A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

If your roots trace back to the Indian subcontinent, your risk of developing type 2 diabetes is significantly higher than that of Europeans. Research shows that Indians, Pakistanis, and Bangladeshis are up to six times more likely to develop the condition, often at a younger age and at lower body weights. For years, carbohydrate-heavy diets were blamed. But growing scientific evidence points to a far deeper and darker cause: repeated famines during British colonial rule that may have altered metabolic resilience across generations.

Can Hunger Change Human Biology?

The idea that starvation can leave a genetic imprint may sound extreme, but science supports it. Prolonged nutrient deprivation can permanently affect how the body stores fat, processes glucose, and responds to food abundance later in life. Even a single famine can raise the risk of metabolic disorders such as diabetes in future generations.

This understanding forms the basis of the “thrifty genotype hypothesis,” a concept widely discussed in evolutionary biology.

The Thrifty Genotype Hypothesis Explained

The thrifty genotype hypothesis suggests that populations exposed to repeated famines develop genetic traits that help conserve energy. These traits are lifesaving during scarcity but become harmful in times of plenty, increasing the risk of obesity and diabetes.

Economic historian Mike Davis documents that India experienced 31 major famines during 190 years of British rule between 1757 and 1947, roughly one every six years. By contrast, only 17 famines occurred in the previous 2,000 years. Davis estimates that 29 million people died in the Victorian era alone. Economic anthropologist Jason Hickel places the death toll from colonial policies between 1880 and 1920 at around 100 million.

Scientific Evidence Linking Famines to Diabetes

A study published in Frontiers in Public Health titled The Elevated Susceptibility to Diabetes in India: An Evolutionary Perspective argues that these famines reshaped metabolic traits. The researchers note that Indians tend to have a higher fat-to-lean mass ratio, lower average birth weight, and reduced ability to clear glucose. This combination increases metabolic stress and lowers resilience, explaining earlier onset of diabetes compared to Europeans.

A Nation That Shrunk Over Time

Colonial-era famines also affected physical growth. Studies show that average Indian height declined by about 1.8 cm per century during British rule. Historian accounts describe ancient Indians as tall and robust, with even Greek chroniclers noting their stature during Alexander’s invasion. By the 1960s, however, Indians were about 15 cm shorter than their Mesolithic ancestors.

Read: How Colonialism Continues To Bear An Impact On The South Asian Health Crisis

While the British did not cause early declines, widespread impoverishment under colonial rule sharply accelerated the trend. Only in the past 50 years has average height begun to recover.

Famines Were Policy Failures, Not Nature

Mike Davis argues that colonial famines were driven not by food shortages but by policy. Grain continued to be exported even as millions starved. During the 1876 famine, Viceroy Robert Bulwer-Lytton refused to halt exports, and relief work was deliberately discouraged. Davis describes these deaths as the result of state policy, not natural disaster.

Medical journal The Lancet estimated that 19 million Indians died during famines in the 1890s alone.

Breaking the Diabetes Cycle

India now faces the consequences. According to the Indian Council of Medical Research, over 101 million Indians live with diabetes today. Experts argue that prevention must begin early, with reduced sugar intake, low-glycaemic diets, healthier fats, and compulsory physical activity in schools. Education about famine-linked intergenerational health risks could also help younger generations make informed choices.

India has avoided famine since Independence in 1947. The next challenge is ensuring that history’s biological scars do not continue to shape its future.

As India steps into 2026, two familiar yet unsettling names have returned to the public health conversation. Nipah virus cases reported from West Bengal and fresh bird flu detections among crows in Bihar have raised questions about how dangerous these infections really are for humans. While both diseases originate in animals and can cross over to people, their risks, spread patterns and fatality levels are very different.

Two zoonotic threats, very different risks

Nipah virus and avian influenza are both zoonotic, meaning they jump from animals to humans. Beyond that similarity, the comparison largely ends. Nipah is rare but extremely lethal when it infects humans. Bird flu, on the other hand, spreads widely among birds and poultry, but only occasionally infects people.

Health experts note that understanding this distinction is crucial. Nipah alarms public health systems because even a small cluster of cases can lead to severe illness and death. Bird flu triggers large scale surveillance mainly due to its impact on poultry and the economy, with human cases remaining uncommon.

Read: Bird Flu In India: How Safe Is It To Eat Chicken And Eggs?

Nipah virus and why it worries health officials

The Nipah virus was first identified in Malaysia in the late 1990s and has since caused multiple outbreaks in South and Southeast Asia. Fruit bats are its natural carriers, and humans can get infected through contaminated food, contact with infected animals or close contact with an infected person.

Symptoms often begin like a common viral illness, with fever, headache and cough. In many patients, the disease progresses rapidly. Within days, some develop encephalitis, seizures, confusion and coma. Respiratory distress is also common in severe cases.

According to the World Health Organization, Nipah’s fatality rate ranges between 40 and 75 percent, depending on the outbreak and access to timely medical care. There is no approved vaccine or specific antiviral treatment. Doctors rely on intensive supportive care, which makes early detection and isolation critical.

In January 2026, West Bengal reported multiple Nipah cases, prompting contact tracing and monitoring of nearly 200 people. Most tested negative, and the WHO assessed the risk of wider spread as low. Still, the high death rate keeps Nipah firmly on India’s list of priority pathogens.

Bird flu and its limited human impact

Bird flu, or avian influenza, is caused by influenza A viruses that primarily infect birds. Strains such as H5N1 and H9N2 have been detected repeatedly in India among poultry and wild birds. Bihar’s Darbhanga district recently reported thousands of bird deaths, triggering containment measures.

Humans usually get infected through close contact with sick or dead birds or contaminated environments. When infection does occur, symptoms can resemble seasonal flu at first, but severe cases may progress to pneumonia or acute respiratory distress.

Some bird flu strains have shown high fatality rates among confirmed human cases, sometimes close to 50 percent. However, experts stress that these numbers come from very small case counts. Sustained human to human transmission remains rare, which limits large outbreaks in people.

Read: Nipah Virus Outbreak In India: Myanmar Airport Tightens Health Screenings

Which virus is deadlier for humans?

In terms of individual risk, Nipah virus is considered deadlier for humans. Its consistently high fatality rate, lack of treatment options and potential to cause severe brain inflammation make it especially dangerous, even when case numbers are low.

Bird flu poses a broader threat to animal health and livelihoods, but its direct impact on human life has so far been limited. Public health officials continue to monitor both closely, knowing that vigilance, early reporting and strong surveillance are the best tools to prevent either virus from spiralling into a larger crisis.

After the death of 150 crows in Bihar's Bhagalpur district in Naugacha, sudden death of 1,500 crows in Chennai, in Tamil Nadu has again raised concerns over bird flu. At the center of all these is Highly Pathogen Avian Influenza or the HPAI, which is also known as bird flu or the A H5N1 virus. While the strain is known for being notorious and have jumped states, spreading outbreaks in many Indian states, including Jharkhand, Bihar, Maharashtra, Andhra Pradesh, Kerala, Telangana, and Tamil Nadu, the concerns do not end there. Many are concerned if it is a threat to humans too.

Can H5N1 Virus Infect Humans?

As per the World Health Organization (WHO) data, between January 2023 and December 2025, a total of 993 human cases of avian influenza were reported in 25 countries. Almost half of them, which is around 477 people, died. The virus has a fatality rate of 48 per cent.

Two different studies, one done by the universities of Cambridge and Glasgow that show how avian flu strains are multiplying even when the body temperatures could hinder viruses. Whereas, another important study led by Indian scientists, by Philip Cherian and Gautam Menon of Ashoka University, published in BMC Public Health predict if H5N1 or the bird flu virus, could start spreading among humans. How quickly must we act to stop it?

Can H5N1 Virus Infect Humans? How It Survives In The Body?

Human influenza viruses infect many each year. The seasonal strains we see most often fall under influenza A and tend to do well in the cooler temperatures of the upper respiratory tract, which is close to 33°C. They are less suited to the warmer, deeper parts of the lungs, where temperatures reach about 37°C.

As per Science Daily, when the body cannot slow an infection, the virus continues to multiply and spread, which can lead to more serious illness. Fever acts as a protective response, pushing body temperature as high as 41°C. Until now, the exact reason why fever slows some viruses but not others has been unclear.

Avian influenza behaves differently. These viruses usually grow in the lower respiratory tract, and in their natural hosts, such as ducks or seagulls, they often infect the gut. Temperatures in these areas can reach 40°C to 42°C, which helps explain their greater tolerance to heat.

Read: Could Bird Flu Become The Next Pandemic For Humans?

Can H5N1 Virus Infect Humans? What Does The India Specific Study Reveal?

Using BharatSim, an open-source simulation platform originally developed during Covid-19, the researchers recreated what an outbreak might look like in real life. “The threat of an H5N1 pandemic in humans is a genuine one,” Prof Menon said, “but we can hope to forestall it through better surveillance and a more nimble public-health response.”

Their model begins where experts believe a real outbreak would: with a single human infection, most likely a poultry worker or someone exposed to infected birds at a farm or market. The danger, the researchers argue, lies not in that first case, but in whether sustained human-to-human transmission takes hold.

The study by Ashoka University has the most sobering findings in how fast control can slip away. According to the simulations, once cases rise beyond roughly two to ten people, the virus is likely to move beyond immediate contacts and into the wider community.

If households of close contacts are quarantined when just two cases are detected, the outbreak can almost certainly be contained. By the time ten cases are identified, however, the model suggests the infection has probably already spread far enough that early interventions no longer make a meaningful difference.

To ground their work in reality, the researchers focused on a village in Tamil Nadu’s Namakkal district, one of India’s largest poultry hubs. With more than 1,600 farms, around 70 million chickens and tens of millions of eggs produced daily, the region reflects the kind of dense human-animal interaction where spillovers are most likely.

In the simulation, the virus spreads outward from a single workplace into homes, schools and markets, tracking primary and secondary contacts. Once “tertiary” infections, contacts of contacts, appear, control becomes dramatically harder without severe measures such as lockdowns.

Read: Bird Flu Variant Can Now Withstand Fever, Sparking Stronger Human Threats

Can H5N1 Virus Infect Humans? What Works And What Does Not Work

Culling birds work, but only if it happens before humans are infected. Once the spillover is done, isolating patients and quarantining is the only option that can stop the virus, that too if done very early. Targeted vaccination could help raise the threshold at which the virus can sustain itself. Quarantine imposed too early keeps families together longer, increasing household transmission. Imposed too late, it barely slows the outbreak at all.