Indore diarrhoea deaths: Blindspotting in India’s cleanest city

The recent diarrhoea outbreak in Indore, Madhya Pradesh, leading to at least 8 deaths and affecting approximately 3,000 people, presents a stark paradox. Indore has consistently been lauded as India's cleanest city under the Swachh Survekshan rankings for several years. This incident, caused by contaminated drinking water supplied through government pipelines, exposes critical blind spots in urban governance and public health infrastructure, even in a city celebrated for its cleanliness.

**Background Context and What Happened:**

Indore's journey to becoming India's cleanest city is a testament to its robust waste management systems, extensive public awareness campaigns, and strong municipal efforts, particularly in solid waste collection and processing. However, the focus on visible cleanliness, while commendable, appears to have overshadowed fundamental aspects of public health, such as ensuring safe drinking water. The outbreak occurred when contaminated water, likely due to leakages in old or poorly maintained pipelines allowing sewage to mix with potable water, was supplied to residents. This is a common issue in many Indian cities, where aging infrastructure struggles to keep pace with rapid urbanization and unplanned expansion, particularly in informal settlements or newly developed peripheral areas that might not be fully integrated into the city's planned infrastructure network.

**Key Stakeholders Involved:**

Several stakeholders bear responsibility and are impacted by this crisis. The **Indore Municipal Corporation (IMC)**, as the primary urban local body, is directly responsible for water supply, sanitation, and public health services within its jurisdiction. Its role includes maintaining water pipelines, conducting regular quality checks, and responding to public health emergencies. The **Madhya Pradesh State Government** provides oversight, policy direction, and funding to the IMC, and its Public Health Engineering Department (PHED) plays a crucial role in water quality monitoring and infrastructure development. The **residents** are the direct victims, suffering illness and loss of life, and their trust in public services is eroded. Central government initiatives like the **Swachh Bharat Abhiyan (Urban)** and **Jal Jeevan Mission (Urban)** also come under scrutiny, as their objectives are to ensure clean environments and safe drinking water, respectively. The incident, receiving international coverage, also implicates India's image on the global stage regarding its urban development and public health achievements.

**Why This Matters for India:**

This incident holds profound significance for India. Firstly, it highlights the persistent challenge of **public health vulnerabilities**, particularly water-borne diseases, which continue to plague urban and rural areas despite significant advancements. It underscores that 'cleanliness' must be holistic, encompassing not just waste management but also safe drinking water and robust sewerage systems. Secondly, it calls into question the **efficacy and comprehensiveness of urban governance models** and evaluation metrics like the Swachh Survekshan. While the survey focuses on several parameters, the Indore incident suggests that critical indicators related to water quality and public health outcomes might need greater weighting or more rigorous assessment, especially in unplanned areas. Thirdly, it exposes the **infrastructure deficit** in many Indian cities, where rapid expansion often outpaces the development of essential services like water and sewage networks, leading to a reliance on outdated or inadequate systems. Economically, such outbreaks lead to healthcare burdens, loss of productivity, and reputational damage. Socially, they disproportionately affect vulnerable populations living in areas with poorer infrastructure.

**Historical Context and Constitutional Provisions:**

India has a long history of battling water-borne diseases like cholera, typhoid, and dysentery, which were major causes of mortality even post-independence. Significant strides have been made through various public health programs and infrastructure projects. The **74th Constitutional Amendment Act of 1992** was a landmark step, empowering Urban Local Bodies (ULBs) like the IMC with greater autonomy and responsibility for urban planning, water supply, public health, and sanitation (listed in the Twelfth Schedule). However, the implementation often faces challenges related to funding, technical expertise, and political will. Constitutionally, the **Right to Life enshrined in Article 21** of the Indian Constitution has been interpreted by the Supreme Court to include the right to a healthy environment and safe drinking water. Furthermore, **Article 47** under the Directive Principles of State Policy mandates the State to raise the level of nutrition and the standard of living and to improve public health. This incident underscores the State's failure to uphold these constitutional obligations in Indore.

**Future Implications:**

The Indore outbreak necessitates immediate and long-term reforms. There will likely be increased scrutiny on urban water supply infrastructure, with a push for **enhanced water quality monitoring** and **pipeline replacement/upgradation** projects, particularly in vulnerable areas. The incident may prompt a review of the Swachh Survekshan parameters to ensure a more holistic evaluation of urban health and hygiene, moving beyond visible cleanliness to include critical aspects like water quality and sanitation outcomes. There will also be a greater emphasis on **inclusive urban planning**, ensuring that all parts of a city, including informal settlements, receive adequate and safe public services. Accountability mechanisms for municipal bodies and state agencies are likely to be strengthened. This event serves as a crucial reminder that sustainable urban development must prioritize equitable access to safe and reliable basic services for all citizens, aligning with **Sustainable Development Goal 6 (Clean Water and Sanitation)**, to prevent such tragedies from recurring in any city, regardless of its 'cleanest' status.