Fault-Lines in the Public Health Approach to Covid-19

Originally published in SSRN on 15 June 2020

Fault-Lines in the Public Health Approach to Covid-19: Recognizing Inequities and Ground Realities of Poor Residents Lives in the Slums of Dhaka City, Bangladesh

In this paper we aim to better understand the lived experiences of the slum dwellers in Dhaka, Bangladesh and the social, economic and health and well-being constraints resulting from the nationwide shutdown due to COVID-19 pandemic. We undertook rapid qualitative research telephone interviews (51, 44 women and 7 men) with slum dwellers. We analyse the data using intersectionality theory. Findings draw on direct experiences on the impact of the shutdown on vulnerable groups living in informal settlements in Dhaka city. Highlighting the tensions between the current shutdown to address the spread of COVID-19 and the immediate and urgent (food and other) needs of poor and vulnerable groups. Slums are overcrowded, steeped in deprivation, with residents using communal latrines, water sources, cooking spaces, with many slum dwellers unable to follow the recommended guidelines for preventing COVID-19. Most were living in panic and fear of getting infected. Stress and anxiety were reported as their precarious existence deepens with the continued containment measures and were particularly reported by women, who were also experiencing increasing levels of violence. Food relief distribution remains uneven and beset with irregularities. While health risks are a very real concern, their overriding insecurity is starvation. We frame our discussion within recommendations made on C-19 and intersectionality highlighting the importance of learning from qualitative testimonies with women and men within the context of informal settlements at this point in lockdown; the need to move beyond a deficit model and recognize and support resilience; and the importance of broadening bailout and stimulus packages to prioritize those most at risk and ensure multi-sectoral action approach to this pandemic in Bangladesh and elsewhere needs to be accompanied by a socially just model that recognizes the ways in which structural, patriarchal and social inequalities interplay to place the poorest most at risk to multiple threats.