because whatever public health services exist are beyond their reach.
In cities, health facilities are available in private clinics and
large public hospitals. But it is hard for poor city residents to
enter their doors. The obstacles are highest for homeless persons,
stigmatised by public authorities as illegal,illegitimate, unsanitary
burdens on the city and its infrastructure, including hospitals.
Public health scholar and paediatrician Vandana Prasad undertook a
study to understand the barriers faced by adult street dwellers in
Delhi in accessing health care. The study focused on this most
marginalised and socially invisible urban population living on city
streets, including able-bodied casual workers, rag-pickers,women who
escape or are expelled from violent and abusive homes, and
peoplesuffering from a variety of disabilities (including mental
illness).
Almost all homeless peopletypically suffer major health problems, not
surprisingly because they are forced to sleep rough, exposed to
extremes of theseasons, and with virtually no access to clean drinking
water, sanitation and home-cooked food. Their health burdens were
reported by the Health Initiative Group for the Homeless based on a
survey of 2,955 homeless respondents: "A high proportion of homeless
people were suffering fromserious respiratory ailments including
tuberculosis, acute and chronic infections, skin diseases and
diarrhoeal diseases". Our earlier research by the Centre for Equity
Studies found that health issues may be also the reason for
homelessness in the first place, including mental illness, mental
retardation and stigmatising illnesses that precipitate homelessness.
Prasad's study clearly documents the occurrence of catastrophic
illnesses as a factor that has tipped poor people into homelessness
The study finds that upper-most among the many barriers faced by the
homeless in attempting to access public health care services is simply
the lack of money. They lack BPL cards which would otherwise make them
eligible for free medicines, and are forced to buy medicines and pay
for tests. Many give up because they cannot affordthe services even of
public hospitals, with devastatingoutcomes on their health,
livelihoods, and their survival with dignity. The researchers
encountered from a very small sample three able-bodied, working,
homeless men who suffered injuries which could have been treated. But
they could not afford the cure in government hospitals. As aresult
today they are permanently disabled, and forced to beg life-long/
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