Risk, precarity, and necropolitics among informal waste workers in peri-urban Islamabad.

Objectives: To examine the occupational risks, health precarity and social marginalisation of informal household waste collectors in Bhara Kahu, a rapidly urbanising peri-urban area of Islamabad, and to interpret these risks through contemporary sociological frameworks. Study design: Qualitative case study. Methods: We conducted in-depth semi-structured interviews with 12 informal household waste workers and paired these narratives with targeted field observations in Bhara Kahu. Interviews were conducted in Urdu or Punjabi, recorded with consent, translated and thematically analysed using a reflexive approach informed by an interpretive phenomenological orientation. Interpretation drew on risk society, environmental precarity, structural violence and necropolitics to situate everyday harms within wider political and institutional arrangements. Results: Five interlocking themes emerged. First, workers reported an absence of enforceable labour rights and social protections, with verbal hiring, arbitrary wage deductions and no insurance, earning about PKR 18,000-25,000 per month (approximately 65-90 USD). Second, safety was systemically neglected: there was virtually no training, minimal provision of personal protective equipment and unsafe transport on open rickshaws. Third, untreated injuries and chronic illnesses were common, including lacerations, musculoskeletal pain, persistent cough and skin conditions, with delayed or foregone care due to cost, time pressure and stigma. Fourth, households faced constant hygiene strain, as crowded housing, poor neighbourhood sanitation and limited vaccination amplified exposures beyond the workday. Fifth, social devaluation enabled economic exploitation and job insecurity, normalising humiliation in public interactions and occasionally extending into clinical encounters. Together, these patterns reveal a sanitation regime that purchases urban cleanliness through sacrificial labour. Conclusions: Improving conditions requires formal recognition of informal collectors as a public health workforce, written contracts and social insurance, reliable PPE backed by practical training, routine vaccination and mobile health services, source segregation to reduce hazardous contact, and anti-stigma measures in communities and clinics. Without such changes, risk will continue to be shifted onto those with the least capacity to refuse it.