India, Jan. 6 -- The recent deaths and hospitalisations in Indore due to contaminated drinking water expose a deeply troubling paradox. For the past several years, Indore has enjoyed the enviable distinction of being India's cleanest city - an informal benchmark for urban sanitation and municipal performance across the country. Yet these deaths underline a stark reality: A city can appear clean on the surface and still fail in its most fundamental public health responsibility - ensuring safe drinking water. This tragedy was neither sudden nor unforeseeable. It was the culmination of repeated and unheard complaints from residents of the localities affected, first reported as early as July 2025 and again in October 2025. Reports of foul-smelling and discoloured water flowing from household taps should have served as unmistakable warning signs for public health authorities. Instead, these signals were ignored until lives were lost. Subsequent investigations revealed leakages in drinking water pipelines that allowed sewage to seep into the municipal supply - a textbook failure of infrastructure maintenance, surveillance, and governance. This incident is especially concerning given that waterborne diseases have long constituted a major health burden in India. Every year, lakhs of Indians suffer from diarrhoeal and other water-related diseases, many of which are fatal. Unsafe water and poor sanitation have historically contributed significantly to child mortality and long-term ill-health. While the economic cost of these illnesses is enormous, the social cost is even higher. Children, women, the elderly, and particularly poor and marginalised communities bear a disproportionate burden, as preventable illnesses push families deeper into poverty through health care expenses, lost wages, and long-term vulnerability, thereby perpetuating inequities. Indore's tragedy is not an isolated episode. Unsafe drinking water remains a persistent challenge across Indian cities. The Indore episode highlights a narrow policy focus that prioritises sanitation scores and visible cleanliness over holistic drinking water safety and robust public health infrastructure. Many Indian cities have not modernised their water supply systems for decades; Indore's own drinking water network is nearly 120 years old. The core problem is not merely ageing pipelines, but the absence of coordinated action on water quality monitoring, weak maintenance systems, and poor responsiveness to early warning signals. Contamination is often allowed to persist until it reaches crisis proportions. Policy responses must, therefore, be substantive rather than cosmetic. Real-time water quality monitoring systems that can detect microbial and chemical contamination - at the source, during distribution, and at household taps - should be made mandatory and their findings placed in the public domain. Urban pipeline infrastructure requires urgent upgrading to prevent leakages and cross-contamination, with a clear physical separation between sewage and drinking water networks. The Indore incident should serve as a wake-up call for every municipal authority in urban India. Cities must adopt comprehensive water safety plans that integrate source protection, treatment processes, distribution integrity, and community feedback mechanisms. Citizen complaints must be recognised as early warning signals and addressed through accessible reporting platforms with guaranteed responses within fixed timelines. Equally important is dedicated financing. Urban local bodies must allocate resources not only for sanitation drives but also for water quality laboratories, routine testing, and rapid-response capable of intervening before harm occurs. Coordination between municipal corporations, health departments, and water utilities is essential to avoid siloed decision-making. While Indore has focused on urban water supply, drinking water availability and quality remain major challenges across both rural and urban India. Nearly 85% of India's drinking water needs are met through groundwater. However, samples from multiple sources indicate that around 15-20% of these sources contain excess fluoride, nitrates, iron, or other contaminants, rendering the water unsafe for consumption. It is estimated that nearly 70% of India's drinking water does not meet prescribed quality standards, and more than half of the population lives in areas facing drinking water insufficiency. In a recent global water quality assessment, India ranked 120th among 122 countries. As water demand continues to rise, local governments have failed to build infrastructure at the pace required to meet both quantity and quality needs. Government initiatives such as the Jal Jeevan Mission, aimed at expanding household water supply, are commendable. However, access alone is not sufficient. Equal emphasis must be placed on ensuring the safety, reliability, and adequate availability of drinking water, particularly for underserved and marginalised populations. For everyone, the Indore incident is a sobering reminder that cleanliness is not merely about swept streets and garbage-free public spaces. True urban public health rests on less visible foundations - safe water, resilient infrastructure, and accountable governance. The history of global public health offers a clear lesson. The cholera pandemics of the 19th century prompted sweeping sanitation and water reforms in Europe, laying the foundations for sustained health, economic gains, and increased life expectancy that continue to this day. Yet in India, policymakers, programme managers, and urban administrators too often appear to have mastered the art of inaction - applying layers of colourful paint to the exterior while ignoring the crumbling structure within. The Indore water contamination crisis is a warning that must not be ignored. It calls for a decisive shift from symbolic achievements to substantive public health protection. This is a lesson not only for Indore, but for every Indian city, rural area, and state that claims progress without securing the most basic of rights for its citizens: Assured access to safe drinking water. We can, and must, do better - and the greatest responsibility lies with our elected governments....