Everyone who works at Rajindra hospital in Patiala knows Karamjit Kaur Aulakh. Their eyes follow the 35-year-old nurse as she walks around the hospital with the support of her crutch. Others stop by to ask how she is after her fall.

On 28 February Aulakh jumped from the dome of the main building at Rajindra hospital, where she had sat for 23 days on a rooftop hunger strike. The leap of almost 15 metres was a desperate cry for attention to her cause, and left her with three major fractures in her right leg. Joining her in the protest was her colleague Baljit Kaur Khalsa, who injured her spine in the jump.

“To have fear, there needs to be some kind of regard for life,” says Aulakh, who is president of the Punjab Contractual Nursing and Ancillary Staff Association. “What have I and my colleagues been left with to live for anyway?”

Aulakh’s act was in protest at the state government of Punjab’s refusal to regularise the jobs of 856 contractual employees at hospitals in Patiala and Amritsar, by adding them to the regular payroll. This number comprises 651 nurses, 75 ancillary staff members – mostly lab technicians and social workers – and 130 so-called “fourth class” workers including ward attendants and sweepers.

“I thought if I died, at least the [other jobs] would be regularised,” says Aulakh.

In Rajindra hospital – one of the biggest government hospitals in the state – only 50 out of 410 nurses are on a regular payroll with a monthly salary of between 45,000-80,000 indian rupees (£510-910). The 360 nurses hired on a contractual basis are paid 21,000 rupees.

“We are just as qualified as regular nurses. We even work more, having to take on night shifts that regular nurses aren’t required to,” says Aulakh. “So why are we paid less?”

The main building at Rajindra hospital, from which Karamjit Kaur Aulakh and Baljit Kaur Khalsa jumped. Photograph: Payal Mohta

According to Satish Chandra, secretary of health in Punjab, the contractual policy was introduced in 1995 to “reduce borderline salaries”. Members of the contractual association argue that the terms of the policy state that staff should be added to the regular payroll within two to three years of employment. For the past two decades, the Punjab government hasn’t done so.

Aulakh’s plunge finally forced the state’s cabinet to approve regularisation this March. But only 539 nurses were added to the regular payroll, while 112 recruits who joined in 2018, the entire ancillary staff and all fourth class workers were left off. The salary of the newly regularised nurses was also reduced to 10,500 rupees – half the previous rate.

“Any employee recruited on a regular basis needs to be kept on a provisional period for two years before we can offer them a full-scale payment,” said Chandra, in explanation of the salary decrease.

Since 2014, Aulakh has been demanding better pay and regularisation of contractual nurses. She has led at least three hunger strikes and jumped in the Bakhra canal at the end of one protest.

“Karamjit and I slept on the parapet of the dome, even on days that it rained through the night,” recalls 33-year-old Baljit Kaur Khalsa.

Nurses from Rajindra hospital march in support of the regularisation of their services, in January 2016. Photograph: Rajesh Sachar/Pacific Press/Alamy

Through her campaigning Aulakh had previously won better working conditions for contractual nurses – three months’ maternity leave at a reduced salary changed to six months of paid maternity leave, and four days off a month increased to eight. There was also the introduction of 15 days’ annual leave.

The cut in pay came as a bitter blow. “By cutting our salaries the government has devalued 13 years of my hard work,” said Aulakh, who joined the Rajindra hospital as a nurse in 2007. “By the end of the provisional period many of us will be of retirement age. Forget regular wages – we won’t even be eligible for pensions.”

An ancillary worker at Rajindra hospital. Photograph: Payal Mohta

For Gurpreet Kaur, 32, an ancillary staff member, the news of her regularisation being denied means prolonged anxiety. “Contractual employees are treated like street dogs, with no dignity whatsoever,” says Kaur, who has a post-graduate qualification in social work and two specialised diplomas. “So many of us are on antidepressants and other sedatives to deal with the everyday stigma. How are we to serve and take care of the patients if we are so mentally disturbed?”

Back in her one-room staff quarters at Rajindra hospital, Aulakh rests her injured leg. The fight isn’t over for her.

“I was just 21 when I began working. I had such big dreams for myself,” says Aulakh, who comes from the small town of Mansa in Punjab. “But I just kept struggling. This job stole my youth and even in my old age I have no security. It ruined my life.”