The Covid-19 pandemic has underscored the immense gulf in healthcare systems between the richest and poorest countries, as well as the inequalities within nations, writes Amit Wanchoo, a 2018 AsiaGlobal Fellow and Founder Chairman of the H N Wanchoo Trust in Srinagar, Jammu and Kashmir, India. For millions of people in developing nations, who cannot afford soap let alone hand sanitizer, the arrival of coronavirus is another threat in an already stressed existence. As the world fights this global health crisis, there is an opportunity to redesign health policies with the same broad goals for everyone but with a country or area-specific methodology of planning and execution.
Keeping apart in India: Almost one-third of the world population lives in substandard accommodation, without running water, sanitation or anything approaching privacy (Credit: Bharat Meraki)
The coronavirus pandemic has opened many tears in the global social fabric but we should see the outbreak not merely as a crisis, but also as an important life lesson. Covid-19 does not differentiate on the basis of ethnicity, caste, creed, color, religion or economic status. It does not distinguish between a developed and a developing country. It does not recognize passports, visas, immigration or asylum.
One of the key terminologies that the coronavirus outbreak has engendered is “social distancing”. I would rather use the term “physical distancing” because socially we should remain connected. But what is the meaning of self-isolation or physical distancing for the world’s poor?
Almost one-third of the world population lives in substandard accommodation, without running water, sanitation or anything approaching privacy. Many of the world’s poor struggle to accommodate entire families of four to a dozen people in 8-feet by 12-feet rooms. Recent news from Singapore about a surge in coronavirus cases among migrant workers living in cramped dormitories illustrates how, even in a wealthy economy, an “invisible” underclass can exist in such conditions. How do we expect such people to follow self-isolation or physical distancing?
Guidelines set by the World Health Organization (WHO) to prevent the spread of Covid-19 include physical distancing, hand washing, staying indoors and other supportive measures. But the poor and underprivileged do not have access to clean water and cannot afford soap let alone hand sanitizer, while protective gear such as facemasks and gloves are beyond their economic reach. They are more likely to die of hunger than from Covid-19. Humanity has failed them.
In China, a lockdown strategy was initiated first in Wuhan and then widened to other areas. Many countries and regions followed that policy partially or completely from January onwards. In Asia, Taiwan, Singapore, Vietnam and Hong Kong pursued similar strategies, limiting cross-border travel and restricting movement or requesting citizens to stay home and to work from home if they could do so.
In India, a 21-day lockdown began on March 24. The short notice generated stress among the public, resulting in panic buying, hoarding and a disorderly evacuation of major cities by millions of migrant workers seeking to return to their homes in small towns and villages without public transport. The service and manufacturing sectors of major cities of India are dependent on such labor. Most of these workers migrate for economic reasons to cities but their social security nets remain in their hometowns.
As the Covid-19 crisis unfolded, these migrant laborers could neither work from home nor be paid in advance for the lockdown period. Their sustenance is directly dependent on daily earnings. Faced with the lockdown and without money, food or affordable accommodation, many sought to walk hundreds of miles to reach their homes. One man from the state of Madhya Pradesh died en route. After the initial chaos, the Indian federal and state governments took some measures to help them get back home, arranging quarantine centers with basic amenities or providing transportation. Delhi’s administration activated about 1,100 community kitchens feeding two meals a day to 800,000 people.
There has been a significant increase in interstate migration of the labor force in India. The 2011 census counted more than 45 million economic migrants. This figure has risen by close to 9 million per year since then, with many more believed to be uncounted by official data.
Migrant laborers are the engine of many economies including India’s and every sector is dependent on them but they are the ones who suffer most in an economic crisis. In India, one of the major issues posed by the exodus from cities was the transmission of Covid-19 infections through these workers to rural India, where primary and preventive healthcare infrastructure is weak, making it difficult to fight any community transmission at the rural level.
Of course, migrant laborers and the underprivileged face similar challenges across the globe, as do marginalized groups such as the homeless in richer countries. The situation in Singapore in recent weeks has highlighted the problem in one of the world’s wealthiest countries and international cities, where poverty is “invisible” even though migrant laborers are visibly contributing to economic growth.
The developing world of course has a disproportionate number of slums and shantytowns, which are particularly susceptible to the spread of disease through crowded conditions and poor sanitation. From Orangi Town in Karachi to Dharavi in Mumbai, from Kibera in Nairobi to Neza in Mexico City, life under lockdown is even harder with a lack of toilets and other basic needs and people living in rudimentary housing vulnerable to adverse weather.
Even as global media has focused on how developed countries such the United States, Germany, Italy, France and Spain are finding it difficult to handle the Covid-19 crisis, the health, education and social-security challenges posed by the pandemic are all the more acute in the world’s low- and middle-income economies, especially those living in poverty. The World Bank announced that it would provide up to US$160 billion over the next 15 months to help countries "protect the poor and vulnerable, support businesses, and bolster economic recovery". Yet is unclear where, when or how these funds will be deployed and managed.
Another social challenge is the stigma associated with the coronavirus. US President Donald Trump has repeatedly and purposefully referred to the “Chinese virus”, defending his use of the term against accusations of racism from his critics. Brazilian leader Jair Bolsonaro’s politician son Eduardo upset Beijing by blaming China for the pandemic.
People of Asian descent around the world have been subjected to racist attacks. In the developing world, people have been hostile toward patients who have tested positive or are even in quarantine facilities. The emergence of “clusters” of infection, such as in a Christian church in South Korea or an Islamic center in India, have resulted in religious discrimination. In India, some patients who were diagnosed with Covid-19 committed suicide due to the associated prejudice. There is also a misconception in developing countries that this disease has come from rich people who travel by air.
All these recriminations and blame mongering obscure the most glaring and iniquitous discrimination that the pandemic is exposing – the inequality that still exists among nations and within economies. While the rich world is scrambling to procure the most and best medical equipment and medicines they can source for treating their sick – sometimes diverting shipments intended for other countries – low-income economies are not even in the race, with little or no money to buy more than the meager supplies they already have.
This international health crisis has created an urgent need for planning, management and implementation on a global scale. We have to design health policies with the same broad goals for everyone but with methodology of planning and execution tailored for specific national, regional or sub-regional requirements. Health policies have to be country and area specific, with consideration given to the local environment, resources and deliverables available. We cannot treat every disease all around the world in same manner, especially when focusing on preventive measures. Global public health governance – the WHO’s health policy and planning – needs a total makeover and shift from its baseline. The top priority of governments all around the world has to be to rescue the poor and underprivileged in their respective countries.
The coronavirus is named for the apparent “crown” or “corona” seemingly visible in images from electron microscopes. In the Hindi language, a near homophonous word is karuna, which means “compassion”. In this time of the coronavirus pandemic, we need to have more karuna for our fellow humans, especially those who cannot make a basic living in this crisis. Only through compassion for all can the world defeat the coronavirus without forcing the most disadvantaged to take the biggest risks and bear the greatest burden.
Goldin, Ian. (April 21, 2020) “Coronavirus is the biggest disaster for developing countries in our lifetime”, The Guardian, London, UK.
Mobarak, Ahmed Mushfiq; and Barnett-Howell, Zachary. (April 10, 2020) “Poor Countries Need to Think Twice About Social Distancing”, Foreign Policy, Washington, DC, USA.
Wanchoo, Amit. (March 26, 2020) “Living in Lockdown: Learning from the Kashmir Experience”, AsiaGlobal Online, Asia Global Institute, The University of Hong Kong.
2018 AsiaGlobal Fellow, Asia Global Institute, The University of Hong Kong