'Designed for death': the Mumbai housing blocks breeding TB

'Designed for death': the Mumbai housing blocks breeding TB

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It’s a hot summer afternoon, but the windows stay firmly shut in the Sheikh family’s home. Fifteen-year-old Samira, who is convalescing after tuberculosis (TB) and needs fresh air, says they keep the window of their second-floor apartment closed because of mosquitoes, bad smells from leaking pipes and a lack of privacy: the next block is just three metres away.

Samira’s neighbourhood of Govandi-Mankhurd was once on Mumbai’s outskirts – far enough away to plonk fertiliser plants, refineries and a rubbish dump. Today, the area is one of the city’s most populous, poor and underserved suburbs. This is where authorities have resettled, in large housing projects, slum-dwellers from other parts of the city whose shanties were cleared for new roads.

The Natwar Parekh compound, built in 2008.



The Natwar Parekh compound, built in 2008. Photograph: Vaishnavi Chandrashekhar

While these multi-storey public housing complexes offer vital shelter to poor families such as the Sheikhs, a new study has found high levels of TB due to poor ventilation and overcrowding in some of the blocks.

The findings confirm what many Mumbaikars have suspected: living conditions in these resettlement blocks are sometimes little better than the shantytowns they replaced.

“The houses are planned in such a way that they are going to lead to illness,” says Dr Ravikant Singh of Doctors for You, the medical NGO that led the study. “They are literally designed for death.”

The report, which studied three housing projects through surveys and modelling experiments, found that 8-10% of the residents in the denser, less light-filled and more poorly ventilated complexes had tuberculosis – compared with 1% of residents in a better ventilated project. Even within a building, the risk of TB declined on higher, airier floors.

The government-funded report blamed the relaxation of building norms for slum-rehousing projects. The result: too many people in buildings stacked too close together, with poorly designed windows that residents keep shut, and lower floors with little natural light or air circulation.

The link to TB would not have surprised civic authorities a century ago. Disease outbreaks in 19th-century cities led to the birth of modern urban planning as reformers, still new to germ theory, blamed crowding, poor ventilation and sanitation. Industrial Bombay, with its booming textile mills and migrant workers, was no different.

The outbreak of bubonic plague in 1896 led to the creation of the Bombay Improvement Trust (BIT), which over the next few decades opened up crowded neighbourhoods. It constructed east-west roads that brought in the sea breeze, and built new tenement housing, known as chawls, with cross-ventilation. It also sought to expand the city with new suburban layouts – modelled on London’s garden suburbs of that era. And it helped introduce the “63.5 degree light angle rule”, which determined building setbacks to optimise light and air right up to the 1950s.

Even then, economic interests were kept firmly in mind. “In fixing our standards of open space, which are the check [on the spread of disease], we must steer between the Scylla of encouraging bad building and the Charybdis of discouraging building altogether,” said BIT chairman James Peter Orr. Orr later became housing director of the London county council, whose projects were influenced by Bombay chawls.

Chawls in Mumbai, which were designed in response to an 1986 bubonic plague outbreak.



Chawls in Mumbai, which were designed in response to an 1986 bubonic plague outbreak. Photograph: Alamy

Similar housing laws were introduced in most cities of that era, including New York, where the State Tenement House Act of 1901, enforced by the health department, mandated that every room have an external window. The rise of skyscrapers focused attention on access to sunlight, leading to zoning and setback laws that have caused the distinctive tapering tops of high-rises such as the Empire State Building.

Sunlight isn’t as much of a design issue for tropical cities such as Mumbai, says Prasad Shetty, faculty member at the city’s School of Environment and Architecture. But ventilation is. The chawls of old Bombay were well spaced because planners understood that the higher the density and the smaller the house, the more space you need around it. Not just for light and air, either: “When you have small, crowded homes, you require outdoor spaces to live life – especially for children and old people,” Shetty says, adding that modern planners have forgotten the lessons of older housing projects.

Part of the reason for the amnesia is that the historical link between health and urban planning weakened as incomes grew, sewers became the norm and – most importantly – medicine became better at treating disease. Yet in poor urban neighbourhoods, the environment remains a health risk – especially for airborne TB. According to the World Health Organisation, overcrowding, poor ventilation, malnutrition, stress and social deprivation are all risk factors for the illness.

With multi-drug resistant tuberculosis on the rise, environmental interventions are even more critical to prevent infection, said Singh, who has run a clinic in Govandi since 2010. India has a quarter of the world’s TB cases, and Mumbai is a hotspot.

A tuberculosis patient takes his medication in Mumbai. Drug-resistant strains of the disease are on the rise.



A tuberculosis patient takes his medication in Mumbai. Drug-resistant strains of the disease are on the rise. Photograph: Rafiq Maqbool/AP

At Govandi’s Natwar Parekh Compound, a complex of 4,800 occupied rooms, patients said they keep their diagnosis secret because of stigma. Some leave for better digs.

The Sheikh family would like to move out, too, for Samira’s health. Slight for her age, she weighs just six stone (38kg). But she’s doing better than a year ago, when she was so emaciated that her grandmother could lift her prone body aloft with her hands. She put on a few more kilos on a visit to her family’s home town, but lost the weight when she returned to Mumbai.

Small design fixes could improve homes such as Samira’s, said the study authors – replacing sliding windows with shutters, installing exhaust fans, and improving stormwater drains. But the real solution lies in structural changes. The hope is to influence the bylaws, which are currently undergoing revision. One proposal would permit slum resettlement projects to rise from seven storeys to 20. At only three metres apart, such housing would be a nightmare, says Singh. “The damage here has already been done,” he said. “But we can still do something about the new developments.”

As for Samira, she still misses her old city neighbourhood of Sewri, where their shanty was demolished for a new road. The air was better there, she says.

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