Yamuna Pushta resident Arun Kumar Jha sits on a footpath across from Ring Road in Delhi / credit: Parva Dubey
DELHI, India—Rohit Sharma stood on the spot where, more than a fortnight ago, he had a bed in a night shelter. After having traveled more than 650 miles from his home city of Patna, Sharma lived for the past four years in a shelter the Delhi Urban Shelter Improvement Board (DUSIB) had provided.
“I used to get picked up from here for work. I would then come back and sleep here. This was my home,” said Sharma, who works in the tent-fitting industry. “Most of us fix tents or work for caterers for different occasions, like marriage or religious programs.”
Yet, everything changed on the night of March 9. That’s when bulldozers, in the presence of police, demolished temporary shelters, according to homeless people like Sharma. Now, he, along with about 1,200 people who used to live in four night shelters, sit under the sky. The site of the former shelter is close to the interstate bus terminus (ISBT) at Kashmere Gate, the northern entrance to the historic walled city of Old Delhi.
Map of Yamuna River flowing through Delhi National Capital Territory / credit: Google Maps
Displacing the Poor Ahead of G20 Summit
Activists and the affected said current demolitions are part of preparations for the Group of Twenty (G20) Summit that the capital city of New Delhi is preparing to host in September. G20 is an intergovernmental group made up of 19 countries plus the European Union. Altogether, the G20 represents two-thirds of the world’s population. Its stated aim is to address global economic issues. Indian Prime Minister Narendra Modi became its chairman last year.
Past G20 summits had been met with protests from both anti-globalization movements and groups opposing the displacement of society’s poorest to make way for a summit venue. Such was the case in 2010 in Toronto, Canada, and in 2017 in Hamburg, Germany, for example.
Similarly, before Donald Trump visited India in 2020 as the president of the United States, the huts of poor families were demolished around the venue to host him in Gujarat state in western India.
Estimates of 100,000 to more than 300,000 people live in Yamuna Pushta, where India’s largest reported slum developed in flood-prone conditions along the banks of the Yamuna River flowing through Delhi, India’s National Capital Territory (NCT).
Demolished shelter in Yamuna Pushta in Delhi near a crematorium known as Nigam Bodhi Ghat / credit: Parva Dubey
Destroying Livelihoods
Since the demolition drive in Delhi began, poor and working-class people said police have been trying to ensure they do not linger in the area where they normally wait to secure gigs for the day.
“They take us in a bus forcefully and drop us at a distance from here and ask us not to come back,” Sharma said, adding, “We find work at this place. Contractors come here and pick us up from here. Where else would we find work?”
The location to which homeless people must be moved is supposed to be “close to where they are concentrated and close to the work site as far as practicable,” as per Indian Ministry of Housing and Urban Affairs’ Revised Operational Guidelines for Scheme of Shelter for Urban Homeless under Deendayal Antyodaya Yojana-National Urban Livelihood Mission (DAY-NULM).
However, the affected said they will struggle to find work after being forced to move.
“I have been working for the cause of the homeless for more than 20 years now. Governments never rehabilitate any homeless, like they claim to do,” alleged social activist Sunil Kumar Aledia, who is National Convenor for Homeless Housing Rights (NFHHR).
Yamuna Pushta resident Rohit Sharma (standing, in a pink shirt) on the spot where his bed once lay before a night shelter was demolished / credit: Parva Dubey
Bulldozing Homes
Aledia filed a Public Interest Litigation (PIL) in the Supreme Court of India on March 3.
“We approached the Supreme Court as the demolition drive was going on in other places, and we did not want other temporary shelters to be demolished,” Aledia said.
But, before the court could take up the matter, Delhi Urban Shelter Improvement Board (DUSIB) razed the shelters.
“We were sleeping when the authorities came with bulldozers. They did not tell us the reason for demolishing our home,” Sharma told Toward Freedom. “Some of the inhabitants were manhandled by the police.”
Little information is available about the source of the demolition drive. NCT Urban Development Minister Saurabh Bharadwaj wrote to DUSIB on March 16, inquiring under whose direction the action was taken. The letter that the Times of India obtained stated:
“Director DUSIB has given a statement in the social media that the demolition has been carried out on the orders of Govt. of NCT, Delhi. DUSIB may kindly specify who in Delhi Govt. has given these directions? And whether these orders were recorded or merely oral?”
DUSIB remains mum.
“The matter is sub judice in the Supreme Court, and it wouldn’t be appropriate to comment at this stage,” P.K. Jha, an official of DUSIB, told Toward Freedom. Sub judice describes a matter under a court’s consideration and, therefore, official commentary is prohibited.
‘We Only Need Food and a Make-Do Shelter’
“Some big event is going to take place here. That’s why they broke this shelter,” said Arun Kumar Jha, another occupant of the night shelter, sitting on the footpath across the road. He frequents different night shelters in the area.
Dozens of homeless still sit in the place where their shelter was until a few weeks ago. They have always relied on voluntary organizations, temples and individuals for food. Across the road, approximately 300 meters (328 yards) away from the shelter is a revered Hanuman Temple. Hanuman is a Hindu god with the face of a monkey known for his devotion via service. The homeless crowd outside the temple has increased after the demolition. They find it easier to find food and money from worshippers visiting the temple.
“Food is not a problem here, many people come and serve us, that’s why we (homeless) do not want to leave this place. We only need food and a make-do shelter,” Jha told Toward Freedom. “Government takes us in a bus from here, but never provides food.”
Parva Dubey is a freelance writer based in New Delhi. Parva can be followed on Twitter at @ParvaDubey.
Farmers protested the Indian government’s pro-corporate farm laws in December 2020 at the Tikri border of the Indian state of Delhi. Meanwhile, the Narendra Modi government has used draconian laws to indefinitely detain activists, academics and journalists / credit: Randeep Maddoke
Aakash Hassan, a 25-year-old independent journalist from the conflict-torn Indian administered Kashmir region, was slated to travel to Sri Lanka for a reporting assignment earlier this year. As Hassan was about to board a flight at New Delhi’s Indira Gandhi International Airport, Indian immigration authorities stopped him. Hassan was provided no reason for the travel ban. However, his boarding pass was stamped with a message: “Stopped without prejudice.”
Although Indian authorities maintain silence about their decision, Akash is sure of what led to this: “It is because of the kind of journalism I practice.”
Arbitrary travel bans against journalists and activists critical of the ruling Hindu nationalist Bharatiya Janata Party (BJP) are trending in India. This is particularly the case for journalists from the disputed Himalayan region of Kashmir. The BJP-led government revoked in 2019 the Muslim-majority Kashmir territory’s autonomous status, resulting in the arrest of activists, academics and journalists.
However, the Indian government has provided no explanation for recent travel bans. Meanwhile, immigration officials have yet to respond to this reporter’s inquiries. Plus, not a single journalist this reporter is acquainted with has been able to obtain the government’s comment on this issue.
“I don’t know what kind of crime I have committed, for which there is a travel ban on me. Stopping us [journalists] from traveling is not only an attack on our personal liberty, but also [on] our fundamental rights,” Hassan told Toward Freedom. “The government should at least provide a reason as to why our freedom to travel is curtailed.”
BJP-Led India’s Flight Bans
Hassan’s is not an isolated case.
Last month, journalist Sanna Irshad Mattoo was also barred from flying to the United States to receive a prestigious award. She had won the 2022 Pulitzer Prize for feature photography for documenting the impact of the COVID-19 pandemic in India. This was the second time in six months she was not allowed to travel outside the country.
In a similar vein, Aakar Patel, a vocal critic of India’s current right-wing regime who once led Amnesty International’s work in the country, was stopped from flying to the United States in April.
Experts based out of the region say that the Indian government is getting increasingly intolerant towards its criticism and dissenting voices are being crushed through intimidation, arbitrary detentions and now travel bans.
“In today’s India, which, if you’re not a propagandist, then you risk being arrested or banned. You risk your funding or sources being cut off,” Kavita Krishnan, a prominent human rights activist and an opposition voice based in India, told Toward Freedom.
Shrinking Freedoms
Punitive actions against critics and journalists have led India to slide down all the major human-rights and freedom indices in the past few years.
Reporters Without Borders (RSF)’s latest “World Press Freedom Rankings” rated India 150th on a list of 180 countries, slipping eight positions since last year.
“The violence against journalists, the politically partisan media and the concentration of media ownership all demonstrate that press freedom is in crisis in ‘the world’s largest democracy,’” RSF noted in its report.
India also ranked 119th out of 165 jurisdictions in the 2021 Human Freedom Index. Its “media self-censorship” score was 3.2 out of 10.
Plus, with a score of 66, the country was listed as “partly free” by the Freedom House’s Global Freedom Score.
The Freedom House mentioned in its report:
“Authorities have used security, defamation, sedition, and hate speech laws, as well as contempt-of-court charges, to quiet critical voices in the media. Hindu nationalist campaigns aimed at discouraging forms of expression deemed ‘anti-national’ have exacerbated self-censorship.”
“The problem with this regime is that they consider that universal standards of democracy, human rights, press freedom don’t apply to them,” Krishnan added.
“They don’t care about violating the rights of people, as they believe themselves to be invincible.”
Intimidation, Arrests and Harassment
For Jenni Rowena, the wife of 55-year-old professor Hany Babu, life has turned miserable ever since his arrest in July 2020. For more than two years, Babu—a vocal BJP critic—has been denied bail, as the Indian government, along with several other prominent academics and activists, have accused him of conspiring against the country and plotting the assassination of Prime Minister Narendra Modi.
Hany Babu / credit: Twitter/AmbedkarSchool
“Everyone knows Babu’s political position. He has been a scholar working for the marginalized and minorities. They are targeting him for his work. You’re not supposed to do anything that questions the government or society or any institution,” Rowena told Toward Freedom. “Cases against him have been fabricated, so as to prolong his trials and keep him in prison.”
Pawan Khera, the national spokesperson of India’s main opposition party, the Indian National Congress, said the country seems to be under an “undeclared” emergency.
“Forget dissent, even questioning the government for its mistakes can land you in trouble,” Khera said in an exclusive interview with Toward Freedom. “This government is known to be misusing [central] agencies whenever anybody goes against them.”
India had officially declared a 21-month period of emergency in 1975, leading to the suspension of civil liberties and media censorship.
“You can see the reflections of the emergency period,” said Shabnam Hashmi, a veteran human-rights activist, “but, even then, there was not so much hatred in India and people of this country were united. See, they all came together—forgetting about their differences with each other—and fought. But, now, the people are polarized.”
Journalists Self-Censor
Quratulain Rehbar, a freelance journalist who has critically reported about the Indian government’s policies from the Kashmir valley, said it is almost impossible to publish stories that don’t toe the state narrative.
“I have been subjected to various forms of harassment by authorities and security forces,” Rehbar told Toward Freedom. Many of her colleagues from the region—like Sajid Gul, Fahad Shah and Aasif Sultan—languish in jails across the country under criminal and terrorism charges because the government recently invoked draconian anti-terrorism laws against journalists and activists. For example, the 1967 Unlawful Activities (Prevention) Act lets the government detain a person for several months without bail.
“In such an atmosphere, I had to take a stand to not write too [many] critical pieces against the government because that would easily put me in trouble,” Rehbar said in a dejected tone. “Now, I am [censoring] myself, like many other colleagues.”
Activists like Hashmi assert India is moving toward “total fascism.”
“But if this government is not defeated, then we could be seeing times like in Afghanistan, Pakistan or in Nazi Germany,” said Hashmi, who is based out of New Delhi. “Almost everything and every institution is penetrated by extreme right-wing ideologues, who do not believe in democracy. So, the future seems very dark for the country.”
Hanan Zaffar is documentary filmmaker and journalist based in South Asia. His work has appeared in Al Jazeera, DW News, Channel 4, Business Insider, TRT World, Newsweek, Newlines Magazine and other media publications. Find him on Twitter at @HananZaffar.
Jyoti Thakur is an independent journalist based in New Delhi. She covers the environment and human rights.
Accredited Social Health Activist (ASHA) worker Kavita Magdum monitors the health of infants and children. Here, she weighs one of twins of Hasina Hajukhan / credit: Sanket Jain
Hasina Hajukhan never imagined that returning to her maternal house would turn into a near-death experience. In April, the 28-year-old was seven months pregnant, and her medical parameters were normal. “I was taking extra care to ensure no complications during childbirth,” she told Toward Freedom.
As is customary in many parts of India, pregnant women return to their parents’ homes to give birth. When Hajukhan first reached her mother’s house in Ganeshwadi village of the western Indian state of Maharashtra, she felt nauseated. “It was April’s final week, and I couldn’t even breathe properly,” she recounted. A heat wave had taken hold. “The climate was the stark opposite of what it was in my husband’s village.” In Ganeshwadi, things kept getting complicated with the rising heat. “Every day, I was breathless and would feel dizzy.”
Using a desk fan at the highest speed didn’t help, as it just circulated more hot air. An air conditioning system was something her family could not afford. The tin sheet roof would get extremely hot. During this crucial time, Hajukhan needed rest. However, she spent most of her day stepping out to gasp for cold air. In May’s final week, things got worse. “I felt as if I was going to die,” she recalled, teary-eyed.
Immediately, her mother dialed Ranjana Gavade, an accredited social health activist (ASHA worker), part of a community of 1 million women healthcare workers appointed for every 1,000 people in India’s villages. ASHAs are responsible for more than 70 healthcare tasks, with a particular focus on maternal and child health.
ASHA worker Shubhangi Kamble spends a significant amount of time each day talking to community women to help them understand the impact of climate change on children / credit: Sanket Jain
“I was worried looking at her rapidly deteriorating health and informed my colleagues.” Upon their instructions, Gavade called a government ambulance and swiftly took her to the district hospital, 33 kilometers (20.5 miles) away. Hajukhan gave birth to underweight twins. Her troubles still hadn’t ended when she was discharged after three days. For a month since then, Hajukhan has been trying to ensure her twins gain weight, but all efforts have failed. As a result, they weren’t administered the necessary Bacillus Calmette–Guérin (BCG vaccine used against tuberculosis), Hepatitis B, and Polio vaccines.
The Kolhapur district, where Hajukhan lives, has been reporting recurring floods, heat waves, incessant rainfall, and hailstorms triggered by climate change. She said everything would have been normal had she not returned to her parents’ home to give birth in the heat waves. “My children wouldn’t have had to live such a dangerous life,” she said.
Like in the village of Ganeshwadi, climate change impacts have been delaying children’s immunization schedules throughout India, making them vulnerable to diseases. Research has found that if a child belonged to a district highly vulnerable to climate change, the odds of stunting rose by 32 percent, low weight by 45 percent, anemia by 63 percent and acute malnutrition by 42 percent. An analysis by global nonprofit Save the Children found that, globally, 774 million children are living in poverty and at a high risk of climate-related disasters. Weather disasters ranging from floods to droughts prevent children from obtaining nourishment, causing low weight, and these disasters put a break on children receiving vaccinations on time. Their weakened immune systems, as a result of a lack of proper nourishment in crisis times, make them vulnerable to other diseases. Being sick can halt the necessary immunizations, and these delays have led to a rise in epidemics and diseases.
ASHA worker Shubhangi Kamble often works beyond her duty to ensure every child completes the universal immunization on time. Here, she speaks to a woman to help her understand how climate change can impact her son’s health / credit: Sanket Jain
How Floods Impact Universal Immunization
Snehal Kamble, 24, a resident of Maharashtra’s flood-prone Arjunwad village, remembers the year 2019 in meticulous detail. “A day before the floods, I was preparing to go to my parent’s house.” Five months pregnant, she was looking for iron folic acid tablets. “Instead, all of us went to a flood relief camp,” she recounted. From there, she moved to another relief camp within a few days, as the water rose further. “During this time, I was worried about my house and belongings,” she said. She fell sick and was away from home for 15 days. “Those were the most difficult days of my life,” she shared. Then in January 2020, she gave birth to a boy named Sangarsh, who has often fallen sick. “When I went to my maternal house, he just couldn’t bear the heat there,” she said. The dehydration and spells of fever he experienced affected his immunization schedule. “His Pentavalent vaccine was delayed by several months because of health ailments,” said ASHA worker Shubhangi Kamble (no relation to Snehal), who has been monitoring this child since birth.
Further, his Measles-Rubella vaccine and Vitamin A dose were also delayed, making him vulnerable to diseases. “Vaccines need to be administered on time,” said Sachin Kamble, a nursing officer at the district women’s hospital in Maharashtra’s Osmanabad district. “Otherwise, it affects a child’s immunity, making them more vulnerable to diseases.”
He pointed out how the lack of vaccinations led to 2,692 cases in 2022 in Maharashtra, which reported the highest measles count in India. That was an eight-fold increase from the previous year. During this time, India reported 12,773 cases. India’s National Family Health Survey (NFHS) said only 31.9 percent of children ages 24 months to 35 months had received a second dose of measles-containing vaccine in 2019-21.
Another healthcare worker, Kavita Magdum, from flood-affected Ganeshwadi village, said that children in her surveying area never fell ill so frequently. She started noticing such stark changes only in the past five years. Upon inspecting this, she found, “Stress caused by the changing climate is leading to this.” For instance, Magdum sees that many children aren’t drinking breast milk, which has impacted their medical parameters. These drastic changes reflect in Indian government statistics, as well. During 2015-16, 58.6 percent of children ages 6 months to 59 months (just under 5 years old) were anemic in India. By 2019-20, this number rose to 67.1 percent. In addition, 32 percent of children nationally remain underweight.
After a year-and-a-half, Snehal’s son started getting better, thanks to Shubhangi’s consistent visits, when she monitored every parameter and ensured the best possible treatment by working hours beyond her duty. “Once the vaccination schedule started falling in place, his health, too, began improving,” Shubhangi shared.
ASHA worker Ranjana Gavade frequently visits Hajukhan’s home to monitor the health of her children / credit: Sanket Jain
Untimely Administration of Vaccines
While climate change is making it difficult for these healthcare workers to complete universal immunization, another challenge is the untimely vaccine administration.
“There are many instances, where vaccines in several villages are just not available,” said Netradipa Patil, leader of more than 3,000 ASHA workers and co-founder of Deep-Maya Foundation, a non-profit that works for women and children. “During such times, it becomes extremely challenging for us healthcare workers to manage everyone.”
Patil has observed that the workload has increased tremendously for all the ASHA workers because of the delay in vaccination. This is because ASHA workers are responsible for immunization, and in case of any discrepancy or error, they are held accountable. Research published in 2016 concluded, “Lack of timely administration of key childhood vaccines, especially DPT3 (the three doses of the Diphtheria, Tetanus and Pertussis vaccine) and MCV (measles-containing vaccine), remains a major challenge in India and likely contributes to the significant burden of vaccine-preventable disease-related morbidity and mortality in children.” Another paper published in 2019 inferred, “The proportion of children with delayed vaccination is high in India.”
In 2021, the World Health Organization found that 25 million children around the world under the age of 1 didn’t receive vaccines, a figure not seen since 2009. “Many children never get the Vitamin A doses on time. These doses are just not available when required,” Patil said, suggesting the Indian government should consult local healthcare workers to arrange vaccination. “We need to reach more and more people, and, currently, looking at the changing climate, we aren’t prepared to do this,” she shared. Patil made simple suggestions like identifying vulnerable children and their locality and monitoring them from the earlier stages, even before the disaster strikes. “Just by proper identification, we can save so many children,” she said.
A woman playing with her child in Maharashtra’s Kolhapur district / credit: Sanket Jain
Rising Undernourishment
Fed up with feeding medications and tonics that didn’t seem to help increase his weight and prevent him from continually falling ill due to the changing weather conditions, Rashi Patil, 23, quit taking her son to the doctor every month after 18 months. “My son just wouldn’t eat anything,” Patil said.
Moreover, the changes in local climatic patterns affected her son’s health, and he often fell sick. Last year, he was hospitalized for a week as his platelets fell and a fever intensified. What followed next were recurring illnesses that delayed his immunization schedule. Because of the fever in March, he wasn’t administered the Pentavalent 1 vaccine (it protects from five life-threatening diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib [Haemophilus Influenzae Type b]). Her son soon became weak and began recovering only after the vaccine’s administration. All this while, her son struggled with good eating habits. After several trials and errors, Rashi and her husband, Rajkumar, discovered the climate affected their son’s health and eating habits.
“Now, their son makes it a point to eat only outside the house, where he gets some cold air,” says Rashi. “Contrastingly, this was never the case with my elder daughter.”
Toward Freedom reached out to Ganeshwadi’s community health officer, Dr. Prajakta Gurav, regarding what steps her team was taking to deal with delayed immunization. Gurav hasn’t replied as of press time.
The impact of poor diets is more obvious at the national level. For instance, just 11.3 percent of children between the ages of 6 months and 23 months receive an adequate diet. Plus, in 2022, India ranked 107 out of 121 countries on the global hunger index. These numbers further reveal how climate change is exacerbating the existing faultlines.
The problem is not restricted to India. Of the countries at severe risk of being adversely affected by climate change, the report by Save the Children says, “Burundi has the highest rate of stunted children (54 percent), followed by Niger (47 percent), Yemen (46 percent), Papua New Guinea (43 percent), Mozambique (42 percent) and Madagascar (42 percent).”
Research published in PLOS Medicine found that in 22 sub-saharan African countries, drought led to lower chances of completion of BCG (Bacillus Calmette-Guérin), Polio and DPT (diphtheria, tetanus, and pertussis) vaccines. “We took vaccines to the last mile. Now, climate change is eroding progress.”
For Komal Kamble, 30, vaccinating her 2-year-old daughter remains challenging. Her remote mountainous village of Kerle, in Maharashtra’s Kolhapur district, remains inaccessible most of the year.
For the village population of less than 1,100 people, the nearest healthcare facility is 15 kilometers away. Last year, within a week of October rains, the road that connects her village to the nearest hospital was completely under floodwater.
Komal’s daughter couldn’t get proper medical care for two days, worsening her health. Her chest was full of cough, and the fever rose, making things difficult for the agrarian Kamble family. This wasn’t restricted to heavy rainfall, though. Since her birth in 2021, Komal has taken her daughter to a private doctor at least 20 times, spending over Rs 15,000 ($182). Last year, she was feverish and wasn’t given the crucial Japanese encephalitis vaccine, a Vitamin A dose and the Measles-Rubella vaccine. This made her vulnerable to more diseases, challenging the Kamble family.
Healthcare worker Shubhangi Kamble from Arjunwad says that instances of children missing their vaccination are rising rapidly. When she went to find out why this was happening in her village, Arjunwad, she saw that children fell sick during floods and heat waves. “This was the time that coincided with their vaccination schedule, and so many couldn’t get the vaccines,” she shared.
However, a delay in vaccination has caused more problems than she had anticipated.
“Almost every day, at least one parent dials me asking where they should get their children hospitalized,” she said.
Now, every rainfall brings a health issue for Komal’s daughter. “I am tired of going to the healthcare center to hear that my daughter is underweight or sick and can’t be given the vaccine,” Komal said, with frustration in her voice.
Meanwhile, with every climate disaster, it will become increasingly difficult for many families to complete the immunization in time. “I’ve been vaccinating children for over a decade, but things never got this difficult. We took vaccines to the last mile. Now, climate change is eroding progress,” said healthcare worker Kavita Magdum.
Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.
Farmer Narayan Gaikwad and his family faced ostracism after he tested positive for COVID-19 in 2020 / credit: Sanket Jain
Narayan Gaikwad knew something was wrong.
For eight days in August, he was given intravenous drips of electrolytes and saline solution, twice a day. By the time he realized he was being treated by a quack, it was too late. Fatigue had grappled him, and in no time, he collapsed in his house in the village of Jambhali in the western Indian state of Maharashtra.
His family feared COVID-19 had caused his symptoms. They rushed 73-year-old Gaikwad to a makeshift public COVID center—10 miles from home. “There were at least 500 patients, while the facility had some 100 beds,” recalls his son, Bhagat. Next, they traveled another eight miles to a private hospital. “The doctor wouldn’t admit him because he didn’t have a COVID report,” recalls Bhagat.
“The entire system was saturated because many private doctors refused to treat COVID patients,” he says. Speedily, they rushed him to a local village doctor, who prescribed a few injections. “I did come to my senses, but my cough and cold didn’t go away,” remembers Gaikwad. All he wanted was a COVID test, which was hard to come by because the system was overwhelmed and unprepared. After that, he spent ₹5,000 (Indian rupees or $70 USD) and got a computed tomography (CT) scan. “We then rushed to a medical doctor, who prescribed week-long medicines and injections. It cost me another ₹13,000 ($180).” This was 10 days into his trek for proper healthcare and Gaikwad still couldn’t get a COVID test. “I was breathless.” To get tested, his family took him to a private university that had been converted to a COVID center—12 miles away. As anticipated, he tested positive. “I was put on oxygen, and within three days, I started feeling better,” he says with a sigh of relief.
Meanwhile, the nine members of the Gaikwad family tested positive for stigma. “People started circulating that my entire family tested positive,” says Narayan, a low-income farmer. None of them were allowed to step out of the house for a month. “We had to throw away 2,000 kilograms of harvested tomatoes worth $275,” says Bhagat. Gaikwad never anticipated this would cost them a season’s earnings.
After he tested negative, Bhagat posted a screenshot of this report on his WhatsApp status, with the caption ‘Negative’. “It was necessary. Otherwise, we would have died of hunger, as people wouldn’t let us step outside,” says Gaikwad. In India, as in many parts of the world, ordinary people rely on groups created inside the WhatsApp messaging application on their smartphones to communicate with wide swaths of people, like their neighbors, coworkers and political allies.
It didn’t take long for the second wave to devastate India. On May 14, India reported 414,182 infections in 24 hours—the highest single day spike in the world. India’s far-right prime minister, Narendra Modi, prematurely declared a victory against COVID in January 2021. Leaders of the Bharatiya Janata Party (BJP), of which Modi is a member, started addressing election rallies in four eastern and southern Indian states—drawing several thousand people without masks. At one event, Modi proudly said, “I’ve witnessed such a rally for the first time.”
On the same day, India reported over 234,000 infections. With an oversaturated healthcare system, India ran out of oxygen, hospital beds, ventilators and essential medicines. Soon, people took to social media, making SOS calls for healthcare facilities. Hospitals started petitioning high courts for the lack of oxygen supply as several people died. As of May 30, India reported over 28 million cases with 329,000 people succumbing to the virus. A New York Times analysis reveals a more likely scenario could be 539 million cases with 1.6 million estimated deaths.
But Gaikwad couldn’t find a bed in the first wave.
“For poor people like us, the system collapsed long ago,” he says.
Three Decades of Austerity
In 1991, India “liberalized” its economy, which meant opening it to international markets, leading to a mass-scale privatization of public services and goods. In 1993, the World Bank released its World Development Report, which focused on healthcare. Ravi Duggal, health researcher and activist writes, “This report basically is directed at third-world governments to reorient public health spending for selective health programs for targeted populations wherein it clearly implies that curative care, the bulk of health care, should be left to the private sector.”
The World Bank report said investments in specialized health facilities should be diverted to the private sector by reducing public subsidies. It encouraged “social or private insurance” for clinical services. The result: 85.9 percent of people in rural India have no medical insurance.
To encourage privatization, the government reduced the customs duty on imported medical equipment from 40 percent in the 1980s to 15 percent in the early 2000s. As of 2016, it was down to 7.5 percent. From 1986-87, India spent 1.47 percent of its GDP on healthcare. Now it has been investing a little more than 1 percent of its GDP. Meanwhile, it has 43,487 private hospitals and a mere 25,778 public hospitals. Yet, a 2019 World Health Organization report pointed out average global healthcare spending was 6.6 percent of GDP.
Frontline Health Care Workers Bear the Burden
In March 2020, India’s Health Ministry tasked the Accredited Social Health Activist (ASHA) workers to contain COVID across 600,000 villages. For this, they survey households, find suspected COVID cases, and monitor oxygen levels and body temperature. ASHAs also support COVID patients who are home-bound and act as a liaison to people who are able to get treatment outside the village. This is in addition to over 50 responsibilities that include universal immunization, ensuring proper pre- and post-natal care, spreading awareness about contraception, hygiene, and maintaining health records.
An Accredited Social Health Activist (ASHA) worker monitoring the temperature of a community member in Maharashtra’s Kolhapur district / credit: Sanket Jain
For every 1,000 people, an ASHA worker—normally a woman from within a village—is appointed under India’s National Rural Health Mission. Swati Nandavdekar, 40, from the village of Mendholi in Maharashtra’s Kolhapur district, is one of 970,676 ASHAs. “We are tired,” says Nandavdekar, who has worked without leave for 410 days. “People abuse me verbally and don’t answer my survey questions.”
In avoiding her, people are bypassing the ostracism that follows if they test positive, as in the case of Narayan. “In the previous lockdown, everyone lost their livelihood, and now they can’t afford an isolation of 14 days,” she elaborates. This is in contrast to last year, when ASHAs like Nandavdekar were able to successfully contact-trace COVID patients.
Dr. Sangita Gurav, the only public doctor for 15 villages that Kolhapur’s Bhuye Public Health Centre serves, commented on the rising fatality rate. “People consult us only after a week from testing positive,” she says. “By this time, their symptoms become severe, and oxygen levels start dipping.”
Sandhya Jadhav, an ASHA supervisor from Kolhapur, who oversees the work of 24 ASHAs, says, “Every day I get calls from ASHAs who talk of mental stress and the instances of verbal abuse.” ASHAs receive “performance-based incentive.” In Maharashtra, they average a meager monthly income of ₹3,000-4,000 ($41-55). But it comes down to $25 for ASHA workers like Nandavdekar, who is from a smaller village. “Most of them haven’t received PPE kits, masks, hand sanitizers and gloves for surveying even in the containment zones,” says Jadhav.
On May 24, ASHA workers across India had gone on a 1-day strike demanding legal status of permanent workers, adequate health safety gear, insurance and a hike in their wages. Last year, over 600,000 ASHA workers protested with similar demands.
For 833 million people, India has a mere 155,404 sub-health centers (which are the first point of contact for rural communities of 5,000 people), 5,183 community health centers, 24,918 public health centers and 810 district hospitals. That’s 1 district hospital for every 1 million people. With such a poor infrastructure, it’s the ASHAs who remain in direct contact with the villages. “We have been working since 2009 and have saved countless lives, which even the government knows,” Nandavdekar says. “But they won’t even treat us with respect.”
Last year, the Indian government announced an insurance program of $69,000 (USD) for frontline healthcare workers. “If there was insurance, why weren’t we informed of the company and other details?” Jadhav says. “They took our signature on a blank paper.”
As cases continue to rise, the job of ASHA workers is far from over.
“We are dying daily,” Nandavdekar says. “The only difference is that it’s not called death.”
Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.