‘Lacking in Care’

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4.1 Introduction
Drawing on the case of the Philippines, this chapter demonstrates how gendered
insecurities are exacerbated when the pandemic response does not reect the cen-
trality of care relations and human security more broadly. Gendered insecurities
during the COVID-19 pandemic are not exclusively shaped by either pre-existing
conditions or the ‘unprecedented’ challenges posed by COVID-19. Rather, they
cascade from and are logical outcomes of how the relationship between care and
security is understood in crisis settings. Data for this research is drawn from an
online survey and key-informant interviews with health workers and women’s
rights service providers from the National Capital Region (NCR) of the Philippines.
The survey consists of 89 anonymized respondents, with 51 identifying as ‘health
workers’ and 38 as ‘women’s rights and service providers’.1 Online interviews
were conducted with ten representatives from organizations of and for health
workers, women’s rights, and service providers. NCR is selected for data collec-
tion because initial data indicated that it was where approximately 41% of the total
number of conrmed cases and 39% of deaths occurred, and it is where densely
populated Manila is located.2 Manila was reported as having one of the longest
lockdowns in the world,3 while the country as a whole has been ranked the ‘worst
1 The survey was administered anonymously via Qualtrics. Participants were recruited purposively
through research assistant s who approached known orga nisations of health workers and women’s
rights service providers in NCR. These groups then shared our survey link with their members to
voluntarily complete. ANU Human Ethics Approval Protocol: 2021/609.
2 WHO Philippines Situation Report 71, February 27, 2021.
3 h t t p s : / / t i m e . c o m / 5 9 4 5 6 1 6 / c o v i d - p h i l i p p i n e s - p a n d e m i c - l o c k d o w n / .
4
‘LACKING IN CARE’
COVID-19 ‘Shadow Pandemics’ in
the Philippines (2020–2021)
Maria Tanyag
DOI: 10.4324/97810 03430742-4
This chapter has been made available under a CC-BY-NC-ND license.
10.4324/9781003430742-4

Lacking in Care 79
Lacking in Care
place’ to be during the pandemic.4 Therefore, NCR constituted a site where acute
cases of gendered insecurities could be examined and, particularly, where we
could expect health workers and women’s rights service providers to have borne
the brunt of the pandemic most severely.5 Secondary sources, including COVID-
19 monitoring reports and news articles in the country, are used to corroborate the
analysis of primary data.
The chapter is structured into three main parts. First, it provides a brief overview
of existing scholarship on global health security and why crisis responses must be
based on human-centric and holistic approaches to security. Evidence relating to
the pandemic response to COVID-19 in the Philippines from 2020 to 2021 is used
to substantiate the argument that the local response stratied health issues rather
than addressing them holistically. Second, the chapter turns to insights from
Filipino health workers and women’s rights service providers to illustrate how the
‘shadow’ or ‘hidden’ pandemics of gender-based violence and insecurities are a
direct result of a national pandemic response fundamentally lacking in care. Their
perspectives corroborate existing knowledge on human security, particularly from
feminist perspectives, which recognize the centrality of care relations in ensuring
the sustainability of everyday life. Third and last, the chapter discusses the impli-
cations of embedding human security perspectives in pandemic response for dura-
ble and inclusive post-crisis recovery. As the Philippine experience underscores,
its national response has prioritized ‘rapid’ or ‘short-term’ relief at the expense of
resourcing care which is central to human security. Gaps in pandemic responses
can be redressed by countermeasures that reect the centrality of care before, dur-
ing, and after pandemics.
4.2 The Philippines’ Pandemic Response
and Competing Health Needs
The rst case of COVID-19 was conrmed in the country on January 20, 2020.6
Consequently, the Inter-Agency Task Force on COVID-19 was created to lead the
pandemic response, and its membership consisted of retired generals and ex-mil-
itary personnel, including a man locally dubbed as the ‘vaccine czar’.7 The task
4 w w w . b l o o m b e r g . c o m / g r a p h i c s / c o v i d - r e s i l i e n c e - r a n k i n g / . Accessed March 19, 2022.
5 This point is made clear by the case of Mindanao examined in Chapter 9 by Ishikawa. The preva-
lence of COVID-19 cases was concentrated in NCR. The national-level pandemic response was
therefore experienced dierently across the country.
6 WHO. 2020. ‘Coronavirus Disease (COVID-19) Situation Report 1 Philippines, March 19, 2020’.
w w w . w h o . i n t / d o c s / d e f a u l t - s o u r c e / w p r o - - - d o c u m e n t s / c o u n t r i e s / p h i l i p p i n e s / e m e r g e n c i e s / c o v i d - 1 9
/ w h o - p h l - s i t r e p - 1 - c o v i d - 1 9 - 9 m a r 2 0 2 0 . p d f ? s f v r s n = 2 5 5 3 9 8 5 a _ 2 .
7 Key gures include retired generals Roy Cimatu, Carlito Galvez Jr, and Deln Lorenzana. See
Nikko Dizon. 2020. ‘Duterte and his Generals: A Shock and Awe Response to the Pandemic’.
Rappler, July 31. w w w . r a p p l e r . c o m / n e w s b r e a k / i n - d e p t h / d u t e r t e - s h o c k - a n d - a w e - c o r o n a v i r u s - p a n -
d e m i c - r e s p o n s e - g e n e r a l s .

80 Maria Tanyag
force did not involve the direct participation of even one epidemiologist (Hapal
2021). President Rodrigo Duterte justied the composition of the task force on the
basis that the military is best placed to lead the pandemic, for it excels in ‘logis-
tics’.8 In his many pronouncements, he repeatedly deployed war-related language
to frame both the virus and people who disobey COVID regulations (in Tagalog,
pasaway) as the ‘enemy’.9 Consequently, punitive and violent lockdown meas-
ures were introduced, with the result that by April 2020, 156,000 individuals had
reportedly been apprehended, with around 41,000 of those having been criminally
charged (Hapal 2021, 230). Since 2020, there have been approximately 60,000
deaths, with 3.6 million having contracted the virus.
Studies on past pandemics and within the global health security literature
more generally indicate that the continued privileging of national and interna-
tional security over human security is evidenced by the global neglect of every-
day health inequalities (Nunes 2014; Vaittinen and Confortini 2019). There is a
need to closely examine the relationship between the pandemic crisis response
and everyday human insecurities—including the ways in which these are gen-
dered. As the experience of the COVID-19 global pandemic showed, the scale of
state interventions deployed to address this crisis has been unprecedented, but so
are the cases of reported human rights violations, including ‘shadow’ or ‘hidden’
pandemics relating to the gendered impacts of COVID-19 that have emerged in
tandem. These hidden or less addressed gendered consequences of the pandemic
have been used in relation to the rise in cases of domestic violence and restrictions
to access to essential sexual and reproductive health services and supplies. Here I
include the well-being of frontline responders themselves as another interrelated
shadow pandemic.
4.2.1 Immediate Impacts
Dierent health needs, from the health of COVID-19 patients to the health of
health workers and social welfare providers themselves, were made to compete
instead of being addressed interdependently. This is evident in the ways that pan-
demic responses worldwide generated shadow or hidden pandemics of violence
against women, restrictions on access to essential services, particularly for sexual
and reproductive health, and the range of harms experienced by health workers
and service providers, such as discrimination and vilication (Mehta et al. 2021).
Their emergence lays bare the limitations and adverse outcomes of a narrow
state-centric security approach in addressing the gendered nature of global health
8 Azer Parrocha. 2021. ‘Ex-Generals Best People to Lead Covid Response, Palace Insists’. Philippine
News Agency, March 23. w w w . p n a . g o v . p h / a r t i c l e s / 1 1 3 45 9 4 .
9 Yvonne Su. 2021. ‘How the Philippines’ President Dutuerte Weaponized a Filipino Custom during
COVID-19’. The Conversation, December 19. h t t p s : / / t h e c o n v e r s a t i o n . c o m / h o w - t h e - p h i l i p p i n e s
- p r e s i d e n t - d u t u e r t e - w e a p o n i z e d - a -  l i p i n o - c u s t o m - d u r i n g - c o v i d - 1 9 - 1 7 3 7 2 3 ; Hapal 2021.

Lacking in Care 81
crises. Human rights and human security were readily sacriced or relegated as
secondary to the overarching pursuit of ‘containing’ the COVID-19 pandemic,
such that these gendered shadows or hidden pandemics are rendered ‘collateral
damage’, particularly in countries such as the Philippines. As I demonstrate in
this chapter, it is not the pandemic itself—but rather the response to it—that has
disrupted the availability of other health services and skewed the distribution of
resources and attention away from women’s health and well-being.
The UNDP and UN Women’s COVID-19 Global Gender Response Tracker10
serves as the main information hub that monitors policy measures enacted by
national governments worldwide to tackle the COVID-19 crisis, as well as high-
lighting responses that are gender-sensitive. According to the rst version of the
report from the Global Gender Response Tracker, published in September 2020,
countries in the Asia-Pacic region had an ‘uneven’ and ‘patchy’ response to the
shadow pandemic. Moreover, ‘[s]ix out of 28 countries and territories analyzed in
the region register no gender-sensitive measures at all in response to COVID-19’
(UNDP and UN Women 2020a, 4). By the third version of the report from the
tracker, published in November 2021, it was found that most countries had stepped
up by developing gender-sensitive measures to address violence against women,
women’s economic security, and unpaid care. Gender-sensitive measures, how-
ever, still comprise a small proportion of total responses (approximately 30%). For
instance, measures taken in response to COVID-19 that directly address unpaid
care represent only 7.3% of all responses for social protection and the labor market
(UNDP and UN Women 2020b).
In the Philippines, COVID-19 intersected with another health crisis in terms
of the alarming increase in teenage pregnancies that pre-dated the pandemic.
Indeed, teenage pregnancies were declared ‘a national and social emergency’ in
2019 (Abad 2020). In one survey, Filipinos reported it as the most important prob-
lem of women in the country at the time. Based on the Population Commission’s
estimates, around 70,755 families were headed by minors at the end of 2020, a
gure expected to increase to 133,265 by the end of 2021 (Abad 2020). One study
found that gaps and challenges in ‘both the supply side (delivery) and the demand
side (access) of essential family planning and maternal/newborn health services’
were exacerbated.11 Moreover, it is by now well documented that there has been a
global rise in domestic violence as people were forced to stay at home and access
to essential services and assistance was constrained—or, in some cases, com-
pletely halted.
10 More information available at h t t p s : / / d a t a . u n d p . o r g / g e n d e r t r a c k e r / .
11 The study was conducted by UNFPA and the University of the Philippines Population Institute
(UPPI). Reference to the ndings was presented is mentioned in a news article available at htt ps://
p h i l i p p i n e s . u n f p a . o r g / e n / n e w s / s i g n i  c a n t - r i s e - m a t e r n a l - d e a t h s - a n d - u n i n t e n d e d - p r e g n a n c i e s
- f e a r e d - b e c a u s e - c o v i d - 1 9 - u n f p a - a n d ? f b c l i d = I w A R 0 Z _ D r V M R N S r 1 w w E 5 D Z O 6 z R d e S v V Q v U
G C s V c d m F O V y U e 9 n I J T 6 z c r - k R WA .

82 Maria Tanyag
The Philippines was no exception (see Figure 4.1). Within months of COVID
lockdowns being enforced in the countr y, women’s groups were sounding the
alarm in relation to a highly likely pandemic ‘baby boom’. It was estimated that 1.8
million unplanned pregnancies and 751,000 unintended pregnancies would result
from pandemic-intensied restrictions to accessing services and supplies (Santos
2020). For a country with already high maternal mortality rates, the baby boom
would also likely be tied to increases in maternal deaths and health complications
emanating from pandemic-clogged health systems and fractured social welfare
mechanisms. Indeed, according to UNFPA Philippines (2020), this is likely to
occur ‘[W]hen health service providers are overburdened and preoccupied with
handling COVID-19 cases. However, lifesaving care and support to [gender-based
violence] (GBV) survivors (i.e., clinical management of rape, mental health and
psycho-social support, etc.) may be cut o. Other vulnerabilities that women are
facing connected to the lockdown have also been reported’. Yet, the view adopted
by the national pandemic response suggests that the COVID-19 pandemic, as a ‘law
and order’ or ‘national security’ matter, was separate from ‘everyday’ health ine-
qualities and concerns. This view did not align with the daily concerns of people,
especially women, during the pandemic. Research indicates that Filipino girls and
young women were worried more about the health of their family (68%), the dura-
tion of the quarantine (53%), slim chances of returning to school, and being able
to leave their house (both almost 49%), than they were about contracting the virus
(40%). They also reported worries about human rights violations and gender-based
violence against girls and young women (Plan International Philippines 2020).
4.2.2 Long-term and ‘Shadow’ Impacts
Shadow pandemics as a result of failures in the COVID-19 response cascade into
what is predicted to be an ‘impending human capital crisis’ in the Philippines
(Cho et al. 2021a, 2021b). The eects of this pandemic will reverberate in the
FIGURE 4.1 Data on sexual and gender-based violence (SGBV) exacerbated by
COVID-19. https://shop .un .org /rights -permissions. Source: UNFPA
Philippines (2020)

Lacking in Care 83
form of long-term suering, as well as compounded harm to the health and well-
being of millions of Filipinos. These eects are also likely to be borne dispropor-
tionately by women and girls, given gender norms around the provision of care.
For instance, there is already strong research that early and teenage pregnancies
severely undermine the human capabilities of girls and further entrench them in
poverty. Research in the Philippines points out that students’ learning losses are
also expected to be enormous as COVID-19 dramatically disrupts access to quality
education (Cho et al. 2021b). While there were already pre-existing challenges in
education— especially among the poor—the eects of the COVID-induced ‘learn-
ing crisis’ in the country are likely to be irreversible, prompting calls to prevent
a ‘lost generation’ of youth. This pandemic learning crisis is gendered, based on
worldwide data that shows girls are still more likely to never attend school or drop
out during the primary level (UNICEF 2020). A pandemic ‘baby boom’ will likely
mean increases in maternal mortality risks and a greater burden of work placed on
health professionals who are already overwhelmed by the realities of triaging in
a poorly managed pandemic. These examples of long-term eects underscore the
urgent need for pandemic responses to be oriented toward a holistic promotion of
human security beyond the ‘emergency phase’.
Another long-term impact is the further erosion of health systems in the
country, which can undermine societal resilience to future pandemics. The
Philippines’ preparedness for a pandemic was very low due to pre-existing health
inequalities and funding gaps in gender-responsive programs, including for sexual
and reproductive health. From the initial phase of the COVID-19 health crisis,
there were clear shortages in equipment and facilities, endangering the safety of
health workers.12 The strain on health systems and health workers, specically,
is also an example of challenges in a country with multiple ongoing humani-
tarian crises. Consequently, the Philippines is among the few countries in the
Asia-Pacic where COVID-19 is having high negative or constraining impacts
on humanitarian access.13 Indeed, key informants interviewed for this research
all argued that state capacity to respond to sexual and reproductive health needs
and gender-based violence was really not available because, even at the height
of the pandemic, there were evident shortages in equipment and facilities that
endangered the safety of health workers themselves. Driven by global shortages,
the Philippines experienced nationwide problems in the availability of personal
protective equipment (PPE), ventilators, beds, and diagnostic equipment and sup-
plies.14 Images of many Filipino health workers improvising their own PPE from
12 See Pham et al. 2020; Cho et al. 2021a, 2021b; UN Women Philippines 2020a, 2020b, 2020c;
UNFPA Philippines 2020.
13 See UN OCHA, n.d. ‘Philippines: COVID-19 Countr y Dashboard’. Accessed August 5, 2022.
h t t p s : / / i n t e r a c t i v e . u n o c h a . o r g / d a t a / a p - c o v i d 1 9 - p o r t a l / c o u n t r y - p a g e . h t m l .
14 World Health Organization. 2020. ‘Shortage of Personal Protective Equipment Endangering
Health Workers Worldwide’. March 3. w w w . w h o . i n t / n e w s / i t e m / 0 3 - 0 3 - 2 0 2 0 - s h o r t a g e - o f - p e r s o n a l
-protective -equipment -endangering -health -workers -worldwide.

84 Maria Tanyag
dierent household materials, such as plastic bags and bottles, rapidly spread on
social media (see, for example, The Guardian (2020)). They have had to make do
with available resources, privately procure supplies themselves, or rely on dona-
tions. These health shortages are structurally driven and attest to decades of weak
resourcing, especially in remote, conict-aected, and rural areas (Tanyag 2018;
see also Chapter 9 by Sachiko Ishikawa).
The already weak health systems in the country were further eroded by the lack
of resourcing for health workers during the pandemic. Worse, in August 2021, a
routine audit of state expenditures revealed that billions of pesos in COVID-19
funds had either not been used or been misused.15 The conditions have rapidly
worsened for health workers, such that, on multiple occasions, a coalition of medi-
cal and healthcare groups protested and threatened to resign from their posts due
to government ineciencies and corruption, which left them underpaid and over-
worked while on the ‘frontlines’ of the country’s ‘losing battle’ against COVID-
19.16 Based on existing data, almost 20% of all those infected in the country are
health workers (The Philippines Humanitarian Country Team 2020). Given that
women account for 70% of the total health and social workforce globally (Davies
et al. 2019), the intensied erosion of health workers and systems will have long-
term gendered eects on women, who disproportionately bear the brunt of work-
place harms and face limited employment prospects within the country. It was
unsurprising therefore that many Filipino health workers protested the govern-
ment’s ban on such workers seeking jobs overseas while they continue to receive
inadequate support as part of the response to the pandemic (Macaraeg 2020).
While the overseas employment ban was eventually lifted, the government intro-
duced a limit, allowing only 5,000 healthcare workers per year to work abroad,
signicantly less than the typical annual rate of 13,000 workers (Macaraeg 2020).
Last, the pandemic response also contributed to undermining the health of
civil society, public deliberation, and democratic decision-making (Atienza et al.
2020). There are already concerning developments relating to how state responses
to the pandemic have exacerbated democratic backsliding in several countries
(International IDEA, n.d.; Asia Centre and Harm Reduction International, 2021),
and made it even more dicult for civil society to ‘ll in gaps’ in humanitarian set-
tings (Auethavornpipat and Tanyag 2021). This was most evident in the sidelining
15 ‘COA: DOH’s Low Utilisation of Crisis Funds Aected Health Services’. Rappler, August 19,
2021. w w w . r a p p l e r . c o m / n a t i o n / d o h - l o w - u t i l i z a t i o n - c r i s i s - f u n d s - a  e c t e d - h e a l t h - s e r v i c e s - c o a
-report -2020.
16 See Adrian Portugal. 2021. ‘Philippines Health Workers Protest Neglect as COVID-19 Strains
Hospitals’. Reuters, September 1, w w w . r e u t e r s . c o m / w o r l d / a s i a - p a c i  c / p h i l i p p i n e s - h e a l t h - w o r k -
e r s - p r o t e s t - n e g l e c t - c o v i d - 1 9 - s t r a i n s - h o s p i t a l s - 2 0 2 1 - 0 9 - 0 1 / ; and Neil Jerome Morales. 2020.
‘“Losing Battle”: Philippine Doctors, Nurses Urge New COVID-19 Lockdowns as Infections
Surge’. Reuters, August 1. w w w . r e u t e r s . c o m / a r t i c l e / u s - h e a l t h - c o r o n a r v i r u s - p h i l i p p i n e s
-idUSKCN24X3IA.

Lacking in Care 85
and at times vilication of public health expertise by the Duterte government two
years into the pandemic. For example, Duterte negatively framed Filipinos—espe-
cially frontline health workers—who expressed their discontent as ‘enemies’ who
did nothing but complain (Ranada 2020). The pandemic response intersected with
other tools used by the Duterte government for repression. For example, the Anti-
Terrorism Act, which came into eect within months of the disease outbreak in
the countr y, reportedly contributed to further restricting access to humanitarian
assistance and the movement of aid workers. The military and police were report-
edly perpetrating intimidation and harassment against civil society actors, par-
ticularly those implementing the humanitarian response. These include churches,
service-oriented groups, and humanitarian organizations.17 They have also tar-
geted local-level initiatives such as volunteer networks behind ‘community pan-
tries’ and other forms of mutual aid or ‘crowdsourcing’ projects (Tanyag 2022; see
also Chapter 9 by Ishikawa).
What explains these negative trade-os? I argue that they emerged because
the pandemic response in the Philippines was not anchored in human-centric or
indeed feminist approaches to security. Feminist and human security approaches
embody holistic approaches and can therefore enrich the way we diagnose sources
of crisis and insecurity beyond the immediate or the spectacular. They pay equal
attention to what is invisible and to underlying causes that are taken for granted
or left unquestioned. They do not treat disease outbreaks as ‘exceptional’ or ‘cri-
sis-specic’. Nor do they separate everyday health inequalities from pre-existing
unequal gender relations. Issues of sexual and reproductive health and sexual and
gender-based violence that have not been accounted for in the initial global and
national COVID-19 responses will continue to be neglected and reproduced in
future pandemics when global health governance operates through a ‘tyranny of
urgency’ (Davies and Bennett 2016; Davies et al. 2019).
By contrast, a human security approach that is also gender-responsive attends
to the dynamics of competition and prioritization in times of crisis. It is attentive
to interrogating fundamental assumptions regarding what counts as a crisis and
assesses which issues need to be taken more seriously. As Ako Muto and Yoichi
Mine (2019, 306) point out, unlike ‘surgical’ or ‘invasive’ therapy that targets spe-
cic sources of pain or illness, human security resembles ‘internal’ or ‘oriental’
medicine designed to promote the resilience of an organism. In the context of the
COVID-19 pandemic, it can be argued that states employed ‘surgical’ interven-
tions that target symptoms rather than root causes. Without human security, pan-
demic responses are proving inadequate in promoting a continuum of long-term
resilience across the security of individuals and communities to states and global
so ciety.
17 High-prole examples include the National Council of Churches in the Philippines; Gabriela
Women’s Party, and Oxfam sa Pilipinas (Oxfam Philippines). See for example ReliefWeb 2020.

86 Maria Tanyag
From a feminist human security approach, we need to interrogate the poten-
tial long-term impacts that result from the prioritization and re-allocation of
resources to the pandemic response in terms of the neglect of other hidden crises.
As this chapter shows, bringing together feminist global health and human secu-
rity research in analyzing COVID-19 is essential in making visible the hidden
pandemic that has accompanied COVID-19 and in problematizing the gendered
biases underpinning what ought to be prioritized. A feminist human security is
more responsive to the realities that result in disease outbreaks and global health
crises being more broadly rendered as gendered crises (Davies and Bennett
2016 ). Robinson argues that human security grounded in care ethics is geared to
‘ask questions about who we care for and under what circumstances’ (Robinson
2016 , 122). It understands human security in terms of ‘beings-in-relation’ rather
than the prevalent assumption that renders individuals as ‘atoms’ situated out-
side of or beyond ‘webs’ of caring relations. Feminist care ethics emphasizes how
mutual dependence is a permanent feature of everyday life (Ro binso n 2011, 2016 ).
Resourcing care practices and institutions is fundamental to human security and
an important indicator of the empowerment and well-being of communities and
societies as a whole. The next section turns to the ndings drawn from a survey
conducted among a purposive sample of health workers and women’s rights ser-
vice providers, as well as key-informant interviews with representatives of organi-
zations of and for these target groups.
4.3 From Makatao to Tayo-Tayo: Care Amid the COVID-19
Pandemic
Key informants representing health workers and women’s service providers
assessed their pandemic experiences in light of a national government response
that was ‘lacking in care’. To them, there was a clear connection between the pan-
demic response and the adverse impacts they were experiencing. As one informant
pointed out, the whole approach was not makatao,18 that is, it did not put people’s
needs at the heart of the crisis management and response. They reported an acute
awareness that the carers are not being cared for. This is corroborated by several
public statements by health workers’ associations, for which they have been vili-
ed by the government, as mentioned above. What this has translated into over
the past two years since the start of the pandemic is the expectation that those who
have the task or duty of providing care to COVID patients, their own families, and
communities—and particularly victims of sexual and gender-based violence—are
elastic ‘safety nets’ who can absorb pandemic impacts and gaps in responses at
their own expense.
18 A Tagalog word that translates as ‘people-oriented’ or ‘human-centric’. Online interview,
February 17, 2022.

Lacking in Care 87
In the survey, health workers and women’s rights service providers were
asked about their level of satisfaction with the support they receive from their 1)
employers; 2) local government; 3) national government; and 4) family, friends,
and community. They were also asked to reect on their own capacity to care
for themselves and what kind of care and support they require to continue their
jobs. Moreover, they were asked to indicate their level of trust or condence in
the ability of their employer, national and local governments, and their own fam-
ily, friends, and community to be able to provide the care and support they need.
For the health workers group, the majority of respondents were satised with the
support received from employers and local governments. This group was divided
in their assessment of the national government, with 35.3% ‘somewhat satised’,
25.5% neutral (‘neither satised nor dissatised’), and 17.7% ‘somewhat unsatis-
ed’ or ‘completely dissatised’, respectively. Similar results were reported by
survey respondents belonging to the women’s rights service providers group.
Indeed, while this group reported satisfaction with support from employers and
local governments, their views were also divided in terms of the national govern-
ment. Around 33% reported low satisfaction or complete dissatisfaction, while
28% were satised or somewhat satised.
Views regarding national and local government responses are likely to dier
due to the fact that a number of local governments did step up to mitigate gaps
in national government responses. There were local mayors who were seen as
more eective and, therefore, more caring or responsive to people’s suering.19
However, instead of being celebrated and emulated, these local government ‘best
practices’ were castigated by President Duterte, who reiterated, ‘it is the national
government that should call the shots’ (Tomacruz 2020). Local mayors were thus
seen as either ‘upstaging’ the national government or representing another case
of pasaway. The results show that various forms of local-level implementation
contributed to unequal outcomes nationwide—especially demonstrated within
NCR—such that some regions had fewer casualties relative to population and had
better relief services available (Talabis et al. 2021).
By contrast, both groups of health workers and women’s rights service provid-
ers overwhelmingly indicated satisfaction with the support they receive from their
own family, friends, and community. When asked to assess dierent sources of
care in relation to their ability to provide the care our respondents needed, the
level of trust or condence decreased as the scale or distance involved in caring
relationship increased (see Table 4.1). Both groups reported very high levels of
trust that their family, friends, and community were able to provide the care and
support they needed, while the national government was viewed as the least capa-
ble of doing so.
19 Notable examples were Quezon city and Pasig city. See Talabis et al. 2021.

88 Maria Tanyag
These survey ndings, although focused on specic groups situated in one of
the most severely aected areas in the Philippines, do corroborate existing reports
and public statements by civil society groups nationwide regarding shortcomings
in the government response. The lack of condence in the ability of the government
to provide care for health workers and women’s rights service providers directly
results from the exclusion of perspectives from these sectors in crisis decision-
making and leadership. A strong example of this is how, from when he came to
power in 2016, Duterte prioritized improvements in the salaries and benets of
the military and police (Tanyag 2022). During his term, health workers did not
receive the same increase in support. Worse, many of them continue to be denied
their COVID-19 hazard pay and benets—even after two years of the pandemic.
Several key informants stressed that the response at the national level reected
a lack of ‘sensitivity’ or awareness of the dierences in access to ‘safety nets’
and coping mechanisms among Filipinos. For example, informants pointed out
how the initial imposition of ‘hard’ lockdowns, which strictly conned people
inside their homes, completely ignored the issue that many urban poor Filipinos
did not have safe and adequate shelter. Those residing in slums often had multiple
or extended families living in extremely small makeshift housing, and thus access
to safe outdoor spaces was a basic necessity.
Another example is how the sacrices expected of ‘frontline’ responders were
not really appreciated due to delays in proper nancial compensation, such as haz-
ard pay, and a lack of workplace protection, including mechanisms to address an
initial wave of stigma and discrimination. Because the government’s militarized
pandemic response was not makatao, they had to resort to ‘self-help’ and rely on
themselves to care for each other, an approach that was described as tayo-tayo.20
One initiative developed by the Philippine Nurses Association Zone 3 (Marikina
and Quezon City districts) was called the ‘Who Cares for the Carers’ program
at a time when fears and anxiety among the association’s members were high.
The program involved crowdsourcing private donations for nurses, ranging from
hygiene kits, PPE, and ‘gifts’ to cheer them up. Reliance on self and immediate
20 Tayo-tayo is a Tagalog word that translates as ‘among or between us’—used to describe reliance
on internal or collective caring eorts.
TA BL E 4 .1 Level of trust in the ability of the following groups to provide the care and
support needed30
Family, Friends,
and Community
Employer Local
Government
National
Government
He al th Wor ke rs 87 71 71 62
Women’s Rights
Service Providers
92 87 53 50

Lacking in Care 89
social relationships, such as family, friends, and community (including co-work-
ers), appears to have been the backbone of health workers’ and women’s rights
service providers’ eorts to survive amid the intensied burdens they faced due to
the pandemic and the government response.
Tayo-tayo was also evoked by the spontaneous and rapid spread of ‘community
pantries’, where residents from a neighborhood share food and basic everyday
supplies with anyone who needs them. This was rst reported in April 2021 when
news spread of an initiative by a woman in Quezon City (Metro Manila) who set
up a community pantry in her neighborhood—named Maginhawa. Within a mat-
ter of days, inspired by the Maginhawa example, community pantries in other
neighborhoods began to emerge all over the country. Many celebrated these com-
munity pantries as embodying mutual aid and trust among Filipinos. However, it
is important to note that this movement—built around community care—emerged
precisely because of the militarized pandemic response. As survey respondents
and key informants of this research stated, these initiatives emerged because peo-
ple did not trust or expect the national government to provide them with sucient
care. As in other crisis settings such as disasters, the romanticization of Filipino
mutual aid practices feeds into national myths of survival. These myths include
the narrative that Filipinos can innately make do or even innovate to survive dur-
ing times of crisis, despite limited relief assistance from the government (Su and
Tanyag 2020).
Interviews with representatives of these groups also yielded many examples of
how the private sector ‘stepped up’ to care for the carers. Many pointed out that
the national government itself was struggling to manage the pandemic, and so
health workers and women’s rights service providers could not aord to simply
wait for or expect assistance from the government. Indeed, others pointed out
that, under Duterte, the national government was a threat to the human security
of these frontline responders, especially those working on women’s rights. Tay o -
tayo became the default coping mechanism among frontline responders and their
families and extended social networks. It therefore demonstrates how caring rela-
tionships are an important aspect of carving out spaces of resistance to counteract
or shift pandemic responses toward more caring approaches. The availability and
reliability of care from families and communities empower health workers and
women’s rights service providers to fulll their duties in managing the pandemic,
as well as in caring for their own well-being.
Paradoxically, despite the lack of care and support received and expected from
the national government, survey respondents indicated condence in their ability to
take care of themselves and to continue in their jobs in the context of the pandemic.
According to the survey results, most healthcare workers were ‘somewhat happy’
with their ability to perform their job in the next 12 months (55%). This group was
followed by those who ‘feel very happy’ (32%), ‘somewhat unhappy’ (9%), and ‘neu-
tral’ (5%). The majority reported that they were somewhat happy with their ability
to take care of their personal health and well-being (68%). Similarly, women’s rights

90 Maria Tanyag
service providers responded that they had also been able to provide for their own
needs and take care of themselves from the beginning of the pandemic. Moreover,
they also believed that they would be able to continue to look after their personal
health and well-being and do their jobs over the following 12 months. What these
responses suggest is an even greater reliance on family and community to ensure
the survival of both caregivers and care receivers during this pandemic crisis.
Unless there is a drastic change in the security approach espoused at the
national level, survey respondents and key informants in this research indicated
that care will continue to be the backbone of pandemic survival, despite the lack
of resources to sustain caring relations, especially among health workers and
women’s rights service providers. Of course, this has implications for the sustain-
ability of their capacity to address ongoing consequences from shadow or hid-
den pandemics, particularly in providing ongoing care for victims of sexual and
gender-based violence and timely access to information and services on sexual
and reproductive health. These are real concerns given reports of the redirect-
ing or refocusing of personnel and resources toward the pandemic response and
away from development and democracy-building programs. A clear example is
that activities that were originally slated as training activities have been refo-
cused as relief response eorts (Nixon 2020). Many civil society organizations
have reported operating at reduced levels or were forced to suspend operations
temporarily (UN Women 2020). COVID-19 is demonstrating that vital services
available to women and girls are constrained, as non-governmental organizations
(NGOs) themselves struggle to mobilize resources for the work they do and as
they too have had to deal with the crisis as it aects them, their families, and com-
munities (Johnston et al. 2021).
Respondents and key informants provided information on what they need to
be able to care for their own health and well-being. At the time of the survey,
some of them highlighted that they need support for their mental health, as they
were already feeling the heavy eect of this pandemic, prolonged lockdowns,
and workplace insecurities. They also stressed that they need aid and nancial
support, and some even expressed a hope that they would have better monetary
compensation and insurance coverage. Financial support was a major concern;
they wanted to remain economically protected despite fears of job loss or under-
employment should they become infected with COVID-19 and, more signicantly,
end up hospitalized as a consequence. Almost all of them expressed that they need
emotional, mental, physical, spiritual, and moral support to be able to continue
in their jobs. Some included wanting to have more training or skills development
activities so they could enhance their abilities.
Respondents who are medical workers also mentioned that they need a ‘real’
break from their jobs, as they were already too tired. They also want some ser-
vices, such as a free shuttle service to and from their jobs, which makes them
feel safe and helps them save money because at least they do not have to pay the
fare. Dierences between the needs of various categories of health workers also

Lacking in Care 91
emerged. For instance, a barangay or community healthcare worker indicated the
need for additional training and support services to relieve anxiety due to job inse-
curity. A physician in a public health facility, on the other hand, shared the view
that their salary is not commensurate with the amount of eort expected from
them. While both expressed the need for care in the form of economic support,
there are clear dierences in the level of economic security given their dierent
status within the country’s health systems. It is important to note that the bulk
of reported care needs by the respondents was nancial in nature and, notably,
required economic resourcing by the State.
4.4 Conclusions
This chapter has examined the pandemic situation in the Philippines from 2020
to 2021 by highlighting the connections between the national pandemic response
and the prevalence of shadow and hidden pandemics relating to gender-based
violence, restrictions on accessing non-COVID and everyday health services—
including for sexual and reproductive health—and deterioration in the health and
well-being of health workers and women’s rights service providers. Drawing on
a feminist human security approach, and with a particular focus on care ethics, it
argues that the pandemic response did not reect how care constitutes a perma-
nent background to human life before, during, and after crises. Using the case of
the Philippines—and specically perspectives from the experiences of ‘frontline’
workers consisting of health workers and women’s rights service providers—this
chapter has shown crucial ‘care gaps’, such that those tasked to give care during
the pandemic were also egregiously denied care by the State.
Consequently, in the absence of state-level care inows to sustain the health
and well-being of health workers and women’s rights groups, they have resorted
to harnessing ‘self-help’ coping mechanisms underpinned by mutual relations of
care. Gaps in the pandemic response triggered the emergence of new commu-
nity-driven, ‘self-help’ strategies based on the belief that people cannot rely on
help from the government and therefore must weather this crisis on their own.
These community-driven initiatives can potentially strengthen civil society and
repair societal damage caused by the pandemic in the long run but paradoxically
may also divert attention from the need to improve national pandemic responses
in the future. While these initiatives have proven valuable, they may not nec-
essarily address the structural root causes of what makes ‘frontline’ respond-
ers insecure. Shifting the crisis response toward human-centric and feminist
approaches will be critical in ensuring that caring relationships, practices, and
institutions are considered a priority and therefore permanently and sustainably
resourced.
The ndings of this research arm the longstanding critique by feminist
and critical health scholars of the dangers of narrow security approaches, espe-
cially regarding gender. This is because crisis responses can create and reinforce

92 Maria Tanyag
hierarchies among health security issues to the detriment of women and girls,
preventing inclusive post-crisis recovery. Indeed, what is evident in the case
of the Philippines is that the pandemic response was lacking in care. There are
worrying predictions of long-term harms to human security emerging from the
compounded impacts of shadow pandemics on gender equality and the empow-
erment of communities more broadly. Crises can provide windows of opportu-
nity to develop antidotes that can reclaim, secure, and promote a human security
approach to intersecting health crises of COVID-19 and rebuilding health systems
in the aftermath.
Two years of the COVID-19 pandem ic have demonstrated clear lessons that can
be applied in strengthening or ‘crisis-proong’ security approaches. First, gender
equality is central to advancing human security. Empowerment—especially for
women and girls—is linked to their right to self-determination or the ability to
make decisions regarding care for others and for their own well-being. Women’s
health and the health of those tasked with responding to the pandemic are indis-
pensable for crisis response and the inclusive long-term recovery of societies.
Second, caring for the ‘carers’ must be considered a necessary investment in crisis
preparedness. Human security approaches need to attend to demands and chal-
lenges at the intersections of crises that recognize women’s and girls’ roles in the
production and reproduction of daily life. The path of re-orienting toward a human
security approach in the Philippines will be long and dicult—but necessary. An
indispensable step in this direction is to recognize and urgently respond to the hid-
den pandemic by ensuring gender perspectives are part of any crisis response. It
is also essential to create spaces for civil society to be able to shape decisions over
post-COVID pandemic recovery and reconstruction plans.
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