Pakistan COVID-19 quarantine: Inequalities and resilience

An organization delivers food aid in Pakistan on Good Friday, during the global pandemic. (Photo by Rubina Bhatti)

By Nadeem Bhatti, Canadian Aid To Persecuted Christians

The deadly COVID 19 pandemic has shaken the world badly, affecting 205 countries around the globe, including Pakistan.

The rapid growth in the number of people infected with COVID-19, the disease caused by the new coronavirus SARS-CoV-2, is overburdening health systems, causing large-scale loss of life and severe human suffering. It is posing a significant threat to the global economy, particularly affecting the most vulnerable and further stretching a social fabric challenged by high levels of inequalities.

Pakistan borders with two hubs of the corona outbreak, China and Iran. At the beginning, officials were somewhat casual about people entering Pakistan from overseas. In particular, lack of proper quarantine facilities and inappropriate screening procedures resulted in several infected people reaching the community from various international borders especially at the Tafton border (Pakistan-Iran border).

The first case was reported in Pakistan on Feb 26, 2020. The cases have multiplied since then. The transmission of the virus has now turned from international (travel) to local (community spread).

Current Confirmed Cases and Deaths in Pakistan as of April 20, 2020:

  • Total cases – 8,348
  • New cases – 710
  • Total deaths / New deaths – 168 /25
  • Total recovered – 1, 868
  • Active cases – 6, 312
  • Serious / critical – 46
  • Total cases per 1-million population – 38
  • Total deaths per 1-million population – 0.8
  • Total tested – 98,522
  • Total tests per 1 million population – 446

The sample size of population screened so far for the COVID-19 in a country of 207.8 million (Census 2017) inhabitants is too little and there may be potentially more undetected cases, which may multiply and appear in the next few weeks.

The world learned that restricting mobility and minimizing person-to-person contact is extremely crucial to control the epidemic. Physical distancing and quarantine is taken as a precautionary measure. Pakistan has been slow in response, but seems to be catching up as coronavirus spreads in the country. The decision to close western borders, ban public gatherings, close educational institutions and limit the international flights operation came on March 12, when already 28 COVID-19 positive cases were confirmed and many as-yet-unknown were anticipated.

The government initially imposed nationwide lockdown on March 24 for two weeks, which later was extended until April 30. Physical distancing, frequent hand washing and sanitizing, and wearing of face masks is advertised and recommended.

COVID -19 and urban inequalities

Pakistan’s 45.5-percent urban population lives in informal settlements. Thus, an estimated 34 million people live in kachi abadies – informal settlements with cramped housing and limited access to water and sanitation.

Likewise, nearly 73 percent of Pakistani workers make their living by working in the informal sector, where workers have only a limited access to social welfare.  This already-struggling working class and urban population is having a hard time escaping the infection and starvation at the same time.

Physical distancing, therefore, is a privilege. One must have a fairly large, fully-provisioned house to practice physical-distancing without any fear of privation and interference.

Frequent hand-washing is a privilege too. It means you have access to an exclusive water connection.

Hand sanitizers are a privilege. You need money to buy them at exorbitant prices.

Living through a lock-down is a privilege. It means you can afford to be home without being constantly haunted by the fear of losing your livelihood.

Strict lockdown in a country where about one quarter of its population earns only 300 rupees (roughly $2 CAD) per day is challenging. Although precautionary, a lockdown is yet disastrous for millions, hits hard the poor daily wagers (laborers, scrape dealers, food stall vendors, sales persons, domestic workers, tailors, barbers, public transport drivers or conductors, etc), who live day-to-day with nothing as savings to practice self-isolation and feed the family. The stress of losing income, jobs and the ability to feed their families is high. Due to the likely economic recession and vulnerability of the employed in the country, the COVID-19 may lead to significant increase in poverty and unemployment.

Initially the country was short of surgical masks, gloves and didn’t have Personal Protection Equipment for the front-line care-givers. The front-line fighters were not provided with all what was needed for their own safety. There have been reports of medics and paramedics being infected in the line of duty, serving without proper PPEs. Two doctors are reported dead and others have been put in isolation.

Gender inequalities

Women’s participation in the labor market is often in the form of temporary employment. As the effects of the COVID-19 pandemic roll through economies, reducing employment opportunities and triggering layoffs, temporary workers – the majority of whom are women – are expected to bear the heaviest brunt of job losses. It also adds to the unpaid and unappreciated work at home.

Most of the women living in slums domestic workers. With the spread of coronavirus, the fear has increased and these women were told not to come to work by their employers. They had already worked for almost one month but the majority did not receive their salaries, while others were laid them off for the upcoming few months.

In order to keep hospitals and the medical staff available for emergency situations, hospitals have closed their Out Patient Departments (OPDs) to decrease number of patients other than those affected by COVID -19. Only emergencies are dealt with. Approaching the hospital is an issue, either due to un-operational OPDs or the fear of catching the infection from hospital. Most births are now unattended.

In cases of shortage of food in the family, this affects the women most, as they choose to feed their children first and go to bed hungry themselves.

COVID-19 public service messages, lockdown and closure of educational institutions has psychologically affected the children. Parents having to keep them indoors mostly in cramped houses is creating a deep-down fear within them which they may not be able to get rid of in their life time. All educational institution are closed until May 31. So children are also losing out on education, missing their schools, teachers and classmates. The curtailed social mingling even within extended family is frustrating for children. The government has started “tele school,” but how many can study without resources or face-to-face and peer support?

Faith-based discrimination and inequalities

COVID-19 is a crisis for all human beings. The emergency needs to be addressed on humanitarian grounds. Yet, unfortunately, denials of rations to religious minorities by NGOs in different areas have been reported. It was very disturbing to learn that Saylani International Trust denied ration to the Christians and Hindu families. Someone present at the scene made a video and it went viral on social media and later in couple of print media.

Unconfirmed sources also reported that the health staff appointed to care for the COVID-19 patients in isolation wards mostly belong to the religious minorities.

Most of the sanitary workers cleaning the city and COVID-19 patients’ waste also belong religious minorities. They are not provided with occupational safety equipment or any hardship allowance. They are highly prone to catching the infection. However, they continue their services so that they don’t lose their jobs or income.

The worship places and religious festivals have not been dealt with equally. During Lent, Holy Week and Easter, churches stayed closed and gatherings banned. Law enforcing agencies patrolled to ensure the orders were followed. People attended the prayer services either online or at home within their families and showed that they are responsible citizens. Now prior to Ramadan, consultations between government and mullahs have taken place and it has been mutually decided that mosques will remain open under the Standing Operation Procedures.

There is a fear that the number of patients will increase significantly, further putting other people at risk and burdening the health system. The World Health Organization has warned that Pakistan’s COVID-19 cases could surge to 200,000 by mid-July.