A recent spike in deaths among Christian sewer cleaners in Pakistan has exposed the country’s long history of discrimination against religious minorities.

According to interdenominational human rights organization International Christian Concern (ICC), Christians make up between 80% to 90% of the sanitation workforce in Pakistan, including the country’s street sweepers, janitors and sewer workers. This percentage is an extreme over-representation, as Pakistani Christians represent less than 2% of the country’s overall population.

Many Pakistani Christians are descendants of lower-caste Hindus who converted to Christianity centuries ago. “Before the partition of India, what is now Pakistan was a much more diverse place,” says BBC News, “but tolerance has declined as society has become increasingly Islamicized and more homogenous.”

Municipalities in Pakistan rely heavily on Christians for manual labor, as many Muslims refuse to do the “dirty jobs,” and Christian minorities are illiterate with few other employment options.

“Almost all of them develop skin and respiratory problems because of constant contact with human waste and toxic fumes,” reports The New York Times. “And for some, the job has been lethal.”

Officially, Pakistan denies the existence of caste-based discrimination in the country, but prejudice is very much ingrained in the culture of the Muslim-majority country. In fact, doctors often refuse to medically examine sanitation workers, classifying them as “unclean” and “untouchable.” And in July, the Pakistani military placed newspaper advertisements for sewer sweepers with the caveat that only non-Muslims should apply. Only after activists protested was the religious requirement removed.

According to ICC, sanitation workers are considered temporary employees with contracts that expire every 88 days. They are then “rehired” every three months, again on temporary contracts. For many, this cycle goes on for decades until they are too feeble to work. No retirement benefits or pensions are offered. Sanitation workers get no days off—no weekends, no holidays, and are not even allowed to take sick leave.

“I get 15,000 rupees ($91) per month and work for 12 hours a day,” Perveen Bibi, a Christian sanitation worker, recently told ICC. “However, we don’t get salaries on a monthly basis. It depends on the officer’s mood. Sometimes he pays us after two months, or it may even stretch to three months plus.”

Christian workers in Pakistan are particularly vulnerable amid the COVID-19 pandemic since much of their work is done by hand, with no protective gear.

“We are scared of the coronavirus; however, we also need our jobs to feed our children,” Saleem Masih, a Christian sanitation worker from a government-run hospital in Lahore, explained.

“After hearing of the deaths in the gutters, I think about what will happen to my family if I die,” another Christian worker told The New York Times. “But Jesus Christ will take care of them.”

“I don’t care about my life as long as I can provide my family with a decent living.”