Pakistani Christians in Sindh province are demanding justice after a 35-year-old sanitation worker died, having been exposed to toxic sewage and refused medical care by Muslim doctors who refused to touch his “unclean” body during Ramadan.

Ramadan is the holy month of Islam, in which Muslims fast from sunrise to sunset to strengthen their faith. The doctors refused to touch the sanitation worker because he was covered in sewage and touching the sewage during Ramadan would “displease Allah,” according to witness accounts given to the British Pakistani Christian Association (BPCA).

“My brother left our family home and arrived at his workplace at 7am as per usual on the 1st of June. The sewerage lines had been blocked for a few days and it is know [sic] this causes a build up of poisonous gases,” Parvaiz Masih, brother of victim Irfan Masih, told the BPCA. “Despite this knowledge senior managers demanded that my brother Irfan and his colleagues Shaukat and Yaqoob Masih enter the sewerage tunnel without safety gear to remove the blockage.”

It is not uncommon for sanitation workers to be forced to dive into raw sewage without protection in Pakistan. Most sanitation workers are Christians as Muslims refuse to do this necessary work, while Christians often belong to the lower classes and find no other choice to secure an income.

All three went down into the sewage. Irfan Masih lost consciousness and died of asphyxia, covered in sewage, because three doctors refused to treat him, his brother said. The doctors were named as Muhammad Yousuf, Allah Daad, and Jaam Kambar. The first doctor, BPCA says, protested that touching Masih’s body would “ruin his fast or make himself unclean which would displease Allah.” The others agreed. The man’s family tried to wash his body to prepare him for the doctors until a fourth arrived, who attempted to administer oxygen, “but the hospital had no available supply,” the victim’s brother said.

Irfan Masih’s mother, Irshad, also spoke to the Express Tribune, corroborating the story. “The doctors refused to treat him because they were fasting and said my son was ‘napaak [unclean]’,” she said.

The Pakistani newspaper Dawn reported that Nazeer Masih, the sanitation worker’s father, has filed a criminal complaint against the three men, identifying them more specifically as “Civil Hospital Medical Superintendent Jam Kunbhar, Medical Officer Yusuf and duty doctor Allahdad Rathor.” At least one of the individuals in question, Jam Kunbhar, is under arrest; all face charges of criminal negligence.

Police have opened an investigation following protests from the Christian community in Umerkot, Sindh, led by the family, who “carried his body from the Civil Hospital to the press club where they sat under a scorching sun for eight hours.”

Members of the Pakistan Medical Association held a counter-protest against the arrest of Kunbhar, challenging the veracity of the Masih family story, Dawn adds.

The incident has nonetheless caused an uproar in Pakistani media. The Express Tribune published an editorial stating the death “should make us all recoil in horror.”

“This is hardly the first time something like this has happened. Apparently sanitary workers are supposed to come to hospital in their Sunday best,” the Tribune editorial notes. “The doctors’ behaviour was classist and this is a practice many people engage in whether attributed to our colonial rulers or the influence from the Hindu culture that once called our land home. The onus of perpetuating the class system falls on us nevertheless.”

The editorial does not address the religion of the victims or the doctors, nor does it make mention of the fact that the doctors used the observance of Ramadan as an excuse to refuse treatment.

The Pakistani Daily Times‘ opinion column on the story does reject religious discrimination. “Over the years, our treatment of religious minorities has been inhuman. While the shameful discrimination against minorities goes on unchecked, and without any personal remorse — the society and the state has been collectively responsible for deaths of those employed as sanitary workers, either through acts of commission or omission,” the article reads.

The Daily Times goes on to note that the government has a long history of forcing religious minorities to do sanitation work for the Muslim majority, going to far as to ban Hindus from leaving the country after its establishment in areas where they could not find enough Christians to replace them.

The issues are related, however. Most Christians are part of the lower Dalit class due to the nature of Protestant proselytizing; most who converted to Christianity came from these lower classes upon the arrival of Protestant missionaries. As such, anti-classism groups such as the Pakistan Dalit Solidarity Network (PDSN) have also stood up to defend the Masih family.

“This is not a simple accidental death. This is a clear case of caste and descent-based discrimination, which is yet to be criminalised in Pakistan,” a statement from the group read. “People being discriminated on the basis of their professions and the refusal of emergency medical treatment on the basis of someone being polluted must be considered a criminal offence.”