The 40-day lockdown may well flatten the curve. But for the poor and the ailing, the treatment prescribed may be worse than the disease.
Twenty-seven days into the national lockdown, it is apparent that the union government has no plan and no idea about how to tackle the problems to those at the bottom of the pyramid are facing because of the sudden shutdown of most services. It is depending on state governments to find solutions for themselves. But the state governments cannot agree on the best way forward either and this only exacerbates the problem.
News reports are already coming in of unrest and tension in migrant labour shelter camps and the occasional food riot. This is only going to go up in the coming days. If solutions are not found quickly and implemented properly and humanely, the long term consequences of this are frightening.
The problems that have been ignored – despite being highlighted by the media almost daily – fall into three broad categories: 1) the migrant labour left in a lurch and stuck away in shelter camps 2) the poor who had come to seek medical treatment in government hospitals from other places and are now having to fend for themselves, quite often in the streets of an alien city because of the sudden shutdown, and 3) the urban and rural poor stuck in slums or factories or villages, running out of money, and getting deeper into debt and despair.
Ignored and Unwelcome: A Ministry of Home Affairs press briefing estimated that there are 37,978 shelters providing relief to 14.3 lakh migrant workers and other people, while 26,000 food camps providing food to over 1 crore people. There are probably a few lakh more migrants who are not in these shelters, suggest press reports from various parts of the country. They are sleeping on roads, under flyovers and or any shelter they can find, or just walking back home. At least 22 migrant workers who have died from exhaustion and starvation while trying to walk back to their villages hundreds of miles away. The Telegraph reported that a migrant trying to reach home on foot walked nearly 850 kilometers from Delhi to Varanasi before collapsing there.
Food riots have broken out in several migrant shelters because of the quantities being supplied. In Pathankot, migrant workers have started skipping meals in the hopes of putting pressure on authorities to release them and send them back home. The desperation to go back home could be seen in the 1000 workers who broke curfew to gather in Bandra on the day when the PM extended the lockdown.
The problem is that the union government has largely washed its hands of the migrant workers, asking states to take care of them. And different states have taken a very different view on how to deal with the migrant worker problem. While Kerala was well prepared with shelters and food, others have not yet got their acts together. Delhi and UP took a few days to get their acts together. Delhi also tried to organise buses that would ferry some migrants out of the city, but that was for only a day.
The migrant worker lies at the bottom of the government’s concerns. The union government had organised to get all Indians stuck abroad back into the country using special flights. Within the country, states like Gujarat and Uttar Pradesh have used specially chartered buses to ferry students belonging to their states but studying for IIT Entrance Examinations in Kota’s coaching centers. These students would belong to families that may be classified at least middle income, so the states have taken their plight into account.
However, for migrant labour, no such plan is even being contemplated. They are supposed to stay in whichever shelter they have managed to find and be grateful for that.
Because there was no clarity till the last moment whether the lockdown would be extended or not, the Railways were booking train tickets from April 15 onwards. They scrambled to cancel tickets and announce that trains would not run only after the PM’s speech. Many migrants had bought tickets in the hope of finally reaching home, only to see their plans crumble.
The migrant workers who are not in state government shelters but living on streets or walking back home are the worst off. They have no money, are often beaten up by policemen and mostly do not find food as many roadside eateries along the route are closed. Only a few of them are entitled to the relief measures announced by the union finance minister and even among those, many have no way of accessing the money in their accounts.
The railways, which claim to have prepared wagons that could be used as quarantine facilities could have been used to solve the problem by organising point to point trains that could take properly screened migrants back to their state capitals, say, from where the home states could take over. But in the absence of a nod from the PMO or HMO, they are not taking any step. And they do not seem to be in any hurry to restart even in a limited way anytime soon. They will probably wait until the PM’s next speech before they take their cues.
Left out in the Cold: According to the website run by the Union Ministry of Health and Family Welfare, as of 8 AM on 20 April, there are 14175 active cases of Covid 19 in the country. And 543 deaths can so far been attributed to the pandemic.
However, no statistics are being compiled on patients who have died or are in grave danger of dying because they can’t access proper medical care as hospital resources get tied up in the Coronavirus pandemic. These include cancer and HIV patients, women about to give birth and others like those with heart or other conditions. For many, the lockdown has meant that hospitals are simply turning them away. For others, it is a case of being stuck waiting for their turn to come as overworked hospitals like AIIMs and Deen Dayal Upadhyay in Delhi and similar hospitals across the country can no longer function to normal capacities because of the pandemic. And for still others, it could mean not being able to reach the hospital on time. There are also reports of hospitals shutting down after doctors and other staff get the infection while treating Coronavirus patients.
There are no proper estimates of how many healthcare facilities are now not functioning or functioning at a very limited strength because of the pandemic. Or how many have simply voluntarily closed all non-epidemic treatment to reduce risks of transmission. But reports suggest that the numbers are significant – between a quarter and a third of all healthcare facilities in the country. India’s healthcare system is woefully inadequate – a Brookings Institute report suggests that we have only 0.55 government beds per 1000 population. Now many of these have been rendered unavailable because of the Coronavirus pandemic. The longer the lockdown continues and the longer OPD departments and surgery rooms remain shut and hospitals turn away patients in order to focus all attention on Coronavirus, the numbers of such non-Coronavirus deaths will only increase.
Already, reports of patients dying as they turned away by hospitals are being reported in every state. Mansi Mandal, an assistant professor in Delhi put up a post on the social media platform Facebook about her mother’s death on April 6 in Darbhanga because every private hospital turned her away saying the administration had instructed them against taking in critical patients. The government hospital was of no help either. Mansi, stranded in Gurgaon, could do nothing as her mother passed away after being denied treatment by one medical facility after another.
Facebook has several posts similar to this one. And these are people who can afford private healthcare. Those purely dependent on government facilities are far worse off.
A recent report in India Today by Ajay Kumar and Gulam Jeelani talked about how the situation has gone out of hand in Delhi itself. According to the report, there are about 57,709 beds across private and government hospitals in the capital city. With several hospitals being designated only for the treatment of Coronavirus patients, and dozens of others closing their OPDs, and several clinics and hospitals that had to be shut down after doctors and nurses contracted the infection, many non-COVID-19 patients have been left out in the lurch. Some of these are poor patients who have come for cancer or other critical ailment treatment to AIIMS or the other government-run hospitals in the city from other states. The sudden lockdown has left them stranded in the city, with money running out, while also unable to get treatment. Some cancer patients have undergone several rounds of chemotherapy or radiation before they were told not to come to the hospital because they were at risk of getting infected.
Kolkata-based journalist Sohini Chattopadhyay wrote an article in Mint newspaper about the crisis building up in blood banks across the country. Donors are finding it difficult to come to hospitals and blood collection drives are postponed because of the scare of infection. The level of blood donation in most states has seen a steep drop since the second half of February. Currently, blood donations are less than half of what they were in January. Sohini talks about cases where families of patients requiring blood have had to scramble to find donors because of the lockdown and shortage of specific blood types.
As several commentators have pointed out, the crisis of non-Covid 19 patients who are critically ill but are being denied proper treatment will only increase as the lockdown rolls on. And there seems no immediate solution in sight either as states and the central government are mulling extending the lockdown further.
Sinking into Debt: One of the under-reported stories of the lockdown is the despair of the urban lower-income groups. Many of them do not fall under the current definition of extremely poor. They are part of the informal economy but, till the lockdown, enjoyed a relatively stable income. They are maids and drivers and private guards, Ola and Uber entrepreneurs, restaurant staff, beauticians, AC repair technicians and carpenters among others. Many of them not only had steady jobs but earned between Rs 20,000 and Rs 60,000 a month. Their prospects have dimmed after the lockdown. Many of them had little savings but EMIs to pay. Many of them were investing in assets and training for a better future when the pandemic came rolling by. Now they are scrambling to meet their EMI and other obligations.
This group also includes the many entrepreneurs of Dharavi in Mumbai, which is Asia’s biggest slum with an estimated million people crammed into tiny homes, in unhygienic conditions, with often hundreds sharing one common toilet. Dharavi has entrepreneurs running shops and manufacturing facilities for everything from leather products to plastic recycling. Now all that is gone and all that is left is a completely locked down hotspot from where no one can do anything.
The problem with this group is that they mostly do not get the benefits of the various schemes of the government. So they lose out both ways. They do not have any benefits of the formal sector and they are often not considered poor enough to get benefits reserved for the very poor.
Many of them can hold out for a month or two, but it seems likely that at least a significant portion of these will be driven to poverty by the time things start getting back to a semblance of normalcy. Their stories will unfold over the next couple of months. The income inequality between the rich and the poor will only increase as the lockdown continues.
The Coronavirus started as an upper-class disease – initially infecting only people who were travelling abroad. But since then, it has spread to everyone. And as it always does, the poor are the worst off. They are also slowly losing patience. Unless solutions are found in double quick time, the tensions rising among India’s poor and deprived could lead to a truly ugly situation very soon.