How Can India Fight COVID Without Proper Sanitation For the Poor?

With the stark reality of open defecation and lack of proper toilets & running water, how can the poor fight COVID?

Image used for representational purposes.

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When the former Union Health Secretary, Government of India, Sujatha Rao said that the class aspects of COVID-19 need to be well-understood, she hinted at various otherwise well-discussed, but usually brushed-under-the-carpet issues of Indian society. As the death toll continues to rise, and we struggle with limited availability of testing kits, and health care facilities, accompanied by the nationwide lockdown and so-called ‘elite’ government directives of physical distancing, washing hands, isolation etc, we need to see what do these directives really mean for the poor.

More so, when the very access to essential sanitation facilities, namely access to clean water and toilets, is a privilege for millions in our country.

Reality of Open Defecation in India & Spread of COVID Through Excreta

With limited research speculating the lingering of coronavirus on human excreta much longer than in respiratory samples, and chances that it may spread through human waste, we should not ignore the grave situation of open defecation in our country. Although India was declared ‘Open Defecation Free’ (ODF) by the central government in October 2019, with the construction of 110 million toilets for 600 million people under the Swachh Bharat Mission (SBM), the reality is actually not that impressive.

The interventions made by the government have not been effective enough to bring behavioural change in ensuring that the construction of toilets also imply using them.

Further, access to running water has also been a factor limiting the use of toilets.

Data collected by independent agencies tell a similar story. In 2014, according to UNICEF, around 620 million people were openly defecating in India. Four years later, a survey conducted by RISE in 2018, revealed that 44 percent of India’s population was still defecating in the open. NSSO 76th round report (2018) on drinking water, sanitation and hygiene also claimed that 29 percent of the country’s population has no access to toilets.

Poverty & Sanitation Concerns: Threat of Faecal-Oral Transmission of Coronavirus

A recent article reported that one toilet for 1440 people in Dharavi (a slum in Mumbai, thirty times more densely populated than New York) and 78 percent of the community toilets built under the Slum Sanitation Programme (SSP) in Mumbai lack water supply. While the lockdown may force households to start using their personal or community toilets built under SBM or SSP, the lack of water supply would still hinder their usage. Further, the SBM statistics still do not speak for those 90 lakhs (0.9 million) homeless people.

Thus, with 344 million people in India still defecating in the open and more than 163 million with no access to clean water, the expectation that people should stay at home, and should wash their hands every alternate hour, is not very practical.

Lack of access to water prevents them from the most basic of preventive measures against COVID-19 – washing hands; defecating in the open exposes the nearby communities to potential faecal-oral transmission of the coronavirus.

Why the Poor Need More Protection Against Coronavirus

If we use the lens of social interaction to understand the present condition, we find that the efficacy of the nation-wide lockdown is contingent upon the state where the infected people are isolated and treated in time, before it trickles down and infects the larger community. A significant proportion of the country’s population, particularly the poor, living in densely populated areas, do not have the privilege to isolate themselves like middle class and affluent folk. The spread of infection to the poor puts us at the risk of entering the much feared Stage III of ‘community transmission’, extending the COVID-19 concern from a pathological one to a much broader socio-economic one.

As a result, marginalised sections of the society (like informal and casual labourers and their families, people living in refugee camps, slum inhabitations, etc) are at much higher risk overall.

The nation-wide lockdown has led to around 92.5 percent of daily wage workers and labourers losing their jobs.

COVID Crisis Provides Policy Window to Govt to Increase Public Investment

A recent survey shows that 42 percent have no rations left for the day, let alone the lockdown period, more so, when it is speculated to be extended further. While the state governments have announced aid packages for ensuring food supplies for all those severely affected due to the crisis, there is still no clear directive available on how these supplies would reach the affected population. When such a huge proportion of country’s population is struggling for food – a basic human right – it will be futile to even urge people to practice isolation and personal hygiene, without focusing government efforts on all these fronts together.

From a policy perspective, the prevalence of poor sanitation conditions not only impedes the efforts of government in controlling the spread of COVID-19, it also feeds into the system and jeopardises the already critical condition, transmuting it into a harsher pandemic situation.

The current crisis provides a much-needed policy window to the government to increase public investment and develop strategies and interventions which will ameliorate the poor sanitation conditions and make sure that “no one is left behind”.

Committing Political & Financial Resources to Supporting Vulnerable Groups Amid COVID

The UN Secretary General Antonio Guterres made a very apt statement: “History will judge us on how we reacted for the poorest communities in their darkest hour. Let us act together, right now”. The response to this statement lies in committing our political and financial resources in preventing the spread amongst these vulnerable populations groups right now, and simultaneously reflecting on the effectiveness and inclusiveness of existing policies for the poor, like the public distribution system, slum sanitation etc.

Unless this is taken on priority, the appeal from the government to stay at home and maintain hygiene can only be observed non-contentiously by the privileged classes, while the poor will continue to witness further rise in their vulnerabilities. It is now in decades, that the commitment of the government to protect its citizens is being put to a real test.

(Deepika Saluja is a Ph.D. in Public Health Policy from IIM-Ahmedabad. She is also the co-founder of Women in Global Health-India Chapter and is currently working as an independent consultant.

Akansh Khandelwal is pursuing his Ph.D. in Economics at IIM-Indore. His interests lie in development, inequality, and feminism.

Karan Babbar is a PhD scholar at IIM-Ahmedabad. He critically engages with issues of social concern like gender, menstruation, etc.

This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)