New Delhi: A narrow, shadowy corridor with cream-colored bare walls leads to room number nine. The door is locked, but one of the flaps of the tiny wooden window has opened out, offering a view into the 10 feet-by-10 feet room in east Delhi’s Mandawali locality where, last month, three children were found dead.

Mansi, 8, Shikha, 4 and Paro, 2, were found unconscious in a pool of vomit in this room where the family had temporarily moved into three days ago. According to the post-mortem, the three had died of “starvation/malnutrition, and its complications".

Going by just numbers, deaths due to malnutrition are not new to India. But the fact that this incident happened in an urban setting, and that too in the heart of the national capital, has brought the focus on to the lives of low-income migrants arrive in cities in search of better opportunity. While poverty and starvation related deaths are more common in rural India, Mandawali is not an isolated incident.

In January this year, a 45-year-old mother of three children, who lived in a rented room in Moradabad town, died due to starvation. There was no food in their house for 15 days and the family survived on whatever the neighbours could spare.

A few months earlier, a 50-year-old woman from Bareilly died of starvation because the family was allegedly denied their monthly quota of ration shop because she could not physically go down to the ration shop for an Aadhaar-based biometric verification.

In another incident in Jharkhand’s Dhanbad district, a 40-year-old rickshaw puller died of starvation after he failed to get ration through the government’s public distribution system.

While a recent report by Preet Vihar’s Sub-Divisional Magistrate stated that the children may have been given some “unknown medicine" by the father the night before their death, the fact remains that India is home to a quarter of the world’s hungry, according to statistics compiled by the Food and Agricultural Organisation. And about 50% of deaths among children under 5 are related to malnutrition, according to the World Health Organization.

That’s the reality of modern India, where, on paper, welfare and food security programs for the poor, like the family in Mandawali, are in place.

Hunger amidst plenty

“It was the invisibility of the family that was a major problem. If you look at the levels of inequalities around, you see how the urban poor have a dystopian kind of existence. There is always some scheme or the other lined up somewhere, but it requires so much capacity to just access it. It is the last mile that is critically missing. The mother should have been getting treatment, the kids should have been in a crèche, but nothing was in place," says Vandana Prasad, national convener for Public Health Resource Network, a not-for-profit working on health-related issues.

Everything that could have gone wrong went wrong with this Mandawali family. The father was the sole earner in the family; his rickshaw got stolen, so he lost his source of employment. The mother is mentally unstable. After failing to pay rent, the family was evicted from an earlier accommodation and had to move in with a friend.

With no one to look after or feed them, the three children, who had diarrhoea and vomiting for days, died, without anyone in the neighbourhood even being aware of it for hours.

The corridor outside the family’s house is scruffy, strewn with spilt over household items, and street dogs mill around. Some women are sitting on charpoys outside their rooms talking about the deaths, others discussing the lives of the poor in general, while the rest are busy with their daily chores. There is a sense of gloom and silence broken only by the occasional voice of squalling children, drifting through the corridor.

Savitri Devi, a housewife, whose husband is a vegetable seller, says if they knew or had received even a hint that the children were hungry, all of them would have helped the family. But “the children didn’t even cry."

“In such social settings, getting support is also very difficult, and particularly in this case, since they had just moved to an area where the neighbours didn’t even know them. In rural areas, there are better social support systems," says development economist Reetika Khera.

She says it is precisely the increased anonymity of the urban setting which demands the presence of free or subsidised community kitchens, such as the Indira canteen in Karnataka or the network of Amma canteens in Tamil Nadu.

The transition from rural to urban is never smooth. It becomes all the more difficult because the migrant or the migrant family is suddenly exposed to a system they don’t know how to navigate, while also fighting for something as basic as getting two proper meals a day.

Exposed to the new market

“The opportunities in cities are shrinking but there is an influx of people coming from rural areas," says International Food Policy Research Institute’s research fellow Anjani Kumar. “When there is distress migration, and the migrants don’t find gainful employment, they suffer even more than they would back in their villages. Getting employment is difficult, and we don’t have a system in place that can provide support in the initial phases, so that these people can sustain for at least some time. When they come, they directly enter the labor market, with no support whatsoever," Kumar says.

Before 1997, India’s Public Distribution System (PDS) didn’t explicitly focus on rural India. It was more of a universal scheme. But, over time, as PDS transformed into an anti-poverty scheme instead of a social safety net program, its focus increasingly centered on rural India.

Struggling for a grain of rice

The National Food Security Act provides for subsidized foodgrain coverage under a targeted PDS for up to 75% of the rural population and 50% of the urban population. Those eligible are entitled to receive five kgs of food grains per person per month at subsidized prices of 3/2/1 per kg of rice/wheat/coarse grains, respectively.

In the east Delhi apartment complex where the migrant family comprising three children made its temporary home, among the 15 rooms spread across two floors, only 2 or 3 families claim to have a ration card. Most of them have no stable income, working as either vegetable vendors, rickshaw pullers or daily laborers, and all fall under the BPL category.

“Both my husband and I have gone out to get a ration card thrice. They keep sending us back saying they aren’t issuing ration cards right now. Come later. That later never comes. For us to chase such things is impossible as we are all daily labourers, and a day’s leave means a huge loss. We eat only when we work, not because of some scheme," says Manorama Devi, one of the residents of the complex.

Where does the pipe leak?

According to the WEF, one among every sixth urban resident in India lives below the poverty line. And a significant majority of the urban poor reside in informal settlements and slums that are usually overcrowded and devoid of basic amenities.

In September, 2011, New Delhi-based think tank Centre for Equity Studies’ researchers Ashwin Parulkar (now with Centre for Policy Research) and Ankita Aggarwal investigated starvation deaths between 2005-10 in three Indian states: Bihar, Jharkhand, and Madhya Pradesh.

The reasons that emerged were that India’s system of distributing food to the needy is flawed; inefficient planning leaves most of the grains rotting in government warehouses rather than reaching the needy, and botched government surveys leave the poor without ration cards.

The common pattern which emerged was a longstanding history of hunger as a disease, because poorer communities experience what is called semi-starvation, which is a chronic pattern of not having secure food, while living in unsanitary conditions, says Parulkar. In cases when there is a patch of days or weeks without work, there is a cascading effect, where these people whose bodies are already compromised by undernutrition fall prey to infectious diseases, or even death, he says. “So, the longstanding cause may be poverty and disease, but the proximate cause is hunger," Parulkar adds.

Vanessa D’Souza, CEO of SNEHA, a non-profit working with undernourished children in urban areas, says the problem arises because the issue of hunger in rural and urban areas is dealt with in the same way. While poverty is poverty, the dynamics of it changes from rural to urban India.

“In urban areas, since there is so much movement happening among low-income families, any kind of intervention becomes difficult. Since in these settings, there are new entrants coming, old ones leaving, within months or days, the ICDS which is supposed to do the screening of children misses out on some kids. An increased and stronger screening is needed here," says D’Souza.

India has developed and launched an action plan to attain an ‘undernourishment free’ India by 2022. The plan pushes for stronger commitment and greater investment in tackling malnutrition, but the lives of the likes of the east Delhi family which lost three little girls is still so precarious that any sudden shock – an illness or the loss of a job – can push them into extended poverty, and, in some cases, even death.

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