Changes in Social Determinant Following Forced Evictions and Their Health Consequences- Economically Weaker Sections (Ews_ Quarters, Ejipura, Bangalore)

Abstract: This paper draws from first-hand experiences of the authors who volunteered for relief during the forced eviction of the residents of Economically Weaker Sections (EWS) housing at Ejipura, Bangalore and analyses the effect of the evictions on health status of the evictee population. The forced evictions constituted a series of violations by the Bruhat Bangalore Mahanagara Palike (BBMP) and the police, with active support from the local MLA and the private contractor Maverick Holdings. In spite of the fact that many of the families were legally entitled to stay on the land and were living there for well over 10 – 15 years; the forced eviction displaced 1500 families overnight and without warning.

The evictions led to a sudden change in the socio-economic determinants of health – namely housing, livelihood, water, food, sanitation, healthcare and education. This impacted directly on the mental and physical health of several families especially children, elderly and pregnant women. Morbidity levels went up with an increase in malnutrition, gastro-intestinal and respiratory illnesses. With the majority of the community being dalit, Muslim or dalit converts to other religions, the forced evictions also demonstrates an open violation of minority and marginalized community rights.

Keywords: social determinants of health, Economically Weaker Sections (EWS), demolitions, forced evictions, dalit women, health impact on women, violence against women, Women and Child Development dept., Human Rights Commission, SC/ST commission, Minority Rights Commission, Bruhat Bangalore Mahanagara Palike (BBMP)

Introduction

From the 18th to the 21st of January 2013, Bruhat Bangalore Mahanagara Palike (BBMP), responsible for providing infrastructure and services in the Greater Bangalore Metropolitan area, bulldozed 1,512 homes and evicted over 5,000 dwellers living in the Economically Weaker Section (EWS) quarters in Koramangala (near Ejipura), Bangalore. The four-day demolition drive, rendered thousands homeless including around 1,200 women and 2,000 children. A majority of those evicted were Dalits, Muslim or Dalit converts to other religions who had either bought or rented the houses from the original allotees.

This study analyses the effect of evictions on the health status of the EWS residents by delineating the pathways and mechanisms by which the change in socio-economic determinants of health (SDH) lead to rapid deterioration in health status of the evictees, using the framework developed by the Commission on Social Determinants of Health (CSDH) (See Fig. 1) (Solar & Irwin 2010). The social determinants of health (SDH) are the conditions in which people are born, grow, live, work and age.

Fig 1: CSDH Conceptual Framework (Solar & Irwin 2010)

The framework proposed by CSDH draws a distinction between two categories of determinants. The structural determinants like income, education, gender, age, ethnicity, caste, religion, sexuality etc. are those which generate and/or reinforce social stratification. They are in-turn affected by the socio-economic and political context which included the policy environment. Intermediate determinants emerge from underlying social stratification and determine differences in exposure and vulnerability to health-compromising conditions (e.g. living and working conditions, housing, access to health care and education). (Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings 2008)(Solar & Irwin 2010)(Diderichsen et al. 2001).

Methodology

This paper is primarily a qualitative exploratory study focusing on processes that promote ill-health and has not evolved out of a pre- planned formal study. The authors were involved as volunteers during the relief and rehabilitation process following the demolitions. As part of a civil society group comprising students, professionals, human rights activists, media persons, doctors etc. they were involved intensively for over two months in the relief effort and less intensively for the next 6 – 8 months for rehabilitation. Primary sources include direct observations and interaction with the community, with police and bureaucracy, individual interviews, discussion with residents and case reports. Fifteen individuals were followed up for a long period and interviewed repeatedly. The secondary sources include primarily media reports and the Fact Finding Report by Housing and Land Rights Network, Delhi and People’s Union for Civil Liberties (HLRN & PUCL 2013).

Data on caste and occupational background of the residents is taken from a survey conducted by local residents in 2011 before the demolitions and is used here with permission. Consent has been sought from residents who were directly interviewed by us and are quoted here and all names have been changed for confidentiality.

Background of EWS, Ejipura, Bangalore

The Economically Weaker Section (EWS) housing at Ejipura, Bangalore was built in 1991 comprising 1512 residential units and was allotted to beneficiaries (Pelicanbriefcase 2013). The poor construction led to collapse of some blocks by 2003 and few more blocks were brought down by BBMP after an evaluation. The residents were settled on the same land in temporary shelters with the promise of quick reconstruction of their houses. In 2004, BBMP floated a tender for construction of residential and commercial structures at EWS site under public private partnership (PPP) without consulting the residents. The award of the contract to Maverick Holdings Ltd. (MHL) was challenged by another contending party in Karnataka High Court. This plea was dismissed in 2010 by the HC clearing the contract for MHL. In 2012, BBMP signed a concessionaire agreement with MHL wherein MHL was to build 1640 units for the original allottees on a 50:50 land development basis (residential + commercial). Meanwhile in Writ petition (No. 45915/2011) filed by few original allotees against the delay in construction of houses, a settlement was arrived at between the allotees, the BBMP and M/s. Maverick Holdings Pvt. Ltd., and on this basis the HC disposed of the matter on 24/08/2012 with a direction to clear the EWS Quarters land. The original allottees (comprising only 18.4% of those actually residing as on Nov

* Pourakarmikaru are safaikaramcharis employed by BBMP.

** Others include Housekeeping, coolie work, painting, electrical work, tailoring, carpenter, security services, salesmanship and as helpers in offices and hotels.

Fig 1: Percentage-wise break-up of occupations of the residents of EWS

Fig 2: Caste Demographics

2003), were to be given a compensation of Rs. 30,000 each and housing in the to-be built quarters. The court did not decide on the rights of the 1101 tenants (81.6%) living on the site since none of the tenants were before the court in the said case and thus no compensation or rehabilitation was provided for them1.

BBMP misrepresented the tenants as “unauthorized encroachers” and suppressed its own earlier resolution which recognized then as rightful residents. When the tenants approached the court against its order affecting them with the plea that they were not heard as part of a case that directly affected them the HC refused to stay eviction orders, thereby becoming a willing party to the violations thereon. Post-evictions, the government also did not provide any relief or rehabilitation to the evictees. The only relief was food and medical supplies from civil society organizations and voluntary groups working in the area (Ranganathan 2013a).

Data from a survey of 987 households conducted in 2011 by local residents shows that the residents of EWS were overwhelmingly daily wage workers in unorganized sector or on contract basis in organized sector.

As per the data from the same survey, about 55% of those surveyed were Hindu and Christian Dalits, about 5% belonged to Other Backward Castes and around 25% were Muslims. Remaining 15% were privileged caste Hindus

Eviction drive and the effect on the socio-economic determinants of health (SDH)

In this section, using the CSDH framework, we document how these evictions affected the health status of the evictees and what were the causal mechanisms via the affected SDH. It is important to note that while the CSDH framework is used to explain inequities in health outcomes of a given population at a particular point in time, our purpose is to use it to explain the variation in health status of the same population over two points in time (pre- and post-eviction) due to an sudden, external trigger – the eviction from housing.

Changes in Structural Determinants

The immediate impact of the eviction on the evictees was the loss of housing and its concomitants– security for women, protection from theft and loss of property, protection from rain and cold, toilets, water supply etc. Almost everyone suffered extensive loss of property including medical reports and prescriptions. Both men and women lost their jobs. Most women were domestic workers and none of them were able to leave their children and belongings on the street to attend work. Some women reported that the loss of their clothing and the inability to bathe prevented them from going to work. Children stopped going to school since their books and uniform were carried away with the rubble. Many drop-outs aged 10-14 years had started working in local repair shops by the end of the year.

The average income of the women domestic workers used to range from Rs. 2,000 to Rs. 3,000 per month. This loss in income greatly affected their purchasing power, especially for food and medicines. As a result the economic conditions of the community deteriorated drastically. All the people interviewed reported a marked decrease in income after the eviction.

As the evictees started looking for housing in the nearby areas, the advances and rents had sky-rocketed. No house was available for less than Rs. 20, 000 advance and Rs 2500 rent. Most families borrowed from relatives, shop-keepers and employers at exorbitant interest rates to be able to rent houses.

Physical injuries

BBMP engineers and police force supervised the eviction that took place early in the morning with all those resisting the demolitions getting beaten and arrested (Ranganathan 2013c). Protestors taken into police custody were stripped in the police station and at least three women sustained serious injuries that required them to drop out of work.

“They made us strip out of all our clothes and squat with our hands folded across. Those women who had periods had to take off their underwear with pads and also squat with the rest of us.” -Maria, (34 years)

The arrested women were produced in Sessions Court without being given an opportunity to apply for bail. The police failed to even inform their families of their arrest. The women were charged under five sections of the Indian Penal Code with charges including unlawful assembly, rioting, insult and criminal intimidation. The women were finally let out on bail. (Ranganathan 2013c)

“We begged the police to release us and not to keep us in custody while our houses were being demolished. We said that our children would come home from school and not know what to do because our houses wouldn’t be there anymore.” –Sabeena (28 years)

On the first two days there were injuries caused by police violence through the use of lathis. Around 50 persons were issued medical certificates for cuts, bruises, burns and injuries related to police violence during the demolition process. One of them was Zara who had fractured her leg from the police violence. A man suffered head injuries from police violence for he was drunk and could not move fast enough.

“Police beat and chase us… where do we go? Isn’t it the responsibility of the police to protect us?”-Saritha(38 years)

There were several cases of injury in the week following the demolition. Suresh worked as a painter and lived with his mother. One night his mother found him outside the house beaten up and with a fractured arm and dislocated shoulder. His mother struggles to support them by selling vegetables. She herself is an epileptic struggling to access her medications.

On September 23rd 2013, a 6-year old boy died after falling into a pit left by the construction group Maverick Holdings (The New Indian Express 2013). While the local MLA blamed the boy for his own death, the construction company paid a paltry sum of money to the boy’s family to prevent any legal action.

Water and Sanitation

The first structures to be destroyed during the demolitions were the water tanks and the public toilets. One of the biggest challenges faced by the evictees was the lack of clean water (for drinking as well as other purposes) and sanitation. The nearest public bathroom was two kilometers away charging four rupees for the use of toilet and Rs. 20 for bathing, forcing women and children to bathe only once every four or five days. This was especially challenging for pregnant women, women with young children, adolescent girls and the elderly.

Zara was one of the women who had sustained a fracture during the police violence. With her leg in a cast she was unable to walk to the public toilet. A temporary make-shift toilet behind her tarpaulin shed consisted of two slabs of stone over a huge drain cutting through the area. Negotiating this with her leg in a cast was stressful for Zara who was scared of slipping and falling into the drain and no one would even notice.

Many women said that they had cut down on drinking water.

“I haven’t been drinking water. It is difficult for me to go to the toilet walking such a distance. Two days back, I had gone to the toilet. When I came back, my gas stove was gone. Someone had stolen it.” -Lissa (70 years)

Increase in diarrhoeal and respiratory diseases

Whereas on the day of demolitions, the proportion of adults seeking treatment for respiratory and diarrhoeal disease was in the range of 1 per 10 households, this doubled by the 3rd day to 2 per 10 households and to almost every household within 7-10 days of the demolitions. While the respiratory symptoms included fever, cough, sputum and sore throat, the gastrointestinal symptoms included diarrhea and dehydration. The cold weather conditions in January, poor sanitation, lack of access to healthcare and medical facilities, and living in inadequate conditions in the open, contributed to the spread of fever, cough, cold, respiratory ailments and malaria. (Yacoob 2013b)

Most of the mothers whose children had diarrhea said that they were unable to cook at home and were dependent on the volunteers for food. Many times the delivery of food was delayed by several hours, rice was sometimes uncooked and the children had to sit on the footpaths to have their meals. Several children developed visible signs of malnutrition within a month of the eviction and assessments done by volunteers showed early signs of scurvy, Vitamin A deficiency and under-nutrition. However, they were neither weighed nor registered by the department of Women and Child development or the Health department.

Private Doctors in the vicinity had a field day treating illnesses. Sometimes the advice given even included commercial food products reflecting the doctors’ insensitivity to the socio-economic situation of their patients.

“I went to the private clinic because my daughter has been having diarrhea for the last three days. The doctor shouted at me and asked me to give her Lactogen. I don’t have money to buy it. The doctor asked me to give her filter water or boiled water. Where will I boil the water for my child?”– Zahira (23 years), mother of Salma (3 years)

Many people began complaining of rashes on their skin. Palaniamma, for example, stated that the itching drives her crazy. “We haven’t had a bath. Every time it rains the dogs come into the shed with us. They huddle in the shed with us. We are not able to chase the dogs out. So we get all kinds of infections.”

Health issues of the elderly

Many of the elderly said that their medications had been lost in the demolitions and they were unable to recollect names of the medication. They were unable to leave their possessions to visit a doctor to get a fresh prescription. The food being provided by volunteers had a high salt content sometimes but lack of an alternative meant that they had to eat whatever was offered.

“I feel giddy and tired all the time. I don’t have any of my medicines. I live by myself. People tell me now that my home is destroyed I should go and stay in a hostel for women. I can’t leave all my friends behind. I don’t know what to do”–Mary (55 years)

Rosemary, aged 60, was inconsolable after the eviction. After three days of being out in the cold and barely eating, she was the first casualty of the eviction process (Mondal & Ramani 2013), (Deccan Herald 2013a).

“She had barely eaten anything in the last few days. All she did was cry. The cold was unbearable. She was trembling and was constantly complaining about the cold. I don’t have money to bury my mother. Neighbours are contributing whatever they can.”-Sobha, daughter of Rosemary

Aggravation of aggression and alcoholism

Women reported that there was an increase in aggression at home by their husbands and sons. Whereas alcoholism had been a problem in the slum prior to the demolition, women complained that there was an increase in alcohol abuse by the men subsequent to the demolition. Two of the women who had been arrested had been assaulted by their husbands, one of them with a razor.

“My husband suddenly pushed aside one of the activists and started cutting me all over with a razor. He repeatedly said that I was talking too much

– with media, with neighbours.” -Parimala (38 years)

“When my husband heard that I had been arrested, he became very suspicious. He kept asking me what the police did to me. If he knew that I had been stripped at the police station he would kill me”. –Zabeena (28 years)

“Many problems start after 10 o’ clock. Men get drunk and shout and scream outside our houses. Our girls are so vulnerable. We are scared to come out but how should we use the toilet after 10 o’ clock?”–Zahida (20 years)

Sexual Harassment

Many adolescent girls had to live out in the open – vulnerable to physical and sexual harassment.

“I have a daughter who is 15 years old. There are groups of men and boys wandering around. How can I just leave my daughter alone on the street and go away to work?” –Vijayalakshmi (35 years)

A woman who was mentally challenged was sexually harassed. She was however also beaten up by the women in the area for ‘soliciting sex’ and thrown out of the temporary shelter. “I have no one to support me. Where will I go? I don’t have parents.”

At least 15 of the women spoken to said that they faced almost daily harassment from the police, the political representatives and anti- social elements within the area.

“One night I was sleeping in the shed with my two children. One of the police came in the middle of the night and lifted the flap and asked me if I would come with him. It is so terrifying to live like this every day. Who is there to protect us?” -Noorunissa (28 years)

Reproductive health issues

The trauma of the eviction has been especially acute for pregnant women. In addition to the difficult living conditions, lack of adequate food and medical assistance, they had no idea as to where or in what conditions they will have to give birth and what future they will be able to provide to their newborns (Yacoob 2013a), (Mondal 2013).

Ruksana, aged 25 years, delivered her third baby and had to live on the footpath on her return on the 20th of January 2013. The two older children aged 6 and 7 years, fell ill repeatedly and one after the other, most often with a high fever. The newborn baby had incessant crying spells while pulling his ears. Ruksana had a severe pain on the left side of her abdomen with vaginal bleeding within 3 days of her delivery. Although a scan was required she was unable to go to the maternity home leaving these three children behind. Since her husband was not being responsible, her mother and sister provide her with basic amenities and support though with some resentment. One of the volunteers supported Ruksana to get a loan for her house advance. She has to repay the loan that she took to pay an advance for the house she moved into after the demolition.

Jyoti, aged 17, was seven months pregnant at the time of the demolition and was unable to go for a checkup till the time of her delivery. She had complaints of severe pain in her legs and abdomen and found it very difficult to walk to the public toilet located 2 km away from the demolition site. Jennifer reported that she had been in her fourth month of pregnancy during the demolition and had acute knee pain after falling on the debris during the demolition drive.

Many of the evicted residents share a sense of despair. They face daily harassment from the police, political representatives and criminal elements in the area. They have lost their community and those who have moved out come back to the demolition site just to meet old friends. Mary, a 65 year old single woman, knows that her only option is to move to a care home, but she weeps at the thought and would rather live in a makeshift shelter on the footpath near the demolished area than move away. Many women complained of inability to eat, ‘acidity’ and inability to sleep.

Response of government

For 5-6 months after the demolitions many families continued to stay in makeshift shelters around the demolition site. There was a sense of helplessness and loss of faith in the system. There has been a striking absence of interventions from several state departments in the wake of these forced evictions. For example, there was not even one visit by the departments of Women and Child Development, the Human Rights Commission, the Minority Rights Commission, the SC/ST commission, the education department and the health department. Immunisation of the children was completely neglected. All attempts to engage with these commissions and departments eventually failed. The only visit by health officials to the area was during the pulse polio drive.

“We have been struggling for a long time. There is no point doing dharna or protest. We have struggled a lot in front of the Corporation. When we don’t follow traffic rules, they impose a fine on us. Why is the same law not applied when we as citizens are being thrown out on the streets? Where should we go? We have all the required IDs.”-Saritha (38 years)

The Municipal Corporation and the government worked in several ways to favour the developers and real estate agencies. There was a complete lack of transparency in the tendering processes with the community not being involved in any decision about the Economically Weaker Section (EWS) land. There were also deliberate efforts to create confusion by sharing conflicting and contradictory information. Demolitions happened suddenly and without warning therefore giving families no time to look for alternative employment, schooling or accommodation.

“They are asking us to leave this area saying they will give us a card. What use is this card? The leaders and the police are crooks. We don’t trust that they will give us houses.” –Mary(50 years)(Ranganathan 2013b)

The judiciary offers a slow mechanism implying that the displaced families have to fight for years to reacquire land that rightfully belongs to them, if at all they can manage the resources required to pursue a protracted legal battle.

The process of displacing people through slum evictions and forcing them into rehabilitation centres on the outskirts of the City is an example of the segregation along caste lines — which has been historically practiced and continues in the name of development” –Kaveri (Deccan Herald 2013b)

Discussion

India is one of the fastest urbanizing nations in the history of the world. While 28.53% of India was living in urban areas in 2001, by 2011 this figure had gone up to 31.16%. The population of Bangalore has increased from 1.7 million in 1971 to 8.5 million in 2011. In the last decade (2001-11), Bangalore added 767 people every day! Many of the migrants who settle in slums in Bangalore are from rural Karnataka or from other states who have been driven out of their villages due to drought or poverty(Gowda & Shivashankara 2007). A majority of these belong to castes placed lower down in the social hierarchy ordained by the caste system in India. These processes of ‘long transition’ (agrarian to industrial; rural to urban) have been fast forwarded in India in a context of neo-liberal policies where State takes less and less responsibility for the well-being of the citizen.

Two marked characteristics of this migration to cities are the informalisation of labor and growth of slums. Most migrants are employed in the informal sector with no social safety net and stay in slums without basic services. In fact, planning for provision of basic services like water, housing, sanitation and electricity for the immigrants is non-existent while the State is more interested in commercialization of spaces leading to transfers land from slums to commercial complexes. There is a systemic failure to provide decent housing to the poor. Often the urban poor are categorized as illegal while it is never questioned why they are not offered legal spaces in accordance with their needs. Like many other cities, Bangalore is also becoming a site of elite consumption for those who can afford it and rapidly being purged of those who build and service it. In the absence of the government providing adequate and inhabitable living spaces and amenities, the poor are forced to live in what are considered unhygienic and unaesthetic circumstances – which then become the basis for their eviction(Leena & Chotani 2007)(Mehta et al. 2013)(Chetan Chauhan 2007).

Forced evictions are not a new phenomenon but in the last decade the incidence and scale of these evictions has been unprecedented because of the policies of liberalization, privatization and globalization that depend on refashioning and reforming cities to lure foreign investment while delinking it from domestic priorities. Urban land and resources are used more for material and symbolic accumulation and consumption of the affluent rather than housing for the poor (Hazards Centre 2005), (Mallo & Obasanya 2012).Recently, Durga basti in New Delhi, inhabited by dwellers employed mainly in the informal service sector – casual labourers, domestic workers, barber, carpenter, iron smith, vegetable vendors, street hawkers, tailors, washermen, cleaners, masons, rickshaw pullers, sex workers etc, was a large slum destroyed to make way for the Delhi Metro(Leena & Chotani 2007). Similar to the Ejipura evictions, in the wake of the city gearing itself for ‘world class standards’, people were driven out from footpaths, roads, parks and other public spaces due to a nexus between government, citizen’s groups and judiciary. The land was taken away from the poor and used for operations of the globalised capitalist economy, the big business players, the real estate lobby and the corporations.

Given this socio-political context and the neo-liberal policy environment, the SDH of the slum dwellers are already low as compared to rest of city dwellers. Consequentially, their ability to absorb any shock which drastically lowers the SDH further is minimal.

The negative effects of slum demolition include an increase in crime rate, prostitution, homelessness, unemployment and poverty(Mallo & Obasanya 2012). Demolitions mean loss of livelihood with little or nothing to fall back on. There is immediate loss of housing, water, toilets, food and livelihood, making communities very vulnerable to ill health with an increase in morbidity and mortality mostly due to preventable diseases such as jaundice, malaria, diarrhea, food poisoning. Children below 10 years age are the most vulnerable. Poor nutritional intake due to falling purchasing power compounded by malfunctioning Public Distribution System further increases their vulnerability.

Rode, for example, compared the incidence of malnutrition in below five age group children in demolished and not demolished slums in Mumbai. After demolition of kucha slums, the incidence of stunting and wasting increased among boys and the incidence of underweight was very high for girls. Incidence of severe malnourishment became double after demolition of kucha slums (Rode 2009). Studies have shown that babies born during demolitions have significantly higher likelihood of low birth weight than those born prior to the event. Families tend to prioritize income on housing and other necessities rather than food. Access to health care is further compromised by unavailability of affordable, low-cost proximate services, the public system already being emaciated by neo-liberal policy regime(Cutts et al. 2011), (Keene & Geronimus 2011), (Struening et al. 1990), (Halpern & Reid 1992). A study on evictions at Ambedkar Nagar slum in Mumbai, found profound effects on health. Stunting and wasting were identified in the children with skin and hair changes suggestive of kwashiorkor and rickets. Two-third of the children had obvious pallor (signifying anemia) and a quarter of them showed signs of hypovitaminosis-A including conjunctivalxerosis, Bitot spots and corneal xerosis. Additionally, there was evidence of widespread infection: diarrhoea, respiratory infections including pneumonia, and skin infections (Emmel & D’Souza 1999).

There has been evidence of stress and poorer mental health associated with evictions. The stress arises from the anticipation of dislocation, lack of opportunity to negotiate with authority as well as loss of community (Greene et al. 2011), (Keene & Geronimus 2011), (Leena & Chotani 2007).

This experience is not limited to developing world only. An ecological study of the 1975 – 79 demolition of low income housing in the South Bronx in New York City found a sudden increase in high risk behaviour such as substance abuse and violence. Additionally, there was an increase in HIV and tuberculosis among displaced residents and the communities which received displaced residents(Wallace 2011), (Greene et al. 2011).

The health consequences of the forced evictions are serious – both acute and chronic. Many of the systems that should normally respond are mostly silent and unresponsive. As in this case, for the government, without an ‘address’, the EWS residents have ceased to exist. They do not have access to PDS rations, to health care, to nutrition, to education, to water or to sanitation. Nor are their voices heard, or any voices heard on their behalf. Families therefore become highly vulnerable and this is often manifested in increased morbidity and mortality. The event of an eviction acts as a trigger putting in motion several mutually reinforcing mechanisms which continue to deteriorate the health of the community via negative impacts on SDHs. Lack of drinking water and sanitation makes the evictees prone to all kinds of infection. Loss of livelihood leads to lowered incomes which affect nutritional intake of the households. It also reduced the ability of the households to avail healthcare which is largely via out-of-pocket expenditures on private healthcare. From the experience of EWS Quarters, Ejipura we can conclude that health consequences of evictions are far greater and lasting, than has been sufficiently understood so far.

The actors in the forced eviction include those who the BBMP hired to do the actual demolitions, the BBMP, the apathetic legal system and the private contractors. The demolitions were not just of the homes of 6000 people at EWS, but of their dignity, their health, their aspirations and of social justice.

NOTE

1 This data is from a BBMP survey done on 14th November 2003. 163 doors were locked on the day of survey.

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—. “In IT city, people live and die on footpath”. The New Indian Express. 2013b. Available at: http://www.newindianexpress.com/cities/bangalore/In-IT-city-people-live-and-die-on-footpath/2013/09/03/ article1765509.ece? service=print.

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Acknowledgements

We would like to express our gratitude towards the residents of EWS and volunteers who conducted the survey.

Contributors:

SYLVIA KARPAGAM. Is a public health doctor who provided medical services at the EWS, Ejipura demolition site.

SIDDHARTH JOSHI. Is a Doctoral Student at Centre for Public Policy at Indian institute of Management, Bangalore. He was one of the volunteers at the EWS demolition site.

DEMOLITIONS AND EVICTION:

IMPLICATIONS FOR SOCIAL DETERMINANTS OF HEALTH

OF THE ECONOMICALLY

WEAKER SECTIONS-EJIPURA,

BANGALORE.

SYLVIA KARPAGAM, SIDDHARTH AND ISSAC ARUL SELVA

Abstract: This paper draws from first-hand experiences of the authors who volunteered for relief during the forced eviction of the residents of Economically Weaker Sections (EWS) housing at Ejipura, Bangalore and analyses the effect of the evictions on health status of the evictee population. The forced evictions constituted a series of violations by the Bruhat Bangalore Mahanagara Palike (BBMP) and the police, with active support from the local MLA and the private contractor Maverick Holdings. In spite of the fact that many of the families were legally entitled to stay on the land and were living there for well over 10 – 15 years; the forced eviction displaced 1500 families overnight and without warning.

The evictions led to a sudden change in the socio-economic determinants of health – namely housing, livelihood, water, food, sanitation, healthcare and education. This impacted directly on the mental and physical health of several families especially children, elderly and pregnant women. Morbidity levels went up with an increase in malnutrition, gastro-intestinal and respiratory illnesses. With the majority of the community being dalit, Muslim or dalit converts to other religions, the forced evictions also demonstrates an open violation of minority and marginalized community rights.

Keywords: social determinants of health, Economically Weaker Sections (EWS), demolitions, forced evictions, dalit women, health impact on women, violence against women, Women and Child Development dept., Human Rights Commission, SC/ST commission, Minority Rights Commission, Bruhat Bangalore Mahanagara Palike (BBMP)

Introduction

From the 18th to the 21st of January 2013, Bruhat Bangalore Mahanagara Palike (BBMP), responsible for providing infrastructure and services in the Greater Bangalore Metropolitan area, bulldozed 1,512 homes and evicted over 5,000 dwellers living in the Economically Weaker Section (EWS) quarters in Koramangala (near Ejipura), Bangalore. The four-day demolition drive, rendered thousands homeless including around 1,200 women and 2,000 children. A majority of those evicted were Dalits, Muslim or Dalit converts to other religions who had either bought or rented the houses from the original allotees.

This study analyses the effect of evictions on the health status of the EWS residents by delineating the pathways and mechanisms by which the change in socio-economic determinants of health (SDH) lead to rapid deterioration in health status of the evictees, using the framework developed by the Commission on Social Determinants of Health (CSDH) (See Fig. 1) (Solar & Irwin 2010). The social determinants of health (SDH) are the conditions in which people are born, grow, live, work and age.

Fig 1: CSDH Conceptual Framework (Solar & Irwin 2010)

The framework proposed by CSDH draws a distinction between two categories of determinants. The structural determinants like income, education, gender, age, ethnicity, caste, religion, sexuality etc. are those which generate and/or reinforce social stratification. They are in-turn affected by the socio-economic and political context which included the policy environment. Intermediate determinants emerge from underlying social stratification and determine differences in exposure and vulnerability to health-compromising conditions (e.g. living and working conditions, housing, access to health care and education). (Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings 2008)(Solar & Irwin 2010)(Diderichsen et al. 2001).

Methodology

This paper is primarily a qualitative exploratory study focusing on processes that promote ill-health and has not evolved out of a pre- planned formal study. The authors were involved as volunteers during the relief and rehabilitation process following the demolitions. As part of a civil society group comprising students, professionals, human rights activists, media persons, doctors etc. they were involved intensively for over two months in the relief effort and less intensively for the next 6 – 8 months for rehabilitation. Primary sources include direct observations and interaction with the community, with police and bureaucracy, individual interviews, discussion with residents and case reports. Fifteen individuals were followed up for a long period and interviewed repeatedly. The secondary sources include primarily media reports and the Fact Finding Report by Housing and Land Rights Network, Delhi and People’s Union for Civil Liberties (HLRN & PUCL 2013).

Data on caste and occupational background of the residents is taken from a survey conducted by local residents in 2011 before the demolitions and is used here with permission. Consent has been sought from residents who were directly interviewed by us and are quoted here and all names have been changed for confidentiality.

Background of EWS, Ejipura, Bangalore

The Economically Weaker Section (EWS) housing at Ejipura, Bangalore was built in 1991 comprising 1512 residential units and was allotted to beneficiaries (Pelicanbriefcase 2013). The poor construction led to collapse of some blocks by 2003 and few more blocks were brought down by BBMP after an evaluation. The residents were settled on the same land in temporary shelters with the promise of quick reconstruction of their houses. In 2004, BBMP floated a tender for construction of residential and commercial structures at EWS site under public private partnership (PPP) without consulting the residents. The award of the contract to Maverick Holdings Ltd. (MHL) was challenged by another contending party in Karnataka High Court. This plea was dismissed in 2010 by the HC clearing the contract for MHL. In 2012, BBMP signed a concessionaire agreement with MHL wherein MHL was to build 1640 units for the original allottees on a 50:50 land development basis (residential + commercial). Meanwhile in Writ petition (No. 45915/2011) filed by few original allotees against the delay in construction of houses, a settlement was arrived at between the allotees, the BBMP and M/s. Maverick Holdings Pvt. Ltd., and on this basis the HC disposed of the matter on 24/08/2012 with a direction to clear the EWS Quarters land. The original allottees (comprising only 18.4% of those actually residing as on Nov

* Pourakarmikaru are safaikaramcharis employed by BBMP.

** Others include Housekeeping, coolie work, painting, electrical work, tailoring, carpenter, security services, salesmanship and as helpers in offices and hotels.

Fig 1: Percentage-wise break-up of occupations of the residents of EWS

Fig 2: Caste Demographics

2003), were to be given a compensation of Rs. 30,000 each and housing in the to-be built quarters. The court did not decide on the rights of the 1101 tenants (81.6%) living on the site since none of the tenants were before the court in the said case and thus no compensation or rehabilitation was provided for them1.

BBMP misrepresented the tenants as “unauthorized encroachers” and suppressed its own earlier resolution which recognized then as rightful residents. When the tenants approached the court against its order affecting them with the plea that they were not heard as part of a case that directly affected them the HC refused to stay eviction orders, thereby becoming a willing party to the violations thereon. Post-evictions, the government also did not provide any relief or rehabilitation to the evictees. The only relief was food and medical supplies from civil society organizations and voluntary groups working in the area (Ranganathan 2013a).

Data from a survey of 987 households conducted in 2011 by local residents shows that the residents of EWS were overwhelmingly daily wage workers in unorganized sector or on contract basis in organized sector.

As per the data from the same survey, about 55% of those surveyed were Hindu and Christian Dalits, about 5% belonged to Other Backward Castes and around 25% were Muslims. Remaining 15% were privileged caste Hindus

Eviction drive and the effect on the socio-economic determinants of health (SDH)

In this section, using the CSDH framework, we document how these evictions affected the health status of the evictees and what were the causal mechanisms via the affected SDH. It is important to note that while the CSDH framework is used to explain inequities in health outcomes of a given population at a particular point in time, our purpose is to use it to explain the variation in health status of the same population over two points in time (pre- and post-eviction) due to an sudden, external trigger – the eviction from housing.

Changes in Structural Determinants

The immediate impact of the eviction on the evictees was the loss of housing and its concomitants– security for women, protection from theft and loss of property, protection from rain and cold, toilets, water supply etc. Almost everyone suffered extensive loss of property including medical reports and prescriptions. Both men and women lost their jobs. Most women were domestic workers and none of them were able to leave their children and belongings on the street to attend work. Some women reported that the loss of their clothing and the inability to bathe prevented them from going to work. Children stopped going to school since their books and uniform were carried away with the rubble. Many drop-outs aged 10-14 years had started working in local repair shops by the end of the year.

The average income of the women domestic workers used to range from Rs. 2,000 to Rs. 3,000 per month. This loss in income greatly affected their purchasing power, especially for food and medicines. As a result the economic conditions of the community deteriorated drastically. All the people interviewed reported a marked decrease in income after the eviction.

As the evictees started looking for housing in the nearby areas, the advances and rents had sky-rocketed. No house was available for less than Rs. 20, 000 advance and Rs 2500 rent. Most families borrowed from relatives, shop-keepers and employers at exorbitant interest rates to be able to rent houses.

Physical injuries

BBMP engineers and police force supervised the eviction that took place early in the morning with all those resisting the demolitions getting beaten and arrested (Ranganathan 2013c). Protestors taken into police custody were stripped in the police station and at least three women sustained serious injuries that required them to drop out of work.

“They made us strip out of all our clothes and squat with our hands folded across. Those women who had periods had to take off their underwear with pads and also squat with the rest of us.” -Maria, (34 years)

The arrested women were produced in Sessions Court without being given an opportunity to apply for bail. The police failed to even inform their families of their arrest. The women were charged under five sections of the Indian Penal Code with charges including unlawful assembly, rioting, insult and criminal intimidation. The women were finally let out on bail. (Ranganathan 2013c)

“We begged the police to release us and not to keep us in custody while our houses were being demolished. We said that our children would come home from school and not know what to do because our houses wouldn’t be there anymore.” –Sabeena (28 years)

On the first two days there were injuries caused by police violence through the use of lathis. Around 50 persons were issued medical certificates for cuts, bruises, burns and injuries related to police violence during the demolition process. One of them was Zara who had fractured her leg from the police violence. A man suffered head injuries from police violence for he was drunk and could not move fast enough.

“Police beat and chase us… where do we go? Isn’t it the responsibility of the police to protect us?”-Saritha(38 years)

There were several cases of injury in the week following the demolition. Suresh worked as a painter and lived with his mother. One night his mother found him outside the house beaten up and with a fractured arm and dislocated shoulder. His mother struggles to support them by selling vegetables. She herself is an epileptic struggling to access her medications.

On September 23rd 2013, a 6-year old boy died after falling into a pit left by the construction group Maverick Holdings (The New Indian Express 2013). While the local MLA blamed the boy for his own death, the construction company paid a paltry sum of money to the boy’s family to prevent any legal action.

Water and Sanitation

The first structures to be destroyed during the demolitions were the water tanks and the public toilets. One of the biggest challenges faced by the evictees was the lack of clean water (for drinking as well as other purposes) and sanitation. The nearest public bathroom was two kilometers away charging four rupees for the use of toilet and Rs. 20 for bathing, forcing women and children to bathe only once every four or five days. This was especially challenging for pregnant women, women with young children, adolescent girls and the elderly.

Zara was one of the women who had sustained a fracture during the police violence. With her leg in a cast she was unable to walk to the public toilet. A temporary make-shift toilet behind her tarpaulin shed consisted of two slabs of stone over a huge drain cutting through the area. Negotiating this with her leg in a cast was stressful for Zara who was scared of slipping and falling into the drain and no one would even notice.

Many women said that they had cut down on drinking water.

“I haven’t been drinking water. It is difficult for me to go to the toilet walking such a distance. Two days back, I had gone to the toilet. When I came back, my gas stove was gone. Someone had stolen it.” -Lissa (70 years)

Increase in diarrhoeal and respiratory diseases

Whereas on the day of demolitions, the proportion of adults seeking treatment for respiratory and diarrhoeal disease was in the range of 1 per 10 households, this doubled by the 3rd day to 2 per 10 households and to almost every household within 7-10 days of the demolitions. While the respiratory symptoms included fever, cough, sputum and sore throat, the gastrointestinal symptoms included diarrhea and dehydration. The cold weather conditions in January, poor sanitation, lack of access to healthcare and medical facilities, and living in inadequate conditions in the open, contributed to the spread of fever, cough, cold, respiratory ailments and malaria. (Yacoob 2013b)

Most of the mothers whose children had diarrhea said that they were unable to cook at home and were dependent on the volunteers for food. Many times the delivery of food was delayed by several hours, rice was sometimes uncooked and the children had to sit on the footpaths to have their meals. Several children developed visible signs of malnutrition within a month of the eviction and assessments done by volunteers showed early signs of scurvy, Vitamin A deficiency and under-nutrition. However, they were neither weighed nor registered by the department of Women and Child development or the Health department.

Private Doctors in the vicinity had a field day treating illnesses. Sometimes the advice given even included commercial food products reflecting the doctors’ insensitivity to the socio-economic situation of their patients.

“I went to the private clinic because my daughter has been having diarrhea for the last three days. The doctor shouted at me and asked me to give her Lactogen. I don’t have money to buy it. The doctor asked me to give her filter water or boiled water. Where will I boil the water for my child?”– Zahira (23 years), mother of Salma (3 years)

Many people began complaining of rashes on their skin. Palaniamma, for example, stated that the itching drives her crazy. “We haven’t had a bath. Every time it rains the dogs come into the shed with us. They huddle in the shed with us. We are not able to chase the dogs out. So we get all kinds of infections.”

Health issues of the elderly

Many of the elderly said that their medications had been lost in the demolitions and they were unable to recollect names of the medication. They were unable to leave their possessions to visit a doctor to get a fresh prescription. The food being provided by volunteers had a high salt content sometimes but lack of an alternative meant that they had to eat whatever was offered.

“I feel giddy and tired all the time. I don’t have any of my medicines. I live by myself. People tell me now that my home is destroyed I should go and stay in a hostel for women. I can’t leave all my friends behind. I don’t know what to do”–Mary (55 years)

Rosemary, aged 60, was inconsolable after the eviction. After three days of being out in the cold and barely eating, she was the first casualty of the eviction process (Mondal & Ramani 2013), (Deccan Herald 2013a).

“She had barely eaten anything in the last few days. All she did was cry. The cold was unbearable. She was trembling and was constantly complaining about the cold. I don’t have money to bury my mother. Neighbours are contributing whatever they can.”-Sobha, daughter of Rosemary

Aggravation of aggression and alcoholism

Women reported that there was an increase in aggression at home by their husbands and sons. Whereas alcoholism had been a problem in the slum prior to the demolition, women complained that there was an increase in alcohol abuse by the men subsequent to the demolition. Two of the women who had been arrested had been assaulted by their husbands, one of them with a razor.

“My husband suddenly pushed aside one of the activists and started cutting me all over with a razor. He repeatedly said that I was talking too much

– with media, with neighbours.” -Parimala (38 years)

“When my husband heard that I had been arrested, he became very suspicious. He kept asking me what the police did to me. If he knew that I had been stripped at the police station he would kill me”. –Zabeena (28 years)

“Many problems start after 10 o’ clock. Men get drunk and shout and scream outside our houses. Our girls are so vulnerable. We are scared to come out but how should we use the toilet after 10 o’ clock?”–Zahida (20 years)

Sexual Harassment

Many adolescent girls had to live out in the open – vulnerable to physical and sexual harassment.

“I have a daughter who is 15 years old. There are groups of men and boys wandering around. How can I just leave my daughter alone on the street and go away to work?” –Vijayalakshmi (35 years)

A woman who was mentally challenged was sexually harassed. She was however also beaten up by the women in the area for ‘soliciting sex’ and thrown out of the temporary shelter. “I have no one to support me. Where will I go? I don’t have parents.”

At least 15 of the women spoken to said that they faced almost daily harassment from the police, the political representatives and anti- social elements within the area.

“One night I was sleeping in the shed with my two children. One of the police came in the middle of the night and lifted the flap and asked me if I would come with him. It is so terrifying to live like this every day. Who is there to protect us?” -Noorunissa (28 years)

Reproductive health issues

The trauma of the eviction has been especially acute for pregnant women. In addition to the difficult living conditions, lack of adequate food and medical assistance, they had no idea as to where or in what conditions they will have to give birth and what future they will be able to provide to their newborns (Yacoob 2013a), (Mondal 2013).

Ruksana, aged 25 years, delivered her third baby and had to live on the footpath on her return on the 20th of January 2013. The two older children aged 6 and 7 years, fell ill repeatedly and one after the other, most often with a high fever. The newborn baby had incessant crying spells while pulling his ears. Ruksana had a severe pain on the left side of her abdomen with vaginal bleeding within 3 days of her delivery. Although a scan was required she was unable to go to the maternity home leaving these three children behind. Since her husband was not being responsible, her mother and sister provide her with basic amenities and support though with some resentment. One of the volunteers supported Ruksana to get a loan for her house advance. She has to repay the loan that she took to pay an advance for the house she moved into after the demolition.

Jyoti, aged 17, was seven months pregnant at the time of the demolition and was unable to go for a checkup till the time of her delivery. She had complaints of severe pain in her legs and abdomen and found it very difficult to walk to the public toilet located 2 km away from the demolition site. Jennifer reported that she had been in her fourth month of pregnancy during the demolition and had acute knee pain after falling on the debris during the demolition drive.

Many of the evicted residents share a sense of despair. They face daily harassment from the police, political representatives and criminal elements in the area. They have lost their community and those who have moved out come back to the demolition site just to meet old friends. Mary, a 65 year old single woman, knows that her only option is to move to a care home, but she weeps at the thought and would rather live in a makeshift shelter on the footpath near the demolished area than move away. Many women complained of inability to eat, ‘acidity’ and inability to sleep.

Response of government

For 5-6 months after the demolitions many families continued to stay in makeshift shelters around the demolition site. There was a sense of helplessness and loss of faith in the system. There has been a striking absence of interventions from several state departments in the wake of these forced evictions. For example, there was not even one visit by the departments of Women and Child Development, the Human Rights Commission, the Minority Rights Commission, the SC/ST commission, the education department and the health department. Immunisation of the children was completely neglected. All attempts to engage with these commissions and departments eventually failed. The only visit by health officials to the area was during the pulse polio drive.

“We have been struggling for a long time. There is no point doing dharna or protest. We have struggled a lot in front of the Corporation. When we don’t follow traffic rules, they impose a fine on us. Why is the same law not applied when we as citizens are being thrown out on the streets? Where should we go? We have all the required IDs.”-Saritha (38 years)

The Municipal Corporation and the government worked in several ways to favour the developers and real estate agencies. There was a complete lack of transparency in the tendering processes with the community not being involved in any decision about the Economically Weaker Section (EWS) land. There were also deliberate efforts to create confusion by sharing conflicting and contradictory information. Demolitions happened suddenly and without warning therefore giving families no time to look for alternative employment, schooling or accommodation.

“They are asking us to leave this area saying they will give us a card. What use is this card? The leaders and the police are crooks. We don’t trust that they will give us houses.” –Mary(50 years)(Ranganathan 2013b)

The judiciary offers a slow mechanism implying that the displaced families have to fight for years to reacquire land that rightfully belongs to them, if at all they can manage the resources required to pursue a protracted legal battle.

The process of displacing people through slum evictions and forcing them into rehabilitation centres on the outskirts of the City is an example of the segregation along caste lines — which has been historically practiced and continues in the name of development” –Kaveri (Deccan Herald 2013b)

Discussion

India is one of the fastest urbanizing nations in the history of the world. While 28.53% of India was living in urban areas in 2001, by 2011 this figure had gone up to 31.16%. The population of Bangalore has increased from 1.7 million in 1971 to 8.5 million in 2011. In the last decade (2001-11), Bangalore added 767 people every day! Many of the migrants who settle in slums in Bangalore are from rural Karnataka or from other states who have been driven out of their villages due to drought or poverty(Gowda & Shivashankara 2007). A majority of these belong to castes placed lower down in the social hierarchy ordained by the caste system in India. These processes of ‘long transition’ (agrarian to industrial; rural to urban) have been fast forwarded in India in a context of neo-liberal policies where State takes less and less responsibility for the well-being of the citizen.

Two marked characteristics of this migration to cities are the informalisation of labor and growth of slums. Most migrants are employed in the informal sector with no social safety net and stay in slums without basic services. In fact, planning for provision of basic services like water, housing, sanitation and electricity for the immigrants is non-existent while the State is more interested in commercialization of spaces leading to transfers land from slums to commercial complexes. There is a systemic failure to provide decent housing to the poor. Often the urban poor are categorized as illegal while it is never questioned why they are not offered legal spaces in accordance with their needs. Like many other cities, Bangalore is also becoming a site of elite consumption for those who can afford it and rapidly being purged of those who build and service it. In the absence of the government providing adequate and inhabitable living spaces and amenities, the poor are forced to live in what are considered unhygienic and unaesthetic circumstances – which then become the basis for their eviction(Leena & Chotani 2007)(Mehta et al. 2013)(Chetan Chauhan 2007).

Forced evictions are not a new phenomenon but in the last decade the incidence and scale of these evictions has been unprecedented because of the policies of liberalization, privatization and globalization that depend on refashioning and reforming cities to lure foreign investment while delinking it from domestic priorities. Urban land and resources are used more for material and symbolic accumulation and consumption of the affluent rather than housing for the poor (Hazards Centre 2005), (Mallo & Obasanya 2012).Recently, Durga basti in New Delhi, inhabited by dwellers employed mainly in the informal service sector – casual labourers, domestic workers, barber, carpenter, iron smith, vegetable vendors, street hawkers, tailors, washermen, cleaners, masons, rickshaw pullers, sex workers etc, was a large slum destroyed to make way for the Delhi Metro(Leena & Chotani 2007). Similar to the Ejipura evictions, in the wake of the city gearing itself for ‘world class standards’, people were driven out from footpaths, roads, parks and other public spaces due to a nexus between government, citizen’s groups and judiciary. The land was taken away from the poor and used for operations of the globalised capitalist economy, the big business players, the real estate lobby and the corporations.

Given this socio-political context and the neo-liberal policy environment, the SDH of the slum dwellers are already low as compared to rest of city dwellers. Consequentially, their ability to absorb any shock which drastically lowers the SDH further is minimal.

The negative effects of slum demolition include an increase in crime rate, prostitution, homelessness, unemployment and poverty(Mallo & Obasanya 2012). Demolitions mean loss of livelihood with little or nothing to fall back on. There is immediate loss of housing, water, toilets, food and livelihood, making communities very vulnerable to ill health with an increase in morbidity and mortality mostly due to preventable diseases such as jaundice, malaria, diarrhea, food poisoning. Children below 10 years age are the most vulnerable. Poor nutritional intake due to falling purchasing power compounded by malfunctioning Public Distribution System further increases their vulnerability.

Rode, for example, compared the incidence of malnutrition in below five age group children in demolished and not demolished slums in Mumbai. After demolition of kucha slums, the incidence of stunting and wasting increased among boys and the incidence of underweight was very high for girls. Incidence of severe malnourishment became double after demolition of kucha slums (Rode 2009). Studies have shown that babies born during demolitions have significantly higher likelihood of low birth weight than those born prior to the event. Families tend to prioritize income on housing and other necessities rather than food. Access to health care is further compromised by unavailability of affordable, low-cost proximate services, the public system already being emaciated by neo-liberal policy regime(Cutts et al. 2011), (Keene & Geronimus 2011), (Struening et al. 1990), (Halpern & Reid 1992). A study on evictions at Ambedkar Nagar slum in Mumbai, found profound effects on health. Stunting and wasting were identified in the children with skin and hair changes suggestive of kwashiorkor and rickets. Two-third of the children had obvious pallor (signifying anemia) and a quarter of them showed signs of hypovitaminosis-A including conjunctivalxerosis, Bitot spots and corneal xerosis. Additionally, there was evidence of widespread infection: diarrhoea, respiratory infections including pneumonia, and skin infections (Emmel & D’Souza 1999).

There has been evidence of stress and poorer mental health associated with evictions. The stress arises from the anticipation of dislocation, lack of opportunity to negotiate with authority as well as loss of community (Greene et al. 2011), (Keene & Geronimus 2011), (Leena & Chotani 2007).

This experience is not limited to developing world only. An ecological study of the 1975 – 79 demolition of low income housing in the South Bronx in New York City found a sudden increase in high risk behaviour such as substance abuse and violence. Additionally, there was an increase in HIV and tuberculosis among displaced residents and the communities which received displaced residents(Wallace 2011), (Greene et al. 2011).

The health consequences of the forced evictions are serious – both acute and chronic. Many of the systems that should normally respond are mostly silent and unresponsive. As in this case, for the government, without an ‘address’, the EWS residents have ceased to exist. They do not have access to PDS rations, to health care, to nutrition, to education, to water or to sanitation. Nor are their voices heard, or any voices heard on their behalf. Families therefore become highly vulnerable and this is often manifested in increased morbidity and mortality. The event of an eviction acts as a trigger putting in motion several mutually reinforcing mechanisms which continue to deteriorate the health of the community via negative impacts on SDHs. Lack of drinking water and sanitation makes the evictees prone to all kinds of infection. Loss of livelihood leads to lowered incomes which affect nutritional intake of the households. It also reduced the ability of the households to avail healthcare which is largely via out-of-pocket expenditures on private healthcare. From the experience of EWS Quarters, Ejipura we can conclude that health consequences of evictions are far greater and lasting, than has been sufficiently understood so far.

The actors in the forced eviction include those who the BBMP hired to do the actual demolitions, the BBMP, the apathetic legal system and the private contractors. The demolitions were not just of the homes of 6000 people at EWS, but of their dignity, their health, their aspirations and of social justice.

NOTE

1 This data is from a BBMP survey done on 14th November 2003. 163 doors were locked on the day of survey.

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Acknowledgements

We would like to express our gratitude towards the residents of EWS and volunteers who conducted the survey.

Contributors:

SYLVIA KARPAGAM. Is a public health doctor who provided medical services at the EWS, Ejipura demolition site.

SIDDHARTH JOSHI. Is a Doctoral Student at Centre for Public Policy at Indian institute of Management, Bangalore. He was one of the volunteers at the EWS demolition site.

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SYLVIA KARPAGAM, SIDDHARTH JOSHI
SYLVIA KARPAGAM. Is a public health doctor who provided medical services at the EWS, Ejipura demolition site.SIDDHARTH JOSHI. Is a Doctoral Student at Centre for Public Policy at Indian institute of Management, Bangalore. He was one of the volunteers at the EWS demolition site.

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