Health

COVID-19: Slums in India provide fertile ground for outbreaks

it is near impossible for slum dwellers to practice WHO guidelines of social distancing, frequent hand-washing

 
By Nijara Deka, Gautam Kumar Das
Last Updated: Monday 11 May 2020
The novel coronavirus disease (COVID-19) is spreading like wildfire in Dharavi — Asia’s largest slum — located in Maharashtra capital Mumbai Photo: Wikimedia Commons

The novel coronavirus disease (COVID-19) is spreading like wildfire in Dharavi — Asia’s largest slum — located in Maharashtra capital Mumbai, with 833 positive cases as of May 9, 2020, confirming the worst fears of explosive contagion in India’s slums.

In India, 5.41 per cent of the total population and 17.37 per cent of the urban population live in slum areas. Overcrowded, highly dense slum and squatter settlements of cities — inhabited by people on the lower rungs of the economic ladder — highlights the challenges of countries’ control over the pandemic.

While living within congested, over-crowded housing and shared basic amenities in such areas of the cities, it is near impossible or meaningless for slum dwellers to practice the World Health Organization (WHO) guidelines of social distancing, frequent hand-washing with soap and water and other hygiene to combat the virus (SARS-CoV-2).

Its spread in Dharavi certainly raised the question of the country’s preparedness for an epidemic like this. The nature of the distress due to the direct impact of the crisis would be the highest among those living in these areas.

A gist of vulnerabilities of housing and basic amenities of people in slums and squatter settlement in India can be gleaned from the Union government’s latest National Sample Survey Office (NSSO) data on Housing and Sanitation in 2018.

Distancing

The data reveals that the ratio of a room to person in urban slum and squatter settlements is 1:1.41, which means more than one individual shares one room. This figure, however, varies in different states.

In West Bengal, one room is shared by more than two individuals. In states like Maharashtra, Uttar Pradesh, Delhi, Gujarat and Assam, the ratios is higher than in other parts of India. This indicates the near impossibility of social distancing and quarantine in urban slums of the country.

Ratio of room to person in slums and squatter settlement

States

Ratio of room to person

West Bengal

2.42

Maharashtra

1.67

Uttar Pradesh

1.80

Delhi

1.52

Assam

1.50

Gujarat

1.70

Tamil Nadu

1.08

All India

1.41

Source: Estimated from NSSO 76th round Housing Data

Emergencies include visiting hospitals, getting medicine and essential food items for the middle- and upper-income population, while following social distancing norms.

For people living in slums and squatter settlements, however, daily unavoidable functions, when they have to come out of their homes, also includes using common sanitation facilities and collecting water to drink and other purposes.

More than 50 per cent households collect drinking water from common sources, including common use of households in the building, a public or private source restricted or unrestricted to particular communities.

Among these, 25.63 per cent of households collect water from unrestricted, public sources. Therefore, to get drinking water, household members have to come out of their homes, where distancing as well as other non-contamination to the virus, is questionable.

Another vulnerability associated with water is the distance to source of water. It is found that around 39 per cent of the households have to go out of their premises for drinking water and nearly 9 per cent of the households walk more than 200 metres to get drinking water.

Shared basic amenities in slums and squatter settlement

Source: Estimated from NSSO 76th round Housing Data

Among the households fetching drinking water from outside, 39 per cent spend more than 15 minutes in a single trip to reach, obtain water and return home, with more than 58 per cent of households in slum and squatter settlements needing more than one trip a day for fetching drinking water from a principal source.

Water used for other purposes, excluding drinking, also demonstrates the vulnerabilities of slum and squatter settlements in India. Nearly 18 per cent of slum households use public tap or standpipe for these purposes.

Again, 21 per cent of slum households have water supply of either once in two days or once in three days or once in a week or even more.

Further to these, 41 per cent of the households do not have bathrooms within their dwelling premises, with around 40 per cent of them having either common use bathrooms or no bathroom facilities.

Health and hygiene

Another advisory of the WHO for reducing the spread of the disease is frequent hand-washing with soap and water. Only 53 per cent of slum and squatter households, however, wash their hands with water before having their meals and almost 17 per cent use only water to wash hands after defecation.

Possibilities of health and hygiene among slums and squatter households

         Regularly wash their hands before meal

         Regularly wash their hands after defecation

With water and soap / detergent

With water and ash / mud / sand etc.

With water only

No

With water and soap / detergent

With water and ash / mud / sand etc

With water only

No

43.63

2.27

52.59

1.51

78.63

4.70

16.59

0.08

         Availability of water in or around the latrine used

Water is available with soap / detergent

Water is available with ash / mud / sand etc

Only water is available

Not available

63.36

2.04

27.28

7.31

         Agency made arrangement for collection of garbage of the household

Panchayat / municipality / corporation

Resident / group of residents

No arrangement

Other

74.78

2.39

20.61

2.22

Source: Estimated from NSSO 76th round Housing Data

In slum and squatter settlements, 16 per cent of the households are estimated to have no sufficient availability of drinking water from principal sources, while 14.51 per cent of households are estimated to have no sufficient water throughout the year for purposes other than drinking.

Nearly 37 per cent of the households use common bathrooms, while 10.32 per cent of the households have no bathroom facilities, that is, open defecation takes place.

Additionally, 27 per cent of the slum and squatter settlement households reported availability of water, but not soap / detergent in and around the bathroom.

Possibilities of health and hygiene among slums and squatter households

Source: Estimated from NSSO 76th round Housing Data

The drainage system in slum and squatter settlement is also vulnerable with 27 per cent of households having open drain and 17 per cent with no drainage system.

Regarding wastewater disposal, 14.16 per cent households are estimated to dispose to open low land areas / streets and 13.37 per cent households are estimated to dispose to the nearby river.

Similarly, in case of disposal of garbage, 33.13 per cent of households are estimated to use a common place (excluding community dumping spot) which includes open areas, streets or open drains.

Again, 21 per cent of slum and squatter settlement households are estimated to have no arrangement of collection of garbage of the households by any agency.

Therefore, the foregoing analysis of housing and basic amenities in slums and squatter settlements proves that people live in urban slums and squatter settlements to meet their immediate need for shelter without any safeguard for disasters and diseases.

These numbers clearly demonstrate the unpreparedness of slums and squatter settlements to face any pandemic of this intensity or even less.

These realities are common in other countries too: Slums of Orangi town in Karachi, Payatas in Manila, Nairobi, Sao Paulo are only a few examples.

In 2014-16 too, the Ebola epidemic impacted the densely populated urban slums of Liberia, Guinea and Sierra Leone. However, increasing urbanisation and other developmental activities overshadowed the critical issue of quality of life in slums. This results in the rapid spread the virus within the circumstances of a pandemic like this.

In search of cheaper shelter in costly cities, households only concentrate on their livelihood and other essential needs, but overlook health risks associated.

Another highlight from the analysis is that although WHO norms for COVID-19 appear very obvious and painless, it is extremely difficult to implement in slums and squatter settlements in cities. In case of slums in India, these are luxuries which everyone cannot afford.

The opinions expressed in this publication are those of the authors. They do not reflect the opinions or views of any institution

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