Principles of road safety help us understand the human cost of the harsh lockdown in India.
On March 24, 2020, the Government of India under Prime Minister Narendra Modi ordered a nationwide lockdown for 21 days, limiting movement of the entire population of India as a preventive measure against the COVID-19 pandemic. More than a billion people were given four hours to prepare for the most brutal lockdown imposed anywhere in the world. We were also told that the virus will be “defeated” in 21 days! The outcome as we know it today was almost predictable.
Overnight hundreds of millions of people lost their sources of income. It didn’t take long for these people who had rural roots to head home. But there was no public transport available. Millions of them decided to walk or cycle hundreds of kilometres to their home, violating laws of the lockdown. We and the world witnessed scenes of the young and old on Indian roads not usually seen except in war zones. And we were surprised.
“How could this happen?” we asked. We shed tears, expressed sympathy and pity for the “migrants.” Not anger or outrage. It is interesting that we called them “migrants.” It is a term to other them. We don’t call company executives and bureaucrats posted away from home in different cities and Indians working at the UN and the World Bank migrants.
We have no idea how many extra deaths (non-COVID) have occurred due to the lockdown, how many are suffering due to non-availability of treatment for existing ailments and how many are going hungry three months down the line. We will probably never know. A public database reports that by June 22 there were 209 deaths among “migrants” walking home due to road accidents. A colleague of mine suggested that we should do an analysis of the causes of these accidents.
That set me thinking. Assigning cause is not a simple matter. About sixty years ago, William Haddon Jr. and his colleagues in USA started a discussion on how to understand the reasons why accidents occur and what to do about them. They were influenced by leading thinkers of the time like J. J. Gibson and others who maintained that injuries due to accidents should be considered another disease where the vector was not a bacterium or a virus but energy. And, thus, it was terribly important that we not indulge in victim blaming and instead look for associated factors that result in injury. Like we do for any other public health problem.
This approach to events we term “accidents” changed how we analyse the occurrence of crashes and injuries on the road. The most important principle is that we do not just look for someone to blame for making a mistake just before the event. We look for all the possible contributing factors, design flaws (vehicle and road), laws, regulations and policies that made it possible for that event to take place. If we follow this scientific approach, then it becomes clear that the principal factor contributing to the migrants’ deaths was the sudden declaration of the nation-wide lockdown. No lockdown, no panic dislocation of millions of normal hardworking citizens of India.
There were other contributing factors we can think of. If all these people owned homes or huts where they worked, many would not have taken to the road. If they trusted their employers and had access to social welfare measures, they may not have fled in such large numbers. If local bureaucrats, members of legislative assemblies (MLAs) and members of parliament (MPs) had come out in large numbers to help give support and confidence to these people, many would not have moved. Those who left could have been provided travel, lodging and food support. These are important issues to consider as India is the only country in the world where we have seen this tragic movement unfold the way it has. Quite obviously, we have come up terribly short as a society that cares for its own.
In a very uncommon situation, special countermeasures have to be put in place in a hurry to minimize unwanted outcomes. This happens more efficiently if the implementers have experience and knowledge to mitigate negative outcomes, and empathy for the people they are supposed to serve. In addition, systems and professionals have to be in place to understand, investigate, and innovate to introduce new solutions and policies. And then to evaluate and change course if necessary. It is quite clear that public policy and the health system in India lack such institutional capability.
Another principle in safety analysis is that you cannot and should not make policies based on events that are complete outliers. Such events have very special conditions associated with them and may not be applicable in everyday life. However, disasters do help us understand what kind of institutional mechanisms should be in place so that we know how to react when necessary. Laws and safety features should not be based on one disastrous event. The event can be used to raise consciousness and social and political support to give the issue much more importance and professional attention later.
What should we learn from this experience? It is quite clear that the existence of public health systems as a public good have been destroyed by economic and budgetary policies that have privileged capital accumulation and expensive private hospitals over the last three decades in India. A majority of public health experts and bureaucrats did not evaluate the policy advice (implementing strict lockdowns) coming from rich European countries and North America and its applicability in a country where 90 percent of workers do not have regular salaried jobs or social security or availability of free medical care. They did not consider seriously alternative policies being followed in Japan and some other Asian countries, or even in Sweden. It is quite surprising that that there has been no serious debate (or even a model) on how many extra deaths have been caused by the economic lockdown. Even more surprising is the fact that few studies have been commissioned to examine the causes of lower death rates reported in Asian and African countries compared to European and American locations.
The central issue in front of us now is the re-establishment of the government’s accountability to democracy. We have to start a conversation on how do we emerge from this man-made disaster through a social mobilization that demands government and experts’ accountability along with people’s rights instead of nationalistic and authoritarian narratives in vogue at present. We will also have to reconsider our drive toward privatizing higher education and research so that we can think of producing professionals who move away from copycat scholarship and research.
It is not clear that this will necessarily happen. But it is the right time for national and international solidarity on the issue.
Dinesh Mohan is Honorary Professor, Indian Institute of Technology Delhi. His main work focusses on road safety and urban mobility.