From Baran, a tribal district in the western state of Rajasthan, to Mumbai, the country’s financial capital, India’s children are suffering from malnutrition and dying.

In the latest study released in January this year, Unicef has revealed that every year, one million children under the age of five die of malnutrition in India.

Despite the country’s grand “development” plans, one in every three malnourished children in the world lives here. In addition, around 46 per cent of all children below the age of three are too small for their age, 47pc are underweight and at least 16pc are wasted. Many of these children are severely malnourished.

In Shahbad block of Baran district, 150km from the nearest city of Kota in Rajasthan, one-year-old Kavita Saharia is weighed at the Malnutrition Treatment Center (MTC). Kavita’s skin hangs loosely around her bones as she cries when the medical personnel at the MTC places her on a weighing scale.

Kavita is clearly malnourished, and weighs only 4kg. Surprisingly, she was not rushed to the health centre for treatment of malnutrition but because she was suffering from diarrhoea.

The situation in Thar is not unique; across the border India also suffers from a serious malnutrition problem

Stoically, the male nurses at the MTC tell Leela, Kavita’s mother, that it will take her five months of a proper diet to beat malnutrition. There is no doctor in sight; Leela has travelled all the way from Mandibohra, which lies 30km from the MTC.

In the unforgiving heat of Rajasthan’s Baran district, 50 to 60pc of deaths of children in the state have been attributed to malnutrition, grassroots-level workers reveal. Lack of medical infrastructure, high level of illiteracy, poor infrastructure, poor hygiene and the remoteness of the villages contribute to this avoidable tragedy.

Ninety per cent of children who come for treatment are between one to one-and-a-half years old

MTC’s male nurse Sanjeev Nagar, who has been working there for the past five years, believes that the only reason mothers flock to this 12-bedded centre, which is open 24x7 and equipped with a skeletal staff of six, is because the government offers an incentive of Rs200 to them during their 10-15 day stay there. The MTC was opened in August 2006 to treat children who were suffering from malnutrition.

“Usually, mothers come here in groups of four from remote areas. We always get severe cases and have to treat anaemic children with respiratory problems,” Sanjeev states.

An overwhelming 90pc of children who come for treatment are between one to one-and-a-half years old. Nurses said that 90pc of the children are admitted with diarrhoea, as there is no safe drinking water available in this tribal district. Sanjeev laments that children need to spend at least two months at MTC and that has to be followed by community intervention. Clearly, the little that is available is not enough. “Some children have been admitted four to five times and they slip back to their original state,” he laments.

Sadly, the story is no different in Maharashtra state, which is considered more developed than the tribal districts of Rajasthan. On Sept 15, 2012, when Mumbai resident Farida Mirza, 28, delivered twins, she had no idea the tragedy that would unfold a month-and-a-half later. One of the twins, her daughter, Ila, who was born after a C-section, died on Nov 1, 2012. Ila’s weight at the time of birth was 2.5kg and at the time of death was 2.4kg.

Deaths due to malnutrition continue in Mumbai in poverty-stricken areas like Rafiq Nagar, Baiganwadi and Govandi. In an area where 99pc of the residents work on the Deonar dumping ground as garbage collectors and there are no basic facilities. “People here have it as hard as it can get. It’s no surprise that the babies are dying of TB, pneumonia and diarrhoea — all malnutrition-related deaths which are excluded from government figures,” said a social worker who runs an anganwadi (school) in the area.

Leena Joshi, an expert on urban poverty, does not shy away from making a connection between demolitions and malnutrition-related deaths in the slums of Mumbai. “Communities which are demolished are denied water and sanitation. This affects the health of adults and children, who are even more vulnerable. As it is, these communities live on the fringe of society and have insecure livelihoods, housing and infrastructure. Their overall human development indicators are extremely poor so it leads to death. Malnourished children will be the worst affected as their resistance to disease is low.”

Between 100 to 300 new families arrive in the city each day in search of work. All too often, migrant families of low economic status find themselves in a slum. Besides children, the women suffer too. “They are not nutritionally fit. Because they are ‘illegal’ they cannot avail of ration or ICDS services.

They have to pay far more than ordinary people who can buy in bulk. They survive hand-to-mouth so their ability to reach the health centre in time is also affected due to the high cost of transport. This also leads to high maternal mortality rate,” the expert believes.

Back in Rajasthan, other issues like deforestation have an adverse impact on maternal and child nutrition. In Bikhera Dang village, 450km from Jaipur, despite government subsidies in food, the tribals here have not been able to uplift themselves. Small-scale farming, sale of forest products and manual labour are just some of the ways in which they eke out a livelihood in this remote hamlet which shares a border with Madhya Pradesh.

Healthcare worker and anganwadi cook, Makhandi Saharia, laments about how tribals who are not landowners have been exploited for their labour. “When I was a little girl, the forest produce was enough for us as it was highly nutritious. But all the forests have been cut. Now people work as daily wagers, and some of them don’t get paid on time. How will they feed themselves or their children? Then they resort to alcoholism,” she says.

With a population of about 80,000, poverty, early marriage and poor maternal health are only a few problems that contribute to malnourishment amongst the primitive Saharias. Rekha Saharia, has been a government healthcare worker for five years, is in charge of identifying malnourished children and then ensuring that the mothers take them to the MTC. “We have conducted door-to-door campaign and have identified six children recently,” she elaborates. But more investigation in the village reveals that the numbers are much higher.

“There are no toilets here, so open defecation is the norm. The water from the pump needs to be boiled before drinking, but the tribals don’t do this. Due to the summer heat, for three months, people get very sick. They use dung as fuel, so the proximity of the dung to the food causes problems. They use ash to wash their utensils. Sometimes, domestic animals live in their huts with them. They don’t eat a balanced diet. All these are issues that cause health problems,” she complains.

But this is not just a rural problem. In India, 600m people defecate in the open. The new government plans to spend Rs1.26 lakh crore on building more toilets under the Swachh Bharat Abhiyan. Previously, under Nirmal Bharat Abhiyan, Rs 80 million (8 crore) was spent on building toilets of which 80pc are unused. In a model village of this programme where 100pc houses had toilets only one was actually in use.

NGO Apnalaya’s Dnyaneshwar Tarwade, who runs the Responsibility Citizenship’s programme in Mumbai’s Govandi area says that a change in strategy to eradicate malnutrition is required. “We need to involve the community and educate them about hygiene and nutrition. Here, a community leader is in charge of each lane in the slum area. We are also training women in home-based child care.” After running a malnutrition treatment centre for three years in the same locality, Tarwade, along with his NGO, decided to make the parents and the community responsible for the state of the children.

With 8,000 children in Mumbai’s slum belt of Govandi, Tarwade believes that micro nutrition therapy will be an answer to the problem. “Basically, we had spent Rs0.5 million over three years on 35 children and we saw no results. With this new approach, we will teach the mothers to feed children this paste-filled cup which is very high in nutritional value, and we will have them deal with this issue as a community, where leaders will be held responsible for the health of a child,” he added.

Published in Dawn, Sunday Magazine, February 8th, 2015

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