Interview with Dr. Siddharth Aggrawal

In an email interview, Dr. Siddharth Aggarwal, Executive Director of UHRC, speaks about the living condtions of slum dwellers and the problems faced by them. He compares Indian slums with Kenyan counterparts, discusses the plight of those living under flyovers and the solutions.

Urban Health Resource Centre (UHRC) is a non-profit organization which addresses the health concerns of the poor living in underserved slum settlements in India. HRC provides technical support on urban health to the Government of India, state governments, urban local bodies and NGOs. It works closely with governments , academic and research organizations, professional associations and other stakeholders for enhanced attention and resources for improving health of the urban poor.

VP: What is the vision and aim of Urban Health Resource Centre?

Siddharth Aggarwal: Urban Health Resource Centre (UHRC) works in partnership with Civil Society Organisations, Government, academia and slum communities to improve the health of the urban poor in India.

Vision: Our vision is an urban India where every resident enjoys optimal health and well-being, realizes his/her full potential and contributes to the nation’s growth and development

Mission: The mission of Urban Health Resource Centre is to bring about sustainable improvements in the health conditions of the urban poor by influencing policies and programmes and empowering the community.

VP: Could we draw any comparison of the conditions of people living in slums in India to other countries, say Kenya?

SA: The condition of people living in the slums of India and Kenya would be similar except issues related to geographical, cultural and political context. Generally the slum dwellers stay in a congested environment with poor access to education, health care, water and sanitation facilities. Most of them also have low access to food, shelter and livelihood services.

VP: What type of people become slum dwellers? (Are they only those who migrate from villages to cities or we could have some population who were born, brought and continue living in slums as adults)

SA: Usually the slum population comprises of people born in the same slums, migrants from village or from smaller cities, and those stay at the periphery of the city who, as result of spatial growth of the city, get included in the city limits. Urban poor in a city can be understood as per several categories.

There are migrants from village to city, comprising of those who have migrated from village in search of livelihood. Often if one member of a family migrates, other from his direct or extended or neighbor family also migrates to the same area. Then there are migrants from smaller city to bigger city. When a group of families feels that they would be better off in terms of livelihood, children’s education, health and other basic facilities, they may move from slum of a smaller city to a large city owing to greater opportunities of livelihood. There are also people living in slums for several generations in the same city with minimal income and still continue to live in slum like condition; such as slums in Old Delhi. Groups of families living at construction sites, Brick Kilns, Lime Kilns, inside factories (Jute Mills in West Bengal, Ply Wood factories in Yamuna Nagar) also constitutes a large section of population which live in slum like condition but often go un-noticed. People in the peripheral villages over a time get included in the city owing to extension of the city limits. Many of them owing to low socio-economic status live in slums or slum like conditions.

VP: How different are the lives of the slum people from those who live under the flyovers?

SA: Both slum dwellers as well as people under the flyovers stay in poor living conditions with very limited access to health and basic services. However, those who stay under flyovers are more vulnerable. People who live in the slum have a relatively (not comfortably) settled life and slightly better access to shelter, health, food, water, electricity and other basic amenities in comparison to people who live under the flyover. As a resident of a slum area, many of them also benefit from few welfare schemes and Government services.

People who live under flyovers are most vulnerable. Since, they stay on road, their children find road as a place of playing. As a result they are more prone to road accidents. Also they do not have any proof of residence they invariably remain unaccounted and considered illegal (where as in the slums at least some of the families have proof of residence). Consequently they are unable to avail any Government facilities meant for poor, devoid of minimum basic facilities and have an insecure life.

VP: What are the kind of problems that these people face which a normal city dweller would most probably not even notice even if they pass the same area daily?

SA: There are major problems faced by slum dwellers. For one, they face constant threat of eviction since a large population of slum dwellers stay on non-notified slums. 59% urban poor households do not have access to toilets as compared to only 4 % in urban non-poor households. Only 18.5% of urban poor households have access to piped water supply at home. Slum dwellers have poor access to health care despite geographical proximity to large hospitals. Only 54.3% of urban poor mothers had 3 antenatal care visits in comparison to 84.1% of urban non-poor mothers. Only 39.9 % of urban poor children received complete immunization in comparison to 65.4% of urban non poor. Urban poor have an Infant Mortality of 54.6 in comparison to 35.5 of urban non-poor and 41.7 of urban average. There is low education attainment amongst them. Drop out rate among 15-17 years old children is 76.4% among urban poor, and only 1.4% of urban poor children avail higher education.

An important problem is lack of negotiation capacity, due to bad experiences from past, lack of information about current schemes and programmes and inherent characteristics of self reservation. One such example is of regularization of Targeted Public Distribution System (TPDS) which often noticed dis-functioned. Furthermore, they also suffer from psychosocial problems. Despair, neglect, exploitation by law enforcement agencies, lack of education, stiff struggle for survivable and lack of social and governmental support hampers their confidence. As a result they often get affected of drug addiction and other social evils.

VP: Would regularization of these slum settlements help change things?

SA: At one level it will help because regularization will give them legal sanction and it will enable them to access entitlement of officially registered slums, road, water, health care, PDS outlets. However, some challenges will still be there related to rapid slum growth and limited access to basic services like toilets, schools, health centers and livelihood options. Therefore along with regularization there is need to create basic infrastructure and services in these slums.

In addition, resettlement of slums if not carried out with adequate planning and social sensitivity could end up adding to the problems of the people rather than addressing them. Large-scale relation of the slums in Yamuna Pushta in Delhi is one such example of relocation to Narela and Holambi Kalan (outskirts of Delhi) without assuring transport facility, schools for children, drainage, water availability, toilets, food and livelihood option for slum dwellers. Hence, resettlement of slums would be successful when accompanied with requisite infrastructure development and service provision.

VP: Do the slum dwellers have any access to clean water?

SA: Only 18.5% of slum dwellers have access to piped water in comparison to 62.2% of piped water facility to urban non-poor. This shows a wide gap of water facility between urban poor and non-poor.

VP: Talking about sanitation, could you give us your comments on Shahana Sheikh’s report of lack of toilets for these people? Does utter lack of sanitation not severely affect their health especially during child birth?

SA: Shahana Sheikh’s report reveals lack of toilet facilities for slum women. Due to poor toilet facilities, slum women have to relieve themselves early morning, before day-break. To avoid the need to relieve themselves during the day in the absence of toilets, many women in slums resort to eating very less during the whole day. This further compromises their already sub-optimal poor health and nutrition level. Another major factor is social discomfort related to women’s defecating especially during pregnancy. Due to unavailability of required number of toilets, women don’t feel comfortable to defecate in open during day time. Further, faeces lying around the ‘bastis’ contaminate the food which in turn can result in intestinal infections such as typhoid.

Compiled by

Shravya Jain