Persistence of manual scavenging: An autopsy and legislative review

INTRODUCTION

In India, the term ‘manual scavenging’ denotes the practice of manually clearing human waste from privately owned properties and facilities maintained by municipal corporations. This process involves individuals using only their hands, brooms, or metal scrapers to gather human waste from dry toilets, pit latrines, sewers and septic tanks. The collected waste is then placed in woven baskets or buckets and transported to disposal sites.¹ Manual scavengers encounter occupational health and safety hazards, including physical injuries, respiratory problems, limited access to clean water and sanitation facilities, and perilous work conditions, which can potentially result in waterborne diseases and contamination.² To reform and address the prohibition of manual scavenging, two important laws have been enacted: The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act, 1993 and The Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 (PEMSR). These collectively aim to eradicate manual scavenging by imposing strict restrictions.³ Under these laws, if an individual wears appropriate protective attire and utilizes the necessary equipment, they are not classified as manual scavengers.⁴ Additionally, these laws focus on the rehabilitation of manual scavengers by providing them with opportunities for alternative employment and improved livelihoods.

THE CASE

A man in his fourth decade was brought to the mortuary by the police for a postmortem examination. He had reportedly fallen into a sewage hole while cleaning the sewage line at a steel factory. Upon external examination, the deceased had mud stains on various parts of his body. His mouth was open and yellow vomitus was observed emanating from both nostrils and the mouth. There were no external injuries evident on the body. Upon internal examination, food particles of yellow colour were found in the trachea, and contusions were observed in the hilar region of both lungs. Further dissection revealed yellow food particles extending to the terminal bronchioles in both lungs. The heart was soft and flabby, with intact and patent valves and coronary arteries. The stomach contained approximately 250 ml of partially digested yellow food particles. There was no peculiar odour, but the mucosa had haemorrhagic areas. The cause of death was deferred pending histopathology and forensic science laboratory reports. The histopathological report indicated autolytic changes in both lung tissue samples. The forensic science laboratory report revealed positive results for methane gas in a portion of the viscera and the blood sample. It also showed negative results for metallic and non-metallic poisons, alcohol, alkaloids, barbiturates, tranquilizers and pesticides. The postmortem findings led to the conclusion that the cause of death was asphyxia due to methane gas poisoning.

DISCUSSION

Manual scavenging, an unsafe and degrading occupation, exerts a substantial toll on the health and well-being of those involved. This practice has adverse effects on multiple aspects of health. Manual scavengers confront occupational health and safety hazards, including physical injuries, respiratory ailments, limited access to clean water and sanitation facilities and hazardous work environments, which can result in waterborne diseases and contamination.² In addition, inadequate hygiene practices heighten these risks. Manual scavengers also endure social stigma, discrimination, stress, anxiety, depression, psychological trauma and exposure to pathogens, thereby increasing susceptibility to infectious diseases such as cholera, typhoid and hepatitis.^2,5 These individuals, often belong to marginalized communities, are economically vulnerable, malnourished, have restricted educational opportunities and suffered social prejudice. Their limited access to education, skill development and empowerment further impedes their ability to secure improved livelihoods and healthcare. The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act, 1993, was a major step towards addressing the issue of manual scavenging in India. However, it was later replaced and strengthened by the ‘Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013’, (PEMSR 2013) which provided a more comprehensive legal framework for eradicating manual scavenging and ensuring the rehabilitation of affected individuals.³

Manual scavenging poses major health and safety hazards, as workers are exposed to severe health risks, including diseases, infections, respiratory problems, and skin ailments, due to the handling of human waste without proper protective gear. Furthermore, manual scavengers confront social stigma and discrimination, often being marginalized as ‘untouchables’ in some societies, leading to their isolation and exclusion from mainstream activities.² To combat this issue, various countries, including India, have implemented legislation, which aimed to ban manual scavenging and the construction of dry latrines. The subsequent enactment of PEMSR 2013 bolstered these efforts, emphasizing rehabilitation and compensation. Nonetheless, challenges persist, particularly in areas lacking alternative livelihood options, adequate sanitation infrastructure and awareness of these laws. Eradication efforts often involve providing affected individuals with alternative job opportunities, access to education and skills training, and support for social integration. This issue is not confined to India, as similar practices exist globally, particularly in regions with inadequate sanitation infrastructure. This has prompted international organizations, such as the United Nations, to spearhead efforts to combat manual scavenging worldwide.^3,6 Padosch et al. reported a fatal occupational accident in a sewage plant involving a technician who fell into a tank. The body, found 48 hours later in a digester tank, showed advanced decomposition and trauma from the pipeline system, highlighting the importance of addressing such incidents in forensic literature for reconstruction and legal considerations.⁷

The persistence of manual scavenging despite the existence of laws aimed at eradicating this practice is a tragic and complex issue. Unfortunately, despite the presence of numerous laws and regulations, this abhorrent practice continues. The question arises as to why manual scavenging continues to exist in some areas despite legal measures:⁴

1. Enforcement challenges: A major concern is the insufficient enforcement of current laws. In numerous instances, authorities may not actively enforce or uphold these regulations, allowing manual scavenging to persist without hindrance.

2. Lack of awareness: A substantial issue arises from the limited awareness among many manual scavengers and their communities regarding their legal rights and the existence of protective laws. This absence of awareness can contribute to the ongoing involvement in this practice.

3. Social stigma and discrimination: The profound social stigma linked to manual scavenging creates formidable obstacles for affected individuals and communities in breaking free from this occupation, even when legal provisions are in place. The apprehension of social ostracism and discrimination constitutes a substantial impediment to change.

4. Inadequate rehabilitation: Although laws often include clauses for the rehabilitation of manual scavengers, the efficacy of these rehabilitation initiatives can vary. A lack of substantial support for alternative livelihoods, education and social integration can impede the process of transitioning away from manual scavenging.

5. Economic factors: Poverty and the absence of viable alternative jobs can compel individuals to resort to manual scavenging as a means of survival. In such circumstances, economic necessity may outweigh concerns about potential legal consequences.

6. Ineffective sanitation infrastructure: Regions characterized by subpar sanitation infrastructure often witness a persisting dependence on unsanitary practices, resulting in manual scavenging. Enhancing sanitation facilities and technology is imperative in eradicating this practice.

7. Corruption and exploitation: Corruption within the system can also sustain manual scavenging. Contractors and employers may exploit manual scavengers, offering them meagre wages obstructing their ability to pursue improved opportunities.

Manual scavenging is exploitative in nature as it is performed in an hazardous work environment. Effectively addressing the issue of manual scavenging requires a multifaceted approach:^5,6,8

1. Rigorous enforcement: Governments and authorities should proactively enforce current laws and hold individuals and entities that employ manual scavengers accountable.

2. Awareness campaigns: Comprehensive awareness campaigns should be directed towards affected communities, highlighting their rights and the perils associated with manual scavenging.

3. Rehabilitation: These programmes should be comprehensive, providing affected individuals with viable alternative livelihoods, educational opportunities and social support.

4. Enhancement of the sanitation infrastructure: Investments in modern sanitation infrastructure are crucial for eradicating the need for manual scavenging.

5. Societal transformation: It is vital to make efforts to combat social stigma and discrimination. Promoting social inclusion and equal opportunities for marginalized communities is essential for driving lasting change.

Asthana and Bahl introduced a system that employs Internet of Things technology to monitor and analyze real-time levels of toxic gases. The system notifies workers and authorized individuals at remote locations through mobile devices and messages.⁹ Substitutive approaches to eliminate human involvement in hazardous environments involve the implementation of subterranean machinery or tailor-made devices designed specifically for the cleaning of domestic or industrial drains. These could include the development of artificial intelligence-based solutions or advanced infrastructure to fulfill these functions.

The enduring presence of manual scavenging represents a deeply entrenched challenge that demands a sustained and collective commitment from governments, civil society, and international organizations to eradicate it. Legal reforms, awareness campaigns, and robust enforcement are all essential components in enhancing the well-being of those involved.

Despite the presence of established laws and regulations, this abhorrent practice persists, requiring an unwavering commitment from governments, civil society, and international organizations to achieve its complete elimination.