Coronavirus, Penn Pandemic Diary Penn Pandemic Diary, Entry #5: How to Fight Coronavirus in Slums

Chandan Deuskar is a PhD candidate in City and Regional Planning at the University of Pennsylvania and a Graduate Associate at Perry World House.

As I write this, it remains unclear how rapidly the coronavirus is spreading (or will spread) in slums in low- and middle-income countries Asia, Africa, Latin America and elsewhere. According to the United Nations, over a billion people worldwide live in slums, which it defines as settlements that are overcrowded, lack adequate shelter, or lack adequate access to water or sanitation. Slowing the spread of this disease is proving difficult everywhere in the world, but the virus could spread through these settlements—and their cities—faster than anywhere else.

Here are some of the special challenges that slums face during this pandemic:

• Slums often have very high population densities. Entire families or multiple families may share rooms. This makes ‘social distancing’ and isolating elderly or other vulnerable populations next to impossible.
• Slum residents often lack access to clean water, let alone hand sanitizers and disinfectant wipes. This makes the regular handwashing that authorities have been emphasizing difficult.
• Slum homes often lack private toilets, making it impossible to remain indoors.
• Slum households may rely on daily or weekly wages to pay for food, water, power, and phone service. Staying at home and not working for even a few days will create not just a health crisis but a broader humanitarian crisis if families are not able to feed themselves.
• Some residents of slums have limited literacy and education, which means that not all channels of communication about public health will reach them. At a time when everyone in the world struggles to differentiate misinformation received through hearsay and forwarded text messages from credible medical advice, it is particularly important to ensure that accurate information reaches everyone.
• Slum residents lack secure property rights. Many rent their homes using informal agreements which do not provide them with much legal protection. Landlords may forcibly evict households who show signs of infection, jeopardizing their health and that of whomever they come into contact with.

Throughout history, governments throughout the world have often blamed slums and their unhygienic conditions for outbreaks of disease, including cholera, malaria, and the plague. During such outbreaks, authorities have often bulldozed slums, causing a further crisis for households that are already sick or vulnerable. Such drastic responses also do not help contain the contagion but instead disperse it. Even if the coronavirus has entered most countries via wealthier international travelers and not poor slumdwellers, the stigma of “uncleanliness” faced by the poor around the world may still make them a target in this pandemic.

Instead of blaming the poor, what can government agencies, international organizations, nongovernmental organizations, and citizen volunteers do to face these special challenges in cities with large slum populations? Here are some suggestions:

• Prevent local governments from demolishing slums or removing households from slums, unless it is to temporarily accommodate them in a safer environment, guaranteeing their ability to return. 
• Get residents of slums involved in planning and implementing these measures. They may not be public health experts, but they are the experts on what will and will not work in their communities.
• Recognize that slums face special challenges and create a plan of action or convene a task force dedicated to combating coronavirus there.
• Deploy water trucks and supplies of soap to help residents of slums wash their hands more frequently to slow the spread of the illness.
• Devise alternate means of slowing the contagion which cater to what is possible in this environment and do not assume the ability to wash hands frequently and self-isolate.
• Find creative ways of communicating public health messages clearly and credibly among less-educated populations.
• Organize food banks which can feed out-of-work households if necessary.
• As long as this pandemic lasts, make it illegal for any landlord, formal or informal, to evict tenants. Take specific steps to ensure the policy is carried out in slums, including harsh penalties on landlords who flout this law.

Many governments, as well as the wider public, are often unsympathetic to the plight of slum dwellers in normal circumstances. Even if they are unmoved by the vulnerability of people in slums, they should recognize that this is a shared crisis, and rampant infection among any section of their population threatens everyone. Measures like these may be expensive, but if they work, they could help mitigate a public health and economic crisis unlike any the world has seen before.

The views expressed in the Penn Pandemic Diary are solely the author’s and not those of Penn or Perry World House.