Part 2 - Behind the Mosquito Epidemic in Delhi

Read Part 1 here

While urban development does have to do with structures like buildings, basements, slums and naalas, it has a lot more to do with the people of the city. And it turns out that mosquitoes have evolved to adapt to urban areas including the urban habits of people living in the cities.

In Sub-Saharan Africa, for instance, people started using mosquito nets when retiring to bed, since the adult Anopheles mosquito (a malaria vector) tends to bite at dusk. The intervention was also encouraged by the state in these countries. Later, however, adult Anopheles mosquitoes adapted to this changed human behaviour and started biting at dawn instead, by which time the nets would loosen up.

Similarly in Delhi, the urban habit of machine fogging to repel mosquitoes initially proved effective at reducing their population. The fogging solution comprises 50% DDT, a harmful pyrethroid insecticide used extensively in the battle against malaria, dengue, yellow fever and chikungunya around the world. As Aedes mosquitoes, unlike other vectors, bite outdoors during the day, fogging was very effective at providing rapid relief. In a matter of 40 years, however, mosquito species had evolved and reappeared to the same pre-DDT extent. Soon DDT was banned in many cities, but continues to be used in countries including India.

Single mosquito net inside a jhuggi, Mehrauli Demolition Site

While urban structures help mosquitoes breed, the rising water scarcity in many cities has added to the situation. Constantly evolving vector mosquitoes need clear stagnant water that does not percolate into the soil for breeding. The growing water scarcity has created just this situation.

As the water level drops in the Yamuna, a river on the road to irreversible pollution, both the urban and periurban residents of the city are battling water shortages by storing more and more clean water. Though Delhi receives rainfall of up to 75 cm a year on average, rampant urbanisation has led to the shrinking of the city’s water bodies by 40% in the past 50 years. This period has seen a 17-fold rise in the artificial urban cover. Along with the growing water scarcity in parts of Delhi it’s helping mosquitos breed substantially.

Water scarcity compels households to collect clean water in containers for days. However, households like those in Devi’s basti are unable to store water for more than a day in times of water scarcity. This is because a single Nagar Nigam (MCD) water tanker only supplies limited water to the entire semiurban colony.

While some colonies in Delhi sustain themselves by collecting water daily for personal use, leaving no scope for hoarding, this is not how water scarcity plays out in the Kidwai Nagar quarters, or in Geeta Ghat. Nidhi starts storing water after announcements of water cuts for the day are made, occasionally. Poonam has a collection of many small and big plastic containers to store water for the family. These plastic containers were prime sites of mosquito breeding in low and medium income households in 2015, and remain so today. This year, fines of 23 lakh Rs were collected as mosquito breeding fines from Delhi households alone.

Devi’s son heating cowdung on a chulha

Delhi is nevertheless faring better than Chennai, which has also been caught up with rising dengue and malaria cases since 2002. The Chennai City Corporation released a report last week stating that a “total of 224 larvicide sprayers, 120 power sprayers, 300 battery-operated sprayers and 229 hand-operated fumigators have been set up by the corporation”. The same release spoke of surveying the drying-up city and its nearly 11 lakh households to fine approximately 9,000 households for becoming mosquito breeding hotspots.

The southern metropolis receives approximately 140 cm of rainfall each year. Despite this the reservoirs went dry and civic authorities brought 10 million litres of water into the city in 2019. The extent of Chennai’s water bodies has shrunk from 32 sq km in 1893 to just 12.6 sq km at present. The scarcity of water was accelerated further by the construction of a 45 km long “IT corridor” in 2008 in the southeast of the city.

The rapid urbanisation in Chennai before the 2015 floods ensured the city could no longer hold or absorb rainfall. That year 289 people were killed in the floods while 1.8 million were displaced from their homes. As Nityanand Jayram, a Chennai-based writer and environmentalist has observed, “Floods and water scarcity have the same roots: Urbanisation and construction in an area, mindless of the place’s natural limits.”

Fogging machine, Ghaziabad

The MCD’s latest report on breeding sites in Delhi this year says that 36% of all mosquito breeding was spotted in desert coolers. 29% were flower pots or vases and 13% in overhead tanks. While rural areas have single overhead tanks for a large number of people, urban areas have them on every building. This means that the three prime locations of mosquito breeding are situated in the residential colonies of rich or middle-class households.

Rama Baru is a JNU professor at the Centre for Social Medicine and Community Health and has worked in the field of social medicine. She says “There is a mentality in social medicine which associates disease-causing vectors like mosquitoes and rats with the poor. But more mosquito breeding of dengue and malaria-causing mosquitoes occurs inside the homes of JNU professors than in slums… So while you say that education and awareness are for the illiterate, it's not that the literates are taking up the issue of mosquitos seriously.”

Baru thinks that intervention policies ought to target middle-income households with cemented rooftops and decorated balconies. Every balcony in Nidhi’s colony is decorated with indoor and outdoor plants. When it rains, the curves of the colony road develop water pits clear as mirrors. And many families have desert coolers that they don’t use.

Domestic breeding checkers are the informalised MCD employees responsible for going inside households like Devi, Poonam and Nidhi’s to check for mosquito breeding. Baru says her conversations with many DBCs reveal that when on inspection, they can walk right up to the kitchens of impoverished households. But when surveying the gated colonies, breeding checkers are not allowed entry. Sometimes the residents assure them there are no breeding spots without even opening the gate. This is popular culture in the Kidwai Nagar government quarters as well. Middle-class homes resist breeding checkers’ entry to avoid the heavy fines, of up to 5,000 Rs, for mosquito breeding sites found inside the premises.

Supposedly organic repellent incense stick, Geeta Ghat

Breeding checkers are not given any authority because they are employed on contractual terms by the MCD, and are responsible for surveying breeding sites on the ground or for spreading awareness. Because the government refuses to regularise their posts, they are often only a means to collect data for the MCD, which needs to release VBD reports weekly as per the mandate. To come out loud to the Delhi MCD, breeding checkers went on indefinite strike from July 31 this year, strategically and after many refusals by the authorities amidst record-high cases of dengue. They demanded regulations in their post’s recruitment and regular wages. Consequently, the Delhi Chief Minister distributed regularisation certificates to around 370 sanitation workers and promised that temporary workers would soon be made permanent at the “ceremony” on August 21.

This push and pull between DBCs and the MCD keeps recurring with no permanent relief – similar strikes were organised in 2022, 2021 and 2019. Regardless, the 3,000 DBCs and 2,000 field workers are still denied employment security and are also mistreated although they are an irreplaceable part of public health systems in the capital city. In Delhi, data on diseases remains a problem because governments have not integrated their data recording systems with the diverse population. Press reports this year found that of 41 recorded VBD cases, 32 remain untraced after investigation due to a lack of personal information on the patients.

The blanks in public health data records have caused Delhiites uncontrolled epidemics in the past. Dengue cases in 2015 were either under or misrecorded. In 2015, MCD recorded “15,687 cases and 60 dengue deaths” and this data was accepted as official data by the NCVBD. However, the Delhi government’s data on births and deaths recorded “486 government certified dengue deaths in the capital”. This discrepancy may have been caused by the difference in parameters used for the data recorded. Even these discrepancies, however, corrode the reliability of public data. Seven years on, and the NCVBD data on dengue and malaria still does not match the Delhi government issued data for the year 2022.

The Delhi government data has an asterisk that reads, “Cases of deaths due to dengue may be either suspected or residing outside Delhi. Clarification/Confirmation from the local bodies is pending.” This is because not all dengue or malaria patients who die in Delhi’s medical facilities are counted in the city’s official death count. Instead, ostensibly to avoid confusion, a review committee analyses the medical circumstances of death before declaring it a dengue/malaria death. The confusion persists.

Containers around a single water tap, Mehrauli Demolition Site

The freshly launched Integrated Health Information Platform of the Union government in 2021 is said to serve as the largest “integrated” medical database. Data for the platform is meant to be collected from health workers, doctors of health centres and diagnostic labs at the district, state and central levels. In an arrangement of data protection and informed consent, the platform might help create a robust database for medical research and innovation, but ironically, dengue and malaria are not among the 33 significant diseases covered in the IHIP.

Mosquitoes: a Cat with Many Tails

The state and municipal governments stand exposed with every health crisis in the cities, and they do not perform their miracles alone. The burden of epidemics is equally borne by the women of Delhi households, who take care of waste management, sanitation, collecting clean water for the entire household, saving young ones from VBDs and providing paramedical care post infection. This work earns no financial compensation and thus remains unaccounted for in public health data. So firstly, there is a need for equal allocation of labour amongst every individual in the household. As this utopia is achieved, prevention and control policies should be formulated keeping in mind that Women of the household are witnessing the mosquito epidemics in Delhi more closely.

The rise in mosquito density as a result of urbanisation, fluctuating weather, water scarcity and a lack of awareness in middle-class households also requires intersectoral intervention, with inputs necessary also from the ministries of women and child welfare.

After a rough battle with Covid, Nidhi’s family remains cautious of the mosquitoes that are probably breeding on her balcony. Two of her good friends suffer from Dengue as she boils papaya leaves to maintain their platelet count. Poonam and Devi recite tales of ambulances once in a while carrying the bodies of those who died of Malaria. Chhoti calls malaria a memory of the past and says her family is safe from almost all global diseases but poverty.

Devi’s daughter eating her meal outside their jhuggi