DELHI, India — At 2 a.m. on the sidewalk outside one of Delhi's best-known public hospitals, Shabana Kumar gently wakes her husband. They sleep in shifts of about an hour at a time because their 6-year-old son is a patient in the oncology ward, being treated for leukemia, a cancer of the blood and bone marrow. They are afraid that if they are both asleep, an urgent call could come about their son's condition and they might miss it.
The Kumar family lives more than 600 miles from Delhi in the state of Bihar. Arun, 32, works as a farmer. Shabana, 30, is a homemaker caring for their only son.
They made the trip to Delhi because they could not afford the cost of their child's cancer treatment in Bihar. The All India Institute of Medical Sciences, or AIIMS, subsidizes expenses for families in need.
But for many families, there is one challenge they must bear on their own — finding a place to live in Delhi during the days, weeks, even months of treatment. Like the Kumars, families who can't afford to rent lodging often set up a temporary dwelling on the sidewalk.
On a night in August, dozens of families were sleeping on blankets or sheets spread directly on the sidewalk. Some tie mosquito nets to railings to protect themselves and their kids. They keep their bags and other belongings beside them as they sleep.
During the day, families move between the sidewalk and the hospital for appointments, tests, medicines and consultations. They carry their most important belongings with them while leaving less valuable items at their sleeping spot. One family member often stays behind to keep an eye on their things.
Like the family from Bihar, people who've accompanied a patient may sleep outside while the patient is housed in the hospital. In other cases, the person receiving care is seen during the day but does not have a bed, so they sleep on the sidewalk as well.
At night, the sidewalk dwellers return to the pavement, where a small ecosystem has grown around the families. Women cook rice over makeshift brick stoves. Volunteers distribute food. Nearby shops sell medicines and other necessities. Nearby tea stalls not only serve beverages but let families charge their phones.
Once strangers, they exchange information about doctors, tests and where to find a free meal or, when none is available, an affordable one they can pay for.
Vishnu Singh, 38, runs a tea stall outside AIIMS.
"I see poor people sleeping here every day, so many that I cannot even count them," he said.
At AIIMS and Safdarjung Hospital, which is associated with Vardhman Mahavir Medical College, we interviewed families who had traveled from across India, often hundreds of miles from home, to seek medical care. The two hospitals stand opposite each other, treating patients with illnesses ranging from cancer and heart conditions to intestinal disorders and other serious ailments.
Some families had been there for a week, others for a month or longer. For many, returning home between hospital visits was impractical, so patients and the relatives accompanying them stayed in Delhi for the duration of their care.
The families we spoke with described their experiences spending days or weeks in Delhi while navigating appointments, tests, consultations and treatment.
When treatment means living outside
It is a startling contrast — a hospital that provides critical care, that, according to its annual report, gives subsidies to thousands of poor families for treatment — and that is ringed by folks who traveled great distances to find care for a loved one and who cannot afford a place to stay.
NPR reached out to the hospital by email to ask about the issue of accommodations and the community of sidewalk dwellers. The hospital did not respond.
AIIMS' website notes that its Medical Social Service Unit provides financial assistance for medical treatment and travel costs for some patients coming from outside Delhi. It also states that the unit helps arrange accommodation for out-of-town patients and their family members and caregivers at dharamshalas, traditional charitable lodging facilities affiliated with AIIMS, or other low-cost accommodation.
The website does not say whether AIIMS pays for those accommodations or provides financial assistance specifically for the lodging costs. Shalini Yadav is one of the patients who sleeps on the sidewalk with her parents.
Yadav is a second-year college student from Piprat village in Tikamgarh district, Madhya Pradesh, in central India. She had been preparing for the state civil service examination. Her plan was to become a government officer.
Now she is spending her days reading Gunahon Ka Devta (The God of Sins), a famous 1949 Hindi tragic romance novel written by Dharamvir Bharati, on the pavement outside AIIMS, waiting to find out when her treatment will begin and when she can go home.
Yadav says she has been dealing with an intestinal illness for five or six years and has already undergone two operations. Her family had sought treatment elsewhere before relatives and neighbors advised them to travel to Delhi in search of better treatment at AIIMS — a trip of roughly 370 miles. "We thought AIIMS was the best hospital in India," she said. The cost of staying in Delhi was also a burden: Her family could not afford a room and had already spent thousands of rupees on travel and other expenses.
When we interviewed her on Aug. 3, she had been there for about three weeks with her parents, Surendra Singh Yadav, 47, a farmer, and Kalpana Yadav, 45.
"We thought the facilities would be good, the doctors would be good, and everything would happen quickly. We never imagined that we would have to sleep on the road," she said.
For her, the pavement is not just uncomfortable, it is also frightening. During the day, she says, she can manage. At night, she worries about the people around her.
"There are all kinds of people here," she says. "Some are good, but some drink or use drugs. There is shouting and fighting. As a girl, I feel very uncomfortable here at night."
But the family has little choice. They cannot afford a room in Delhi, she says. "We have decided that we have to sleep on the road because there is no other option."
During the day, Yadav goes into the hospital for appointments, tests and checkups, then returns to the pavement while waiting for the next step in her treatment. Everything is on hold — her college education, her hopes of qualifying for a government job, her father's farming work.
"It feels like we are being forced to live like this," she says.
"I just pray that I can meet a doctor"
Lakhi Bai, 62, from Ramnagar in Maihar district, Madhya Pradesh, in central India, about 500 miles away, came to Delhi seeking treatment for diabetes and a condition that she says causes numbness and a loss of sensation in parts of her body.
She says she could sometimes sustain an injury without feeling pain. When we met her, she had been sleeping outside Safdarjung Hospital for about 20 days. During that time, she says, she had been going to different doctors and departments for consultations and tests but had not yet received a treatment plan.
Bai is a farmer and describes herself as a homemaker. She said she has three sons but is no longer in contact with them. She came to Delhi alone.
"I cannot afford to bring someone with me," she says. "If I bring someone, I have to pay for their food and accommodation, too."
It's been a difficult period. "Sometimes I don't even get food," she says. "I sleep with an empty stomach."
Sleeping outside is also stressful. The heat is hard to endure, she said, as is rainwater.
"When it rains, water comes here," she said. "There is nowhere to go."
AIIMS did not respond to requests for comment about her account or the experiences described by other families interviewed for this story.
Bai did not know how much longer she would have to remain in Delhi. "I have no place to stay," she says. "I just pray that I can get the treatment I need and something can be done."
A month outside awaiting a child's heart treatment
In August, Balraam Singh, 35, a brick-kiln worker from Meerut, Uttar Pradesh, had been sleeping outside Safdarjung Hospital for about a month with his wife and their 7-year-old son, Munna Singh.
Munna has a heart condition that his father describes as a "hole in the heart."
They had come from about 50 miles away seeking further medical evaluation and treatment at Safdarjung Hospital.
"We came with a lot of hope that we would find a doctor and my son would be treated," he says. "But now it feels like we may have to go back without knowing what will happen next.
For Singh, who can earn $5 to $7 a day at the kiln where he works, staying in Delhi means not only a loss of income but the need to spend money on food and other daily needs.
Six months of saving for another hospital visit
Gulshan Bano, 38, had come to Delhi from Bihar with her 60-year-old mother, Asma Khatoon, and her 6-year-old daughter, Fiza. They had been sleeping outside Safdarjung Hospital for about a week when we met them in August.
Bano says her mother has had a heart condition for several years and was receiving treatment in Bihar. Her mother had undergone checkups and tests there, but the family felt she needed further evaluation and care.
Relatives also advised them to seek treatment in Delhi, and the family decided to travel for further consultations and tests.
Bano said doctors have told them that her mother has a heart problem and have prescribed medication rather than recommending surgery.
The family returns to Delhi for checkups about every six months. To pay for the trips, Bano works in domestic jobs in Bihar.
"I work for months and save whatever I can, and then I come here," she says. "Whatever little money remains has to be used here."
Bano said her husband does not contribute to her mother's medical expenses and she has little choice but to keep making the journey to Delhi.
A visit can last about a month, Bano said, as the family waits for scheduled consultations, tests and follow-up care. Because they cannot afford other accommodation, they sleep outside the hospital between appointments and tests rather than return home and make another journey to Delhi.
"Where should I go?" she said. "I have to come here because my mother needs treatment."
For families like Bano's, charities and volunteers can provide some of the practical support they need while they wait outside the hospitals.
Rajiv Ranjan, who works with the Delhi-based Donate A Meal Trust, said his organization regularly helps patients and their attendants staying outside AIIMS and Safdarjung Hospital by distributing food, clothes and rations.
He said the organization has seen many families remain outside the hospitals while seeking treatment or caring for relatives inside.
"We come here for people who sleep outside while they or their family members are receiving treatment inside the hospital," he says. "They have nowhere else to stay, so we try to help with whatever we can." The group distributes about 100 meals a day, Ranjan says.
Food, however, is only one of the needs.
"People need shade from the sun, and during the rainy season they need somewhere to stay dry," Ranjan said. "Some of them take shelter under the Delhi Metro, the city's rapid-transit rail system, when it rains."
For Shalini Yadav, the 20-year-old college student from Madhya Pradesh who traveled to Delhi for treatment, the food distributions and other help have become part of life outside the hospital. She said people arrive to help in whatever way they can, but the assistance does not reach everyone.
"Sometimes we get food. When we don't, we buy it nearby. But there are many people here who don't get anything to eat."
For families, treatment means returning to Delhi again and again
Suhana Bano, 47, from Bareilly, Uttar Pradesh, has been bringing her 18-year-old son, Mohammad Sameer, to Delhi for treatment for about two years.
Sameer has irritable bowel syndrome. He was in seventh grade when this digestive ailment forced him to leave school. The family first sought treatment at several hospitals in Bareilly, about 155 miles from Delhi, before traveling to Safdarjung Hospital.
Suhana Bano said the family turned to Delhi after seeking treatment locally, hoping to find the specialized care Sameer needed.
The family travels to Delhi whenever Sameer is due for a consultation or tests. Typically, they stay one to two months, Bano says. While in Delhi, the family sleeps outside Safdarjung because they cannot afford a room.
Aamar Singh, 60, a farmer from Hathras, Uttar Pradesh, had been sleeping outside AIIMS for about a week when we met him in April.
His 35-year-old daughter, Neelam, was admitted to the AIIMS intensive care unit with a respiratory problem, he said. His 40-year-old sister, Rashima, stayed outside with him. At night, they sleep alongside stray dogs that also gather on the pavement.
Singh does not know how long his daughter will remain in the ICU after being admitted for treatment and therefore does not know how long he will have to remain outside.
Food is not always available, he said, and some days they go hungry.
"Sometimes you eat, sometimes you don't," he said. "My daughter is inside, so I have to stay here. What else can I do? This is our situation."
So Aamar Singh waits on the pavement for news about his daughter until he can take her home.
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Sajad Hameed is an India-based journalist and multimedia storyteller focusing on South Asia. He writes about politics, human rights, health, business, the economy and the impact of climate change, with particular focus on the region's evolving social and political landscape.
Rehan Qayoom Mir is an independent journalist whose work has appeared in outlets including Al Jazeera English, The Guardian, Nikkei Asia, The Progressive, Jacobin and more. He reports from across India and South Asia, with a focus on ground reporting and human-interest stories.
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