Fighting from the bottom, India's sanitation workers are also frontline workers battling Covid-19

The legacy of social exclusion is deeply entrenched in his conscience. As he begrudgingly hauls this stigma every day of his life, door-to-door, picking up waste from households in Southeast Delhi, 36-year-old Pawan stands at a crossroads yet again: as pots and pans rung out loud from balconies to boost morale of doctors, nurses and frontline workers fighting coronavirus, where's the round of applause for him?

"We don't get the same respect as doctors, other medical staff even when we put our health at risk everyday. Our work is still not considered as an essential service," said Pawan (name changed), a migrant worker from Gorakhpur in Uttar Pradesh, who handles garbage of more than 100 houses.

Pawan is part of India's indispensable 40 lakh waste pickers in the informal sector, and garbage collectors employed by states, the backbone of the waste management system. Yet, despite providing an essential public health service to residential colonies, hospitals, and commercial establishments, most work without safety gear, have no social security, face rampant discrimination, but still keep our cities clean. Now, they are also at risk of exposure to Covid-19 from handling unmarked medical and contaminated waste.

When asked if he's scared of the coronavirus, Pawan stared blankly, then cobbled up his thoughts and said, "Karein to kya karein? Bina khaye mar jaaye? Dar hai lekin bhookha peth marne se acha hai kaam karoon. Mere paanch betiyan hain ghar pe (What do I do? Should I starve to death? I am scared but not as much as dying on an empty stomach. I have five daughters at home)," he added, rubbing his index finger and thumb together to scrape off the stubborn dirt.

Trash contaminated with bodily fluids from hospitals, quarantine centers, and home quarantine for suspected Covid-19 patients poses a daunting challenge for waste management authorities, sanitation workers and waste pickers alike as even loosely discarded face masks, gloves, tissues, cotton swabs, syringes from households could be likely carriers of the virus, even before a patient is diagnosed as symptomatic.

In this regard, the Central Pollution Control Board (CPCB), had issued guidelines in March for handling, treatment, and safe disposal of waste generated during treatment, diagnosis and quarantine of confirmed or suspected Covid-19 patients. Even though India already has a Bio-Medical Waste Management Rules (BMW), 2016, the updated guidelines were issued specifically to make sure that the waste generated during testing and treatment of coronavirus patients is scientifically disposed of, given the contagious nature of the virus.

For households and quarantine camps, the guidelines said that waste generated "should be collected separately in yellow-coloured bags and handed over to authorised waste collectors engaged by ULBs".

Hazardous waste increased during pandemic

But it isn't that simple, as coronavirus can stay on certain surfaces for more than three days. According to a paper published in the New England Journal of Medicine, even after waste is disposed of, the novel coronavirus can survive on surfaces such as cardboard for 24 hours and more than three days on plastic and metallic surfaces.

"All waste, including food, if it comes into contact with Covid waste becomes hazardous. As per Bio-Medical Waste Rules (BMW), 2016, hazardous waste must be disposed of in incinerators," said Dr Jugal Kishore, head of the Public Health Department at Delhi's Vardhman Mahavir Medical College and Safdarjung Hospital.

Hazardous waste generation has increased from households in containment zones and quarantine centres during the pandemic, said Varsha Joshi, Commissioner, North Delhi Municipal Corporation. "In the last 41 days of lockdown, an additional 11.4 tonnes of hazardous waste was generated from households. To minimise chances of infection, all waste, including food, from hospitals, quarantine centres, isolation wards, home care of suspected Covid-19 patients is being treated as hazardous waste," she said.

Dr Kishore agreed that biomedical waste generation has increased sharply since the start of the pandemic. He said bigger hospitals are taking all precautions but the ones outside cities and in periphery areas have poor waste compliance.

Hazardous waste generation has increased from households in containment zones and quarantine centres during the pandemic, said Varsha Joshi, Commissioner, North Delhi Municipal Corporation. "In the last 41 days of lockdown, an additional 11.4 tonnes of hazardous waste was generated from households. To minimise chances of infection, all waste, including food, from hospitals, quarantine centres, isolation wards, home care of suspected Covid-19 patients is being treated as hazardous waste," she said.

Dr Kishore agreed that biomedical waste generation has increased sharply since the start of the pandemic. He said bigger hospitals are taking all precautions but the ones outside cities and in periphery areas have poor waste compliance.

Wuhan generated six times medical waste during pandemic

Then, a campsite for migrant workers in Delhi's Sharan Vihar area, that the Indian Express visited, had rows of medical waste such as surgical masks, gloves, syringes, tunics, gowns and empty tablet packets, among other items, stuffed inside blue bags.

Then, a campsite for migrant workers in Delhi's Sharan Vihar area, that the Indian Express visited, had rows of medical waste such as surgical masks, gloves, syringes, tunics, gowns and empty tablet packets, among other items, stuffed inside blue bags.

Another problem area for garbage collectors is managing household waste from residential colonies, given that most across India don't segregate their waste into wet and dry, increasing chances of medical waste being mixed with general waste. Some Resident Welfare Associations (RWAs) that indianexpress.com spoke with in Delhi, and Bengaluru pointed to negligence in segregating waste among residents, especially used masks, napkins, and other items.

"We are seeing a lot of masks carelessly thrown away on the roads, footpaths, and even into water bodies and stormwater drains in the locality. This issue can be resolved by stopping it right at the source – with the government banning the use of non-cotton masks in households," said Brigadier R S Murthy (retd), president of HSR Layout Sector-2 Residents' Welfare Association, Bengaluru.

Dr Jaijeet Bhattacharya, who is in the management committee of H-Block RWA in Southeast Delhi's Chittaranjan Park, rued that nothing has been communicated at all to residents on managing medical waste. "I am very disappointed. Some people in our colony have resisted imposition of new rules, so we are highly discouraged from bringing in new guidelines. Nothing has been discussed on the key issue of waste itself being a vector for coronavirus," he said.

India's waste management system is not prepared to handle the pandemic, leaving the vulnerable most exposed as they will frequently encounter contaminated waste, said Dr Kishore. Non-segregation of waste has been one of the inadvertent consequence of the pandemic.

India's waste segregation plans have gone for a toss and people have gone back to mixing waste to avoid contact with waste collectors, said Jaya Dindhaw, Director of Integrated Urban Planning at the World Resources Institute.

"There has been an increased usage of masks, gloves and most people don't know how to dispose of them. This waste is mostly ending up in waste segregation centres and there are chances of secondary infection from that," she added.

For Golu, this is a cause of worry: the potentially contaminated trash discarded by asymptomatic people not knowing it is infected. Before the outbreak, the 30-year-old sanitation worker was accompanied by another colleague in a green and white municipal corporation truck in Delhi's Naraina Vihar. After his partner left for his hometown in UP a few days before lockdown was announced, he comes alone and announces from the loudspeaker that people put their trash in the truck themselves. "I am scared to touch the garbage so I have stopped collecting it manually to avoid any contact," he said, with trepidation.

Golu's apprehensions are well placed. The lockdown has severely curtailed social mobility and threatened the livelihoods of many sanitation workers and waste collectors, who are also migrants. Over the last few months, no food and work forced thousands of migrants to walk back to their villages or hometowns in the absence of bus and train services. On national highways, a sea of humanity walked, with blisters on their feet, defying lockdown norms. Some died mid-way, in some cases, hit by speeding buses. At least 134 migrant workers have been killed on roads in the last 54 days (as on May 17).

"It's clear that coronavirus is not only a health crisis, but also a sustainability challenge. When Covid was spreading, we were expecting safai sathis to work, but didn't think about their survival during lockdown. If they are starving, how can they carry on with their work?" said Shoko Noda, resident representative, UNDP India.

The lockdowns globally have dismantled the informal workforce and strained the plastic recycling markets, making joblessness a stark reality for waste pickers who survive on a daily basis by selling discarded plastic.

According to a report by the International Labour Organisation (ILO), 1.6 billion workers in the informal economy stand in immediate danger of having their livelihoods destroyed due to the pandemic.

"There has been a complete breakdown of the waste management value chain. Waste pickers couldn't step out in lockdown. Even those who had collected the trash, couldn't sell it as the waste value chain was shut," said Shekhar Prabhakar, founder of Hasiru Dala, a Bengaluru-based not-for-profit organisation that works with waste pickers.

'Hopefully society will view sanitation workers with dignity after lockdown'

The Covid-19 pandemic has brought a whole range of uncertainties in its wake, but for some sanitation workers it has slightly changed people's perception of them. A study conducted by Praxis, a civil society organisation, on sanitation workers in Tamil Nadu's Coimbatore and Tiruchirappalli last month, found that among the 45 interviewed, at least 82 per cent of them said that society will view sanitation workers with dignity after lockdown. One of the respondents they spoke with said before coronavirus their recognition was very less, but things have changed a little. "People have started to respect us solely for the work we do, the same work for which we were looked down for years," said Bhaskar K, a sanitation worker from the Arunthathiyar community in Tiruchirapalli.

While coronavirus may have led to a slight tweak in public perceptions on sanitation workers, it remains to be seen if it will sustain, after the pandemic is over.

(Input and image from theindianexpress.com)