New Delhi: “We’ve become used to it – the constant headaches, the breathing problems,” says Mohammad Irfan, an e-rickshaw driver in Rohini, Delhi, summing up the fatigue many feel as the Air Quality Index (AQI) oscillates between “very poor” and “severe categories in the national capital. He moved to Delhi from Mainpuri in Uttar Pradesh about a decade ago.Like Irfan, Kirti Ahirwar, who migrated from Madhya Pradesh in 2020 and works as a domestic worker in the same area, described the pollution crisis as a slow erosion of hope. Her children struggle with fatigue. Schools are shut due to severe smog. Meanwhile, healthcare remains out of reach for them. “We came with big aspirations, but now even surviving is hard. We can’t keep taking medicines, and we can’t afford them anyway.” She relies on so-called “home remedies” – cinnamon, cloves, carom seeds, ginger, lemon – “whatever is affordable”.Across the city, the working class, which includes many migrant families, has no insulation from this pollution crisis. Their jobs – construction, driving, vending, sanitation, delivery, domestic work – require them to remain outdoors regardless of how toxic the air becomes. For daily wage earners, missing even one day of work means losing the income they rely on to survive. The choice is brutally simple: breathe polluted air or go hungry. As prolonged exposure weakens their bodies, the burden only deepens.“All the ministers sit here. They are the 1% and are safe because they can afford everything. The rest of us live our lives in sacrifice,” Kailash Kumar, a cobbler, who works at the Central Secretariat, the hub of government offices, said capturing the divide starkly.While air quality is categorised as moderate, poor, very poor and severe, pulmonologist and epidemiologist Dr Sandeep Salvi warns that these labels dangerously understate the crisis. “Even the so-called green or moderate zones are harmful for human health,” he explains.Nearly 98% of India’s population, Dr Salvi points out, is exposed to unsafe levels of air pollution. Delhi, often portrayed as an outlier, is simply the most visible example, its smog heavy enough to be seen, smelt, and tasted, he notes.Why the poor breathe more poison than the richThe privilege of breathing cleaner air is increasingly determined by class. For those with stable incomes, a certain degree of protection comes easily: sealed office buildings, filtered ventilation, air purifiers, and digital AQI screens near elevators signalling when it is “safe” to step outside. For migrant workers, there is no escape.“Poverty itself is a risk factor,” Dr Salvi says. “Poor housing, overcrowding, indoor pollution from cooking fuels, outdoor exposure – everything compounds.” Suresh Kumar, a construction worker at a residential site in Rohini Sector nine, continues work without protective gear while air quality remains severe. Photo: Aishwarya Bajpai.One of the most devastating outcomes of this exposure is Chronic Obstructive Pulmonary Disease (COPD), now the second leading cause of death in India. Once associated largely with smoking, COPD is increasingly driven by air pollution. In a Pune-based study led by Dr Salvi and published in The Lancet in 2009, 70% of COPD patients had never smoked – reshaping global understanding of the disease.The data confirms what people feel in their bodies. PM2.5 is now the single largest external threat to life in India, reducing average life expectancy by 3.5 years nationally and by a staggering 8.2 years in Delhi. One in seven deaths in the capital – over 17,188 in 2023 – was linked to toxic air. Government-backed scientists have also found that airborne pathogenic bacteria are twice as high in densely populated areas, carried deep into the lungs by PM2.5 particles.Delhi continues to draw workers because rural India continues to fail them. The National Capital Territory (NCT) of Delhi has 2.9 million migrants, according to the 2011 Census. As of 2011, Uttar Pradesh and Bihar were the largest sources of inter-state migrants, while Delhi was one of the largest receiver states with a net inflow of 48 lakh migrants.In the national capital, for many migrant workers, exposure is relentless. They live near highways, construction sites, industrial clusters, or garbage dumps. Their homes trap pollution; their work multiplies it.Welfare fund not for allThis invisibility, labour experts argue, is structural. “Most occupational safety and health laws were designed for organised sector workers inside factories,” said Rajesh Upadhyaya, convenor of the National Alliance for Labour Rights. “External occupational hazards like air pollution were never factored in.”When construction is halted under the Graded Response Action Plan (GRAP), unions demand compensation. The Delhi government recently announced an ex-gratia payment of around Rs 10,000, but only for workers registered under the Building and Other Construction Workers (BOCW) Welfare Board.“The board has welfare funds,” Upadhyaya said. “So unions demanded their release, like during COVID.” However, a large section of unorganised workers remain outside the board, he added.Those registered under the Union government’s e-Shram portal – gig workers, vendors, informal labourers – receive no such support. “For e-Shram workers, there is no ex-gratia announced,” he said. “The benefits remain extremely limited.”Health schemes that stop at hospitalisationIndia still does not recognise pollution as an occupational hazard for informal workers. While formal workers can access Employees’ State Insurance (ESI), informal workers depend largely on Ayushman Bharat, which covers hospitalisation up to Rs 5 lakh.“Ayushman Bharat helps only if you are hospitalised,” Upadhyaya said. “Outpatient care for respiratory illness comes straight from workers’ pockets.”Dense smog severely reduces visibility along the Delhi–Sonipat Highway. Photo: Aishwarya Bajpai.Responding to an RTI query, the Union health ministry on February 28 stated that the total pending dues of empaneled hospitals that have provided free treatment to patients under Ayushman Bharat Yojana is Rs 1.21 lakh crore with 63,89,517 medical cases uncleared. The RTI was filed by activist Ajay Basudev Bose this January.A CAG report tabled in the Delhi assembly on February 28 has further exposed the fragility of the city’s healthcare system. As of March 2022, the health and family welfare department faced a 21% staff shortage, thereby increasing pressure on already overburdened facilities, the report underlined.The report also mentioned that major government hospitals recorded extremely high workloads at registration counters, and in departments such as medicine, doctors were able to spend less than five minutes per patient on average. The audit also flagged irregularities in drug procurement, including the purchase of medicines from blacklisted and debarred firms and shortage of critical injections for life-threatening conditions such as haemophilia and rabies, raising concerns about both quality of care and patient safety.Further, the closure of mohalla clinics has hit migrant workers hardest. “These clinics were last-mile facilities,” Upadhyaya said. “Their closure denies affordable care during pollution peaks and heatwaves.”The cycle is relentless: pollution leads to illness, illness to lost wages, lost wages to deeper poverty – and another winter of toxic air.Governance without workers at the centreDespite GRAP measures being implemented every winter since 2017, the ground reality has barely shifted for those most exposed. In its November 26 order, the Commission for Air Quality Management (CAQM) revoked Stage III restrictions but kept Stage I and II measures in place. Construction activity remains subject to specific permissions, leaving workers scrambling for alternative livelihoods.A subsequent order on December 13 reflected the same emergency-driven approach. Triggered by AQI crossing 450, CAQM invoked Stage IV GRAP, tightening vehicle restrictions and suspending earlier relaxations. Yet these measures disproportionately affected transport workers and daily wage earners, without income protection or health safeguards.Also read: Protests Erupt Over Aravallis, Opposition Parties Lend Support, But Union Env Minister Claims Hill Range Is ‘Safe’Notably absent was any direct engagement with labour welfare or public health preparedness. The focus remained on compliance and enforcement, not accountability or long-term prevention.Meanwhile, Delhi’s vehicular population has tripled – from 2.2 million in 1994 to 7.6 million today – driving emissions ever higher.The deeper problemThe struggles of Delhi’s working class remain peripheral to pollution policy. Migrant labourers, construction workers, street vendors, domestic workers, and drivers are the most exposed, yet remain largely invisible in responses.Even as India has launched national missions on family planning, road safety, anti-tobacco use, dengue prevention, and COVID-19 behaviour change, air pollution – despite killing millions – has never been treated as a national emergency.There are no sustained behavioural campaigns promoting public transport, reducing private vehicle use, or encouraging mask-wearing during peak smog. Investments in buses, walkable streets, cycling infrastructure, and last-mile connectivity remain inadequate.If behavioural change is to be expected, the government must first create systems that support it – affordable, reliable, and accessible mobility options and urban infrastructure that prioritises clean air.Towards a climate-aware labour policyUpadhyaya called for pollution and climate risks to be legally recognised as occupational hazards. “Labour laws must move beyond the formal–informal divide,” he said. He underlined that employers – public and private – must provide protective equipment and that burden cannot fall on workers who cannot afford it. Further, he stressed the need for affordable health centres near worksites and migrant settlements.Heavy pollution engulfs a residential area in Ghaziabad, leaving the surroundings barely visible. Photo: Aishwarya Bajpai.“You can change the name,” he said, referring to mohalla clinics, “but you cannot abandon the service.”On prevention, he criticised measures that burden the poor while sparing the affluent – such as banning coal tandoors at small dhabas while failing to curb vehicular traffic. He also pointed out that stubble burning has declined significantly, yet pollution persists.For Dr Salvi, the deeper issue is political ownership. “When ministers say there’s no proof that air pollution causes deaths, it’s shocking,” he said. “We have decades of global evidence.”Air pollution, he argues, falls between ministries – environment, health, transport, urban development – with none taking full responsibility. “Health must lead, but every sector must act.”Until that happens, Delhi’s most vulnerable will continue to inhale the toxic air the city produces – not by choice, but by necessity.Aishwarya Bajpai is a freelance journalist and researcher based in Delhi.