Rekha (15 years) lives in an informal settlement in the national capital Delhi with her parents who are labourers. They have limited access to food and electricity. Hence, she prefers to be at school, because staying at school offers her food and a brief respite from the electricity-starved environment at home, especially in summer. Amidst the lockdown, living in space- constrained houses and acute shortage of food make children like Rekha increasingly susceptible to diseases arising from malnourishment and unhygienic conditions.

If Rekha had to experience food shortage and the scorching Delhi summers, Shiva (14 years) is concerned about accessing public toilets in the tightly packed slum of Dharavi, Mumbai. His neighbourhood either relies on shared toilet complexes or make use of open spaces adjacent to it . Social-physical distancing is not just burdensome, but, in short, impossible.

Telephonic conversations with children across seven cities — Delhi, Mumbai, Kolkata, Guwahati, Chennai, Bengaluru and Hyderabad — conducted by World Vision India indicate acute food insecurity and social stigma faced by children in low-income families living in urban slums.

Almost all the children stated that their parents had lost their primary source of income due to the lockdown. The uncertainty over resumption of normal life invites anxiety, stress and fundamental concerns about financial well-being. Children also reported lack of access to toilets and safe drinking water. Many also mentioned increased incidences of domestic violence

The Covid-19 pandemic and the nationwide lockdown have created a disruptive new normal for everyone through shelter-in-place orders and social distancing guidelines. India has a population density of 200,000 people per square kilometre in slums like Dharavi, which simply means that social distancing is almost impossible in the country. The urban slum population is more prone to deficiency of basic amenities like safe drinking water, sanitation, housing and health care services.

The public health system in India has witnessed tremendous progress since the world’s first cholera pandemic in Kolkata in 1847 and the burden of mortalities during the 1918 flu pandemic.

However, due to the complex and unique Indian phenomenon of neighbourhoods, where the urban poor and middle class live together, India is still in a vulnerable stage of defence against any communicable disease, especially one that turns into an epidemic or pandemic.

Policy reform

This pandemic raises a pressing need of policy level reform to ensure holistic inclusiveness and preparedness of the country to develop a more responsive framework to redesign the cities so as to mitigate urban inequality during any similar outbreaks in future.

For families living in poverty, missing work means missing meals. Even if children do not get the coronavirus, their nutritional status could suffer significantly. Children’s safety is also an area of concern. When emergencies occur, social systems tend to break down, and children become more vulnerable and exposed to violence. In this case, the perpetrators are not only external parties but may include their own family members.

Lack of support to these children and families may spell a disaster. In order to address this, community-based child protection mechanisms should be activated. The government should ensure access to food, shelter, healthcare and basic needs of the urban poor population as an interim relief.

In addition, it should learn from this pandemic and focus on social determinants of healthcare by creating a robust, equitable and sustainable infrastructure that should be inclusive for all levels of society and ensure strong grassroots level partnership with communities.

The outbreak of Covid-19 has been an important lesson for the national and city governments. The current situation demands a social innovation framework where every citizen is an actor of change and having certain roles and responsibilities towards creating a safer, healthier and resilient nation.

Pandemic preparedness

Therefore, drafting out of a city-level ‘pandemic preparedness index’ will help Urban Local Bodies (ULBs) plan for the future. These are realities that we must confront and address immediately by providing innovative and sustainable solutions. As more cities continue to experience a rise in the number of coronavirus cases, and economies begin to slow down, children are vulnerable in many ways.

One is the lack of food, leading to poor health and nutrition. The Indian Council of Medical Research (ICMR) study on Global Burden of Disease (GBD) reports that 68.4 per cent of child deaths are due to various forms of malnutrition. This pandemic will most likely exacerbate the situation. The risk of the Covid pandemic might be high but that of hunger and starvation is also equally real and a bitter fact even today. As a war-like movement, it requires massive preparation in all levels to mitigate the perilous impact on vulnerable classes.

There is dire need for concerted efforts by key stakeholders, including governments and non-state actors, to ensure that we respond efficiently and effectively to safeguard the most vulnerable children of our society. Lest children like Rekha and Shiva would be left behind. The pandemic preparedness index will not only protect them against immediate vulnerabilities but also act as a long-lasting urban public health strategy against any future epidemics.

The writer is Senior Director-Special Projects, World Vision India