Summary box
Responsive and timely research is needed to better understand the challenges faced
by poor and vulnerable populations to inform immediate interventions and policies
to address this unprecedented COVID-19 modern-day pandemic.
There is a need to research changes through time to understand and address the continuous
and long-term economic, mental and emotional impact of lockdown on the most marginalised.
Many of the Bangladeshi population are vulnerable, yet the COVID-19 response focuses
on individual behaviour with limited attention to the social, economic and contextual
factors that prevent the most marginalised from following national recommendations.
In the context of structural constraints, continuation of the lockdown has to be accompanied
by strong political resolve to ensure that people do not go without basic meals and
have basic health information and support.
The experiences of people living and working in slums in Bangladesh needs to be captured
and translated to context specific strategies for lockdown, as current measures risk
starvation for many.
In the context of COVID-19, the lockdown model is being imported from a different
context (western or developed economies) with stronger economic bases and better social
safety nets for those in need, but is there a better way forward for low resource
contexts?
Economic mortalities may overtake health mortalities for the poorest who survive on
daily wage labour.
Rapid responsive research in Bangladesh is revealing the realities of lockdown for
the poor and vulnerable
In Bangladesh, the James P. Grant School of Public Health is undertaking responsive
research to try and understand the needs of the population during COVID-19. The multidisciplinary
research includes 80 case studies in urban slums to capture the lived experiences
and the impact of shutdown of the people living and working in Dhaka during COVID-19.
In addition, a rapid large scale urban/rural survey is being conducted via phone interviews,
with follow-ups, aimed to assess the possible effects of the pandemic on several domains
of a household or family such as consumption, income, health, coping strategies, psychological
well-being and gender. The survey takes a dynamic approach: questions are modified
based on current understandings and relevant emerging issues related to the crisis.
With a focus on marginality, interviews have taken place with the transgender group
of people commonly known as ‘Hijra’ in South Asian countries and with street workers
including adolescence and young adults.
Reading these data alongside media reports and articles on the coronavirus pandemic,
one is overcome with a range of emotions: depression, paralysis, anger, denial and
helplessness; emotions that are reflective of being privileged and of having the luxury
to dwell on them. For the vast numbers of the poor, microbusiness owners, labourers,
transport workers, informal sector employees and many other groups who depend on daily
wages/earnings and have no social safety net, there is now only the pain of hunger,
not figuratively, but literally. With the shutdown now extended to a month, these
groups are under real threat of starvation. There are international conventions and
declarations on the right to food, on the right to be free from hunger.1 Yet the world
suffers from an estimated 9 million people dying of hunger and hunger related diseases
annually, more than AIDS, malaria and tuberculosis combined.2 It is the world’s biggest
health problem, and with entire countries and economies now under lockdown, it risks
getting much worse for those who live in difficult environments. Although Bangladesh
has achieved a lot over recent decades, with improved availability of food due to
increased production, 40 million people—one quarter of the population—remain food
insecure, and 11 million suffer from acute hunger.3 These figures will worsen after
the impact of COVID-19.
For many, every day is a battle: COVID-19 is one addition to a long list of challenges
for survival
The poor and the vulnerable with their erratic and meagre earnings somehow manage
to keep fighting and living and demonstrating impressive resilience, being confronted
with illnesses and deaths is an everyday reality for many. While there is fear of
the coronavirus, there is also the acceptance that it is yet another addition to an
already long list of health challenges that they face. Furthermore, with access to
their sparse resources being severely constrained or denied as a result of the shutdown,
for many, the immediate threat to consumption for survival, and not necessarily the
pandemic, is becoming a greater concern. BRAC’s (NGO) conducted a rapid perception
survey on COVID-19 conducted between 31 March 31 and 5 April 2020 for instance found
that 18% and 10% of urban and rural respondents, respectively, had no food stored
at home, while 37% and 21%, respectively, had only 1–3 days food reserve.4
Figure 1 shows ‘looting goods from a truck carrying relief’
(source: photo TBS (The Business Standard), 12 April 2020).
Figure 1
Looting for Food: Desperation Sets In.
The focus on individual behaviour prevents the poorest from following national recommendations
Health bodies and various governments have been promoting different measures to contain
the pandemic that focus on individual behaviour with little attention to the social,
economic and contextual factors. Public health preventions tend to be based on the
biomedical virus and individual determinants of health, whereas for millions, the
stark living conditions, social and contextual inequalities and realities of how and
where they live prevent them from following such recommended guidelines. There needs
to be a recognition of the complexity of factors that underlie and impact on marginalised
populations lives. Practising social distancing, washing of hands with soap and staying
at home are all very well for the privileged who can afford to do so; however, for
the poor with 5–6 or more members crammed in one room within slums, sharing irregular
water supply, communal latrines and cooking spaces, in some of the dirtiest and densest
places on earth, such messaging needs urgent adaptation to reflect the realities of
context and support is critical.
The poor and vulnerable already live on the edge. The added stress of the pandemic
combined with prolonged shutdowns will amplify further their despair and hopelessness.
While health is a very real concern, for Bangladesh to sustain the shutdown requires
all of us to focus all of the country’s resources on ensuring that no one goes without
food. We have to believe the rest will follow, once this is ensured. If not, as Nobel
Laureates Esther Duflo and Abhijit Banerjee highlighted with respect to the situation
in India, the poor and the vulnerable will be left with no choice but to break the
shutdown for their livelihood.5
The last interview of an adolescent street peddler stated, ‘how much longer? We heard
four more days. We have no food, no money’. These narratives are typical for most
of the poor families we interviewed, in similar distress and concerns were echoed,
much more in the urban surveys compared with the rural surveys (for now) and case
studies in Dhaka city urban settlements with mainly the informal workers, who are
dependent on daily wages to survive. Try imagining, if you can, the gut-wrenching
panic and anxiety, when many of them learn it will be an additional 10 days or more.
Rumours that the shutdown may continue until end of April or even May is going to
lead to unimaginable consequences on the poorest and for the country as a whole. We
need a socially just model to tackle this pandemic, and this requires us to acknowledge
the fault lines that exist in our underlying assumptions as well as the very real
inequities that exist between the poorest and others.
Political commitment for economic support for the poor needs urgent and effective
implementation
Bangladesh, like many other countries, has rolled out an economic stimulus package
to address the severe economic and business fallout from the pandemic. The government
is also in the process of unveiling support for the poor. This scheme will also include
support for farmers who are critical for ensuring the food supply chain for all of
us—the rich, the middle class and the poor. While this package should really have
been the first step taken by the state, it now needs to be implemented efficiently,
systematically and equitably. There are numerous articles and reports detailing the
mismanagement,6 7 favoured groups in communities and a complete lack of coordination
between different bodies involved in distributing the initial state funded food and/or
cash aid programmes.8–10 This has to stop. While there is no easy solution or strategy,
for Bangladesh and its high proportion of vulnerable populations, continuation of
the shutdown has to be accompanied with strong political resolve to ensure that people
do not go without food and have basic health information and support, given the grounded
realities of their lives. Otherwise, it will be the final nail in the coffin for the
poor and maybe even beyond. The trauma and enormity of what will unfold if this is
not done properly cannot be emphasised enough.
The shutdown or lockdown model has been imported from western or developed economies
with stronger economic bases and better social safety nets for those in need. But
is it the only way forward? China, Hong Kong, Singapore, countries that were successful
in containing the first wave, are now facing a resurgence largely due to infections
coming from outside travellers, and some countries have begun reinstating containment
measures again.11 How long can a shutdown be sustained in a largely different context?
While this is an entirely unknown territory, Iran’s president for instance declared
that ‘low-risk’ economic activities will resume from April 11 in spite of the virus
not being contained.12 The Iranian government is thus balancing the risks of the pandemic
versus further wrecking a sanctions battered economy. Sadly, countries with large
pools of poor populations may soon be forced to confront similar trade-offs, with
all its moral and ethical implications, if there is no solution soon in sight.
The political and social actions taken now at the global, national, subnational and
local levels to understand and meet the needs of the urban poor are essential to addressing
the current pandemic and also in preventing a post-COVID-19 rise in people experiencing
extreme poverty and death from the wider social determinants of health. If action
is taken now, there is a chance to learn and build cities that are more resilient
and responsive to future crises. Having a responsive research agenda is the first
step to informing, developing and delivering policies and strategies that are informed
by data, within Lower Middle Income Countries (LMICs) and in all countries and contexts
where inequities exist. However, these must be developed in partnership with civil
society organisations, community leaders/gatekeepers and residents who know what is
needed to make a difference, now and in the future. There is also a need to engage
in cross-country discussions to share learnings from previous emergency responses
in urban settings and support sharing and solidarity around current promising strategies
across and between different contexts.