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It's been over a month since his mother died, but Vishal Meghwal can still hear her struggling to breathe as he desperately messaged friends to lend him money for the drugs she needed.

The coronavirus pandemic had already cost the 24-year-old his savings and his income from painting houses in Ajmer, a city of tombs and shrines in northwest India. Losing his mother was the biggest blow of all.

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Vishal Meghwal looks at a photograph of his mother who died of COVID-19 in May this year at his home in Ajmer, India. June 24, 2021. Thomson Reuters Foundation/Deepak Sharma

"I have never been in a situation like this," said Meghwal by phone from Ajmer. "I have loans to repay now. There is no work. And my mother is no longer by my side."

Meghwal is one of tens of thousands of Indians having to contend with the triple burden of bereavement, joblessness and debt after a brutal second wave of COVID-19 that brought the country's fragile health system to its knees.

Repeated lockdowns have caused unemployment to soar and wiped out the savings of many households in India, where families impacted by the pandemic had to fund treatment for sick relatives themselves, often having to borrow to do so.

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A woman walks through an empty street of a bamboo furniture market amid easing lockdown restrictions in Ajmer, India. June 25, 2021. Thomson Reuters Foundation/Deepak Sharma

As case numbers fall, the country has begun to unlock. But the virus has left deep scars on its economy, which suffered its worst ever contraction last year, and families face the daunting task of repaying large debts with work still scarce.

The central bank slashed growth forecasts, with economists pointing to a range of data – from the rate of cheques bouncing to the amount of mortgaged gold jewellery up for sale - showing the scale of the hardship.

Savings exhausted

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A daily wage labourer smokes bidi, a hand rolled cigarette, as he waits for work in Ajmer, India. June 25, 2021. Thomson Reuters Foundation/Deepak Sharma

When his mother fell ill, Meghwal eventually managed to get her a bed in a government hospital. But he had to buy everything she needed himself - from drugs to oxygen masks - from pharmacies that had doubled their prices.   

"We were never rich. But we were never poor either," he told the Thomson Reuters Foundation.

"My father and I were both earning. And we ate well. But we exhausted our savings on food and bills to survive last year's lockdown after we stopped getting work."

Before the pandemic struck, Meghwal's father built houses, and he painted them.

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Vishal Meghwal paints the wall of a house after days of struggling for work, in Ajmer, India. June 26, 2021. Thomson Reuters Foundation/Deepak Sharma

When that work dried up, and with unemployment rates touching a 12-month high of 11.9%, Meghwal took work as a porter.

But partial lockdowns make the work uncertain, and even on the rare days when he gets work, Meghwal only makes about 300 rupees. He worries endlessly about the 60,000 rupees ($807) that he borrowed for his mother's treatment and must now repay.

About 100 million people lost jobs during the nationwide lockdown last year and about 15 million workers remained out of work at the end of 2020, according to the State of Working India report, a study conducted by the Azim Premji University.

An estimated 230 million people earned less than $5 a day between March and October 2020, according to data from the privately-owned Centre for Monitoring Indian Economy.

The impact on the informal sector, which employs the bulk of India's workers, has been particularly devastating.

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Hand cart pullers rest post noon as the market shuts early owing to lockdown restrictions that have hit local businesses and impacted work opportunities for hand cart pullers in Ajmer, India. June 25, 2021. Thomson Reuters Foundation/Deepak Sharma

While the incomes of salaried employees fell by an average of 40% in April, the drop for small traders and daily wage workers was 75%, according to data from the National Bureau of Economic Research.

"Nearly half those in the formal work sector are now doing informal work where there are no safety nets," said Amit Basole, director of the Centre for Sustainable Employment at Azim Premji University, who co-authored the study.

"They will have to make tough choices going ahead - from pulling kids out of school to delaying healthcare. Any emergency or sudden expenditure will finish them." 

Costly treatment

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Renu Agarwal and her 16-year-old daughter stand for a photo in their two-room rented house in Agra, India. July 1, 2021. Agarwal lost her husband to COVID-19 after he was refused admission to a private hospital due to a lack of oxygen. He received mouth-to-mouth resuscitation but died outside the government hospital’s medical facility. "It was all over in 24 hours ….. Just like that, I became in charge of my school-going daughter's and my own future." Thomson Reuters Foundation/Ruhani Kaur

Two weeks before Meghwal lost his mother, Renu Singhal was rushing her husband in an autorickshaw through the streets of Agra, the city in northern India that is home to the famed monument to love, the Taj Mahal.

The 45-year-old's husband died in her arms, up-ending her "happy family life" and leaving her with unpaid bills, rent and meagre savings.

“It was all over in 24 hours - his fever spiked, I rushed him to hospitals and he died in an autorickshaw waiting to be admitted," Singhal said in a matter-of-fact tone from her Agra home.

"Just like that, I became in charge of my school-going daughter's and my own future."

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16-year-old Bhoomi Agarwal sits in her two-room rented house with the photo of her deceased father in the background in Agra, India. July 1, 2021. After her father’s death she has been spending her days trying to call up District Officials to get her father’s death certificate made. She is hoping she will be able to continue her education and has plans to do her MBA. Thomson Reuters Foundation/Ruhani Kaur

Singhal, a housewife, has not had a chance to mourn her husband's death. She is spending every waking moment trying to figure out how to pay rent and where the next meal will come from once the "charity of strangers" stops.

"Whatever savings we had was spent on his treatment, the funeral, paying last month's rent and running around," she said.

India's creaking public healthcare infrastructure meant even those without means had to pay for treatment as state-run hospitals quickly became overwhelmed.

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Renu Agarwal walks outside her home in Agra, India. July 1, 2021. Agarwal has barely left her house since she lost her husband to COVID-19. Thomson Reuters Foundation/Ruhani Kaur

State governments including Maharashtra, Kerala, Assam and Tamil Nadu capped the rates that private hospitals could charge for treating coronavirus patients.

But in practice, families desperate to get treatment for a loved one were prepared to pay whatever it took, often going into debt in the process.

More than 60% of spending on healthcare in India comes from private individuals, one of the highest rates in the world, with the federal government accounting for only about 9%, official estimates show.

'Poverty trap'

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A daily wage labourer waits for work in Ajmer, India. June 24, 2021 Thomson Reuters Foundation/Deepak Sharma

Since the start of the pandemic, household savings have dropped and borrowings have gone up, according to the central bank's most recent estimates.

A Reuters survey found that borrowing had risen by three times since the pandemic hit in March 2020 and about half of that was taken out the past six months.

The long-term consequences of this in a country that even before the pandemic was grappling with widespread inequality and a major youth unemployment problem is hard to predict.

India has lifted tens of millions of people out of extreme poverty in the last decade, but the World Bank has said the pandemic has reversed that trend, at least temporarily.

The number of Indians with incomes of $2 or less each day, has gone up by 75 million as the recession brought by the virus clawed back years of progress, the U.S.-based Pew Research Centre said in a report.   

It estimated the number of people earning between $10 and $20 a day shrank to 66 million, down a third from a pre-pandemic figure of 99 million.

The rise in informal working has pushed poverty levels up, with women and younger workers worst hit, said the State of Working India report.

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Bhoomi Agarwal calls District Officials to try to get her father’s death certificate made in Agra, India. July 1, 2021. Her mother had fainted when her father was declared dead after a private hospital refused to admit him when his symptoms became severe. Her mother lost her purse and her father’s medical records, so they are struggling to get the required documents to declare his death. Thomson Reuters Foundation/Ruhani Kaur

Households have coped with the decline in earnings by eating less, selling belongings and borrowing, it said.

Basole warned that a delayed economic recovery would mean that "the increase in poverty will persist and there is a danger of people not being able to recover from poverty even if growth comes back later".

"This is because debts may build up and assets will be sold. This can create a poverty trap," he said.

Hunger

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A woman holds food in her hand distributed by non-profits outside a state-run hospital in Ajmer, India. June 25, 2021. Thomson Reuters Foundation/Deepak Sharma

As India struggles to balance reining in COVID-19 with reopening, campaigners say a shadow pandemic of hunger is taking root.

"Hunger is a continuous disaster for large parts of our population," wrote Anshu Gupta, founder of non-profit Goonj in The Indian Express newspaper, saying access to lentils and rice - the staple food of millions - was no less important than access to oxygen.

India ranked 94th of 107 countries in last year's Global Hunger Index, which described its hunger level as "serious".

In their letters to the government, campaigners at the Right to Food Campaign - a collective of individuals and organisations working on hunger and malnutrition - said families were earning less, eating poorly and borrowing money to buy food.

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A man stands in the near-empty street of Dargah Bazar, in Ajmer, India. June 22, 2021. Thomson Reuters Foundation/Deepak Sharma

"The expenditure on healthcare is much more this year. Those who could meet daily expenses last year are unable to manage this time around," said Dipa Sinha, a professor at Ambedkar University and Right to Food campaign member.   

To mitigate that, Prime Minister Narendra Modi has extended until November a free food scheme started last year to get people through the worst impacts the pandemic on jobs and wages.

Under the scheme, 800 million of India's 1.3 billion people are eligible to receive 5kg a month of free food grains.

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Volunteers distribute free food to attendants of patients and poor people outside a state-run hospital in Ajmer, India. June 25, 2021. Thomson Reuters Foundation/Deepak Sharma

Some nutritionists have said that is inadequate and warned that undernourished people were less able to fight the virus

"There is no oil, salt or pulses (in the free food programme)," said Veena Shatrugna, former deputy director of the National Institute of Nutrition.

"A working adult needs 2,400 calories, a teenager needs 2,000 calories and the government free food grain aid only adds up to 600 calories per person per day," she said, warning that "the collateral damage of the pandemic is going to be huge".

'Prepared to die'

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A daily wage labourer waits for work in Ajmer, India. June 24, 2021 Thomson Reuters Foundation/Deepak Sharma

Even the food grains scheme is no guarantee against severe hunger for those without documents.

Guddi Devi, a 40-year-old single mother of five, used to pack goods at a factory in the northern Indian town of Aligarh for a monthly wage of about 4,000 rupees - just enough to feed her children, none of whom were enrolled in school.

But when lockdown was imposed on March 24 last year, the factory laid off all workers, including Devi. By May this year, she and her children were found starving.

"When I pleaded for help, I thought of it as my last shot at life. I was prepared to die," Devi told the Thomson Reuters Foundation from her hospital bed in Aligarh.

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Laid off factory worker Guddi Devi, 40, poses for a picture from her bed in a hospital where she was admitted in an acutely malnourished state along with her children in May this year in Aligarh, India. Handout picture: Hands for Help, Aligarh

"We had eaten a roti or maybe two in the last 12 days," she said, referring to the flatbreads that are a staple of northern India.

Without documents, Devi said, she had no way to seek foodgrains being given for free by the government.

The hospital's medical superintendent said the whole family was malnourished when they were admitted and were suffering from fever and weakness. One of Devi's sons was so anaemic that he needed a blood transfusion.

Dignity

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Vishal Meghwal poses for a picture with his family outside his house in Ajmer, India. June 24, 2021 Thomson Reuters Foundation/Deepak Sharma

Dignity has been a recurring loss during the pandemic in a country with no social safety net.

When Meghwal was fighting to get his mother admitted in a government hospital, another woman on a stretcher died outside the hospital, under the harsh sun, her family looking helplessly around.

"This happened in front of me. My mother was by my side, sinking, but I was told to get a note of approval from an official in another hospital to get her admitted. I didn't know what to think, what to do," Meghwal said.

Those who survived the second wave said fear and frustration had stripped their loved ones of a dignified farewell.

Singhal in Agra had not had a proper conversation with her husband for almost a week when he was isolating at home. Her last moments with him were outside a hospital as she tried in vain to resuscitate him.

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Renu Agarwal sits in her home with the photo of her deceased husband in the background in Agra, India. July 1, 2021. Agarwal worries how she will bring up her daughter and take care of herself, even as she looks for a job at a time when unemployment rates are touching a 12-month high of 11.9%. Thomson Reuters Foundation/Ruhani Kaur

Meghwal had watched helpless as his mother stopped breathing on the afternoon of May 6, but there was no doctor around until past midnight to declare her dead.

"They kept telling me she was sleeping," he said.

The next morning, Meghwal was given a PPE kit to wrap his mother's body in. He wheeled her out on a stretcher and put her in an ambulance that charged him 1,000 rupees for the drive to the cemetery 2 km (1 mile) away.

"Whatever we had is now gone," he said. "I hear about government helping COVID-affected families. "I am trying to figure out how that works."

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Vishal Meghwal looks at a photograph of his mother at his home in Ajmer, India. June 24, 2021. Thomson Reuters Foundation/Deepak Sharma

India's Finance Minister Nirmala Sitharaman has announced the strengthening of public healthcare institutions and a credit guarantee scheme for small borrowers.

"Families have regressed," said Sunil Kumar, whose Aligarh-based non-profit Hands to Help is helping Devi. "People have lost work and their health is suffering. This pandemic has broken everyone financially."

Reporters: Roli Srivastava and Anuradha Nagaraj
Text editing: Claire Cozens
Photographers: Deepak Sharma and Ruhani Kaur
Producer: Amber Milne