Slums provide uniquely challenging conditions for containing the coronavirus and confronting the threat of COVID-19. There may be no ambulances. No hospitals. No tests. No or few police. Only some of the most densely populated places on earth. When COVID-19 reaches the world’s slums, few policy options are available; and those that exist often entail hellish bargains with the criminal groups that so often rule such areas.
Poor areas that surround the developing world’s great urban centers are crowded places where one-room shacks may house a multi-generational family. They are deprived of public services, with water for drinking and washing often only available at communal distribution points. Sometimes, criminal groups in collusion with corrupt water authorities sell water from tankers or street carts. Washing hands diligently is impossible. Shacks lack toilets and entire neighborhoods have no sewage systems. Since households don’t have electricity or refrigerators, stocking up on food is not feasible. In the absence of a safety net, staying at home can mean starvation.
Quarantine restrictions are compounded by the lack of official law enforcement. Social norms and the suppression of street crime are frequently provided not by police but by criminal or militant groups, even though they themselves are perpetrators of criminality and violence. In some cases, such as in Rio de Janeiro’s favelas, local criminal gangs have already taken it upon themselves to declare a coronavirus-related curfew, trying to mount some public health measures despite President Jair Bolsanaro’s downplaying of the pandemic.
Criminal groups may even distribute some public resources such as water, soap, or food to families of the sick, seeking the political capital with which they rule slums. In other cases, governments and politicians who sometimes clandestinely, and other times openly, outsource the management of slums to criminal groups will explicitly ask these groups to contain the spread of COVID-19 in the areas they control. In some neighborhoods an enhanced police or military presence is considered predatory and would be met by local resistance.
Yet quarantine enforcement by criminal groups can be a dangerous strategy. Criminal groups can exploit the opportunity to eliminate their criminal rivals or opposition by civil society groups. They can use quarantines to tighten their hold on territories and the delivery of vital services and essential commodities, jacking up prices to prohibitive levels. Pogroms against ethnic minorities or migrants, falsely labeled as disease carriers, are a high risk in places such as India, Pakistan, and South Africa, where minority groups are routinely subjected to violence. Governments may ask criminal groups to restrict movement of the community members, secretly paying or encouraging criminals to act violently against anyone attempting to leave the slum-turned-ghetto.
When the virus hits these urban areas, the toll is likely to be catastrophic. There are few medical personnel or hospital beds, and likely no ventilators. Quarantined slum communities are not likely to have access to health systems built for the urban mainstream. The wealthy do not need to rely on public health provision, building their own clinics in their residences and buying up ventilators, as some of Russia’s millionaires as allegedly doing. Unlike the global response to Ebola, COVID-19 is ravaging the entire world, including countries that have traditionally staffed and funded the few international humanitarian medical groups capable of deploying to underserved areas of the world.
The first task is to hold both the governments and criminal groups accountable for the health and security of the urban communities under their jurisdiction or control. To the extent that medical isolation facilities can be established, such efforts should receive priority. Criminal groups must be informed that they do not have carte blanche to exterminate their opponents or marginalized groups or hike up prices of commodities and medicines in the name of COVID-19 precautions; they should face special oversight and prosecution if they use lockdown enforcements for such purposes.
In contrast, humanitarian groups seeking to deliver medical aid in urban areas controlled by criminal or militant groups must be made immune from for providing material support to illicit actors. Such criminalization of humanitarian cooperation with these groups exacerbated the mortality from the famine that struck Somalia in 2011 and has hampered access for humanitarian personnel to needy communities in areas outside formal state control. To the extent that local, often informal groups, such as youth or religious groups, can be mobilized for the dissemination of COVID-19 information or service provision — such as food delivery — governments and international actors should provide oversight and negotiated security.
It is also essential to anticipate the development of an efficacious medication or vaccine. Such efficacy demands urgent provision. Yet the poor are often the last to get access. This must not happen again. The world must pay attention to the plight of marginalized urban populations and craft COVID-19 responses that can successfully navigate the complex health and security realities that define both their vulnerabilities and resilience.