Alka Pande, GPJ India
Chhote Lal holds the health card issued by the Department of Medical Health and Family Welfare for his 11-month-old son, Anshu. The card provides the immunization schedule that Chhote Lal and his wife, Poonam, need to follow to ensure Anshu is fully immunized.
DHANKUTTI, INDIA — In October 2014, Katika traveled with her maternal uncles from her home in Malhar, a small town in Chhattisgarh state, to Uttar Pradesh state – a 14-hour journey by train.
Her uncles and their wives work at the Waris Brick Field in Dhankutti village in the Barabanki district of Uttar Pradesh. Here, workers form clay bricks with a hand-press machine, dry them in the sun and bake them in a kiln. The bricks are sold at nearby construction sites.
Katika, 8, who goes by just one name, came along to look after two of her cousins while her uncles and aunts work in the brick field. The younger of them, Anshu, is now 11 months old.
In May 2015, Anshu fell sick. She had diarrhea, and was vomiting. with diarrhea. Katika did not know how to care for him.
Dehydration caused Anshu’s health to deteriorate quickly, says his father, Chhote Lal, 23.
“Eventually, we had to take him to the doctor, who gave him an injection and some powder to drink with water,” he says.
The powder was an oral rehydration salt.
Katika says she often sees sick children in the brick field.
“I didn’t know that going to the toilet repeatedly and throwing up can be a disease, as all children keep having this,” she says.
Last April, children and adolescents at the brick field were immunized for the first time in their lives as part of Mission Indradhanush – or Mission Rainbow – a government immunization drive. A health team came to provide the immunizations each month through July.
The children of construction and brickfield workers live in harsh environments, with little or no access to medical and educational facilities. As part of a migratory population, the children often miss out on routine government health drives, leaving them susceptible to preventable life-threatening diseases, including tuberculosis, pertussis, diphtheria, tetanus, polio, hepatitis, measles and vitamin A deficiency.
To immunize the children of migrant and nomadic families – and any other children who might not otherwise get immunizations – the Indian government carried out the four-month immunization drive in Uttar Pradesh and 27 other states.
The construction and brick field workers migrate from their home states to find work, says Kamlesh, who serves as a mediator between brick field owners and migrant laborers. Kamlesh, 33, supplies workers and negotiates with employers on their behalf.
Taking their families with them, these laborers work at brick fields and construction sites for eight months at a time, starting in October or November, Kamlesh says. When the monsoon begins in June, they return to their home states until the rains end in September.
The brick fields are usually 10 to 20 kilometers (6 to 12 miles) from cities, where there are open fields with clay for making bricks, he says.
The laborers are paid between 30,000 rupees ($474) and 50,000 rupees ($790) for their eight months of work, part of which is advanced to them at the start, Kamlesh says. They use the advance to repay loans taken out during the monsoon season or to send home to family members for sustenance until they return. These laborers are in constant debt, trapped in a cycle of borrowing money and working to pay it off. The arrangement has turned into a form of bonded labor.
Uttar Pradesh also is home to nomadic sites where nomads do small-scale income-generating work, such as making iron tools for gardening and farming.
As of April 2015, Uttar Pradesh had 20,891 brick fields, 6,463 construction sites and 17,218 nomadic sites, says Dr. A.P. Chaturvedi, state officer for the Expanded Program on Immunization, under the Department of Medical Health and Family Welfare. Those figures change frequently.
About 30 percent of Indians – more than 307 million people – have moved away from the areas where they were born, according to the 2001 census.
The government has yet to provide data on internal migration from the 2011 census, but a 2013 UNESCO report project the number of migrants at 400 million people – 33 percent of the population. Estimates of the number of short-term or seasonal migrants, such as brick field workers, vary from 15 million to 100 million.
Many children in India are not fully immunized, says Dr. Kanupriya Singhal, health officer at UNICEF India’s Uttar Pradesh office.
A 2009 survey by UNICEF and the Ministry of Health and Family Welfare found that only 61 percent of Indian children between the ages of 1 year and 23 months were fully immunized.
Forty-four of the 201 districts with low immunization were in Uttar Pradesh state, according to the survey, Singhal says. Only 40 percent of Uttar Pradesh children in the target age range were fully immunized in the state, and nearly 20 percent had received no immunizations.
Population migration and a shortage of health care workers contribute to the immunization shortage, Singhal says.
In December 2014, the Indian government launched Mission Indradhanush to increase immunization coverage in the country from 65 percent, as recorded in 2013, to at least 90 percent by 2020. The first phase of the drive focused on the 201 districts of Uttar Pradesh and 27 other states with low immunization rates.
During their monthly visits to migrant and nomadic communities, health care teams provide checkups and immunizations.
The program began in April and continues through July.
Sunil Manjhi, a worker at the Rama brick field in Uttar Pradesh’s Hardoi district, has often watched her children – and other children at the brick field – fall sick.
“Intermittent fever, cold, pneumonia, diarrhea or vomiting are common problems for our children,” says Manjhi, 33, a mother of four children ranging in age from 10 months to 12 years.
Those symptoms sometimes signal serious diseases that could be prevented by immunizations.
Photos by Alka Pande, GPJ India
Sanju, 13, gets a tetanus toxoid injection. All adolescent girls living with their migrant laborer parents at brick fields and other construction sites receive the injection.
Chhote Lal, his wife, Poonam, and their children live in a small, temporary house while they work at the Waris Brick Field in Dhankutti village in Uttar Pradesh state. The makeshift dwelling has no windows or vents. The family eats and sleeps outdoors.
The Waris Brick Field in Dhankutti village in Uttar Pradesh state produces clay bricks for construction sites in the area. Nearly all the laborers here are migrants who work about eight months a year. The workers return to their home states during the monsoon season, usually from June to September, when the rains halt work at the brick field.
Migrant laborers who work at brick fields build temporary houses with the same mud they use to make bricks. They dry bricks in front of their houses before firing them in a big furnace. The children of laborers play in the dusty area.
Workers at Waris Brick Field move sun-dried mud bricks to be baked in a kiln. Although Indian law prohibits child labor, parents sometimes enlist older children when the workload becomes heavy.
Priyanka completes her day’s work at Rama Brick Field in Sandila by about 2 p.m., when the sun is hottest. A migrant laborer from Chhattisgarh state, Priyanka works at the brick field with her husband, Indrajeet. Priyanka uses a wooden mold to shape softened clay into a brick. Bricks she has made are lined up in rows behind her.
Health worker Firoz Jahan (seated on knitted cot), an auxiliary nurse midwife, or ANM, explains the importance of immunization to laborers at Rama Brick Field in Sandila during a government-run immunization drive, Mission Indradhanush. Siya Dulari (in white sari with black border), an accredited social health activist, or ASHA, looks on.
Phulo, a migrant worker at the Rama Brick Field in Sandila and a mother of six, holds her youngest son, Arjun, 1, as he receives an oral polio vaccine. After India went three years without a report of a new case of polio, the World Health Organization declared India polio-free in 2014.
Fifteen families, with 24 children under 16, live in makeshift homes at the Rama brick field, Manjhi says. Most of the families, including Manjhi’s, are from the Nalanda district of Bihar state.
Manjhi and her family have migrated to the Rama brick field for four years.
Manjhi’s children do not attend school. They spend their days playing while she and her husband work. Their 12-year-old son assists them in their work, she says.
Because the family moves so often, Manjhi had not received any benefits from government welfare programs, so she was surprised and pleased when the health team visited the camp in April. She is relieved that her children are receiving vaccinations, she says.
The visit was to be the first of several, to ensure that children receive the recommended doses of immunizations over time. During these visits, parents learn about immunizations and other health procedures.
Firoz Jahan, an auxiliary nurse midwife working with the Department of Medical Health and Family Welfare, provided immunizations at the Rama brick field. In her monthly visits, she has learned the names of all the children. She maintains a record of their immunizations.
“It is tough for us to keep a track of migrant populations, as sometimes they leave their health cards at home,” she says. “This is necessary because if any of the immunization doses are missed, the cycle breaks and the vaccines lose their effect.”
State hospitals and clinics provide health cards to pregnant women and children under 2. The cards provide a record of vaccinations and visits to health centers.
Chaturvedi agrees with Jahan, saying the districtwide immunization programs already cover many children of migrant families. But because they do not remain in one place for long, they are unable to complete courses of immunization.
“They get the first dose, go back to their districts and do not bother about completing the rest of the doses, thus remain partially immunized,” he says.
Living conditions at the brick fields make the children susceptible to disease, Manjhi says. Small, poorly ventilated bedrooms and kitchens are built with the same mud used to make bricks. There are no toilets. Families obtain their water from one deep-bore well.
The children play in unclean surroundings abuzz with flies and mosquitoes, she says.
“Immunization is not enough,” says Prem Nath Raj, state general secretary of Uttar Pradesh Bhawan Nirman Mazdoor Sabha, a building construction laborers union. “The migrants come with their families and stay at work sites, with zero facilities for their children’s schooling, medication, nutrition or protection to their own lives.”
Arundhati Dhuru, an adviser on food security issues to the Commissioners of the Supreme Court, agrees.
“Immunization is only one aspect of a child’s wellbeing, and alone it will not make a difference to the children of migratory population,” she says.
These children require food, nutrition, education and sanitation facilities as well, Dhuru says.
The government must ensure that the owners of construction sites and brick fields provide their workers with child care centers to ensure the children’s holistic development, she says. If the owners fail to do that, the government can set up play centers at which children receive nutrition and elementary education.
The laborers can benefit from existing government welfare schemes but, lacking awareness of them, they are not registered with the government, Rai says.
Less than 10 percent of migrant laborers in Uttar Pradesh are registered with the government, Rai says. Those who are registered get benefits from many government schemes, such as nurseries, health insurance, and water and sanitation facilities.
“They don’t know about their rights, and the government does not educate them,” he says.
Juhie Singh, chairperson of the Uttar Pradesh State Commission for Protection of Child Rights, admits the state agencies have not always been effective in serving the migrant population.
“We are aware of the problems, which are mostly due to lack of coordination between the various departments involved in the welfare of these children,” she says.
The commission began work in February and is currently gathering information, Singh says.
“We are asking other state commissions also to share with us what they are doing for the welfare of the children of migrant population,” she says. “The first thing we will focus is to get all laborers registered with the government so that they start getting the benefits of the various schemes.”
Dhuru says every effort should be made now to ensure that the children of migrant laborers have a better future than their parents.
“Apart from their holistic development, these children also require dignity and surety that they will not end up doing the same job as their parents,” she says.
Katika, Chhote Lal and Kamlesh do not have last names, which is common in their community.
Alka Pande, GPJ, translated some interviews from Hindi.
