In 2011, an Indian government report estimated that 29.4% of the country’s urban population live in low quality, semi-permanent structures, known as slums.
Many of the homes here don’t have bathrooms or running water. Some slum residents get their water from a communal tap, while others collect theirs in canisters and buckets from tankers that visit a few times a week.
This all makes it difficult to wash hands regularly. “Where on earth are they going to find the water and soap that they need?” questioned Prabhakar. “I think it’s going to be nearly impossible to implement that plan.”
It may also prove difficult to maintain the type of social isolation as ordered by Modi. In India, there are 455 people per square kilometer (or 1,178 people per square mile), according to World Bank statistics — significantly more than the world average of 60 people, and much higher than China’s 148.
“Social distancing in a country like India is going to be very, very challenging,” Prabhakar said. “We might be able to pull it off in urban areas, but in slums and areas of urban sprawl, I just don’t see how it can be done.”
Countries around the world have launched education campaigns advising people to sneeze into their elbow and avoid touching their face. But sharing that information with a population as large as India’s will also be a challenge, he said.
The challenge of going into lockdown
Every country that goes into lockdown faces a huge economic impact. But in India, telling people to stay home puts millions of jobs at risk.
According to official statistics from 2011-2012 — the most recent data available — there were around 400 million people in India’s labor market. Of those, more than half were self-employed, and 121 million were casual workers, meaning they had irregular work and were only paid for the days they worked.
Those people — India’s cleaners, household workers, and construction workers — are exactly the people who could be hurt by lockdowns.
The Ministry of Labor and Employment has issued a notice to businesses, asking them not to terminate employees or cut salaries.
Modi has already expressed his concern for the millions of workers who rely on a daily wage. “In such a time of crisis, I request the business world and high income segments of society to as much as possible, look after the economic interests of all the people who provide them services,” he said.
“In the coming few days it is possible these people may not be able to come to office or your homes. In such a case, do treat them with empathy and humanity and not deduct their salaries. Always keep in mind that they too need to run their homes, protect their families from illness.”
Chief minister of northern Uttar Pradesh state Yogi Adityanath said that each of the 1.5 million daily wage laborers in his state will be given 1,000 rupees ($13) via direct transfer to help them meet their daily needs.
“That might end up saving lots of lives if the government has a program to basically issue a paycheck to all those daily workers and people who earn below a certain level of income,” Prabhakar said.
But even if the authorities are able to roll out financial help for daily wage workers, not everyone will benefit.
According to government estimates, there are around 102 million people — including 75 million children — who do not have an Aadhaar identity card, which is used to access key welfare and social services including food, electricity and gas subsidies. Most of these people are essentially undocumented — and are less likely to receive a government handout.
Other difficulties facing India
On top of all of these issues, India also has an overburdened and underprepared health system.
“The public health sector is woefully inadequate,” said Prabhakar, explaining that there is a lack of medical supplies and trained staff in India.
As the WHO’s Swaminathan said, the health system across India is quite variable.
“There are some states with very well-resourced, well-equipped health systems, and others which are weaker,” Swaminathan said. “So the focus really needs to be both in short term and the medium to long term on strengthening the health systems in those states where it is relatively weak and this would involve a number of different actions.”
According to Christian Medical College’s Abraham, there are only about 50 to 60 specialists in India who have received formal structured training in handling infectious diseases.
According to the World Bank, India spends about 3.66% of its GDP on health — far below the world average of 10%. Although the United Kingdom and the US have struggled to deal with their own outbreaks, each spend 9.8% and 17% of their GDP on health, respectively.
At a news conference on Monday, Lav Agarwal, a senior official with the Ministry of Health and Family Welfare, said the government is working with all of India’s states to increase the capacity of health facilities.
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