Why Unsafe Drinking Water Remains India’s Most Underestimated Public Health Emergency

India has learnt to quantify many of its environmental crises. Air pollution is tracked daily through the Air Quality Index; heatwaves and floods dominate headlines and policy briefings. Yet when drinking water turns lethal, the response remains delayed, fragmented, and fleeting. The recent deaths and illnesses linked to contaminated water in Bhagirathpura, Indore, are not an aberration. They reveal a deeper governance failure that repeats itself across states, cities, and political regimes.

From Indore to Odisha: a pattern, not an exception

What unfolded in Indore mirrors a troubling national pattern. In Gujarat’s Mahisagar district, a jaundice outbreak was traced to contamination of borewell and municipal supplies. In Tiruvallur, Tamil Nadu, residents were hospitalised after consuming polluted tap water. A decade earlier, the hepatitis outbreak in Sambhalpur, Odisha, devastated entire communities.

These incidents are often treated as local lapses. In reality, they are manifestations of a systemic failure in ensuring safe water delivery — a failure that cuts across geography and governance models.

The hidden scale of India’s water-borne disease burden

The numbers reveal the magnitude of the crisis. Between 2005 and 2022, India recorded over 20.98 crore cases of major water-borne diseases — including Acute Diarrhoeal Disease, typhoid, viral hepatitis, and cholera — resulting in more than 50,000 reported deaths.

Yet these figures barely capture the full toll. According to the “NITI Aayog”’s Composite Water Management Index, nearly 2 lakh people die every year due to inadequate access to safe drinking water. Globally, India ranks 120th out of 122 countries on the Water Quality Index, with an estimated 70% of water sources contaminated.

Despite this, unsafe water rarely generates the political urgency that air pollution or climate disasters do.

The economic cost no one talks about

Beyond hospital wards lies an economic burden that remains largely invisible. Water-borne illnesses trigger lost workdays, rising medical expenses, and declining productivity. Estimates from the Ministry of Water Supply and Sanitation suggest that contaminated water affects nearly 37.7 million people annually, leading to the loss of around 73 million working days every year.

This is not merely a health issue; it is a drag on economic growth and household resilience, particularly for informal workers who cannot afford prolonged illness.

Where contamination really begins: the journey to the tap

In most outbreaks, the problem is not the source of water but its journey through urban infrastructure. In Bhagirathpura, reports point to sewage mixing with drinking water pipelines — a familiar failure in Indian cities.

Municipal departments function in silos. Road construction agencies dig without coordinating with water or sewerage boards. Accurate, shared maps of underground utilities are often absent. Heavy machinery cracks water mains and ruptures adjacent sewer lines. During pressure drops, sewage is sucked into drinking water pipes, contaminating supply long before the problem becomes visible.

This is less a technical failure than an institutional one.

Why urban missions struggle to deliver safe water

India’s flagship urban programmes recognise the problem in principle. The second phase of the “Atal Mission for Rejuvenation and Urban Transformation” (AMRUT 2.0) aims to make cities “water secure”. In practice, however, implementation remains heavily skewed towards asset creation — laying new pipelines, building treatment plants — rather than ensuring safety at the tap.

Ageing, leaking networks beneath city streets are often left unattended. Monitoring systems are weak. Protocols for contamination detection and rapid response are poorly institutionalised. India has built much of the hardware of urbanisation without embedding the software of safety, surveillance, and accountability.

The regulator problem: when the polluter audits itself

A deeper governance flaw compounds the crisis. Municipal bodies often act as water provider, quality tester, and adjudicator of their own performance. The potential polluter and the regulator are frequently the same institution.

In the absence of independent water regulators with the power to enforce standards and impose penalties, testing data remains opaque. Contamination is often acknowledged only after an outbreak causes illness or death. Governance becomes reactive — patching pipes after tragedy — rather than preventive.

What preventive water governance would look like

Breaking this cycle requires a shift from emergency response to systemic prevention. Key steps include:

• Comprehensive, publicly accessible mapping of underground utilities to prevent accidental damage
• Independent water quality regulation that separates service provision from oversight
• Continuous monitoring of water quality up to the consumer tap, not just at treatment plants
• Reorienting AMRUT 2.0 from coverage and asset targets to measurable safety outcomes

These are governance reforms as much as engineering ones.

From welfare issue to constitutional obligation

India has demonstrated that it can measure and respond to environmental threats when political attention follows — as with air pollution. Drinking water demands the same seriousness. Safe water is not a welfare add-on; it is a constitutional obligation tied to the right to life, and a foundational economic necessity.

Until policy moves beyond counting pipes and plants to guaranteeing safety at the tap, outbreaks like Indore will continue to shock the nation — even as they remain entirely predictable for those who live with contaminated water every day.