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Unspoken inequality: How COVID-19 has exacerbated existing vulnerabilities of asylum-seekers, refugees, and undocumented migrants in South Africa



An estimated 2 million foreign-born migrants of working age (15-64) were living in South Africa (SA) in 2017. Structural and practical xenophobia has driven asylum-seekers, refugees, and undocumented migrants in SA to abject poverty and misery. The Coronavirus Disease 2019 (COVID-19) containment measures adopted by the SA government through the lockdown of the nation have tremendously deepened the unequal treatment of asylum-seekers and refugees in SA. This can be seen through the South African government's lack of consideration of this marginalized population in economic, poverty, and hunger alleviation schemes. Leaving this category of our society out of the national response safety nets may lead to negative coping strategies causing mental health issues and secondary health concerns. An effective response to the socioeconomic challenges imposed by the COVID-19 pandemic should consider the economic and health impact of the pandemic on asylum-seekers, refugees, and undocumented migrants. Résumé On estime que 2 millions de migrants internationaux en âge de travailler (15-64 ans) vivaient en Afrique du Sud en 2017. La xénophobie structurelle et pratique a conduit les demandeurs d'asile, les réfugiés et les migrants sans papiers en Afrique du Sud à la pauvreté et à la misère. Les mesures de confinement de la maladie coronavirus 2019 (COVID-19) adoptées par le gouvernement sud-africain à travers le confinement de la nation ont considérablement approfondi le traitement inégal des demandeurs d'asile et des réfugiés en Afrique du Sud. Le gouvernement sud-africain ne tient pas compte de cette population marginalisée dans les programmes économiques, de lutte contre la pauvreté et de lutte contre la faim. Le fait de laisser cette catégorie de notre société hors des filets de sécurité nationaux d'intervention peut entraîner des stratégies d'adaptation négatives qui causent des problèmes de santé (Continued on next page)
C O M M E N T A R Y Open Access
Unspoken inequality: how COVID-19 has
exacerbated existing vulnerabilities of
asylum-seekers, refugees, and
undocumented migrants in South Africa
Ferdinand C. Mukumbang
, Anthony N. Ambe
and Babatope O. Adebiyi
An estimated 2 million foreign-born migrants of working age (1564) were living in South Africa (SA) in 2017.
Structural and practical xenophobia has driven asylum-seekers, refugees, and undocumented migrants in SA to
abject poverty and misery. The Coronavirus Disease 2019 (COVID-19) containment measures adopted by the SA
government through the lockdown of the nation have tremendously deepened the unequal treatment of asylum-
seekers and refugees in SA. This can be seen through the South African governments lack of consideration of this
marginalized population in economic, poverty, and hunger alleviation schemes. Leaving this category of our society
out of the national response safety nets may lead to negative coping strategies causing mental health issues and
secondary health concerns. An effective response to the socioeconomic challenges imposed by the COVID-19
pandemic should consider the economic and health impact of the pandemic on asylum-seekers, refugees, and
undocumented migrants.
Keywords: COVID-19, Asylum-seekers, Refugees, Undocumented migrants, Mental health, South Africa
On estime que 2 millions de migrants internationaux en âge de travailler (1564 ans) vivaient en Afrique du Sud en
2017. La xénophobie structurelle et pratique a conduit les demandeurs dasile, les réfugiés et les migrants sans
papiers en Afrique du Sud à la pauvreté et à la misère. Les mesures de confinement de la maladie coronavirus 2019
(COVID-19) adoptées par le gouvernement sud-africain à travers le confinement de la nation ont considérablement
approfondi le traitement inégal des demandeurs dasile et des réfugiés en Afrique du Sud. Le gouvernement sud-
africain ne tient pas compte de cette population marginalisée dans les programmes économiques, de lutte contre
la pauvreté et de lutte contre la faim. Le fait de laisser cette catégorie de notre société hors des filets de sécurité
nationaux dintervention peut entraîner des stratégies dadaptation négatives qui causent des problèmes de santé
(Continued on next page)
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* Correspondence:
Burden of Disease Research Unit, South African Medical Research Council,
Cape Town, South Africa
Full list of author information is available at the end of the article
Mukumbang et al. International Journal for Equity in Health (2020) 19:141
(Continued from previous page)
mentale et des problèmes de santé secondaires. Une réponse efficace aux défis socioéconomiques imposés par la
pandémie du COVID-19 devrait tenir compte de limpact économique et sanitaire de la pandémie sur les
demandeurs dasile, les réfugiés et les migrants sans papiers.
South Africa (SA) has been a preferred destination for
many migrants from other parts of Africa, particularly
those from the Southern African Development Commu-
nity (SADC) countries. An estimated 2 million foreign-
born migrants of working age (1564) were living in SA
in 2017, representing 5.3% of the South African labor
force. Between 2012 and 2017, there was a 1.4% increase
in international migrants of working age in SA [1]. Un-
officially, the foreign-born migrant population in SA
today is estimated to be around 4.2 million [2].
SAs commitment to upholding human rights and the
rights of asylum-seekers and refugees make the country
an attractive destination for people fleeing their home
countries in the quest for a more dignifying and humane
existence. The economy of SA, which is one of the most
advanced on the African continent, has contributed to
the exponential increase in the number of people seek-
ing asylum from the continent and the world at large.
The unprecedented flow of asylum-seekers and refu-
gees into SA has compromised the governments stance
to adhere to its commitment towards upholding human
rights while delivering its promise to uplift the socio-
economic welfare of its citizens; especially those that still
feel the brunt of apartheid a system of institutionalized
racial segregation. While there is the political will to ac-
commodate and cater for asylum-seekers, refugees, and
undocumented migrants in SA, the increasing economic
and financial woes of the country has led to the govern-
ment adopting and frequently changing laws that in
many ways, have impacted negatively on the lives of these
foreign-born migrants.
The South African Refugees Act provides the right for
asylum-seekers and refugees to work and study, to ac-
cess medical services and life-saving treatment and free-
dom of movement [3]. SAs considerate assertion to
these rights partly accounts for the influx of asylum-
seekers and refugees. However, failure to regularize the
national asylum system, bureaucratic inefficiency, and
corruption have engendered issues such as lack of
personnel capacity and logistics to deal with the volume
of asylum-seekers and refugees, consequently, creating a
backlog in the processing and adjudication of the docu-
ments [35]. To this end, many foreign-born mi-
grants remain undocumented and/or asylum-seekers for
years, and those with refugee status find it difficult to
obtain documents like the refugee identity or travel
document [4].
The difficulty in obtaining or renewing documents on
time makes it challenging for most asylum-seekers and
refugees and, of course, impossible for undocumented
migrants to gain any meaningful and long-term em-
ployment even if they are qualified. Most of them are
relegated to the informal sector and nudged to reside
in underprivileged communities. Foreign-born mi-
grants are, therefore, more likely to be informally
employed and face precarious employment conditions
[1]. According to the African Centre for Migration
and Society [1], a foreign-born migrant with the same
age, gender, and level of education, belonging to the
same population groupand living in the same place
as a South African, has a higher probability of being
employed than a South African. Therefore, there is
the conception in most communities where these
foreign-born migrants reside and work that they deprive
South Africans of employment and other business oppor-
tunities and are a strain on the limited social services and
amenities, constituting the main drivers of xenophobia [6].
To avoid the killing of foreign-born migrants by the gen-
eral population, the South African government enacted
bylaws that make it challenging for foreign-born migrants
to gain employment in SA. The abovementioned struc-
tural and practical xenophobia have plunged foreign-born
migrants living in SA into abject poverty and misery [6,7].
Most asylum-seekers, refugees, and undocumented
migrants entering SA come from regions with en-
demic malaria, HIV, and TB infections [810]. In
addition to these infections, there is equally a huge
burden of non-communicable diseases among foreign-
born migrants living in SA [11]. Migration also in-
volves going through certain stages involving lack of
preparedness, difficulties in adjusting to the new en-
vironment, the complexity of the local system, lan-
guage difficulties, cultural disparities and adverse
experiences, which can cause distress and anxiety to
the foreign-born migrants with a negative impact on
their mental well-being [12]. Despite this high disease
burden, foreign-born migrants face various challenges
accessing preventative and curative healthcare services
including the lack of migration-aware and mobility-
competent health systems programs [11].
Main text
Unspoken inequality
On the 23 of March 2020, President Cyril Ramaphosa
announced a nation-wide lockdown to help curb the
Mukumbang et al. International Journal for Equity in Health (2020) 19:141 Page 2 of 7
spread of the Coronavirus Disease 2019 (COVID-19)
epidemic in SA [13] and to enable the health systems to
prepare for the increasing influx of moderate to severe
COVID-19 cases [14]. In addition to the national lock-
down, other social distancing measures such as isolation
of individuals infected with the SARS-CoV-2 virus and
quarantining of those who may have been exposed to or
were in contact with an infected person are also encour-
aged or enforced [15]. In spite of these containment
measures, SA has the highest number of infections with
SARS-CoV-2 in Africa with more than a 100,000 cases
and 2000 deaths reported as of the middle of June 2020
[16]. While these containment measures are estimated
to have negatively affected all those living in SA, asylum-
seekers, refugees, and undocumented migrants dispro-
portionally experience the negative impacts of the pan-
demic because of existing vulnerabilities affecting this
population Fig. 1[17].
Before the lockdown containment measures, foreign-
born migrants living in SA had relatively weakened so-
cial support structures, bleak socio-economic prospects,
unequal access to health care and social services, precar-
ious housing conditions, tenuous living and working
conditions, and higher risks of exploitation and abuse
[18]. The lockdown containment measures worsened
their conditions as they found themselves suddenly job-
less, being evicted from their homes, hunger insecure,
and trapped in dormitories or camps where adequate
physical distancing is impossible [19]. These conditions
have created and continue to fuel feelings of uncertainty,
distress, anxiety, fear, anger, and hopelessness; condi-
mental health illnesses such as anxiety and depression
[20,21], and secondary health concerns neglect of
self-care, respiratory infections, HIV, and substance
abuse [22]. Studies conducted in other countries have
demonstrated that nation-wide lockdown is associated
with depressive symptoms, anxiety symptoms, and
sleeping disturbances [23,24].
Organizations working with foreign-born migrants
during the COVID-19 pandemic containment measures
have raised concerns regarding the arrest and detention
of foreign-born migrants [25], their placement in, and
subsequent repatriation from camps and shelters. There
are also reports that foreign-born migrants are more
likely to be arrested for minor offenses during the lock-
down period and less likely to be released on bail be-
cause of expired documentation [25]. The closure of the
Department of Home Affairs, which is responsible for
renewing and issuing refugee permits, asylum permits,
and residence permits, has made many foreign-born mi-
grants vulnerable to harassment and extortion by law
enforcement agents who are likely to ignore the mora-
torium on arrests of all those whose permits expired
during the lockdown [2]. Migrants are consequently less
willing to seek testing or care for COVID-19 symptoms
as they are afraid of being detained or deported. These
repatriation centers and prison stations are also prone to
overcrowding, making it challenging to practice social
distancing and recommended hygiene measures [26].
Under such conditions, these foreign-born migrants are
at heightened risks of contracting COVID-19 but tend
not to seek care when they notice the signs and symp-
toms of COVID-19, which makes them more likely to
spread or die from the disease.
During the mandatory nationwide lockdown, asylum
seekers, refugees, and undocumented migrants found
themselves trapped indoors leading to the feeling of iso-
lation [27]. Isolation, scarcity of resources, and the lack
of social contacts may have created and continue to fuel
Fig. 1 Crisis impacting foreign-born migrants Adapted from United Nations [17]
Mukumbang et al. International Journal for Equity in Health (2020) 19:141 Page 3 of 7
a negative impact on peoples emotions and psycho-
logical well-being [28,29]. Also, with an increasing num-
ber of cases in SA, there has been a significant increase
in the stigmatization of anyone remotely related to
COVID-19. Stigma and discrimination that stems from
COVID-19 can occur when people associate it with na-
tionality or being a foreign-born migrants and can lead
to further social avoidance, denial of health care, and
perhaps even violence fueling secondary health concerns
[30]. Stigma also makes people feel isolated; even to the
point of feeling abandoned and increases the chances of
anxiety and depression [31].
Although lockdown is comparatively easier for people
who live in houses with big gardens, it is harder for
those who live in crowded homes and camps, sharing
their living spaces and toilets with non-relatives and
strangers such as is the condition of most asylum-
seekers, refugees, and undocumented migrants living in
SA [32]. Under these conditions, the risk of abuse (emo-
tional and sexual), exploitation, and violence are height-
ened. Evidence shows that foreign-born migrants living
under such circumstances in sub-Saharan Africa have
consistently poorer physical and mental health outcomes
than others [33].
To address some of the socio-economic hardship
that the COVID-19 pandemic containment measures
have placed on the South African population, the
South African government adopted various economic
and hunger alleviation measures. First, the govern-
ment announced the COVID-19 Social Relief of Dis-
tress grant of R350 ($20) to all South Africans who
are unemployed including those who lost their job as
a result of the COVID-19 pandemic for a period of 6
months from May 2020. Secondly, the South African
government increased the value of the child and so-
cial support grants until October 2020. Thirdly, the
government pledged a Business Relief Fund of
R500 million ($30 million) for businesses that may
have their operations affected by the COVID-19 pan-
demic. Finally, the government is providing tax
subsidies for small businesses and individuals and
lowering contributions to the Unemployment Insur-
ance Fund (UIF).
While these strategies are commendable, it is unclear
how asylum-seekers, refugees, and undocumented mi-
grants living in similar or worse situations are being con-
sidered. Not only are they no longer able to acquire
finances through work of any kind, but they also are not
being considered in any of the governments plans to
mitigate the impact of the lockdown measures. For in-
stance, the African Centre for Migration and Society [1]
report indicates that foreign-born migrants of working
age living in SA are more likely to own a business and
be employers. Unfortunately, most of these businesses
owned by asylum-seekers, refugees, and undocumented
migrants, although their operations are equally affected
by the COVID-19 crisis, are not considered for the Busi-
ness Relief Fund as they are automatically excluded
based on the qualification criteria businesses must be
100% South African owned, at least 70% of employees
must be South Africans and recipients must be tax com-
pliant [34].
For asylum-seekers and special-permit holders who
were employed in the formal sector and who paid the
mandatory taxes into unemployment before the lock-
down measures were imposed, their UIF payments are
not being paid while the South African employees in the
same companies receive theirs [35]. The argument for
non-payment of foreign-born migrants' UIF is that the
electronic system used by the UIF does not recognize
foreign passport numbers [35]. The Department of Em-
ployment and Labour made these payments to help indi-
viduals cope with the worst effects of the national
lockdown. For the South African citizens, the UIF pro-
vided some relief, as this income replacement allowed
them to take care of their families. However, the socio-
economic situation of refugees, asylum-seekers and
special-permit holders not receiving the UIF has deterio-
rated further.
The South African government also embarked on
providing food parcels to those who are threatened
by food insecurity. During these food distribution
campaigns, it has been observed that foreign-born mi-
grants form a significant number of attendees [36].
Similar to accessing the Social Relief of Distress grant
of R350 ($20) and receiving UIF payments, a South
African national ID or special permit is required to
receive food parcels, which foreign-born migrants are
unlikely to possess. [36]. In this way, asylum seekers,
refugees, and undocumented migrants are excluded
from the governments food relief programs [37].
The South African Department of Home Affairs an-
nounced they will ensure that anyone whose immigration
status permit expires before the end of the lockdown
period will not be penalized as long as they present
themselves to a refugee reception office within 30 days
of the lockdown ending. Nevertheless, some asylum-
seekers have been undocumented for months and even
years prior to the national lockdown [4]. These undocu-
mented migrants are most vulnerable to harm and infec-
tion with COVID-19 as they are most likely to be
homeless and their access to basic human rights and ser-
vices is particularly limited. Consequently, the lockdown
containment measures can potentially increase their vul-
nerabilities regarding mental health and secondary
health concerns as people who are homeless are already
prone to mental health issues and problems in physical
health [12] due to neglect of self-care, leading to the
Mukumbang et al. International Journal for Equity in Health (2020) 19:141 Page 4 of 7
prevalence of respiratory infections, HIV, and substance
There is an overall poor engagement of SAs public
healthcare system with migrants, therefore, testing and
treatment responses within public health systems fail to
engage with asylum-seekers, refugees, and undocu-
mented migrants [38]. As discussed earlier, undocu-
mented migrants are also usually reluctant to seek
medical and other assistance due to their lack of docu-
mentation for fear of possible arrest, detention, and even
deportation. According to Kruger [39], where someone
suspected of having symptoms related to the SARS-
CoV-2 infection refuses to take a test, an enforcement
officer should apply to a magistrate for a warrant to
compel such testing. Unfortunately, this cannot be
applied to undocumented migrants as individuals are re-
quired to provide information on their nationalityand
identification details to take a SARS-CoV-2 test in most
parts in South Africa [2]. Therefore, early detection, test-
ing, diagnosis, contact tracing, and seeking care for
Covid-19 becomes challenging for undocumented
migrants, thus increasing the risk of outbreaks among
migrants and the general population, as COVID-19 is as-
sociated with clusters and outbreaks [14]. Their exclu-
sion from accessing testing, treatment, and the palliative
measures put in place during this COVID-19 period will,
ultimately, undermine the governments efforts to curb
the spread of the virus.
Call to action
Some civil societies such as the Scalabrini Centre of
Cape Town are working to address the conditions of
asylum-seekers and migrants. The Scalabrini Centre
of Cape Town is a non-governmental organization
based in Cape Town, SA that provides specialized
services for refugee, migrant, and South African
communities. For instance, the Centre has, in coord-
ination with the major banks of SA, managed to not
freeze the bank accounts of asylum-seekers and refu-
gees whose permits got expired during the period of
the national lockdown. This is meant to permit them
to have access to their finances to buy food and pur-
chase other essential goods and services. Unfortu-
nately, many foreign-born migrants with expired
permits report that their accounts are still fro-
zen. Also, the Scalabrini Centre of Cape Town has
recently won a Court Order that may ensure some
of SAs asylum-seekers and special-permit holders to
be able to apply for the COVID-19 Social Relief of
Distress grant. Other non-governmental organiza-
tions have focused on hunger alleviation by provid-
ing food parcels.
While the efforts made by these civil societies to allevi-
ate hunger and provide some relief to the economic
situation of asylum-seekers, refugees, and undocumented
migrants are commendable, these efforts are not sustain-
able without the governments support. According to the
United Nations [17], four basic tenets should drive ef-
forts to support foreign-born migrants in the era of
COVID-19 and moving forward: (1) Their exclusion is
costly in the long-run whereas their inclusion pays off
for everyone. (2) The response to COVID-19 and pro-
tecting the human rights of migrants are not mutually
exclusive. (3) No-one is safe until everyone is safe. (4)
Migrants are part of the solution. The International
Labour Organization (ILO) also confirms that the inclu-
sion of foreign-born migrants in national COVID-19
policy responses can help to ensure the realization of
equality and social justice [40]. Equality and social just-
ice could be achieved by engaging with and including
migrant-led organizations, civil societies, international
organizations, and researchers working with migrant
groups towards developing programs that consider
ILO also suggests that governments should include
asylum-seekers, refugees, and undocumented migrants
in their national income and related policy responses.
To achieve this, foreign-born migrants living in SA
will require their status in SA to be legalized as many
forms of access are contingent upon having
proper documentation, such as access to healthcare,
education, food parcels, banking services, unemploy-
ment benefits, social grants, or even, at times, free-
dom of movement. The COVID-19 pandemic and its
implications necessitate an inclusive approach, which
leaves no one behind because our individual and col-
lective wellbeing is precariously interconnected. In the
era of the COVID-19 pandemic, a narrow citizenship
approach will be inadequate in dealing with an inter-
twined sociality.
The South African government should also extend ac-
cess to health services and social protection coverage to
this category of our society [40]. For instance, provide
healthcare to foreign-born migrants irrespective of
migration status. The International Organization for
Migration [21] also reiterates its call to ensure that
foreign-born migrants and displaced persons are in-
cluded in governmentsplans for mental and psycho-
social support provision in the context of COVID-19
and moving forward.
The response to COVID-19 and ensuring the health and
well-being of asylum-seekers, refugees, and undocu-
mented migrants are not mutually exclusive. The first
step to effectively address the socioeconomic and psy-
chosocial impact of the COVID-19 pandemic and lock-
down on foreign-born migrants while reducing
Mukumbang et al. International Journal for Equity in Health (2020) 19:141 Page 5 of 7
inequities between them and local communities involves
developing policies that take their realities into account.
Although these migration-aware and mobility-
competent policies do not necessarily translate in prac-
tice, the South African government should engage with
and include migrant-led organizations, civil society,
international organizations, and researchers working
with migrant groups in the development of appropri-
ate responses. Leaving this category of our society out of
the national response safety nets may engender negative
coping strategies leading to mental health issues, and
secondary health concerns.
COVID-19: Coronavirus Disease 2019; ILO: International Labour Organization;
SA: South Africa; SADC: Southern African Development Community;
UIF: Unemployment Insurance Fund
We wish to acknowledge Dr. Peter Delobelle for reading and commenting
on an earlier version of this manuscript. We are also immensely greatful to
the reviewer who provided valuable and constructive comments to improve
the quality of the submission.
FCM conceived the original idea and wrote the first draft of the manuscript
as well as the final document. ANA and BOA critically reviewed the paper
and contributed important intellectual content. All authors read and agreed
on the final manuscript.
No funding was received.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated
or analyzed during the current study.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they do not have any competing interests.
Author details
Burden of Disease Research Unit, South African Medical Research Council,
Cape Town, South Africa.
Department of History, University of the Western
Cape, Cape Town, South Africa.
Child and Family Unit/Social work,
University of the Western Cape, Cape Town, South Africa.
Received: 10 June 2020 Accepted: 10 August 2020
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... 31.9, 41.1, 37.9 % respectively) (3). There was also strong evidence that COVID-19 has deepened existing social-ethical issues such as stigma, discrimination, and equality (4)(5)(6)(7)(8). COVID-19 has disproportionately affected vulnerable populations. ...
... With the systemic medical failures, discourses on injustice, unfairness, and instability within societies have increased (4). Racism and biases against minorities during the pandemic have prevailed (6). Social inequality has increased, especially for the poorer and less literate, both in developing and developed countries (7)(8)(9). ...
This narrative review aims to identify psycho-social issues related to the COVID-19 pandemic, especially among vulnerable populations. Through understanding the psychosocial meanings underneath, the suffering from the pandemic and the transformative experiences toward better society could be substantiated. Searching relevant studies and literature on psycho-social impacts in relation to COVID-19 was conducted from psycho-social points of view. Vulnerable populations such as the mentally ill, the poor, refugees, immigrants, the elderly, and other stigmatized groups were focused on. Reflections and plans on the worsened health disparities and increased stresses among vulnerable groups will help our society to be healthier and safer.
... However, in countries like Jordan, refugees and asylum seekers were integrated into the national health scheme (United Nations Economic and Social Commission for Western Asia, 2020, p.7). However, Mukumbang et al. (2020) argued that COVID-19 lockdown measures have economically affected both documented and undocumented migrants. Botes and Thaldar (2020) argued that prior to COVID-19, foreignborn migrants living in South Africa experienced unequal access to healthcare and social protection services, precarious housing conditions, tenuous living and working conditions, and higher risks of exploitation and abuse. ...
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Human migration is one of the great factors of human history that has created great debates in modern international relations. While human migration is a feature of modern international relations that promotes human relations and cooperation, it also existed before the signing of Westphalia peace treaties in 1648. The aim of this paper was to assess the effects of COVD-19 on human migration and economic security in Africa. Managing human migration during the COVID-19 pandemic has presented numerous challenges that have affected economic security. COVID-19 has limited migrants to migration leading to the
... A nivel global, se han publicado diversos estudios enfocados en experiencias de migrantes internacionales durante la pandemia y el impacto sobre sus vidas (25)(26)(27)(28)(29). Un estudio cualitativo sobre el impacto del COVID-19 en el acceso a la salud por parte de personas migrantes provenientes de Venezuela en siete ciudades de Colombia y Perú concluyó que la pandemia ha exacerbado las condiciones de informalidad e inequidades en salud para esta población. ...
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Objetivo Conocer, en contexto de la pandemia por SARS-CoV-2, las vulnerabilidades psicosociales y socioeconómicas de la población migrante internacional en Chile y los recursos y capitales sociales reportados desde la propia comunidad. Métodos Estudio cualitativo descriptivo. Se realizaron 40 entrevistas semiestructuradas a migrantes (N=30) e informantes claves (N=10), ejecutadas virtualmente durante el 2020. El material fue analizado mediante análisis temático. El proyecto fue aprobado por el Comitè de Ètica Científico de la Facultad de Medicina de la Universidad del Desarrollo. Resultados Como principales vulnerabilidades enfrentadas por parte de personas migrantes en pandemia se identifican: hacinamiento, precariedad laboral y necesidades económicas, uso del transporte público, desinformación y creencias en torno al COVID-19, discriminación, falta de redes de apoyo, y estatus migratorio. Como recursos se reconocen: contar con redes de apoyo, posibilidad de teletrabajo o salir a trabajar, acceso a información y a la red asistencial y municipal, apoyo gubernamental y de la sociedad civil. Adicionalmente, se reportan experiencias de diagnóstico de COVID-19, identificando dificultades en acceso a PCR y adaptaciones familiares y laborales como cambios en los hábitos de vida dentro y fuera del hogar. Discusión El estudio entrega información relevante e inédita para la construcción de políticas en salud para migrantes internacionales con foco en crisis sanitarias. Se destaca la necesidad de fortalecer adecuaciones interculturales en las estrategias de prevención del contagio y de promoción de la salud y aumentar la disponibilidad de respuesta en el acceso a salud en el marco de la pandemia, mitigando así la vulnerabilidad social en migrantes y potenciando sus recursos de afrontamiento.
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Historically, across Europe, data and research on racialised minority groups have not been collected or carried out in a sufficient, adequate, or appropriate manner. Yet, to understand emerging and existing health disparities among such groups, researchers and policymakers must obtain and use data to build evidence that informs decision-making and action on key structural and social determinants of health. This systematic search and review aims to contribute to closing this gap and promote a race-conscious approach to health research, strengthening the utilisation and deployment of data and research on racialised minority groups in Europe. Its ultimate goal is to improve equality and equity in health. Concretely, the study will do so by reviewing and critically analysing the usage of the concepts of race, ethnicity, and their related euphemisms and proxies in health-related research. It will examine the collection, use, and deployment of data and research on racialised minority groups in this area. The study will focus on Belgium, France, and the Netherlands, three countries with graphical proximity and several similarities, one of which is the limited attention that is given to racism and racial inequalities in health in research and policy. This choice is also justified by practical knowledge of the context and languages. The results of the review will be used to develop guidance on how to use and deploy data and research on and with racialised groups. The review is part of a larger project which aims to promote race-conscious research and data. The project does this by a three-pronged approach which: 1) highlights the need for a race-conscious approach when collecting and using data, carrying out research on racialised minority groups; 2) builds expertise for their effective use and deployment, and; 3) creates a knowledge network and community of practice for public health researchers working in Europe.
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This study investigates the definition of “vulnerability” in the visualisation and underpinning index of Stats SA’s South African COVID-19 Vulnerability Index (SA CVI)’s data visualisation dashboard. The paper establishes definitions of vulnerability in relation to literature before COVID-19, research in the time of the pandemic, and in relation to data visualisation. The discussion finds that while the pandemic is widely perceived as a “health crisis”, South African vulnerability to this pandemic is mostly constituted by factors that fall outside of normative “health” concerns – beyond “straightforward” medical, biological and epidemiological factors. Instead, South African vulnerability to COVID-19, and the “health” of its citizens in this context, are largely to be understood as systemic, socio-economic, and necropolitical conditions. It is found that these conditions have not been generated by the pandemic but have rather been exposed by it.
Gender in healthcare comes with a substantial price tag. The politics of sex and reproduction has surpassed solely fiduciary concerns, however, and scientific developments and shifts in ideological understandings have reconstituted ‘women’s health’ in this clinical subset, posing modern regulatory conundrums introduced here. Publicly funded UK provision, and the government and societal linkages shaping these policy outcomes, is the book’s central concern. To tackle this objective, therefore, the interactions of the health policy network in three key areas—namely adolescent sexual health, abortion and assisted reproductive technologies (ART)—will be explored throughout this project. These case studies will additionally map COVID-19’s intervening impact, with a concluding chapter considering alterations to network dynamics in the wake of the pandemic and the future for gendered healthcare.
The COVID‐19 pandemic has issued significant challenges to food systems and the food security of migrants in cities. In China, there have been no studies to date focusing on the food security of migrants during the pandemic. To fill this gap, an online questionnaire survey of food security in Nanjing City, China, was conducted in March 2020. This paper situates the research findings in the general literature on the general migrant experience during the pandemic under COVID and the specifics of the Chinese policy of hukou. Using multiple linear regression and ordered logistic regression, the paper examines the impact of migration status on food security during the pandemic. The paper finds that during the COVID‐19 outbreak in 2020, households without local Nanjing hukou were more food insecure than those with Nanjing hukou. The differences related more to the absolute quantity of food intake, rather than reduction in food quality or in levels of anxiety over food access. Migrants in China and elsewhere during COVID‐19 experienced three pathways to food insecurity—an income gap, an accessibility gap, and a benefits gap. This conceptual framework is used to structure the discussion and interpretation of survey findings and also has wider potential applicability.
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The pre-Covid-19 world of work was rife with inequalities and difficulties, with more than 40 per cent of working-age South Africans unemployed. The majority of those in employment were barely able to eke out a living-between 20 per cent to 30 per cent were working in the informal economy, 1 mostly without labour rights and social protection and earning low incomes that trapped them in poverty.
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Asylum seekers face multiple language, cultural and administrative barriers that could result in the inappropriate implementation of COVID-19 measures. This study aimed to explore their knowledge and attitudes to recommendations about COVID-19. We conducted a cross-sectional survey among asylum seekers living in the canton of Vaud, Switzerland. We used logistic regressions to analyze associations between knowledge about health recommendations, the experience of the pandemic and belief to rumors, and participant sociodemographic characteristics. In total, 242 people participated in the survey, with 63% of men (n = 150) and a median age of 30 years old (IQR 23–40). Low knowledge was associated with linguistic barriers (aOR 0.36, 95% CI 0.14–0.94, p = 0.028) and living in a community center (aOR 0.43, 95% CI 0.22–0.85, p = 0.014). Rejected asylum seekers were more likely to believe COVID-19 rumors (aOR 2.81, 95% CI 1.24–6.36, p = 0.013). This survey underlines the importance of tailoring health recommendations and interventions to reach asylum seekers, particularly those living in community centers or facing language barriers.
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Vulnerable populations such as camped refugees are often exposed to spread of infectious diseases because of their living conditions, limited resources available to them and exclusion from social services. This study examined the psychological state of camped refugees in Ghana during the COVID-19 pandemic and how their background characteristics predict the severity of the pandemic’s psychological impact. It covered 763 refugees aged 15 years and above resident in two (Krisan = 316 and Ampain = 447) camps. Nine COVID-19 Anxiety Scale indicators were used to examine the psychological state of camped refugees. A composite indicator was derived to examine the overall psychological impact. Logistic regression was used to examine the factors that were associated with severe psychological impact. The multivariate analysis revealed that sex of the respondent, marital status and age of head of household were the only socio-demographic factors associated with having a severe psychological impact of the pandemic. There was very strong evidence that respondents who had moderate (OR = 1.74, 95% CI = 1.12, 2.7) and high (OR = 1.66, 95% CI = 1.05, 2.63) knowledge of the disease had increased odds of severe psychological impact. Also, those with moderate (OR = 2.97, 95% CI = 1.78, 4.97) and high (OR = 12.98, 95% CI = 7.86, 21.42) adherence had increased odds of severe psychological impact. None of the pre-existing health conditions and challenges were not significantly associated with severe psychological impact. The limited number of significant socio-demographic covariates suggests that severe psychological impact of the pandemic was a problem in the general population, and thus interventions should target the general population of camped refugees. Also, health education should not only focus on enhancing knowledge and promoting preventive measures but also on managing psychological distress.
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Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies.
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Objective: Social distancing is crucial in order to flatten the curve of COVID-19 virus spreading. Isolation, scarcity of resources and the lack of social contacts may have produced a negative impact on people's emotions and psychological well-being. This study aims to explore the reasons and the ways through which social distancing generates negative emotions in individuals who experienced the lockdown. To a larger extent, the objective is to check the existence of relations between negative emotions and the satisfaction of basic needs. Materials and methods: In Italy 140,656 online interviews were collected from March 22 to April 2, 2020. Data analysis was carried out using mono and bivariate statistical analysis, K-means clustering and the Principal Components Analysis (PCA). The parameters for the identification of six clusters were: the intensity of the respondent's basic emotions and the layers of Maslow's hierarchy of needs. Results: The majority of people involved in an emergency situation, implying a collapse of social contacts, experience some kind of emotional reactions. In our study, we found a correlation between basic emotions and Maslow's hierarchy of needs. In times of crisis, the most basic needs are the physiological ones. Fear, anger and sadness are predominant in all population groups; anger and disgust mainly appear when people are exposed to the risk of not being able to meet subsistence needs, thus perceiving a lack of economic security. Conclusions: The well-known Maslow's theory of human needs seems to fit well with the outbreak of negative emotions in the context of COVID-19. This study demonstrates the existence of links between negative emotions and primary needs that mainly refer to the first three levels of Maslow's pyramid. As a result of COVID-19 worldwide pandemic, many people have been sucked into the bottom layers of the pyramid. This change in individual basic needs has triggered a relevant transformation in individual emotional status and a shift towards negative emotions.
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Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored. A national cross-sectional survey was performed during the last 14 days of the Italian lockdown. Questionnaires assessed socio-demographics characteristic, behaviors and healthcare access. The outcomes were assessed using Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2. Participants with sleep disturbances completed the Insomnia Severity Index. The sample size was 1515. Depression and anxiety symptom prevalence was 24.7% and 23.2%; 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, an increased time spent on the internet and an avoidance of activities through peer pressure increased the likelihood of at least one mental health outcome. Increasing age, an absence of work-related troubles and being married or being a cohabitant reduced such a probability. Females and participants with chronic conditions were associated with a higher prevalence of sleep disturbances. It is crucial to study effective interventions, specifically planning strategies, for more vulnerable groups and to consider the role of the internet.
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COVID- 19, a biomedical disease has serious physical and tremendous mental health implications as the rapidly spreading pandemic. One of the most vulnerable, but neglected, an occupational community of internal migrant workers is prone for development of psychological ill-effects due to double whammy impact of COVID-19 crisis and concomitant adverse occupational scenario. Permutations and combinations of the factors viz susceptibility for new viral infections, potential to act as vectors of transmission of infection, high prevalence of pre-existing physical health morbidities such as occupational pneumoconiosis, tuberculosis, HIV infections, pre-existing psychological morbidities, adverse psychosocial factors like absence of family support and caretaker during the crisis, their limitations to follow the rules and regulations of personal safety during the crisis, social exclusion, and inability to timely access the psychiatric services; all give rise to the peri-traumatic psychological distress to internal migrant workers. Superadded, is the blow of financial constraints due to loss of work, absence or suspension of occupational safety and health-related basic laws and associated occupational hazards, which makes this occupational group highly vulnerable for the development of psychological illnesses. We attempt to draw the attention of mental health professionals, general medical practitioners and occupational health policymakers to the various, interrelated and interdependent predisposing and causative factors for the development of psychological ill-effects amongst internal migrant workers with the interventions needed to address it, from an occupational health perspective angle
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There is growing attention to disparities in the incidence, prevalence, and mortality associated with COVID-19 (Coronavirus disease 2019) in racial/ethnic communities. The conditions leading to these disparities may be a function of social determinants of health and stigma linked to the disease. It is important to examine how these factors may be implicated in COVID-19 onset, treatment, and outcomes. A brief overview of these issues allows for a cursory examination of the role of social determinants of health and stigma in COVID-19. Consideration is given to how understanding COVID-19 in the context of social determinants and stigma may be included in interventions to mitigate its transmission within vulnerable populations.
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Background: The current ongoing pandemic outbreak of COVID-19 (Coronavirus Disease 2019) has globally affected 213 countries and territories with more than 2.5 million confirmed cases and thousands of casualties. The unpredictable and uncertain COVID-19 outbreak has the potential of adversely affecting the psychological health on individual and community level. Currently all efforts are focused on the understanding of epidemiology, clinical features, mode of transmission, counteract the spread of the virus, and challenges of global health, while crucially significant mental health has been overlooked in this endeavor. Method: This review is to evaluate past outbreaks to understand the extent of adverse effects on psychological health, psychological crisis intervention, and mental health management plans. Published previous and current articles on PubMed, EMBASE, Google Scholar, and Elsevier about psychological impact of infectious diseases outbreaks and COVID-19 has been considered and reviewed. Comments: COVID-19 is leading to intense psychosocial issues and comprising mental health marking a secondary health concern all around the world. Globally implementing preventive and controlling measures, and cultivating coping and resilience are challenging factors; modified lifestyle (lockdown curfew, self-isolation, social distancing and quarantine); conspiracy theories, misinformation and disinformation about the origin, scale, signs, symptoms, transmission, prevention and treatment; global socioeconomic crisis; travel restrictions; workplace hazard control; postponement and cancellation of religious, sports, cultural and entertainment events; panic buying and hoarding; incidents of racism, xenophobia, discrimination, stigma, psychological pressure of productivity, marginalization and violence; overwhelmed medical centers and health organizations, and general impact on education, politics, socioeconomic, culture, environment and climate - are some of the risk factors to aggravate further problems.
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In the midst of an unprecedented public health crisis, extraordinary containment measures must be implemented. These include both isolation and quarantine, either on a voluntary basis or enforced. In the transition from voluntary to mandatory isolation, conflicts arise at the intersection of ethics, human rights and the law. The Siracusa Principles adopted by the United Nations Economic and Social Council in 1985 and enshrined in international human rights legislation and guidelines specify conditions under which civil liberties may be infringed. In order for isolation processes in South Africa to claim legitimacy, it is important that these principles as well as national laws and constitutional rights are embedded in state action.