An interview with a field worker of the NGO Apnalaya on the frequent occurrences of malnutrition related deaths among children in the slums of Mumbai.
What’s the reason for the frequency in deaths from malnutrition in Mumbai?
These deaths occurred in a community of ragpickers that lives off Mumbai’s biggest garbage dump. If they don’t spend their day sorting out and selling garbage, they can’t eat. The women are anaemic; their children are born underweight, and often don’t survive beyond two months. Amongst those that do, their nutritional status keeps going down because they live only on breast milk.
Apnalaya started working with this community after their homes were demolished in December 2004, leaving them in the open. We started a mobile clinic along with another NGO, and a growth-monitoring programme as per the guidelines of the national Integrated Child Development Scheme (ICDS). The result is that the number of children below five suffering from third-degree malnutrition has come down from 92 in 2005 to 19 this year. Nevertheless, when we weighed them last month, we found that 62% of the children were malnourished. Wherever communities exist in such conditions in Mumbai, with no access to electricity, clean water and sanitation, malnutrition and related diseases exist.
What’s the government doing?
The state government refused to acknowledge that malnutrition deaths were taking place in Mumbai, or in any urban centre, till Dr Abhay Bang’s report in 2004 which was commissioned by the government itself. The report showed that malnutrition kills 56,000 children annually in urban slums. The report pointed out that, unlike in rural areas, no primary healthcare system existed in cities. Mumbai has superb speciality hospitals, but no basic healthcare system. Dispensaries, maternity homes and immunisation centres are both few and understaffed. Government and municipal officials say they can’t get qualified staff. Can you believe that there are no takers for government posts?
In 2005, malnutrition deaths in another slum created a media sensation. That helped us prod the government into setting up 1,100 aanganwadis (mother and child care centres) in the city – a big achievement. But the government said it had no space to run them! So now they are run out of private homes, but with no supervision. They function like food distribution centres where teachers come, register their attendance and leave after an hour.
What’s the solution?
There must be community monitoring of the ICDS scheme. The Bruhanmumbai Municipal Corporation (BMC) must set up a primary healthcare system for the poor, also to be monitored by the community. But the BMC has tremendous hostility towards slum-dwellers. Outsiders-locals, taxpayers-non-taxpayers – all these issues are brought in, but malnutrition, the central issue, is ignored. Slum-dwellers spend more on basic services than the middle class do, but the money goes to the mafias controlling their supply, who are in league with the BMC. Why can’t the BMC provide them these amenities legally and at regular rates? Slum-dwellers would readily pay. But the government and the BMC want the poor to get out of Mumbai. You build flyovers for car owners, but for the labourers – including policemen – without whom this city could not run, you plan rental housing schemes far outside the city.
There has to be equal distribution of Mumbai’s earnings and resources, because all citizens have a right to them, regardless of whether they are migrants or locals. Where does Mumbai get its water from, and who uses it? Mumbai has always absorbed the richest and the poorest; it’s everybody’s city. It cannot be made into a city only for the rich.