COVID-19: How Prepared is Urban India?

The current pandemic is a serious challenge for Indian cities. But Soumyadip Chattopadhyay, Simi Mehta and Arjun Kumar argue the outbreak of contagious diseases is less of a natural disaster – and maybe more of a man-made one. Of inequalities, poor infrastructures and the way forward.

Cities around the world are currently experiencing the downside of ever-increasing globalisation and urbanisation. The COVID-19 pandemic demonstrates how vulnerable we really are and highlights the conditions responsible for the spread of contagious diseases. Cities in the global south are particularly affected, especially the population living in slums and peri-urban areas.

We take a look at the situation of one of the world’s most populous regions: urban India. How prepared is the country when it comes to the current pandemic? To answer this we need to take a look at demographic changes, infrastructure, and governance – and how they ultimately relate to disease prevention, mitigation as well as possible disaster responses.

Population and Mobility Dynamics

Population growth and density are major factors influencing the spread of diseases in cities. This is exemplified by recent outbreaks of Ebola in dense urban areas and slums in Monrovia and Freetown (Sierra Leone), and the spread of SARS-CoV across different urbanising regions in Africa and Asia. For a country like India, this has serious implications: the 2011 Indian population Census revealed that 377 million people live in urban areas with a projected increase to around 600 million by 2030 alone.

The increasing development of city cores, and people’s inability to bear the high living costs in cities, leads to a major transformation of urban areas as people are forced to relocate to from the centre to the periphery. Newly built towns of high-rise apartments and peri-urban informal settlements with very high population densities characterise this phenomenon of sub-urbanisation. Indeed, almost two-thirds of statutory towns in India have slums. According to a 2011 census of the Indian Ministry of Housing and Urban Affairs (MoHUA), India faced a 37.14 per cent decadal growth in the number of slum households – and the most recent estimation from 2013 projected that by 2017 about 104 million Indians will live in slums. After China, India is indeed projected to have the largest share of the world’s population living in slums in 2020.

An overwhelming majority of families living in slums and peri-urban areas are migrants who are engaged in informal activities with conspicuously low wages, severe job competition, and tenuous employment security. During the current nationwide lockdown due to COVID-19, these workers simply cannot afford to remain ‘locked up’ as they need to go to work daily to earn their livelihoods. Work opportunities have however declined, forcing many to return to their hometowns on foot.

Such a sudden mobility pattern, driven by a myriad of socio- economic and political factors, could abet the spread of this contagious disease. Therefore, India’s ability to monitor rural-urban as well as inter-urban migration will be crucial to mitigate the spread of this disease.

Infrastructural Bottlenecks

Infrastructural development in urban areas has not been able to keep up with the increasing population growth in India. A vast majority of the population living in slums and peri-urban areas still lack access to basic services including water, sanitation, solid waste management and adequate housing facilities. A 2012 report of the Technical Group on Urban Housing Shortages indicated a national urban housing shortage of 18.78 million, which is projected to further increase to 34 million by 2022. The situation becomes more dire, when we consider the situation in the slums.

Half of all slum households in India consist of only one-room accommodations. A third do not have any access to basic facilities of electricity, tap water and sanitation. Under such precarious living conditions – where even basic preventive measures like social distancing and frequent hand washing are an unimaginable luxury – an outbreak of COVID-19 would easily turn into a profound public health emergency. Indeed, the outbreak of contagious diseases is less of a ‘natural’ disaster but emerges alongside social and spatial inequalities in housing and access to basic services.

Disempowered Local Governments

The deplorable state of urban services in India is typically attributed to poor financial health and lack of planning. These are in turn linked to weak institutional capacities and the absence of effective governance structures of the Indian cities. The 74th Constitutional Amendment Act (1993) sought to improve the delivery of basic services but political empowerment has been derided by irregular elections at the local level. In most states in India, the executive authority of the city governments is vested on state-appointed commissioners. Thus democratically elected mayors and city councillors have very little say in the management of the cities, let alone on emergencies like COVID-19 at the city-level.

To be more specific, the 2020 Urban Governance Reforms study conducted by Praja reveals that out of 21 analysed city governments not a single one has full control over essential constitutional city functions, such as water supply, sanitation or waste management. It is also mainly state governments that control key healthcare infrastructure such as hospitals, clinics, and primary healthcare centres. Overlapping institutional responsibilities raise questions as to who should deliver basic services; and the problems become far more severe in case of managing disease outbreaks. This feeds into the existing uncontrolled population growth, unregulated development and the abysmal service delivery in peri-urban areas in India.

The Way Forward

We stand at a turning point. Cities, especially slums and the suburbs, are hotspots for diseases like COVID-19 due to their spatial and structural characteristics. In the coming weeks and months, it is essential to plan and implement a slew of urgent short-term measures including aggressive and affordable testing, tracing, proactive surveillance, and rapid isolation. Provision of door-to-door drinking water and portable toilet facilities in densely populated slum and peri-urban areas is critical – failure to provide these services is not an option, as these dense spaces are a ticking time bomb in the COVID-19 challenge.

In the medium- and long-term, it is pertinent to identify the gaps in urban planning and the underlying socio-economic determinants of public health. This helps to streamline resource flows to vulnerable areas more effectively. It is equally important to create a city-wide pandemic preparedness index, mapping the situation of vulnerable groups and getting a clear overview of hospital beds and ICU capacities at the neighbourhood level. It can serve as an evaluation tool, similar to the Rapid Urban Health Security Assessment (RUHSA) Tool developed by Georgetown University, in order to assess city-level public health preparedness and response capacities.

This pandemic provides a rare opportunity for an earnest collaboration with urban local governments. Genuinely empowering cities to discharge their functions, has to be part of any outbreak management masterplan. Even more: building municipal capacity to prepare action plans in advance for better preparedness should feature in any national urban policy framework.