n the narrow alleyways and cramped dwellings that make up the refugee landscape in Delhi, Maina Prakash is washing clothes and cleaning her humble home. It’s the second day of her monthly period and, as usual, she is in pain. But as the water collects in a shabby-looking bucket, she confides that she hadn’t had the chance to consult a doctor, so her monthly agony has been left untreated.
Since migrating to India from Pakistan years ago, her family had been precariously navigating the maze of expenses that, more often than not, left them on the brink of survival.
“I didn’t see a doctor because I don’t have money to see one,” says Prakash, wincing. “The pain is unbearable this month but I can’t stop doing daily chores.”
In fact, Prakash has no money to buy feminine pads either. Her family’s sole provider is her husband, who sells phone covers at metro stations, and they are lucky to have two meals in a day. And so whenever it’s her time of the month, Prakash makes do with whatever she can get her hands on, which today happens to be an old saree made of synthetic material.
“I can’t afford to buy sanitary pads, so I tear up my old sarees to use during my periods,” she says. “If I had money, I’d rather give a nice meal to my children.”
Attempting to wash the saree fragment, she turns on the tap, but it yields no water. “Most of the time, we don’t have access to water so we hold the urge to urinate or change cloth pads for long hours during our periods,” says Prakash. “It’s not easy to live here.”
“Here” is a refugee camp for Pakistani Hindus in North Delhi, near the Majnu ka Tilla Gurudwara, one of the oldest Sikh shrines in the Indian capital. At present, there are around 300 to 350 families in the camp, including hundreds of women and girls who like Prakash are suffering from what development and health experts call “period poverty.”
Initially defined as the inability to buy safe and clean feminine hygiene products, the term has evolved to include the lack of access to hygiene information and clean bathroom facilities.
India itself has been considered one of the world’s period-poverty hot spots. According to U.K. street child rights organization Toybox the South Asian country has a mere 36 percent of its 355 million menstruating females using sanitary pads. One major reason for this is that many Indian families lack the money to buy these for their female members.
A study published in the scientific journal BMC Public Health in 2022 noted, “A pack of 10 sanitary napkins in India currently costs around INR 30–40 (US$0.39–0.52), which is extremely expensive and unaffordable for most rural households in India.”
But exacerbating the situation, said the study’s researchers, are “social stigmas associated with talking about reproductive health issues,” leading to “adolescent girls (lacking) proper and adequate knowledge about their bodies, especially the functioning of their reproductive systems.”
There is also India’s perennial water problem, which makes potable water inaccessible and which constantly poses a challenge to having water supply that is safe and adequate enough even just for keeping oneself and one’s surroundings clean, especially among refugees like Prakash.
All these problems, however, are magnified several times more in India’s temporary settlement sites for refugees, many of whom have waited decades for a change in their status. Many of the families at Prakash’s camp, who arrived in India in 2013, are still waiting to be granted Indian citizenship that would enable them to look for better employment and shelter, as well as access to basic services.
Swati Maliwal, chairperson of the Delhi Commission for Women (DCW), a statutory body under the Government of Delhi focusing on women’s issues, has herself spoken out about the dismal conditions at Prakash’s camp.
“I met these Hindu refugees at Majnu ka Tilla” India Today quoted her as saying in 2022. “They are living in the most pathetic conditions. They have kutcha (makeshift) houses, which become even more difficult to live in during monsoons. Reptiles often sneak into their houses. They are often forced to defecate in the open due to a lack of access to proper toilets. Lack of electricity and water has made this area uninhabitable. They don’t even have adequate opportunities for a livelihood.”
Forced to be unhygienic
According to the U.N. Refugee Agency (UNHCR), India is home to some 250,000 forcibly displaced persons, half of whom are women and children. As of Jan. 31, 2022, more than 46,000 refugees and asylum-seekers were registered with UNHCR India. Almost half (46 percent) of that number are women and girls.
Such a share mirrors global statistics that say about 50 percent of internally displaced or stateless people as well as and refugees are women and girls. Not surprisingly, too, the period poverty that exists in India’s refugee camps can also be found in similar settlements in other countries.
According to a 2019 UNHCR report, period poverty is a severe issue in refugee camps, with only 37 percent of menstruating women among the inhabitants having appropriate access to underwear and only 55 percent having adequate access to period products.
The study published by BMC Public Health two years ago also pointed out that poor menstrual hygiene habits can lead to rashes, itching, foul odors, and many other reproductive health morbidities, as well as urinary tract infections and reproductive health problems.
Dr. Rakhi Gupta, a Delhi-based gynaecologist, says that the cloths women and girls use at the camps whenever they menstruate can cause severe infections that can be “life-threatening” if not treated well. “The women mostly use dirtier cloth and even insert it inside their vagina,” she says. “That’s not recommended at all. If they don’t have the option to use sanitary pads, they should use washed and hygienic cloth and dispose of it afterward.”
Sometimes even unhygienic toilets or public toilets can lead to various infections, she says, adding, “It’s important to have access to clean water and toilets for good health.”
Prakash and her fellow refugees are in dire need of such access as well. Their reality, however, consists of muddy pathways and living cheek by jowl in an area that always has an unpleasant smell hovering over it.
At Prakash’s camp, there are eight communal toilets and a handful of private ones that are mostly in a state of disrepair. Prakash household’s toilet is considered the cleanest and best of the lot, even if it doesn’t have electricity and has just a solitary plastic tap and two containers, plus a muddy floor strewn with discarded cigarettes and other refuse.
“For us, this is what’s clean.” Prakash says, laughing awkwardly. “We’re not privileged to (have) a lot more. We are refugees living in unsanitary camps. What do you expect?”
Suffering in silence
Twenty-year-old Komal Salonki is one of the women who use Prakash’s toilet. She says that her vagina burns and itches if she urinates when she is on her period. “It pains me so much that I have to sleep keeping my legs wide open,” she says. “The toilet is usually unclean and that’s also a source of infection, I believe. And it can be unclean water too. Here, access to clean water is somewhat limited.”
She says, though, that she has yet to take any medication even when “my vagina starts to produce white and thick discharge days before and after my periods. And that leads to intense itchiness and soreness around it.”
Salonki says that community elders urge them to keep their periods a secret, especially from men. “But there shouldn’t have been shame associated with periods,” she says. “Men should know the struggles and pain that we go through.”
Yet she narrates some taboos associated with menstruation, such as combing one’s hair during one’s period (“because it would lead to hair loss”) or not taking a bath. Says Salonki: “We don’t take a bath because if we do, we will have problems getting pregnant.”
At least, Salonki is openly talking about all these, and with a visitor at that. For many women and girls in South Asia, such topics are usually kept under wraps.
“They don’t talk about periods openly here,” says Neha, a community teacher sent by a nearby temple. “It’s because of the taboos that they remain silent even if they are in pain.”
Neha, who goes by a single name, spends five hours with several women in the camp every day, who open up to her at times and tell her how some of them feel about their bodies during their monthly cycles.
“For some, the periods last for nearly a month,” she says. “And they still don’t tell their family about it because they are ashamed as if there is something wrong (with it). It is not.”
The 23-year-old says that there is a next to zero concept of hygiene in the camp. She also confirms that the women have been living with old concepts and myths. “That needs to change,” she says. “I try to talk about it with them but they resist because of the shame.”
In 2022, DCW launched a study focusing on the plight of women and child refugees residing in the camp nearby the Majnu ka Tilla Gurudwara. According to an India Today report that year, the Commission was to issue notices to various government departments for resolution actions.
Asia Democracy Chronicles (ADC) reached out to the Commission for updates on the study and the notices, but after days of keeping ADC in the loop, it stopped responding. ◉