What Past Responses to Health Crises Teach us About Indian Cities

The current crisis may very well lead to an impetus to formulate a new urban strategy that is tailored to serve and protect different social groups.

Indian cities have been going through major convulsions, particularly after the gradual lifting of the lockdown since early May.

Cities (especially Mumbai, Delhi, and Chennai among metros, but also, Ahmedabad, Hyderabad, Pune and Bengaluru) have borne the brunt of the disease, but it has also spread to the countryside mainly through the tragic phenomenon of ‘reverse’ migration.

On the national scale, it started in globalised spaces like big cities, western and southern India and has now spread to eastern and northern India, and the countryside. A disproportionate share of the pandemic-induced distress has fallen on the working poor and marginalised castes, but more affluent groups and privileged castes have not been spared by the pandemic in its still-early stages.

So far, the focus in India has been on addressing the immediate crisis: through social-distancing measures, emergency hospital care, and limited amounts of testing and contact-tracing. These short-term concerns should be thought alongside more medium and long-term concerns in order to design effective policies moving forward. We focus on the latter in this piece, by analysing the impact on Bombay of two major pandemics of the past: bubonic plague (1896-1940) and influenza (more popularly, ‘Spanish’ flu, 1918-20).

As is well known, pandemics generate health and economic crises. A severe pandemic sets the template for future responses, e.g. measures like quarantining and marking affected homes, employed today, were used to counter bubonic plague. In fact, the word quarantine is derived from the Italian term for 40 days, the isolation period for ships thought to be affected, during the plague-ravaged Middle Ages.

Also read: Conspiracy Theories, Evading Quarantine: The Bombay Plague Bore Witness to It All

An underappreciated fact is that pandemics and major diseases have influences beyond health and economy.  In Western countries, tuberculosis has been linked to how modernist architecture (functional, minimal and without ornament) became rooted especially in residential housing and sanatoria. As we illustrate from the case of Bombay below, pandemics have led to the restructuring of city spaces and unleashed political forces, even providing an impetus for the nationalist movement. 

Bubonic plague was first detected in India in September 1896 in Bombay. It spread to other parts of the country and resulted in about ten million (a crore) deaths over the next four to five decades. It left several important legacies for Bombay. First, it led to the complete restructuring of the city space of Bombay.

Migrant workers from Lucknow walk along Mumbai-Nashik highway to reach their native places, during a nationwide lockdown in the wake of coronavirus, in Thane, Wednesday, April 29, 2020. Photo: PTI/Mitesh Bhuvad

The three main factors that were held responsible for the spread of plague in Bombay were: population density, poor sanitation, and poverty. The British government created a new public institution called the Bombay City Improvement Trust (BCIT). BCIT, in concert with Bombay Port Trust, municipal corporation of Bombay, and to a lesser extent Back Bay Reclamation Trust, restructured the city in response.

From the works of scholars (Mariam Dossal, Rahul Mehrotra and Sharada Dwivedi), we learn that the southern part of Bombay island was extensively reshaped, and a significant part of the present South/downtown Bombay was constructed during the period 1898-1925.

The city expanded northwards through the construction of various suburbs. Public transport services like trains and tramways were extended and new roads were laid to improve connectivity within the expanded city. Notably, the issue of housing was addressed, in the process segregating the rich from the poor (apart from other axes like European versus native, and religion).

Second, the containment policies of the British government were seen as highly intrusive and insensitive to existing social norms (e.g. related to gender and caste). This resulted in a series of protests, aided by rumours and panic, some turning violent. The fear of the pandemic and British policies led to a large-scale fleeing (mainly of migrants) from the city.

Also read: How the Bombay Plague of 1896 Played Out

In the first three to four years of the plague, the city was reduced to about half of its pre-1896 population on account of out-migration and death. However, the Indian countryside was in the grip of a famine and did not provide a safe haven.

Third, as historian Myron Echenberg has argued, the plague gave a major impetus to the nationalist struggle. Tilak and Gokhale emerged into leadership positions in the early nationalist battles against the British. Essentially, in the spatial, economic and political spheres, the bubonic plague left an indelible impact on the city of Bombay.

Migrant workers wait to board buses to the Borivali Railway Station, Mumbai, May 21, 2020. Photo: PTI

In contrast, the Spanish flu, by far the deadliest pandemic of the modern era with a horrific mortality of about 15-20 million for India and 50 million globally, left a meagre long-run imprint on Bombay and other Indian cities. The reasons are many. The historian David Arnold argues that unlike the plague, Spanish flu, although it seriously affected city dwellers, also spread rapidly to the countryside and tribal regions from cities decimating vast populations of the relatively young people (age range, 20-40) and women more than men.

This pandemic disappeared around 1920. Given their past experience, the British were apprehensive about implementing policies that could be perceived as hostile. While they did publish pamphlets, advocated social distancing and such measures, they did not resort to deep interventions. Part of the reason is that bubonic plague came with a lot of historical baggage of outbreaks in medieval Europe, whereas influenza did not.

Also, bubonic plague of the 1890s, while it came most likely from Hong Kong, took deep root in India, began to be seen as an ‘Indian’ disease, and the British felt compelled to take it head on. They invited the cholera expert, Waldemar Haffkine, who was already in Calcutta, to develop a vaccine for bubonic plague. On the contrary, the Spanish flu was of Western origin and the British felt that its epidemiological aspects had to be settled in the US and European countries. Even in terms of popular lore, plague had come to be known as Mumbai-mai, in the Indian tradition of naming contagious epidemics after mother goddesses, whereas Spanish Flu did not get similarly christened.

Also read: How Our Cities Turned the National COVID-19 Crisis From Bad to Worse

What are the effects of COVID-19 so far on India? The pandemic has already brought to fore stark inequalities prevailing in Indian cities and the countryside. Both in health and economic terms, the wealthy and middle-classes of the country have been able to cope better thus far.

The crisis has exposed the precarious state of rural-urban migrants, urban poor and landless rural workers. In terms of differential effects on castes, it has adversely affected the Dalit, Adivasi and OBC communities that are over-represented among the migrants even though there might have been a temporary erasure of caste hierarchies among returning migrants themselves in the wake of common adversity.

Representative image showing houses in Mumbai. Photo: Pti

The pandemic has also seen a massive increase in household reproductive labor, the burden of which falls mainly on women. In cities, lack of proper housing, health care, employment/basic safety-net and basic amenities (e.g. clean water) are the main reasons for the vulnerability of the poor. Of course, chronic-poverty and associated malnutrition weaken immunity. Without addressing these problems, it is impossible to implement measures like social distancing. Severe lockdowns alone will not be able to effectively counter any future outbreaks of the current pandemic or future ones.

What can we learn about post-coronavirus restructuring of cities, from the experiences of previous pandemics? The idea is not to abandon cities, which come with distinct advantages like agglomeration economies, cosmopolitanism, lower per-capita carbon emissions, and intense cultural experimentation. The experience of Spanish flu is that of a cautionary tale. Indian cities could simply march on without making any deep structural changes. This would be a case of a lesson not learnt even after an opportunity presents itself.

On the other hand, the experience of bubonic plague is what is more pertinent at this juncture given the extent of adversity that COVID-19 has already created, and might continue to do so until a durable solution is found. In terms of restructuring city spaces, as we discussed above, there was an outward expansion of Bombay city into suburban areas in the wake of the plague. Urban sprawl may increase as a result of COVID-19 too.

Also read: After the Lockdown Lifts, We Need to Make Cities Liveable for Migrants

Commuting from peri-urban areas (instead of migration), may get a fillip, although this needs infrastructural improvements. Affluent households may wish to reduce their dependence on informal workers through processes of mechanisation (e.g. robotic cleaning) that could also heighten spatial segregation along class lines. BCIT ended up creating a class-segregated city by the 1920s. Bombay became even more segregated after the onset of neoliberal economic reforms in the early nineties. Religion-based segregation has also increased due to housing discrimination and communal violence. These spatial changes may actually diminish the inherent advantages of city life.

Our work on Hyderabad and Mumbai demonstrates the adverse effects of such segregation and spatial changes. We find that mixed neighbourhoods (in terms of class or caste or religion), even when they are unequal, tend to produce much better development outcomes like lower poverty and higher educational attainment. These outcomes and better health are linked through a virtuous cycle. It is therefore important to avoid creating sprawling, segregated cities.

We could imagine much better cities in response to COVID-19.

In terms of working poor, bubonic plague teaches us a particular lesson. Those fleeing Bombay in the 19th century were caught between famine (for which the British were responsible) in the countryside and disease in the city. Today, agrarian distress and feeble welfare packages resulting from the failures of successive governments, are the counterparts to the famine.

The problems of housing, sanitation and lack of decent and safe work that became glaring in fin-de-siècle Bombay are equally stark in Indian cities now. Migrant workers are caught between these two worlds of distress. The lesson here is that rural livelihoods and welfare schemes ought to be improved, as several commentators and rural scholars have already noted.

At the same time, the urban working poor have to be given a right to the city (including democratic access to open spaces) and a strong voice in any changes that are contemplated and implemented. This cannot be done through profit-seeking private companies or by private firms that make profit at public risk (public-private partnerships) that the current government is promoting.

Health workers wearing Personal Protective Equipment (PPE) sit on a bench at a crematorium in New Delhi, India, June 24, 2020. Photo: Reuters/Anushree Fadnavis

The adverse effects of the privatisation of health care over the last 30 years is also visible in the stark choice that the current government has to make between severe lockdowns and a rapidly spreading pandemic. Public institutions are democratically accountable and would represent the interests of diverse social groups better. Like the BCIT, which was a public body, public institutions have to be created to address the public health, housing and employment/welfare related concerns of the urban poor and migrant workers, while avoiding the adverse effects mentioned above.

A hopeful insight from the plague experience is that it created political awakening and protests amidst all the gloom. In Bombay, the British responses to the plague deepened an anti-colonial, nationalist consciousness. In our context, where there is an observed tendency towards imposing a one-size-fits-all strategy for the entire populace in all domains (economic, political and cultural), the pandemic may be the juncture when opposition could emerge to this top-down imposition of ‘national’ homogeneity. This may very well lead to an impetus to formulate a new urban strategy that is tailored to serve and protect different social groups, while retaining the inherent advantages of cities.

Infectious diseases will continue to emerge and spread as a result of climate-change and globalisation. We have to dig deep into history both for inspired responses and to avoid the errors of the past. 

Vamsi Vakulabharanam and Sripad Motiram teach economics at University of Massachusetts Amherst and University of Massachusetts Boston, respectively.