Not everyone can "stay home" — here's why informal settlements are at risk. COVID-19 Lockdown
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As part of Covid-19 guidance, governments around the world have advised people to wash their hands and stay at home. But what if your closest clean water supply is outside your home, in a public location?
To effectively combat both Covid-19 and future public health crises, policymakers should improve data collection in informal settlements, collaborate with local residents, and strengthen cooperation with local governments. Informal settlements, or ‘slums’, are urban areas where housing structures don’t comply with government building regulations. Residents often squat or rent informally. Usually, these areas are a result of a lack of affordable housing, economic insecurity, and high migration — meaning that inhabitants are especially vulnerable to health risks such as Covid-19.
Informal urban settlements tend to have high population densities and housing densities, making effective physical and social distancing difficult. Household structures are flexible, with people moving between homes to sleep, prepare food, or provide childcare. As increased mobility is an integral feature of most informal settlements, any instruction to “stay at home” will most likely fail, argued the paper.
Residents of these settlements also experience limited access to clean water, prohibiting frequent hand-washing. The paper identified water supply as an area of high risk — not only is it scarce and often expensive but communal water pickup points could be sites of transmission while people wait in queues.
Self-isolation is almost impossible in homes without basic services. Residents need to leave to retrieve food and water for basic sanitation and hygiene needs and to participate in both social and economic networks. Most people living informal settlements are less able to store food, and banning movement could prevent them from purchasing clean water and food, potentially worsening pre-existing health inequalities.
A Covid-19 response that doesn’t take these features of informal settlements into account runs the risk of being not only ineffective but also harmful, the research warned. To accurately capture the unique vulnerabilities of each settlement, response planners need access to relevant and up-to-date data.
Understanding how health systems operate within informal settlements will be vital to creating a targeted Covid-19 response. While much of the global conversation has focused on hospital capacity, sick people in informal settlements are unlikely to visit hospitals in the first place. Instead, many rely on informal health providers or community advisers for health advice and visit pop-up pharmacies for treatments.
These local providers will know the most about community health. Travelling health workers are at risk of spreading infection, but will also have the most up-to-date information on where people are getting sick. Barriers to formal healthcare make it more likely that cases spread undetected, so crisis responders must engage with these community health carers to successfully track infections.
These insights should shape short-term efforts to combat the spread of Covid-19, but they also illustrate a larger need for change in urban planning and development. To improve public health, policymakers should prioritize effective health infrastructure in informal settlements, as well as invest in basic services such as water, sanitation and electricity