March 30, 2020

The slum of Mathare, in Nairobi, the capital of Kenya, is a difficult place to live at the best of times. It is a warren of tin-roofed shacks wedged into a valley between a highway and a bleak, sewage-filled creek. Most of its residents live on at most a few dollars a day, working in backbreaking informal jobs.

Electricity is provided by criminal cartels who rig up dangerous connections to the grid. Cooking is done on charcoal fires which poison people’s lungs. People get water from shared standpipes or the river; cholera outbreaks are common. During election periods, anger often boils over into protests.

And with Covid-19 reported in Nairobi, things are looking particularly bleak for the people of Mathare. According to Fred Njoroge, a resident who runs a slum cinema, “the community has come together… People are taking precautions”. But it is not easy. “I am not staying in the house because I have to go find something to eat, people here, they cannot just stay in the house”.

He and his neighbours are taking turns to fetch buckets so that people can wash their hands. But even finding water takes time and effort. “We share the same toilets, all of us”, he says.

On Friday night, a curfew was imposed across Kenya, including in the slums of Nairobi. It was chaotic, with police beating up offenders, some of whom simply hadn’t made it home in time because of the punishing traffic. “They are telling us to choose between hunger or Covid 19”, says Njoroge.

The coronavirus has turned life upside down in rich countries like nothing else in most people’s lifetimes. Millions may die, and even if the measures our governments have taken succeed in preventing that, the hit to our economies will last much longer than the lockdowns. But though this challenge may seem incalculable from our comfortable living rooms, the one facing poorer countries is likely to be much more severe.

In most of Africa and the Indian subcontinent, health systems are bare, governments are weak and people are desperately poor. In cities, large proportions of the population live in slums like Mathare without much access to clean water. In Mumbai; 42% do; in Lagos, the figure is 66%. China has high levels of poverty too of course, but in trying to control its epidemic, it was able to use the full weight of its authoritarian state. The Nigerian state does not have such capabilities.

There is reason to hope poorer countries in Africa and Asia will avoid the worst of the epidemic. Some early research suggests the virus may spread less effectively in hot, humid climates. Populations are generally much younger — in most of Africa, the median age is under 20; in India, it is 27 — and young people do seem more likely to be able to shrug it off. Iran, which was hit early by the virus, has so far reported relatively fewer deaths than other countries in a similar point in their epidemic, despite its considerable poverty.

And for all that their states are weak, societies that are used to deaths from transmissible diseases such as malaria, tuberculosis and cholera are resilient in ways comfortable western societies are perhaps not.

But even if death rates did not reach the peaks seen in other populations, if the virus spread widely, it could still be devastating. There are over three billion people in Africa and the Indian subcontinent; if half were infected, and 0.5% died, that would be 7,500,000 deaths. And we have no idea what the effects would be on people who may already be sick with other diseases. Some 25 million people in Africa are living with HIV. In India 15% of the population are undernourished and half of all adult women are anaemic.

Truly effective social distancing measures might be impossible to carry out, but poor countries have to try them anyway. In India, where the state is more capable than many African nations, Narendra Modi’s government has banned all flights in and out of the country and ordered a 21-day lockdown. South Africa locked down before Britain. In Nigeria, where most of the population live on less than $1.90 per day, the army is reportedly ready to enforce social distancing.

But the results have not been altogether reassuring. Lathi-wielding cops in Mumbai have chased down people defying the measure. And there are unintended consequences to a lockdown. Migrant workers, fearing being trapped in fetid dormitories with no work, have started traveling home to their villages, crowding bus shelters. One financial analyst in Mumbai tells me vegetable prices have soared, even as farmers are having to throw away produce in the countryside.

It is worse still in even poorer places. In Goma, a big city in conflict-hit eastern Congo, it is worse. My colleague Olivia Acland has reported on how food prices have shot up since Rwanda closed its border. Eastern Congo only recently recovered from an epidemic of Ebola. People are worried that they may starve.

In Europe, most governments are trying to mitigate the economic consequences of locking down. So too in the poor world: India and South Africa have increased social spending. But it is not so easy when money was already so tight to begin with. Bond markets stand ready to fund the British, American or French governments’ responses at tiny interest rates; investors do not see countries like India or South Africa in the same way. If they print money to try to protect people’s incomes, inflation will be the likely result. Their economies will shrink in any case, even before measures come in, as foreign investors pull out. In most of Africa, most foreign currency comes from commodity exports. The oil price plunge is already starving governments of funds to deal with the crisis.

So what should be done? Poorer countries have to take the disease seriously — and not all are. The government of Ethiopia appears to be claiming local alternative medicine is the solution. The president of Tanzania, John Magafuli, apparently thinks the virus cannot enter churches. Complacency risks an almost unprecedented humanitarian catastrophe. Both Africa and the subcontinent over the past two decades have seen incredible improvements in living standards as diseases such as HIV and malaria have been reduced. That progress might be undone, if not by the virus itself then by the global economic collapse that will surely follow.

Rich countries could help: with the foreign exchange and heft needed to ensure food still crosses borders. And it would be in our interests to do so. If lockdowns work, we still face at least a year, maybe more, before a vaccine can be created during which most of our population will remain vulnerable to infection. Turning half of the world into reservoirs of the virus cannot be wise.

So how best to help poorer countries contain the virus? Earlier this century, George W Bush’s PEPFAR programme helped to bring under control an epidemic still considerably worse than the current one: HIV/AIDS. Roughly 400,000 Africans still die each year from the disease, but the figure is down by 40% compared to a decade ago. The scale of the new coronavirus is at least as significant. If there were ever a time for a new such project, surely it is now.

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