Why COVID-19 poses a particular threat in the world's slums

One of the bitter ironies of life for one billion slum dwellers in our world today is that, despite humanity’s progress, their greatest vulnerabilities stem from the lack of the most basic public services: access to water and sanitation. Science has conquered deadly diseases over the past century and even started 3D-printing human organs, but governments have failed in the primary task of extending clean water and sewage coverage to all areas within their capital cities.

The global risks embedded in the unsanitary conditions and other failures in global urbanization patterns are now coming back to bite humanity – collectively, given how interconnected cities are through air travel, trade and investment flows. Vast urban areas cut off from the public benefits associated with modern states – starting with basic sanitation and extending all the way to security and broader socioeconomic development – are weak links in a chain of cities now fighting the spread of a global pandemic.

COVID-19 and its fallout highlight how failures in urban governance can exacerbate the social impact of threats facing our world. Challenges that may seem local and confined to low-income areas often undermine broader development and even political stability. Armed violence is a prominent example: in the Pakistani mega-city of Karachi, the Taliban has been suspected of shooting workers conducting polio vaccinations. Militia in cities near armed conflict often control and even block access of local dwellers to healthcare. In Mathare, a slum in Nairobi, Kenya, gangs often demand payment for access to public toilets. Urban-based armed groups, therefore, profit on provision of public services, damaging the population’s trust in government and negatively affecting public health at the same time.

Settlements like Mathare will become crucial battlegrounds if COVID-19 spreads further in sub-Saharan Africa, where 55% of the urban population lives in slums. Alongside Sars, Mers, swine flu and Ebola, the coronavirus fits into a trend of increased global incidence of infectious diseases in the 21st century that scientists believe is partially linked to the unprecedented number of people agglomerated in cities. Research on links between public health and urbanization has shown that cities' peripheries are especially susceptible to infectious diseases that jump the animal-to-human species boundary. The COVID-19 pandemic, the Sars epidemic of 2002–3 and Ebola are all thought to have originated in animals.

This is extremely worrying for global public health, as the prevailing pattern of cities’ population growth in the developing world is precisely urban sprawl that encroaches on rural areas: horizontal expansion via slums and low-income peripheries, rather than vertical growth through taller buildings. This pattern places growing numbers of people in greater contact with potential vectors for “zoonotic” diseases – those that spread from animals to humans. A 2015 article in the journal Infection Ecology & Epidemiology says that hotspots for transmission of diseases from animals to humans “often correlate where the process of urbanization is on the clear rise”.

Governance failures further limit the reach of public policies and their effectiveness in sprawling slums. Governments have often been unable or unwilling (or sometimes both) to provide public services and institutions. With social isolation being adopted by governments throughout the world as a critical measure against COVID-19, the combination of density and lack of sanitation in slums is worrying, to say the least.

In the case of Latin America, which is highly urbanized in comparison with other developing regions, the assistant director of the Pan American Health Organization (PAHO) told Reuters he is concerned that the overcrowded conditions in slums “can be an accelerator for the transmission”. As Annie Wilkinson, a public health expert at the Institute for Development Studies, has asked: how can people comply with the two most basic government instructions to wash their hands thoroughly and isolate themselves “where water for basic needs is in short supply – let alone 20 seconds’ worth – and where space is constrained and rooms are often shared'?

Water access is another shortcoming in public services that carries implications both for slum dwellers' health and for broader social stability. Slums' lack of reliable access to drinking water has served as a tool for armed groups to increase their grip on communities by taking over water delivery. This has been the case, for instance, for water mafias allied with armed wings of political parties in Karachi, Pakistan, as well as for criminal gangs in Nairobi, Kenya.

Though cities concentrate plenty of vulnerabilities, however, they have also been sites for innovative policy responses to the pandemic. Municipal governments have developed and led responses to the health and socio-economic impact of COVID-19, ranging from changes in public transportation patterns to local emergency support measures for entrepreneurs.

A website created by UN-Habitat and partners currently lists 133 such municipal initiatives. As UN-Habitat Executive Director Maimunah Mohd Sharif has said, local and regional governments “are on the frontline” of responses – not just in regards to the immediate and significant challenge of keeping basic services going, but also in mitigating the longer-term socioeconomic impact on the poorest sectors of the population and the recovery of economic activity.

Interventions in the urban space – for instance, via improvements to housing, local public services or common spaces – are key tools to steer urbanization towards better and safer outcomes. For the sake of humanity's wellbeing, such improvements need to be scaled up at a global level to reduce vulnerabilities in our increasingly urban world.