India’s biggest slum tests Modi’s coronavirus response

India’s biggest slum tests Modi’s coronavirus response

Outbreak in Mumbai’s cramped and unsanitary Dharavi highlights magnitude of challenge

As alarm rose about the spread of coronavirus in India, one case at the start of April struck a chord: the death of an unnamed 50-something garment merchant in Dharavi, one of the world’s largest slums in the heart of Mumbai.

The death was the first known case of an outbreak that has swelled to over 200 confirmed infections in Dharavi. Some 800,000 people live in a one-square-mile stretch, boxed in between thundering train tracks and a polluted river separating it from the skyscrapers of Mumbai’s financial district.

The outbreak in places like Dharavi highlights the magnitude of the challenge facing India, a country of 1.4bn where poverty complicates efforts to contain the virus.

Mumbai’s slums, where an estimated 40 per cent of the city’s 20m population lives, are particularly susceptible to the spread of Covid-19. Families or groups of migrant workers often live in single rooms. Many share public toilets and water taps, requiring multiple daily trips. And poverty means that staying at home and losing income is untenable for many.

“The lanes are very narrow. It's just not possible to walk on the street without touching each other,” said Abubakar Sheikh, a 29-year-old leather worker who lives in Dharavi. “We are all scared because we are so many people living in such a small space. If one person gets it, then it will spread very fast.”

Mr Sheikh, whose workshop closed after Prime Minister Narendra Modi declared a nationwide lockdown in late March, wishes he could return home to the village from which he migrated, some 900 miles east. But trains have also been suspended for the duration of the lockdown.

“My income has completely stopped. Our expenses have increased,” he said. “There is no work and people don't have much to eat.”

Mr Modi was praised by some for imposing the lockdown, suspending travel and closing businesses when India’s caseload was only about 500. Local authorities have followed with measures such as creating strict containment zones to close off hotspots and dousing the streets — and sometimes people — in disinfectant.

Critics say India’s low testing rate is undermining these efforts in a country which has confirmed 21,000 coronavirus cases and 680 deaths — a relatively low number for a country of India’s size. They also point to the fact the measures disproportionately affect the poor and are hurting an economy that was already being squeezed before the pandemic. 

Slums make up about a fifth of urban households, with large chunks of the rural population also living in cramped conditions with shoddy infrastructure.

Many state health services are poorly funded and maintained, while pollution and poor sanitation mean health problems are already rampant: tuberculosis, another infectious respiratory disease, afflicts millions of Indians every year, more than any other country.

“India is a country in transition,” said Shahid Jameel, chief executive of the Wellcome Trust/DBT India Alliance, a biomedical research charity. “There are fancy apartment buildings and villas, and right next to it there’s a slum that houses the construction workers that built those villas . . . But the virus propagates more quickly in a slum.”

Brookings India, the think-tank, found that the epicentres of almost a third of the 500-odd containment zones set up by local authorities were in slums. Another third of the zones were within 100 metres of one.

“It’s not a coincidence,” said Vaidehi Tandel, one of the paper’s authors. The living conditions in slums make them “very conducive to spread”.

Dharavi is a veritable metropolis in its own right with thousands of small businesses, including manufacturers and retailers. The area featured in the 2008 Oscar-winning film Slumdog Millionaire, helping to make it a popular destination for so-called “slum” tourism.

Local authorities have set up barricades to seal several suspected hotspots within Dharavi, containing more than 50,000 people, screening them for symptoms and testing suspected cases.

Kiran Dighavkar, the official leading the response, said the slum’s density made some of the best known defences — such as social distancing — ineffective.

“In a 10x15ft house, you will find 10 people sleeping. So to ask them to practise social distancing is next to impossible,” he said. “The only option that remains with us is to contain the spread in the limited pockets where it has been observed, rather than spreading it to the entire Dharavi.”

But this has created everyday difficulties for residents, some of whom have had to depend on food packets distributed by officials and non-governmental organisations.

Ramesh Singh Rajpurohit, a 28-year-old jeweller, said he had been too scared to leave the house to buy fresh food and risk coming into contact with others, opting instead to survive on pulses and other dried supplies. “I don't go out at all,” he said.

Public health experts expect that the true number of infections in Dharavi is far higher than what has been detected. The coronavirus death toll, which has risen to 13, implies that there are many hundreds more as yet unknown infections, said Ramanan Laxminarayan, founder of the Centre for Disease Dynamics, Economics and Policy.

“This was originally a disease of the rich, of people who travelled abroad,” he said. The lockdown was reversing this dynamic. “The lockdown reduces transmission among people who have space to distance . . . As a result you’re going to see more disease in the poorer areas, in the slums, now.”

The damage could be lasting.

Megha Gupta, whose business sells products sourced from artisans in the area, said many of the dozens of craftsmen she works with are migrants like Mr Sheikh who are now desperate to return home.

“Dharavi always had work, there was always something or another. People in the first week of the lockdown didn’t understand how badly they’d be hit,” she said. “The day the trains start, half of Dharavi is going to be empty.”