How Ineffective Healthcare System Is Adding To The Woes Of Manual Scavengers In India

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“In India, a man is not a scavenger because of his work. He is a scavenger because of his birth irrespective of the question whether he does scavenging or not.”

– Dr B.R. Ambedkar

International Labour Organisation describes three forms of manual scavenging in India: removal of human excrement from public streets and dry latrines, cleaning septic tanks, cleaning gutters and sewers. In India, the inhumane task of manual scavenging is exclusively carried out by the Dalit community of specific sub-castes and is an archetype of the oppressive legacy of the hierarchical Hindu varna system.

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Employment of manual scavengers was declared unlawful in India back in 1993 under The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act, which was followed by Prohibition of Employment as Manual Scavengers and their Rehabilitation Act (2013), with an aim to outlaw manual excrement-cleaning of insanitary latrines, open drains, or pits. The act also serves as a legal instrument to ensure rehabilitation of manual scavengers and their families, but the employment of manual scavengers continues unabated. Bezwada Wilson, the national convener of the Safai Karmachari Andolan, estimates that there are no less than 25 lakh manual scavengers in India, of which almost 1.6 lakh are women.

Indian Council of Medical Research has documented a range of medical conditions associated with manual scavenging which includes: infectious diseases, respiratory diseases, musculoskeletal conditions, and can be highly fatal attributing to carbon monoxide and methane poisoning, especially when most manual scavengers work without any protective equipment.
Recently, Indian Express reported a fatality rate as high as one death every five days. There is only fragmented public health evidence in terms of the health status of manual scavengers with total disregard of the fact that utilisation of health services is extremely low amongst manual scavengers and their families.

According to Human Rights Watch, the World Health Organisation has taken up manual scavenging as a health issue, but it has not been translated into action. Ministry of Health and Family Welfare has remained elusive of the health problems of manual scavengers even though the National Health Policy (2017) calls for action on social determinants of health. Currently, data on health and other economic, social and political issues have only been generated by Dalit human rights groups like International Dalit Solidarity Network, National Safai Karmachari Commission, Rashtriya Garima Abhiyan etc.

No efforts have been made by the Ministry of Health and Family Welfare to collect information regarding health status or to track morbidity patterns amongst manual scavengers in order to improve their access to health and health status by acting on stigma and discrimination faced by manual scavengers and their families, which should run in parallel to other rehabilitation schemes.

The Prohibition of Employment of Manual Scavengers and their Rehabilitation Act (2013) does not mention health as a component of rehabilitation and provides a meagre amount of money to the worker in the name of assistance for alternative occupations, which most manual scavengers remain unaware of. Also, it is of utmost importance to recognise that problems arising from the occupation of manual scavenging are not merely occupational hazards, but a paradigm of inequity of healthcare stemming from the rigid caste and feudal system (Brahminism) in India.

In the words of Bezwada Wilson,

The state must see that the law enforcing agencies are functioning. I must say that very clearly, these (deaths) are murders by the state.

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