Two killers: Cities and centralismThe federal government’s attempt at absolute control and its lack of support of the vulnerable is going to add to the death toll.
Paul Collier, one of the most famous development economists of our times and author of several bestselling books including The Bottom Billions (2007) and The Future of Capitalism (2017), equated British cities of the 1840s with killing fields. The industrial revolution (1780-1830) had triggered rapid industrialisation and urbanisation. The British rural population rushed to emerging megacities that had become new manufacturing hubs. A combination of inadequate urban infrastructure for the added population, pollution from coal-burning factories, cramped accommodations, poor quality of water supply, malnutrition and lack of proper personal hygiene etc. resulted in frequent outburst of cholera, often in epidemic scales, and scarlet fever. They killed hundreds of thousands of young migrants. Limited healthcare facilities then available were invariably overwhelmed by the speed of the contagions and the number of patients at any given time. The average life expectancy at birth in many large British cities (except London) then dropped to as low as 30 years at one point of time.
At present, the world is in the ever-tightening grip of the novel coronavirus pandemic. Even after a hundred and eighty years, the cities of the world, sadly, continue to be the major killing fields from transmissions, like of Covid-19. The cities in the developing world, in particular, are turning out to be more vulnerable, as their fundamental condition is still comparable to the British cities of the 1840s. Urban migration has grown exponentially, even in developing and emerging economies.
UNESCAP, a United Nations’ agency, estimates that India has around 139 million internal migrant workers employed in sectors like construction, hospitality and manufacturing. The apparel sector in Bangladesh has about four million migrant workers and Nepal has about two million. Long and severe Covid-19 induced lockdowns in these economies has impacted jobs and livelihoods of millions of these internal migrants. The urban-rural reverse migration during the initial days of lockdown and, lately, their re-entry into the cities has been an additional cause of the rapid spread of the virus.
Many of these cities are densely populated with illegal settlements and without basic facilities like potable water, electricity and housing with the proper flow of air. For example, in the Dharavi slum area of Mumbai, India, on average, 270,000 people live in every square kilometre. In Nepal, according to a World Bank estimate, more than 50 percent among the urban population lives in slums or in cramped, shared accommodations. In these conditions, social distancing, a prerequisite to contain the coronavirus, becomes practically impossible. Awareness of these inhabitants is constrained by limited access to information and level of education. These have a telling effect on their social behaviour. This is exactly the reason why densely populated cities, including the Kathmandu Valley, are becoming the new hotspots of Covid-19 transmission.
The Nepali state has also grossly underestimated the compulsion of this economically vulnerable section that needs to earn every day to survive. The state mechanism has failed to provide alternative means for survival, a must until the vulnerable can return to some gainful employment. The clandestine movements of urban migrants to find ways to survive—circumventing security barriers even during the lockdown—are only adding to the risk.
When Nepal first imposed a nationwide lockdown in the last week of March, the situation here seemed to be much safer than several other countries. One of the reasons for that psychological cushion was the sheer hope that the political leadership would learn from the experiences, good or bad, of other countries, and introduce containment measures that were proven in the highly affected areas of the world. But during the four-month-long lockdown, the government only managed to bungle everything—in procuring related healthcare materials, in managing quarantines and lockdowns, in adding testing and tracing facilities, and in equipping the hospitals adequately for critical care.
The public healthcare system of Nepal is naturally overwhelmed, as well as being centred in the federal or provincial capitals. It is miserably understaffed, underfunded and grossly mismanaged. But, fortunately, as a boon of the free-market policies that the country in a brief stint of three years (1992-95) implemented, Nepal has an impressive network of private hospitals and medical schools spread across the country. The government, with timely and appropriate policies and operations guidelines, had the opportunity to utilise and mobilise these important resources. Even now, when the situation already looks dangerously precarious, the government with its deep-rooted ‘License Raj’ mindset is toying with a half-hearted approach towards utilising the readily available infrastructure, manpower and facilities that are in private hands. This is one very costly miss which the government must immediately reconsider.
Further, the federal government did not adequately and wholeheartedly partner with both provincial and local governments in the fight against the virus. Local governments were and still are enthusiastic to contribute to the cause of virus containment. In fact, they are best placed to do so, if resources, technical support and clear guidelines were given. But the federal government has refused to budge from the idea of fully centralised control of procurement and order. As a result, the local government representatives who are dedicating their sincere efforts in every possible aspect of Covid-19 containment and cure measures have started to speak out about the complete lack of support of the federal government extended to them. On the contrary, the federal government, in the pretext of the pandemic, is infringing upon the decision-making authority of the local level, blatantly defying the spirit of fiscal federalism.
There are at least five thousand private hospital beds that are lying idle in Nepal. The experience of other countries shows that, given sincere effort and the necessary will, every adequate facility, from schools to buses, can be converted into medical facilities. The Chinese city of Wuhan set up tented hospitals within a week to accommodate ten thousand patients. The reality of the situation in Nepal is that the government is not putting sincere efforts to provide treatment to Covid-19 patients while patients are dying in extreme inhuman situations. Most are suffering due to the lack of timely treatment, as they are forced to hop between different hospitals and cities. Here again, a recent government instruction that makes Health Ministry approval mandatory before referring a Covid-19 patient to another hospital for further treatment is turning out to be a major problem. This is because the ministry is taking a long time to respond to approve referral requests of even critical patients. Such mala fide centralism is proving to be a larger killer than the novel coronavirus itself.
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