According to UN-Habitat, approximately one-third of the population in low- and middle-income countries (LMICs) lives in slums, informal settlements, or deprived urban areas. This translates to around 70% of the population in African cities and around 30% of the population in Asia cities living in slum-like conditions. In the context of the COVID-19 crisis, infection and mortality rates indicate that people living in such deprived communities are particularly vulnerable. In East Asia, Europe, and North America, there have been extensive COVID-19 responses; however, such responses and guidelines are not tailored to conditions in LMIC cities, and in particular, not to deprived communities.
Characteristics of deprived areas vary widely within and across cities worldwide, though a typical slum structure has one or two small rooms, commonly shared by more than three people per room. Taking the example of Dharavi (Mumbai) with an estimated 700,000+ people living in an area of 2 km2, it is obvious that social distancing is not feasible in such a high-density urban environment. In many deprived areas, hundreds of people have to share one toilet seat. In addition to high population density, characteristics of deprived areas include poor quality and absent infrastructure resulting in open sewers, uncollected trash piles, few if any communal water taps and toilets, and informal electrical lines. Such environments contribute to the outbreak of infectious diseases and make following WHO advice for COVID-19 impossible. Since many countries went into lock-down, the informal economies, normally a significant source of livelihoods for communities, largely collapsed, causing local food crises on top of local health emergencies.
Yet, deprived communities are requested to follow guidelines developed without understanding local conditions, and community members have been exposed to criticism for not following social distancing and other COVID-19 guidelines. Little attention has been paid to the practical solutions proposed and being rolled out by slum dwellers and local authorities to mitigate COVID-19 in dense, low-income settlements. These include community-based interventions such as installing Tippy Tap hands-free handwashing stations, agreeing on a one-way foot traffic system for narrow paths, and limiting foot traffic between different parts of slums. As of mid-May 2020, official WHO advice offers generic solutions assuming conditions found in planned and better-off areas of cities, focused on individual and household interventions: keep a distance of at least one metre from people who are coughing and sneezing, wash hands regularly with an alcohol-based gel or soap and water, stay home if experiencing symptoms of COVID-19, and sneeze and cough into a bent elbow or tissue that is immediately discarded. Not only are these measures difficult to follow in crowded homes and neighbourhoods, this advice requires a working WASH infrastructure. Additional advice is urgently needed for high-dense low-income communities. Perhaps this advice has not been forthcoming because LMIC cities and nations lack a clear picture of where, and how many people, live in deprived urban settlements?
As COVID-19 infections accelerate in LMICs, municipalities and deprived communities need to be urgently supported for appropriate responses. Evictions, such as those that recently happened in Kariobangi (Nairobi, Kenya), need to be stopped. Communities can continue to self organise; however, ultimately some outside assistance for food, testing, and treatment are needed. So far, government responses to COVID-19 in LMICs include cash transfers to the poorest residents, food distribution, isolation centers, and mobile testing stations. However, without maps of deprived areas and reliable estimates of their total populations, millions of the poorest are falling through the cracks. Data on slums, informal settlements, and other deprived areas – in particular, spatial data – are not readily available handicapping governments, aid agencies, and civil society organisations from effectively locating and providing relief. If routine, accurate maps of urban deprivation had been available before COVID-19, the story for more the world’s one billion poorest could have been very different.
