India is still in vulnerable stage of defense against any communicable disease especially which turns into an epidemic or pandemic.
In April 2020, National Center for Disease Control under Health Ministry issued an advisory for urban slums and similar deprived population zones which primarily talks about containment plans in case any positive case is detected in these areas. According to the advisory, local influencers are expected to ensure do’s and don’ts including social distancing and common sanitation measures. The dynamics of health management at an urban poor population is very different from that of wealthier section of the society and mere advisory may not be an effective tool to combat the biological and social strains of COVID 19 among this section of the society.
Slums in India majorly constitutes of migrant workers who are engaged is short- and long-term employment with unorganized economy which is very sporadic in nature with constant job insecurity. The unprecedented lockdown in the country to prevent spread of the virus may be well-intentioned but not adequate for this section of population. While Dharavi of Mumbai is in limelight being Asia’s largest slum, there are many other similar or smaller zones spread across the urban landscape of India where media outreach is minimal, and it is unclear whether the virus has made its way to those slums. Lockdown may be an effective approach to stop the spread of virus. However, Impact of COVID 19 on informal workers, domestic workers, street-vendors etc., who are often ‘invisible’ during the old normal days will not only be restricted to them, but it will have multidimensional risk to the country as a whole.
Migrant workers who are anchors of a slum population started moving back towards their native due to fear, anxiety and hunger, majority of them are daily wagers and do not maintain cash liquidity for this kind of uncertain situation. According to latest India 2020 publication, the unorganized sector in India accounts for 97% of workforce and majority of them are inter/intra state migrants. Reverse migration of these workers will adversely affect sectors including but not limited to real estate, manufacturing, milling, textile, travel and tourism, e-commerce delivery, private security and facilities management. Once the curve of COVID 19 gets flat, the reverse migration will have notable economic impact on both the states, from where the migrant workforce come and to where they go. States like Uttar Pradesh, Bihar, Odisha and West Bengal, native of most of the migrants may witness a sudden sprawling flood of population creating unusual burden on economic and social infrastructure of the society, whereas, states such as Delhi, Haryana, Punjab, Gujarat, Karnataka, Maharashtra and Tamilnadu will witness sudden ebbtide of workforce leading to reduction in production capacity.
A random telephonic survey conducted by Afridi et al. in Delhi indicates the social stigma faced by low income families living in urban slums. 85% of respondents cited that they have lost their primary source of income due to lockdown while half (53%) of those did not received full salary for the month of March 2020. Undoubtably there is support from government in terms of providing free food/ration, direct infusion of cash into bank accounts, but these provisional measures are grossly inadequate to ensure social security. The uncertainty to resume the normalcy of life invites anxiety, stress and fundamental concerns about financial well-being. Though there are less reported evidences but based on psychological theories, a high degree of possibility exists to support the prediction of increased incidences of domestic violence, crime against women, theft, dacoity and robbery etc., due to emotional and financial stress. This pandemic raises a pressing need of policy level reform to ensure holistic inclusiveness and preparedness of the country to develop a more responsive framework to mitigate urban inequality during any similar outbreaks in future.
Healthcare institutions, government including World Health organization is delivering a lesson of handwashing and social distancing, in most of slums in the country where shared tap is the only source of water it is unclear that how this segment of population will adhere to the preventive guidelines. Poor-resourced settings are most vulnerable to any communicable disease, in absence of a curated strategy to control the pandemic among urban poor, India cannot boast of flattening the curve. Primary healthcare centers (PHC) which are the bottom of pyramid of healthcare system, already in short-supply or facing infrastructural deficits are not adequate to take the burden of a pandemic. Apart from those who are active COVID 19 patients the virus creates a passive challenge for those who are suffering from other critical ailments such as cardio-vascular, renal etc., and most importantly it impacts the scheduled care of expecting mothers, neonatal and children whose routine check-ups, immunization and treatments are disrupted. Malnutrition among children below 5 years from urban poor population is still a persistent problem in India, seizure of income due to lockdown may further result in dependency of food from government or charitable organizations and if this is not taken seriously, this may result in a bigger outbreak of multiple diseases caused due to nutritional deficiency.
“One-size-doesn’t-fit-all” considering the epidemiology of COVID 19 transmission through physical contact, droplets, contaminated surfaces, and aerosol, the government should create community-specific detection, containment, and treatment plan. The standard procedure of testing, containment, and treatment followed in a well-resourced society cannot work in an urban poor settlement.
While ensuring access to food, shelter, healthcare and basic needs of the urban poor population as an interim relief, the government should learn from this pandemic and focus on social determinants of healthcare by creating a robust, equitable and sustainable infrastructure which should be inclusive for all level of the society and ensures strong grassroots level partnership with communities. The government should create a communication strategy that ensures preventive measures such as basic sanitation practices, hygiene is getting blended into the day-to-day culture rather than being promoted as a temporary situational treatment. The current situation demands a social innovation framework where every citizen is an actor of change and having certain roles and responsibilities towards creating a safer, healthier nation.