In Dr. Balram Singh v. Union of India, the Supreme Court expressed serious concern over the continuing deaths of workers while cleaning sewers despite its earlier directions to eradicate manual scavenging. The Court noted that 54 sewer deaths were reported in 2024 and 46 in 2025, raising concerns about the ineffective implementation of its orders. It observed that judicial directions had not sufficiently “percolated” to the local level. The Court also emphasized administrative accountability, rejecting attempts by States to shift responsibility onto private contractors. It held that senior administrative authorities must ensure compliance with the law and court directions. The Supreme Court issued show-cause notices to the Chief Secretaries of Maharashtra, Tamil Nadu, Rajasthan, Gujarat and Uttar Pradesh, asking them to explain why contempt proceedings should not be initiated against them. The judgment reinforces that manual scavenging violates human dignity and Article 21, and that constitutional and judicial protections must be effectively implemented on the ground.