Review of 'COVID-19 & informal settlements: is Stay Home safe?'

This is a very timely and important article that highlights the need to focus on informal housing and settlements which is essential in mitigating risks posed by COVID-19. The authors draw on their earlier work in India to showcase the abysmal conditions of these settlements which are characterized by poor ventilation, inadequate indoor and outdoor hygiene, absence of toilets, and crowding. These conditions, while increasing the levels of existing chronic diseases, also heightens the risk  of severe outcomes posed by COVID-19. Housing inadequacies are also directly linked to access to health services. Presenting health inequalities, often worse for women and children. Such housing conditions further increases exposure to infectious diseases, environmental pollution, while limiting a healthy lifestyle, and compromising general immunity.

Moreover, inadequate housing also poses restrictions in imposition of COVID-19 mitigation measures like social distancing, given the small size of households and often inter-generational; and makes recommendations like stay and work at home futile. Given that most residents are also dependent on community facilities to access toilets and water, physical distancing becomes impossible. The authors provide a comprehensive account of existing inadequacies both in terms of design, construction and architecture of housing facilities as well as the vulnerabilities these bring to fore for those residing in these settlements. The pandemic has indeed brought to fore housing inequalities and the risk of exposure to COVID-19 due to these inadequacies, which in turn does not allow compliance to recommended prevention measures- exposing a mismatch between recommendations and existing conditions on the ground.

While the authors sound out both immediate and long term recommendations to improve housing conditions and thereby reduce health inequalities, I believe, the authors could also benefit by highlighting some of the slightly success stories of COVID-19 management, particularly from Dharavi in Mumbai. Without undermining the long term suggestions for improvement, the case of Dharavi highlights the innovative ways that can be put in place by authorities, community and grassroots health workers to make the best out of existing resources and facilities. Also important are setting up of mobile testing clinics for early detection, thorough contact tracing and linkages to health care centers. Additionally, strengthening of local urban bodies through decentralization and provision of adequate social security and insurance (in current times), is essential. The article could also benefit from some statistics on informal settlements worldwide, how many people live in these settlements, income disparity etc.

To reiterate,  addressing housing deficiencies is mandatory in tackling the pandemic. Governments globally should take up the challenge now, since COVID-19 is not and will not be the last event of a zoonosis to impact the world.