Local response in health emergencies: key considerations for addressing the COVID-19 pandemic in informal urban settlements

Abstract

This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There are further challenges to do with the lack of reliable data and the social, political and economic contexts in each setting that will influence vulnerability and possibilities for action. The potential health impacts of COVID-19 are immense in informal settlements, but if control measures are poorly executed these could also have severe negative impacts. Public health interventions must be balanced with social and economic interventions, especially in relation to the informal economy upon which many poor urban residents depend. Local residents, leaders and community-based groups must be engaged and resourced to develop locally appropriate control strategies, in partnership with local governments and authorities. Historically, informal settlements and their residents have been stigmatized, blamed, and subjected to rules and regulations that are unaffordable or unfeasible to adhere to. Responses to COVID-19 should not repeat these mistakes. Priorities for enabling effective control measures include: collaborating with local residents who have unsurpassed knowledge of relevant spatial and social infrastructures, strengthening coordination with local governments, and investing in improved data for monitoring the response in informal settlements.

COVID-19 pandemic: environmental and social factors influencing the spread of SARS-CoV-2 in São Paulo, Brazil

“…Interestingly, Hamidi et al (2020) have reported that at county level in the USA, population density is not significantly related to infection rate possibly because of adherence to social distancing. In low-and middle-income countries though, high population density is commonly associated with informal urban settlements, being social distancing impracticable (Wilkinson 2020). The sensitivity analysis indicated the importance of the average income and the gross domestic product within the expanded metropolitan area of São Paulo, Brazil (Table 3) possibly due to higher frequency of international traveling of population living in wealthier neighborhoods.…”

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

“…6 7 While tight restrictions on movement may contribute to reduced disease transmission, there are social and economic consequences of locking down slums and the impact on access to healthcare. [8][9][10] It is the latter that we focus on in this paper. Effective public health strategies in slums cannot overlook the perspectives, insights and solutions offered by those who must work and live with them.…”

“…Effective public health strategies in slums cannot overlook the perspectives, insights and solutions offered by those who must work and live with them. [8][9][10] Our study forms part of the NIHR Global Health Research Unit on Improving Health in Slums, a multipartner, multimethod collaboration 11 exploring healthcare and access in seven slums in Bangladesh, Kenya, Nigeria and Pakistan. Although the term 'slum' is widely debated, for this paper, we define a slum as an area of high population density that lacks sanitation, clean water, safe and durable housing, as well as basic services.…”

The Spatial Dimension of COVID-19: The Potential of Earth Observation Data in Support of Slum Communities with Evidence from Brazil

“…In the case of COVID-19, characterizing the spatio-temporal burden of diseases at a community scale provides critical support to city authorities and community-based organizations for the development of targeted strategies to minimize virus transmissions and provide better healthcare. This problem is not specific to the COVID-19 pandemic, as UN-Habitat also acknowledges that, within cities, there is a "lack of data" on deprived areas that do not allow for effective responses to most emergencies [14]. Data on such areas often lack reliability and information about the number of people, along with their health conditions.…”