David Pratt: What's at stake for poorer countries in the pandemic

Sometimes, however, facts and figures can help encapsulate the scale or immensity of a crisis, as is the case with Covid-19 pandemic right now.

Just for a moment pause and consider these glaring global insights from a few of the countries and communities least equipped to tackle the onslaught of the coronavirus. Mali in West Africa, for example, has three ventilators per million people. In Zambia, there is one doctor for approximately 10,000 people.

In Pakistan, health spending per head is one two hundredth the level of the United States, one of the richest countries in the world which itself is struggling to cope with the effects of the virus.

Consider, too, that currently it’s estimated that more than 1.6 billion people worldwide live in substandard housing. Of those, at least 150 million have no home at all.

Then there are the 70 million displaced people worldwide. Among them are the Rohingya in camps on Bangladesh’s border with Myanmar and hundreds of thousands of Syrians escaping Idlib province crammed up against the border barrier with Turkey.

For many of these people, social distancing is a near impossibility as is regular hand-washing in places often already unsanitary and without clean running water.

As statistics go, if these are not enough to send a chill down the spine, then I don’t know what is. I do know that to talk of the world right now feels tough in these times. Each and every one of us are all intimately feeling the pain in one shape or form from the impact of coronavirus. But to ignore what is unfolding elsewhere in far-flung parts of the world is to do so at our peril.

As former President Ellen Johnson Sirleaf, who beat Ebola in Liberia, put it recently: “Coronavirus anywhere is a threat to people everywhere.”

While a truism in itself, if one other thing is certain in these uncertain times, it’s how history has shown us that pandemics hit the poorest hardest.

The Spanish flu of 1918-20 is said to have wiped out 6% of India’s population, the vast majority among the country’s poorest and most vulnerable. More recently most people who died of Aids were African, those from a continent where swathes of the population exist on or below the subsistence level and where healthcare provision is often sparse to say the least.

Just last month, Bill Gates, the American business magnate and philanthropist, warned that the pandemic could kill 10 million Africans if it were allowed to rip through the continent.

Right now it is wealthy countries that are the epicentre of this deadly virus, but, as Jose Maria (Chema) Vera, interim executive director of Oxfam International, ominously observed the other day, already Covid-19 has started to “prey through the colossal cracks that divide our world”.

So just what are the implications for the world’s poorest and most vulnerable as the pandemic takes grip within their countries and communities? What must be done to assist in militating against its worst ravages?

I say must because, as Abiy Ahmed, the 2019 Nobel Peace Prize laureate and prime minister of Ethiopia, rightly pointed out in the Financial Times last week, if Covid-19 is not controlled in Africa and other parts of the developing world, then it “would quickly bounce back on the rest of the world”.

Many of the world’s neighbourhoods the pandemic now threatens are the last stop.

These are places where a person can’t fall any further short of being totally destitute or dead. In many years of covering the world as a reporter, I’ve seen first hand the struggle to survive in these places of near unimaginable squalor and poverty.

Places like the slums of Kibera, Mathare and Korogocho in the Kenyan capital Nairobi, which are among some of the biggest in Africa.

In fact it’s estimated that 60% of Nairobi’s entire population, some 2.5 million people, are slum dwellers, many living up to 10 to a single room in little more than a corrugated steel shack.

In Korogocho slum in the city, countless people survive by scavenging the gigantic and infamous Dandora illegal dumpsite. There, thousands of tonnes of waste are heaped daily from across the city, including the unfinished food from the flights arriving at Nairobi’s international airport, where almost all the coronavirus cases gained entry into Kenya.

But those slum dwellers in Africa are far from alone in the teeming cheek-by-jowl existence and wretchedness that blights their lives.

Far from Africa, on the Caribbean island of Haiti, the poorest country in the western hemisphere and barely a few hours flying time from Miami and New York, people in slums like Cite Soleil likewise live one on top of another in an indescribably filthy warren of alleyways and concrete boxes.

During one visit, just after the devastating 2010 earthquake that has since made the situation worse, I was told how 60,000 people crammed into a single kilometre in parts of Cite Soleil. So congested was it that “shift sleeping’’ was common, and families would bed down on a rota basis, four hours inside and four hours in the alleyways outside. In such communities, the arrival of coronavirus is a near death sentence.

FOR both slum dwellers and often refugees alike, population density is perhaps the first in a series of factors that makes them extremely vulnerable to the spread of the virus. In the case of refugees, multiple families are often forced to share the same bathroom, the same cooking, and the same bathing facilities, if they have access to them at all.

Secondly, both groups generally have difficulty accessing basic services, especially healthcare. Thirdly, the limited access to reliable information for displaced communities will also complicate efforts to respond. Misinformation, mistrust of authorities, the absence of communication networks and language barriers can all prevent accurate and far-reaching messaging among those living in urban slums and refugees in informal camps.

“Without critical information about the coronavirus, the displaced may not only risk spreading the infection, but find themselves in violation of new policies,” warned the humanitarian agency

Refugees International in a newly published report addressing the threat posed by Covid-19 to already existing emergencies involving displaced people across the globe.

“At risk of deportation, asylum seekers without legal status are often reticent to trust local authorities, much less reveal themselves once they get sick,” the report highlighted.

For aid agencies the challenges are immense as their humanitarian supply chain may be broken by the outbreak and aid workers perhaps have to reduce or cut contact with communities to help prevent spread of the virus. Many humanitarian agencies also warn they will not have the training or resources to respond to such an unprecedented crisis.

All this before the role of politics impacts on the most vulnerable, as national governments often restrict the movement of international personnel and supplies, or close borders. Aid agencies fear a looming disaster both for slum dwellers and those refugees and migrants in informal camps.

“When the virus hits overcrowded settlements in places like Iran, Bangladesh, Afghanistan and Greece, the consequences will be devastating,” Jan Egeland, secretary general of the Norwegian Refugee Council, warned last week.

“There will also be carnage when the virus reaches parts of Syria, Yemen and Venezuela, where hospitals have been demolished and health systems have collapsed.”

Such challenges for aid agencies and the poorest are only made worse, of course, in those countries where the political leadership is scathing of the threat prosed by the pandemic.

In Brazil, for example, President Jair Bolsonaro has dismissed the coronavirus as nothing more than the “sniffles” and criticised regional lockdown measures.

Such is the anger with the Bolsonaro’s response that recently many of those living in Brazil’s low-income favelas or

unregulated slums in major cities took part in a “panelaco”, a protest that involves banging pots together outside a window and screaming insults such as “Bolsonaro, out!” and “Bolsonaro, assassin!”

Stepping into the breach, meanwhile, in the absence of a considered and concerted response by Bolsonaro’s government, Brazil’s drug gangs and paramilitary groups began enforcing social distancing to combat the spread of coronavirus.

Just these past weeks as the Covid-19 death toll has climbed, gang members have been circulating in the Cidade de Deus – City of God – favela in western Rio, ordering residents to remain indoors after 8pm.

THE community made famous by Fernando Meirelles’s 2002 movie blockbuster City Of God was among the first to record a case of coronavirus. “Whoever is caught on the street will learn how to respect the measure. We want the best for the population. If the government is unable to manage, organised crime resolves,” read one message circulated by WhatsApp to residents of one Rio slum.

But exceptionally bizarre responses such as this aside, it remains national government and help from the international community that most of the world’s poorest communities will depend on in their bitter struggle with the pandemic.

Time, now, is of the essence. Africa has reached a “break-the-glass moment”, an emergency in which international actors need to take drastic action if the world’s poorest continent is to avoid a human and economic catastrophe, Ken Ofori-Atta, Ghana’s finance minister, told the Financial Times last week.

The problem is that so many places are now facing their own “break-the-glass” emergency moment, with potentially nightmarish economic consequences.

More than 40% of the world’s poorest countries – and half of those active in international bond markets – were already in or at high risk of debt distress before the crisis hit.

Some 85 countries have already approached the International Monetary fund (IMF) for short-term emergency assistance in recent weeks, around double the number that called on the fund in the immediate aftermath of the 2008 financial crisis.

As many humanitarian agencies also point out, many responses will have very specific needs that require a strategy tailored to the circumstances of the population in question.

As the recent Refugees International report has made clear, however, there are common elements across countries and continents that should be part of any effective humanitarian response to the pandemic.

Among those identified include ensuring that the response must be inclusive, reaching all vulnerable populations, including slum dwellers, refugees, asylum seekers and the internally displaced.

It will need to enhance communication and flow of information, deploy medical personnel and protective clothing, improve access to water and hygiene and focus on isolation and quarantine capacities, as well as testing for the virus.

If there are positives in all of this, one of them is that the population of poor countries are predominately young with a median age of 20, in theory making many physically more resilient. But offset this against hunger, and already existing ill health, and it is of little comfort.

On a more constructive note, especially in Africa many lessons have been learned from fighting Ebola. But coronavirus is an altogether different proposition in terms of infection rate and spread.

The bottom line is that any response will be incredibly challenging and problematic for the international community and those organisations tasked with helping those most in need, not least as governments globally look to their domestic needs and demands during the crisis.

But it is precisely the scale and speed of the pandemic that has underscored how deeply interconnected the world’s populations are.

Across the globe the poorest and most vulnerable have sometimes been regarded as a kind of sea of lost souls, their lives ignored, hidden from sight or forgotten.

The coronavirus pandemic has reminded us all of the dangers in such blindness, as well as the moral imperative that exists to assist those most in need in overcoming the onslaught they now face.

Former Liberian President Ellen Johnson Sirleaf is right. Coronavirus anywhere is a threat to people everywhere.

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