The first line of defense recommended by WHO against COVID-19 is social distancing and frequent handwashing. However, the aim to “flatten the curve” through these precautions can be extremely difficult to put into practice in heavily populated, informal urban settlements, where overcrowding makes the “two meter separation rule” almost impossible to practice. In addition, due to lack of access to basic services like water and sanitation, slum dwellers are most vulnerable and not ready to manage this epidemic. Hence, it is a justified supposition that slums can become a haven for COVID-19 and consequently lead to unrestrained spread throughout the country. Not only that, but the shocks to the domestic economy due to COVID-19 and measures taken thereof, in particular during the government mandated lockdown, to avoid its spread will further burden these structurally disadvantaged slum dwellers.
About a billion people live in slums all over the world. The UN Habitat defines slums as places that lack one or more of the following: (1) access to public water, (2) access to piped sewerage, (3) sufficient living space, (4) durable housing of permanent nature, and (5) security of tenure. Often perceived as an incurable nuisance, the urban poor (36.67% of the total population) in Pakistan are trapped in an “illegal” and informal world – in slums that are not reflected on maps and hence do not exist officially. This lack of administrative data adds to the problem. Policy makers who make the crucial choices are lacking high quality, high-resolution data on important questions such as: Are there priority areas that needs to be controlled to limit further proliferation? Where are the most vulnerable communities? What steps can be taken to help the most deprived? For policy makers to phase in a targeted policy intervention, identifying and delineating slum boundaries is crucial. Authorities can map areas with a high level of detail, using a combination of available primary data collection, such as Pakistan Bureau of Statistics and satellite imagery. As a result, initiatives taken by the government such as “Ehsaas Programme” or “Corona Relief Tiger Force” can be mobilized on a priority bases in these marginalized areas that are not covered by the existing social protection schemes.
COVID-19 is exposing a lot of structural disadvantages that low-income people face. Staying in, piped water and soap is a luxury for many. The grim reality is that more than 40% of the world’s population lack adequate access to basic handwashing facilities. The current lockdown has put the responsibility squarely on the government to be the main driver of proactive water resources planning to guarantee that sufficient water is available to vulnerable sections of the society for domestic and increased hygiene needs. A few urgent steps to managing water resources in the pandemic include, identifying hotspots of water insecurity in urban and rural areas to plan and implement contingency measures. In case of acute water shortages, alternative ways to support hand hygiene, such as providing hand sanitizers in unregulated slum areas is necessary. The government can also adopt a policy decision to defer utility bills until the pandemic crisis ends. A coalition of UN agencies under the banner of UN-Water with other programs and entities are providing emergency safe drinking water and handwashing facilities in key locations in slums and high-density public areas. However, such efforts are yet to be witnessed in Pakistan.
For a city to be prepared to fight COVID-19, it has to focus on its ability to prevent, detect, respond and care for patients. In the absence of community testing, it is unclear whether the outbreak has made its way into the urban slums yet. However, it is abundantly clear that concentrated efforts are required to prevent this cataclysmic wave of contagion in these socially “invisible settlements”. The families living in these slums do not have enough cash to stockpile food or pay for necessities; hence, majority of them can out migrate to their villages, which may exacerbate the extent of outbreaks in Pakistan. The government can get in touch with community leaders and groups from every slum to calm down the migrants and most importantly disseminate information about COVID-19. The situation calls for a rollout of urgent administrative measures, starting with affordable or free testing, identification and quarantine of bearers of the virus in slum areas. This would necessitate the provincial government to work closely with the union councils, the local zakat committees, private NGOs etc. for effective implementation of measures. Moreover, surveillance technology can be used to contain the spread of the virus and keep a tab on the whereabouts of the infected.
Lack of sanitation and public toilets can also be a source of coronavirus transmissions as per the new research in China. Chinese virologists have discovered that genetic material of the virus was found in the stools and rectal swabs of patients. Hence, it is very likely for the virus in the feces to be transmitted through the air, especially if you live close to an open drain, evidently seen in slums. An immediate corrective measure should be to cover to these drains and arrange for portable toilets.
Our most deprived and vulnerable communities face a “crisis within a crisis.” Perhaps, the only silver lining of the pandemic is the shared realization that we are all in this together. Even as we take care of our own families and neighborhoods, but allow it to go unchecked in the less-resourced areas, it will haunt us all.