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8 April 2020updated 30 Jul 2021 7:57am

In South Asia, there is no safety net against the pandemic

India's huge, densely located population faces particular challenges.

By Suddaf Chaudry

Nearly one fifth of the world’s people – 1.3 billion – live in India, the second most populous country in the world and, despite its huge size, more densely populated than Japan. The lockdown imposed by Prime Minister Narendra Modi on 24 March would always have posed a great challenge, but it has been further complicated by the economic outlook. In recent years, rapid growth has increased living standards for many, but now, like elsewhere, the coronavirus crisis looks likely to cause the greatest suffering to the poorest and most disadvantaged. 

There are currently 5,194 confirmed cases of Covid-19 in India, but only around 100,000 tests – one for every 12,500 people – have been performed. India already has the largest cohort of people in the world living with respiratory disease, thanks primarily to its chronic air pollution and high rates of tuberculosis. Accordingly, the government has chosen to treat coronavirus as a national disaster, calling on its National Disaster Management Authority, which is tasked with disaster mitigation planning for events such as flooding, drought, and terrorism, as well as possible nuclear attack and biological disaster. “India is at a critical stage and even a single misstep could lead to the deadly virus spreading like wildfire,” said Modi as he introduced the lockdown. “If we continue to be negligent, India will have to pay a heavy price.”

The regime is strict, with citizens restricted to their homes and all road, rail and air travel suspended. This is a particular issue for the country’s estimated 120 million migrant workers, who travel from rural areas to work in the cities. Their accommodation is frequently insecure and many are stuck with little access to food or proper sanitation. Many face a difficult choice between staying in dangerous lockdown conditions in cities or walking many hundreds of miles back to their home villages. Refugees travelling from Delhi have already suffered police brutality; one group was hosed with water and disinfectant by police in the neighbouring state of Uttar Pradesh.

There are similar issues in Pakistan. In Karachi, a city initially applauded for implementing a lockdown, hundreds of out-of-work labourers marched in the streets on 1 April asking for basic rations. Professor Ammar Ali Jan is based in Lahore and a member of the Haqooq-e-Khalq movement, a democratic pressure group. He has volunteered to deliver food to the most vulnerable, many of whom, he says, have been “abandoned”. “We had to deliver discreetly,” he adds. “Otherwise, we would have been faced by large crowds.”

Coronavirus has also exacerbated existing problems with gender inequality in the region. In South Asia 80 per cent of women in the workforce are in informal employment; many face insecure food supplies and are reliant on NGOs in times of crisis.

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“For many millions of daily wage earners, the lockdowns caused by the pandemic have forced them to make the cruel choice between preserving their lives or their livelihoods,” says Omar Waraich, Amnesty International’s South Asia director. “There is no safety net. Governments in South Asia don’t have the resources to commit to a stimulus package that will meaningfully sustain them through this crisis.”

Misinformation is also an issue. “When the world first learnt about coronavirus, here in India political activists started selling urine [as a treatment] to ward off the pandemic,” says Hemant Rajura, a health reporter at the Hindu daily newspaper. There have also been reports of Hindu nationalists drinking cow’s urine in the belief it would prevent infection. “If I don’t go out and report the stories, how will we spread awareness?” asks Rajura. “The scientific approach is missing.”

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There are also incidents of doctors being ostracised by their communities. “Many have been accused of bringing the infection back to their homes,” says Dr Srinivas, a resident practitioner at the All India Institute of Medical Sciences in Delhi. “Doctors are increasingly questioned by their communities if they are taking adequate precautions such as PPE. The reality in places like Calcutta is that doctors are using raincoats to protect themselves.”

Nurses and doctors have said that the Indian government should focus on testing and providing safety equipment, rather than offering compensation to their families in the event of their deaths. One doctor, who preferred to remain anonymous, told me: “I don’t want to be paid to die, just give me the equipment so I can do my job safely.” India’s Ministry of Health and Family Welfare did not respond to a request to comment.

Public healthcare spending in India is only around 1.3% of GDP, and the weakness of the healthcare system may be one of the reasons why Modi enforced such a strict lockdown. “I think India’s decision was shaped firstly by beneficial observation of the responses of China, US and Europe. Many of the least effective responses were piecemeal, ambiguous and poorly communicated. The crackdown Modi announced took these three lessons into account,” says Milan Vaishnav, director and senior fellow of the Asia programme at the Carnegie Endowment for International Peace. “The government understood how quickly India’s weak health care capacity could be overwhelmed.”

Pakistan’s approach has been markedly different. “I could deliver a complete lockdown but that would mean 25 per cent of the poorest people in Pakistan would die,” Prime Minister Imran Khan said in a national address. The former interior minister, Ahsan Iqbal, pointed out that 43 per cent of Pakistanis haven’t taken any precautionary measures against coronavirus. “That is higher than any other country, people are unaware of the potential danger. There has been a lack of action by the government on all three fronts – containment, prevention and treatment.”

Covid-19 is a global pandemic, but in South Asia its economic and social effects are faced by governments and populations that are less well prepared for disaster. In this region, the crisis has only begun.