Vignettes of Equity: A Glimpse into COVID-19 in Southeast Asia

 

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Foreword

What a year 2020 has been! The COVID-19 pandemic has truly been an eye-opening and life-changing event in all of our lives. As the pandemic has unfolded, members of the 2019 cohort of EI Fellows took it upon themselves to reflect on what they have seen in their work and their communities and took note of how it negatively and disproportionately affects the vulnerable and marginalized populations. The Equity Initiative was established six years ago in response to social inequities that exist throughout Southeast Asia and China, and the insights of our EI Fellows, described in the following pages, highlight some of the ways that our vision of “a fairer, healthier, and more equitable Southeast Asia and China” is translated into action. Their individual and collaborative efforts bring to life our mission of “supporting the development of a thriving community of Equity Initiative Fellows and strategic partners that can influence meaningful systems change for health equity.”

As equity warriors, we cannot help but see the inequities this pandemic has exposed: while the pandemic is natural in origin, in the form of a virus, the impact to society, for the most part, is manmade, reflecting the ways that our societies and systems are structured. In the following collection of 11 essays, our EI Fellows document their thoughts and observations on the ways systems respond to the pandemic and the impact it has on the lives of the most vulnerable among us throughout the region. Despite differences in localities, customs, languages, and political and social structures, two messages came through clearly in all these stories: (1) the negative impacts are very much avoidable; and (2) we cannot afford to look the other way as our fellow human beings suffer if we want a better future for ourselves and for society.

On behalf of the staff and the Fellows of the Equity Initiative, we are proud to bring this collection of essays and stories to you. My EI colleagues and I appreciate the time and effort our Fellows devoted to bringing these vignettes to light. We extend a particular note of gratitude to Raudah Yunus and Gideon Lasco, who worked with contributors to bring each piece to final form and who wrote the introduction and conclusion, which link the individual vignettes to create a bigger picture of equity. Ana Santos, a 2018 Fellow, generously applied her talents to bring another layer of polish to each piece. If the Equity Initiative is to succeed, it will be through the spirit and dedication of our EI Fellows, which are embodied throughout these pages. Now, more than ever, we need our Fellows to continue to be vigilant in their role as equity warriors on behalf of all people throughout the region.

With immense gratitude and respect,
Le Nhan Phuong
Executive Director, The Equity Initiative

 

Table of Contents

  1. Introduction
  2. Vignettes of Equity
  3. COVID-19 and Children
    1. Virtual Exploitation in the Midst of COVID-19 (Gideon Cauton, Philippines)
    2. Children’s Nutritional Status in the Face of the Pandemic (Blandina Rosalina Bait, Indonesia)
    3. Child Helpline Cambodia Alleviates COVID-19 Fear (Sean Sok Phay, Cambodia)
  4. COVID-19 and Migrant Populations
    1. COVID-19 and Migrant Workers in Singapore (Rajaraman Natarajan, Singapore)
    2. A Story of Seventy Workers (Letchimi Devi, Malaysia)
    3. Stranded at Sea, Vilified on Land: The Fate of the Rohingya (Raudah Yunus, Malaysia)
  5. COVID-19 and Informal Workers and People with Disabilities
    1. The “Collateral Damage” of COVID-19 Countermeasures (Rapeepong Suphanchaimat & Kritaya Sreesunpagit, Thailand)
    2. The Impact of COVID-19 on Small Fishers (Alfredo Coro II & RARE Philippines,  Philippines)
    3. Living with Disabilities in Times of a Pandemic (Le Thi Nhat, Viet Nam)
  6. COVID-19 and Sex Workers, People Living with HIV (PLHIV), and LGBTQI Communities
    1. New Barriers to HIV Testing and Treatment among Men Who Have Sex with Men (MSMs) in Viet Nam (Nguyen Quoc Thanh, Viet Nam)
    2. The Impact of COVID-19 on LGBTI and PLHIV Communities in Thailand (Midnight Nike Panusart, Thailand)
  7. Discussion
  8. Conclusion

 

Introduction
Many have spoken of the coronavirus pandemic as a “great equalizer” in the sense that everyone is affected by it in one way or another. Still, it is more accurate to view it as a “great amplifier,” given how it has both exposed and exacerbated social, economic, and health inequities in every corner of the world. As Philip Blumenshine and colleagues presciently noted[1], three sources of disparities in major outbreaks are disparities in exposure, susceptibility, and access to treatment. A person who lives in an urban slum, for instance, will find it impossible to practice social distancing in their homes, will be more at-risk of contracting the illness due to weakened immunity and poor nutrition, and will be unable to access good quality healthcare, lacking financial and social capital. On the other hand, someone from an affluent family can afford to quarantine in their houses indefinitely while maintaining a reasonable quality of life, will have had good health and nutrition prior to the pandemic, and, in the event of sickness, can readily access primary healthcare.

Beyond Blumenshine’s framework, we can point to other disparities that affect not only who gets the disease, but who is most affected by responses meant to slow the transmission of COVID-19. We can see how social and economic disparities impact people’s ability to live through the pandemic, maintain their income and livelihoods, and attend to other healthcare needs.

But who exactly are the groups affected by these disparities? Although the general pattern is clear, the project of actually documenting the lived experiences of marginalized groups is as relevant and urgent as ever, given its potential to inform policy and serve as lessons for future health crises.

This preliminary report seeks to contribute to this project by presenting vignettes from the Southeast Asian region of how the pandemic and responses related to it are impacting vulnerable groups. Written by the Equity Initiative Fellows, based on their firsthand experiences, and drawing on their respective fields of expertise, this collection of stories is not a comprehensive survey; nonetheless, it gives insight into the predicaments of some under-documented (and, in some cases, undocumented) groups of people and the responses of the groups themselves, as well as of the people who are supporting them and advocating for their welfare.

We begin with three stories that focus on children. In terms of COVID-19 infection, they may be the least likely to be infected or get a severe illness from the virus, but they are no less vulnerable. In the Philippines, Gideon Cauton sheds light on the grim reality of online sexual exploitation of children in their homes, while in Indonesia, Blandina Rosalina Bait warns of how the pandemic is impacting children’s nutrition. Meanwhile, in Cambodia, Sean Sok Phay writes of how the support hotline service Child Helpline Cambodia (CHC) is stepping up to respond to the dramatic increase in demand from children seeking help for their medical and psychosocial needs.

The next trilogy of stories features migrants and refugees, whose pre-existing vulnerabilities have been compounded by pandemic-related policies. Rajaraman Natarajan shows how the pandemic has exposed the plight of migrant workers in Singapore, spurring public sympathy for their long-ignored predicaments, and potentially paving the way for future reform. In neighboring Malaysia, however, Letchimi Devi shows how migrants are not only losing jobs but also, because of xenophobia, are being blamed for the outbreak. At the same time, Raudah Yunus depicts a similarly dire picture for the Rohingya refugees in the country.

In the next set of cases, we see that, despite the massive amounts of financial assistance governments are giving their citizens, not everyone is (adequately) reached by such help; the account of Rapeepong Suphanchaimat and Kritaya Sreesunpagit in Thailand demonstrates this. Local governments are often left to fill the gaps, and Alfredo Coro’s vignette of helping fishers on a Philippine island is one good example of local responses, while also illustrating the need for economic responses.

People living with disabilities (PWD) can be related to all the above cases, given that, in many ways, PWD often need care from their families, are excluded from the rest of the population, and are economically vulnerable. In Le Thi Nhat’s case, we see how the pandemic is cutting off PWD from the health care services they need while at the same time threatening the already limited jobs available to them.

Finally, the pandemic is also exacerbating gender-based vulnerabilities. In Thailand, Midnight Nike Panusart shows how sex workers and transgender women have lost income opportunities and are reluctant to seek care for fear of stigma and discrimination. Similar concerns exist among men having sex with men (MSM) in Viet Nam, who have also been cut off from their treatment centers for HIV due to the quarantine and other measures. Both the Thailand and Viet Nam cases show that the heightened attention to COVID-19 care has not necessarily translated to better care for other conditions.

Taken together, the vignettes speak of the enormity of the work ahead if we are to improve health equity in the region, as well as the inexorable links between health, culture, economics, and even politics. However, they also demonstrate how, even in the face of the pandemic, vulnerable groups and their partners are not giving up, and are seeking ways to improve their situation.

As we continue to grapple with an unprecedented global crisis, surely we can learn and draw inspiration from each other, and create a more equitable region.

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COVID 19 AND CHILDREN

Virtual Exploitation in the Midst of COVID-19
Gideon Cauton, Philippines

gideon day careSophia is a 16-year-old Grade 9 student whose last month of schooling has been interrupted because of the Enhanced Community Quarantine (ECQ) in Metro Manila brought about by the COVID-19 pandemic. The last time she saw her friends was during their high school prom, just before the school closure mandated by the ECQ. Sophia is unsure when she will see her friends again or if they will be moved up to Grade 10 as they have not had their final exam yet. While on lockdown, she tries to fill her time with movies, books, and online courses. She alternates her screen time with guitar practice, house chores, and spending time with family at home. However, Sophia’s experience is not every Filipino child’s experience. Growing evidence shows that the lockdowns have put vulnerable children in greater danger.

The Philippines is a source country for online sexual predators – mostly from developed nations – who demand sexual exploitation of children in exchange for money. According to a report by the United Kingdom’s s National Crime Agency, at least 300,000 pedophiles are prowling the Internet, posing a considerable threat to children worldwide under the lockdown.[2] The Australian Federal Police has likewise noticed an increasing demand for child sexual abuse materials (CSAM) and livestream sexual exploitation of children since the strict COVID-19 restrictions were put in place. In their database of 22 million seized videos and images, they saw more rape and torture of children.[3] The UK and Australia are just two of the many more “demand countries” where online sexual predators reside and take advantage of the huge economic disparity between them and traffickers in the Philippines.

Internet-enabled crimes against children are appalling because one predator can easily connect to several traffickers in the Philippines who have access to children for online sexual exploitation with relative impunity and operate in the comfort of his own home. Most of the victims of online sexual exploitation in the Philippines are children under 13 years old. According to International Justice Mission (IJM), 62 percent of traffickers are parents, relatives, or neighbors.[4] IJM Philippines is working with the Philippine government to address this issue, focusing on the livestreaming of child sexual exploitation. This is compelling because the abuse is ongoing and each incident leaves a little digital footprint, which makes intervention difficult. Capturing the scale of the crime is challenging because online sexual exploitation of children (OSEC) is a hidden crime and is underreported. However, the increase of online predatory activity in demand countries is seen to have a direct correlation with source countries like the Philippines. Because of this, IJM continues to support law enforcement intervention to rescue children from OSEC during the lockdown period. On April 6, 2020 police in Lapu-Lapu in Cebu arrested a trafficker and rescued her three children. This was an offshoot of a case investigated by the FBI in the United States where the demand-side trafficker already pleaded guilty to two counts of sexual exploitation in December 2019 in Minnesota.[5] On April 22, 2020, the police in their personal protective equipment (PPE) caught a trafficker in the act of offering children money in exchange for sexual acts. This arrest was done in collaboration with the U.S. Homeland Security Investigations, which was investigating the U.S.-based trafficker. The 25-year-old perpetrator was immediately placed under arrest, and seven children were removed from the location of the abuse.[6] Rescue operations continued even during community quarantine because lust has no respect for time or place as the Philippine Supreme Court has penned in many of its decisions. In some of these operations, the police seized thousands of dollars, which is much higher than the subsistence needs of the perpetrator.

The ECQ in the Philippines has amplified the danger of children being exploited in their own homes; a danger that is filtered through several layers of inequity. First, there is the power imbalance between traffickers and the victims: often, these traffickers are in a position of authority and command the trust and confidence of their victims. Second, there is economic disparity between traffickers (buyers) in demand countries and traffickers in source countries. At a time when the local economy has stalled, the trafficker is still able to cater to his demand for OSEC for as little as US$10 per transaction. On the other hand, the source or supply-side trafficker enjoys a source of illegal income unlike other sources of livelihood, which are relatively unaffected by police checkpoints or “lockdowns.”

Moving forward, we need to take into account children’s safety in preparing for the next pandemic or similar health crisis, bearing in mind that for many children, one’s own home – and computer screen – can pose a bigger threat than any virus.

 

Children’s Nutritional Status in the Face of the Pandemic
Blandina Rosalina Bait, Indonesia

Picture4East Nusa Tenggara Timur (NTT) Province, the southernmost of Indonesia’s 34 provinces, has faced various forms of deprivation even before the COVID-19 outbreak. The region is plagued by widespread poverty, high rates of malnutrition, high maternal and neonatal deaths, and repeated crop failure. Of the 2.2 million children or 42 percent of the total population in NTT province, a large proportion live in rural areas. In 2015, almost 600,000 children (27 percent) were living below the poverty line according to 2015 data .(<USD$ per person per day).[7]

The impact of COVID-19 and the enforcement of the lockdown were intensified by the crop failure in several districts such as Timor Tengah Selatan (TTS) and Kupang located in West Timor.[8] As a result, many people – including small-scale farmers – lost their livelihoods and struggled to earn enough for their families. As of 3 May, the Labour Union (SPSI) of NTT Province reported a total of 6,529 farmer workers affected by COVID-19 in NTT province alone.[9] The impact on informal workers is likely to be higher, but it is difficult to determine as the informal sector often lacks official or published data. Some workers have had to “send their wives and children back to the village” so that they would not go hungry.

“I let my wife and children return to the village as there is still food there so that they are not hungry.”

~Marthen, an undocumented worker from Kota Kupang, East Nusa Tenggara Timur (NTT) province.

From a nutritional perspective, job losses always have an impact on children’s nutritional status. Common outcomes of compromised nutrition include stunting, wasting, micronutrition deficiency, and obesity. Prior to the pandemic, NTT province had the highest percentage of under-five children with stunting[10] (42 percent) and wasting (12 percent)[11]. Causes of malnutrition in NTT province have been identified as inadequate dietary intake and diseases. Only 26 percent of children under two years old in NTT province had a minimum acceptable diet, while 52 percent received complete basic immunization.[12] Furthermore, almost 80 percent of its population were found not to practice proper hand-washing and only 32 percent of households had access to nutritious food.[13]

To alleviate the impact of COVID-19, the government carried out several social safety net programs to help those affected, which included cash transfers, basic food cards, and others. In Kupang Municipality, one of the 22 districts in NTT province, the local government implemented social protection measures for all affected households by providing IDR300,000 (or approximately US$25) per month for three months. Nevertheless, that amount of money is far from sufficient; it can only cover basic food items, such as rice for a family of five, and perhaps electricity bills. Another drawback of the initiative is that unregistered informal workers cannot access it. In NTT province, many of these workers are without identity cards, thus they are automatically excluded from this economic relief scheme.

Indonesia has yet to see the full-blown impact of COVID-19, especially with regard to children’s nutritional status and well-being. Official studies or data are not yet available, but given the current trend of job losses and threatened livelihoods, the existing problems of malnutrition – including severe acute malnutrition among poor children – are likely exacerbated. This may complicate morbidities and mortalities related to COVID-19, as a minimum acceptable diet is key in strengthening the immune system – a vital aspect of fighting coronavirus infection.  

 

Child Helpline Cambodia Alleviates COVID-19 Fear
Sean Sok Phay, Cambodia

CHC Phone Counselor Answering Calls from ChildrenLike other countries, Cambodia has been dramatically affected by the COVID-19 pandemic. In early March 2020, the Royal Government of Cambodia announced the closure of all educational institutes, which included kindergartens, schools, and universities. The lockdown measure has drastically transformed the lives of many children and families. Disruption of children’s routines coupled with a lack of social support in the case of working parents who struggled to find new childcare options have somewhat led to public anxiety. This was further aggravated by the general concern about rising rates of COVID-19 infection. Those who lost their jobs or saw their livelihoods threatened by the disease outbreak and subsequent lockdown suffered from psychological distress. For some, this psychological trauma was expressed through aggression. Often, children had to face the sharp end of this aggression, which was manifested as family violence or child abuse.

Child Helpline Cambodia (CHC) is a free counselling referral and telephone service that offers support to any child or youth who calls in, is threatened by or faces serious forms of abuse, and needs someone to talk to or a referral to appropriate services.[14] Throughout the COVID-19 crisis and lockdown, the number of calls made to CHC rapidly increased. Children, young people, and women were the most common callers, often reporting experiences of family violence and conflicts. Other than that, many of them were anxious and “fearful of death.” This could be a result of the pandemic-related media frenzy that has swept not only Cambodia, but almost every corner of the world.

Children and women were not the only groups affected. Circulation of fake news and false information on social media had provoked hate speech and discrimination against certain ethnic minority groups. For instance, it was reported that the Chinese and Khmer Muslims became targets of online hateful comments and mistreatment in public spaces for being associated with the spread of COVID-19.[15] Similarly, discrimination and conflicts among people in the same communities occurred out of fear of COVID-19 contagion.

Throughout this difficult period, CHC has continued its operation 24/7 to allow children and young people to call and seek support. Frontline phone counselors worked on 24/7 shift rotations to ensure that every call was answered. The hotline was a source of educational information on self-protection from COVID-19 and mental and emotional support via telephone counseling. In addition, the counselors connected callers to other organizations or government agencies that could offer the specific services needed. Reports on violence and abuse were taken seriously: risk and needs assessments were conducted to ensure that children and young people were safe and interventions were tailored according to their needs.

Due to the nationwide movement restriction, CHC implemented a number of strategies to ensure that children and young people could still participate and access the needed psychosocial support services. These included:

  1. a) Dissemination of information through social media: with over 916,000 followers, CHC’s Facebook page has great potential to reach out to children and young people in Cambodia through educational messages embedded in child-friendly images and videos;
  2. b) Technology: CHC is strongly supported by the Ministry of Posts and Telecommunication and all private phone companies. Children and young people across Cambodia can reach CHC to talk with professional phone counselors without payment/costs associated with calls/credit as long as they have access to a phone;
  3. c) |Collaboration with other NGOs and international organizations to strengthen child protection measures. For instance, the Ministry of Social Affairs, Veterans and Youth Rehabilitation, and the National Child Protection in Emergency Coordination Group, including UNICEF and several NGOs, developed a new Child Protection in Emergency Contingency Plan for 2020-2021, to include COVID-19. This contingency plan is built on the past experiences and lessons of child protection concerns, constraints, protective and preventive actions and responses, mainstreaming child protection in other sector coordination groups and relevant Ministry sectors. It also provides clear standards and operating procedures on when, what, how, and who should be doing what before, during, and after a disaster.

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COVID 19 AND MIGRANT POPULATIONS

COVID-19 and Migrant Workers in Singapore
Rajaraman Natarajan, Singapore

PhotoSingapore’s COVID-19 experience has been characterized by early success in containment among the local population, followed by a surge of cases among migrant workers living in dormitories. Singapore is home to about 1,427,500 migrant workers[16], with 300,000 housed in various classes of dormitories.[17] These are mainly low-skilled workers from Bangladesh, India, and China who work in construction and other selected sectors.[18] Early COVID-19 cases from January to March 2020 were mostly imported or limited to local clusters. They were met with robust containment measures focusing on travel restrictions and a test-trace-isolate/quarantine regime. By mid-April, however, sporadic outbreaks among the migrant worker dormitories snowballed into a second wave, which exceeded the locals’ figures. For example, 20 April 2020 saw 1,426 new COVID-19 cases reported. Of this number, 1,410 were migrant workers.[19]

No death from COVID-19 among migrant workers has been reported as of 21 May 2020. This is partly attributable to their young age, as the upper age limit for work permit in Singapore is 60.[20] The non-health consequences of the outbreak, as well as the response measures, have been a greater concern. Due to the strict lockdown measures targeting dormitories starting mid-April, many workers became anxious about the possible loss of income, as the majority of them began their tenures in Singapore with heavy debts from recruitment costs.[21]

Singapore’s national response rapidly pivoted to concentrate on the outbreaks among migrant worker dormitories from starting April. Public statements by the Prime Minister[22] and Minister for Manpower[23] reassured migrant workers they would be cared for. New measures for disease control were coupled with welfare protections such as mandating continuity of salary payments[24], and complete subsidization of COVID-19-related medical costs.[25] Other strategies included rehousing essential workers; locking down dormitories coupled with aggressive testing, isolation and quarantine; and scaling up capacity for facility-based care for migrant workers.[26] These efforts appeared to be paying off. By 21 May 2020, 448 new cases were reported, of which 435 were among migrant workers.[27] Myriad civil society initiatives have sought to aid migrant workers, from expressing encouragement and solidarity[28] to crowd-sourced language aids.[29]

The public response has been predominantly sympathetic. Media coverage by the local and international press has drawn attention to the circumstances of low-wage migrant workers in Singapore, highlighting their general living conditions, food quality, and employer relations.[30] Singaporean voices amplified long-standing grievances that migrant workers felt powerless to press.[31] At times, this has extended to outrage and critique of Singapore’s treatment of them, and to its philosophy of the government.[32]

There are numerous factors responsible for the baseline differences in social determinants of health between the local and migrant worker populations in Singapore. These are the economic realities such as how the low-cost dormitories that migrant workers can afford are characterized by cramped spaces and high population density. Additionally, there are policies that contribute to the structural barriers to accessing primary healthcare and early self-isolation.[33] The COVID-19 pandemic has surfaced the acute social and health vulnerabilities of low-wage migrant workers in Singapore and the importance of ensuring no one is left behind.

 

A Story of Seventy Workers
Letchimi Devi, Malaysia

LetchimiKhan is one of the 6 million migrant workers in Malaysia. Originally from Bangladesh, he had first worked in Brunei for two years before returning home to get married. Life became hard again for his family, so he decided to migrate for the second time. A broker told him he could get a job for Khan in Malaysia and help with all the paperwork, but with one condition: Khan must pay him MYR 18,000 (approximately US$4,500). Seeing no other option, Khan agreed and took out a bank loan to pay the broker. He then left his wife, Sharmin, and their two children in the village and flew to Malaysia.

Khan arrived at the Kuala Lumpur International Airport, along with a group of 15 workers, to start a new life chapter. All of them had valid documents and had been recruited to work at SSN Medical Products Sdn Bhd, a company affiliated with the state of Melaka but located in Malaysia’s richest state of Selangor. Altogether there were 71 workers. Soon, the first surprise came. Khan and his co-workers found that they were given a one-year work permit but had signed a three-year working contract. When it was time to renew their work permit, the company refused to take on the responsibility. With their passports held by their employer and their work permit expired, they entered a world of undocumented workers. With this new status, Khan found himself in a more vulnerable situation; he and his friends could not move freely. Most of the time they were restricted to the company’s premises as extortion by authorities was a common experience outside. To make matters worse, the company stopped paying them.

Multiple attempts to lodge complaints and seek help from the Bangladeshi Embassy failed. Khan and his friends tried to reach out to the Labour Department in Putrajaya but to no avail. After a while, they managed to contact activists from the Socialist Party of Malaysia (PSM), who then took the workers to the Labour Department (Jabatan Tenaga Kerja) in Bangi to file a complaint. The Chief Minister Incorporated (CMI) director assured them that the matter would be resolved soon. Three months passed and nothing happened.

The COVID-19 outbreak and subsequent partial lockdown in the country pushed Khan and his friends toward greater adversities. Their working hours were reduced, and as a result, the employer paid them – not on a regular basis – a fraction of their actual salary, in the amount of RM 200 (less than 50 USD) per person in January and February 2020. At times, Khan and his friends put together what they had to purchase basic food items. Other times they went hungry for days. On and off, some well-wishers chipped in some money to alleviate their suffering.

Amidst the call for social distancing, migrant workers like Khan continued to live in squalid conditions. All they had was a 20 x 10 square foot space with 15 to 20 people squeezed in. A total of 71 workers had to share five rooms and one kitchen and pay MYR 50 (US$12.50) per person per month. Maintaining physical distance and observing proper hygiene were impossible.

Given that gloves were one of the company’s main products, things took a different turn in March when the pandemic started to grab more news headlines in the country and infection rates soared. The global shortage of gloves and other PPE brought factory operations back to life. The factory resumed daily operations and every worker was assigned to daily eight-hour shifts. Khan and other workers were provided with a mask and their body temperature was screened each day at the workplace. But the old problem remained unresolved – their wages for March and April remained unpaid. The company dismissed the workers’ repeated pleas. To date, Khan can only hope that his employer would fulfil his responsibility by paying his long overdue salary, which he desperately needs for his family’s Eid celebration back home.

The sad story of Khan is just one example. In Malaysia, such a story is common among low-skilled migrant workers who are mostly regarded as an invisible group, often forgotten and detested. There are thousands of other Khans whose stories have not reached the public ear. The COVID-19 outbreak has plunged countless migrant workers into poverty and further stigmatized them. Not only are they losing their dirty, dangerous, and demeaning (3D) jobs, but they have become targets of hate speech in social media and xenophobic reports in local media outlets. If previously migrant workers were accused of “stealing jobs,” now they are loathed for “becoming a source of disease.”

It is widely hypothesized that infection rates of COVID-19 are higher in this group (mass-screening is in progress). This has been used to justify the mass arrests that took place.[34] However, it is crucial that Malaysia takes a step back and reflects. Instead of blaming migrant workers, we should ask ourselves: how have we been treating them?

 

Stranded at Sea, Vilified on Land: The Fate of the Rohingya
Raudah Yunus, Malaysia
Cox's BazarFor decades, Malaysia has adopted a relatively lenient, even regarded by some as welcoming, approach towards the Rohingya and other refugee groups. This is despite the country’s clear position of not being a state party to the 1951 Refugee Convention and its 1967 Protocol.[35]  However, due to the lack of a proper socio-legal framework to cater to refugees’ needs, evidence of abuse, exploitation, and mistreatment have been extensively documented. Malaysian society, on the other hand, is largely supportive and accepting of the Rohingya. This is reflected in the strong, consistent condemnation by Malaysian leaders of the Burmese government’s violence against its ethnic minorities. Malaysian civil society organizations (CSOs), often funded by public donations, have also rendered generous assistance to refugees of various backgrounds. Nevertheless, the majority of the Rohingya in Malaysia live in poverty. They are marginalized and deprived of basic social services including education and health.

On 16 April 2020, while the country was fiercely battling COVID-19, a boat carrying 200 Rohingya refugees heading to the Malaysian shore was turned away by two navy vessels. By that time, Malaysia had 5,182 confirmed COVID-19 cases, with 84 deaths.[36] Officials cited COVID-19 as one of the main reasons for not allowing the boat into the country, which could hamper the existing measures to contain the spread of the virus. The response by Malaysian society was mixed. This time, the previous overwhelming support for the Rohingya was eclipsed by applause for the authority’s “swift action.” Refugee advocates, NGOs, and human right activists voiced their concerns and pleaded with the authorities to reconsider their decision but to no avail.

Things spiralled quickly into online chaos, with social media being the main platform for hate speech and dissemination of fake news. COVID-19 became a justification for denying entry to the Rohingya refugees and imposing greater restrictions on those already within Malaysian borders. Amidst the fiery debates, pro-Rohingya activists were cyberbullied and threatened with violence. Online petitions were launched to urge citizens to denounce the Rohingya and demand that they return home. There were at least five reported petitions inciting hate against the Rohingya. Some of them were titled “No More Rohingya in Malaysia, Government Please Send Them Home” and “Say NO to Rohingya.” Some were said to have gathered up to 250,000 signatures.[37] News reports cited the Rohingya refugees feeling unsafe “for the first time,” while some others pleaded for “safety and mercy” from the Malaysian public.[38] Following the lodging of reports by activists, the petitions were eventually taken down.

The saga, however, did not stop there. In early May 2020, Malaysian authorities rounded up and detained more than 500 undocumented migrants, including children and Rohingya refugees. Authorities claimed that such a step was necessary to prevent them from traveling or moving around – a violation of the imposed movement restriction – in order to contain the spread of COVID-19.[39] The mass raids had run contrary to the health ministry’s prior assurance that “migrants had nothing to fear” when coming forward for COVID-19 screening. By the end of May, new COVID-19 clusters were detected in a few detention centers, and the majority of daily new cases came from the migrant population.[40] Additionally, like other vulnerable groups, the Rohingya community was severely affected by the pandemic due to business shutdowns and closure of construction sites, which have caused job losses.

Upon the imposition of the nationwide movement control order (MCO), the government announced a stimulus package comprising initiatives such as greater flexibility to withdraw savings from the Employee Provident Fund (EPF), allocation of MYR500 million (about 117 million USD) to the health ministry, MYR130 million (about 30 million USD) for every state government to assist those affected, and deferment of loan repayments. However, these measures were mainly focused on citizens, leaving out refugees and other migrant populations. Local response has come mainly from CSOs, NGOs, and human rights groups, who extended different forms of support and services mainly in the form of food supply and provision of other basic daily needs such as formula milk (for babies) and various household items.

In times of crisis and disease outbreak, marginalized groups – including the refugee communities – are often forced to face greater adversities. First, the stigmatization of being the source of disease renders them vulnerable to more mistreatment and deprivation. Second, their irregular status can easily land them in detention centres – squalid and crowded – thus further increasing their risks of contracting COVID-19. If there is one thing this pandemic has taught Malaysia, it is important to treat its migrant populations fairly, not only in terms of health access but also its wider social determinants. In the end, the health status of both groups – the host society and refugee communities – are interdependent.

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COVID 19 AND THE INFORMAL WORKERS AND PERSONS WITH DISABILITIES

The Collateral Damage of COVID-19 Countermeasures
Rapeepong Suphanchaimat & Kritaya Sreesunpagit, Thailand

P1020168Despite being the first country outside of China to have a confirmed COVID-19 case, Thailand has performed remarkably in controlling the virus.[41]  Even so, a number of issues remain unresolved. Poor households and other vulnerable groups have been disproportionately affected by this crisis that has so far caused job losses and business closures, and threatened livelihoods throughout the country.

Beginning in mid-March 2020, the number of those who tested positive for COVID-19 skyrocketed and deaths increased. In response, the government announced a nationwide lockdown that restricted people’s movement across provinces and confined them to their homes. This has severely affected the poor and informal workers (e.g., fishermen, farmers) who do not have the not privilege to work from home. Even though the country’s 2002 Universal Health Coverage health safety net can be considered a success story, social protection measures to address other needs remain absent. Thailand has few social protection measures in place, unlike China, Malaysia, and other upper middle-income countries. According to a World Bank report, the country’s spending on social protection is still lagging behind that of neighboring countries. For instance, in 2015, Thailand spent 3.7 percent of its GDP on social protection, compared to 6.3 percent in Viet Nam and China, and 10.1 percent in South Korea.[42]

The Thai universal healthcare coverage (UHC) operates via three public insurance schemes: (1) Civil Servant Medical Benefit Scheme (CSMBS) for civil servants and dependents (covering approximately 5 million people); (2) Social Security Scheme (SSS) for employees in the formal sector (10 million people); and (3) Universal Coverage Scheme (UCS) for the rest of the Thai population, who are mostly informal sector workers and the self-employed (47 million). Even though treatment benefits across all schemes are relatively equivalent, there are some subtle but important differences.[43] For instance, the monthly wage of civil servants remains unchanged as the government has a policy not to downsize civil servant posts in times of crisis. On the other hand, SSS beneficiaries can avail themselves of an unemployment stipend. However, for the informal workers and self-employed, the scheme only covers treatment costs but does not provide a subsidy or any form of compensation during unemployment periods.

To prevent informal and self-employed workers from becoming collateral damage, the Thai government announced that 5,000-Baht (US$166) would be provided every month to individuals whose businesses were affected by the COVID-19 crisis. The initiative was no doubt intended to assist the most vulnerable, but various implementation challenges stood in the way. The registration and application processes were complex, often leaving people – mostly those who are technologically illiterate – unable to navigate the system. On top of that, registration or application did not guarantee remittance as all applicants are filtered by the government’s (black box) software.[44] Media reports claimed that millions of poor people had been disqualified based on the screening criteria. In mid-April, hundreds of people whose applications were turned down gathered in front of the Ministry of Finance building to demand answers. Some attempted to commit suicide out of desperation. The COVID-19 crisis period witnessed a sharp increase in death by suicide, especially among the poor.[45]

In response, community-based organizations and NGOs sprang into action. With many farmers and fishermen unable to sell their produce due to the nationwide lockdown, initiatives were set up to trade agricultural produce for seafood. Online markets were launched to allow local farmers to reach consumers directly. Although the number of people they serve is still small, the platform has offered an alternative that can be scaled up in the future. Another example of a community-based program was the “Pun-gun-im” project – literally meaning “sharing a full stomach” – which supplied basic food items for the poor and homeless, whose numbers rapidly rose following the declaration of the lockdown.

While many countries across the globe – including Thailand – have chosen the lockdown or implemented movement restriction policies to contain the spread of COVID-19, one aspect that has been largely overlooked or inadequately addressed is the unintended consequences of such measures. Public health protection needs to be carefully planned so that it does not cause greater problems, especially those that may further exacerbate existing inequalities. Lockdown policies or social distancing measures per se are not wrong but their implementation without proper and effective interventions for the vulnerable is problematic and may aggravate many social problems.

 

Impact of COVID-19 on Small Fishers
Alfredo Coro II & RARE Philippines , Philippines 

Mobile Market 01When the Philippine government decided to impose a community quarantine throughout the country on 16 March, small-scale fishers were among those who voiced immediate concerns. Considered the poorest sector due to their reliance on natural resources for livelihood, small-scale fishers are confined to coastal areas and have to go out to sea almost daily to provide sustenance for their families and earn a decent income. Due to the public health emergency, fishers initially faced severe limitations, with Coast Guard personnel restricting the movement of fishing vessels.[46] Fortunately, the Department of Agriculture recognized the critical role of farmers and fishers in providing food for the country’s 110 million people. On 25 March, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) approved the proposal to consider the two sectors as “food security frontliners” that are crucial in the production chain.[47]

The economic downturn and border closures resulting from the lockdown had a severe impact on fishers, however, as their markets dried up. With most restaurants and tourist resorts closed, and many daily wage earners losing their jobs, fish prices went down due to the absence of commercial and even household buyers. An article in the Philippine Daily Inquirer quoted a fisherman in the Visayan Sea, one of the country’s richest fishing areas, as saying that the price for a 40-kilo tub of fish went down from P6,000 (US$119) to a low of P1,000 (US$20) since the quarantine was imposed.[48] Some fishers on the island of Siargao, a popular tourist destination that has seen resorts closing en masse since the onset of the pandemic, opted to stop going out to sea because of the low prices. However, they were replaced by other residents who lost their livelihood means, such as pedicab drivers and construction workers.

Transport difficulties also disrupted the fisheries supply chain, despite the creation of Food Lanes and issuance of Food Passes intended to facilitate the smooth flow of food supplies across checkpoints. In the early days of the lockdown, trucks getting stuck at checkpoints became a common sight in metropolitan areas due to confusing guidelines that prevented them from bringing seafood from provincial fish ports to city markets. According to the Bureau of Fisheries and Aquatic Resources, fish stocks piled up in cold storage while fish exports could not move due to port congestion. In far-flung areas, some fishers reported difficulties in securing ice to preserve their catch.

Meanwhile, illegal fishers took advantage of the COVID-19 crisis to use prohibited gear or enter marine-protected areas that had been declared as no-take zones for marine life.[49] The fisheries bureau reported that the most common violation among commercial fishers was the use of the Modified Danish Seine, which is banned in Philippine waters. Others used fine-mesh nets or gathered prohibited species in municipal fishing grounds. At the Siargao Island Protected Landscapes and Seascapes, the largest marine-protected area in the Philippines, key personnel who are based on mainland Mindanao could not enforce the law due to travel restrictions.

In Indonesia, the Traditional Fisherfolk Union (DPP KNTI) conducted a survey in early April to find out the impact of the pandemic on small-scale fishers, who comprise about 97 percent of the total number of fishers in the country. The group reported that most coastal regions experienced a significant decline in fish prices, as fish traders limited their purchases and destination countries for exports imposed a lockdown.[50] To survive, many fishers used up their savings to meet daily needs or were forced to borrow money. The scenario was the same for fishers in the Philippines.

In response, the Philippine government has come up with various programs to ease the burden on affected families, including fishing communities.[51] However, some fishers have complained that they are not prioritized in the distribution of social amelioration funds. Others say the requirements for availing livelihood assistance for displaced workers are too cumbersome for a minimal amount of P5,000 (US$99) to P8,000 (US$158) per family.

Coastal municipalities in Siargao that are part of “Fish Forever campaign”[52] benefited from an updated registry of fishers, which proved useful in validating the identity of beneficiaries for government assistance.[53] Fishing communities that organized savings clubs continued their weekly deposits, realizing the value of financial resilience when a crisis such as the COVID-19 pandemic hits households. Fishers’ organizations guard their fish sanctuaries closely, knowing that their fisheries’ future depends on the conservation of local resources. To solve supply chain problems, local governments have been encouraged to develop community-based interventions such as providing transportation for fishers or buy their fish catch and including them in food relief packages distributed to households affected by the lockdown.[54] Community fish landing centers in the municipalities could be utilized as ice production and cold storage facilities.

With the easing of quarantine restrictions, the government could provide supplemental livelihood such as cash-for-work programs for activities like mangrove planting, and honorarium for fishers that help enforce fisheries laws.

 

Living with Disabilities in Times of a Pandemic
Le Thi Nhat, Viet Nam

Screen Shot 2020-06-29 at 10.44.41According to the Viet Nam National Survey on People with Disabilities, 7 percent of the Vietnamese population– equivalent to 6.2 million – live with one type of disability.[55] The survey showed that more than three quarters of households with a person with disability were in rural areas and households with a person with disability were twice as likely to be poor. A rapid assessment of the socio-economic impact of COVID-19 on persons with disabilities in Viet Nam found that 28 percent of responders had their income adversely affected, rendering 72 percent of them earning below 1 million dong (approximately US$42) per month.[56]

The International Committee of the Red Cross (ICRC) Physical Rehabilitation Program in Viet Nam[57] – a project that assists the disabled by providing orthopedic support – has been similarly hit by the impacts of COVID-19. Due to movement restriction and physical distancing measures, people living with disabilities (PWD) have reported greater difficulties in earning and getting access to prostheses. For instance, during an interview, one person with bilateral amputation shared that he could not go the streets to sell lottery tickets – his regular job – since the government had imposed measures to contain the disease outbreak. Unable to earn income, he had no option but to depend on a small allowance – provided by the government – for older adults with disabilities. He received only around 700,000 dong (approximately US$30). There was also assistance in the form of food supply (by another organization), but it was not enough as he has two daughters with him, both with disabilities. In spite of his eligibility for the government’s newly announced relief scheme, he was unsure how long the “waiting period” would be due to the relatively slow implementation of the program.

Given the physical distancing policy, public orthopedic hospitals have had to rearrange their schedules and operate at 30 percent of their capacity. Emergency cases were thus prioritized. On top of that, hospitals discharged patients whenever possible or asked them to return once the measure is lifted. As a result, some PWD could not obtain their orthopedic support on time. For instance, one interviewed respondent was supposed to receive prostheses but distribution was delayed because of the new hospital policy. He is currently moving on his bare stumps and mobilizing on his three-wheel vehicle. The good news is that he received information and education on COVID-19, and applied preventive measures such as washing hands frequently and wearing a mask in public.

The chairman of the People with Disabilities Association in Da Nang city claimed that PWD in remote areas suffered from a “double burden”: first, the burden of disability, and second, the burden of lacking access to information. In addition, service providers and organizations assisting those affected by COVID-19 often could not reach PWD living in remote rural villages the way they reached city-dwellers. He also observed that PWD whose disabilities were categorized as mild tend to “fall between the cracks.” The social protection measures designed by the governments largely catered to individuals with severe and very severe disabilities. In contrast, those with mild disabilities and working in informal sectors were somewhat “overlooked” and not included.

Responding to COVID-19 impacts on the national economy, a subsidy package of US$2.7 billion was approved by the government to assist affected individuals, households, and businesses. PWD categorized as having severe or very severe disabilities were entitled to financial support. Business owners could postpone their tax payments as well as insurance payouts for their employees. In addition, small business owners among PWD were entitled to US$45 per month for three months. Humanitarian bodies and NGOs implemented various initiatives such as providing sign language on the mainstream TV channel[58] to ensure the deaf could access adequate information, supplying basic food items to those in need, and distributing hygiene kits to PWD.

One of the challenges the PWD community faces is discrimination in terms of eligibility to access government funds, which is largely based on levels of disabilities. As the majority of PWD were already struggling with financial constraints prior to the COVID-19 outbreak, such a crisis immediately renders them more vulnerable. Those with mild disabilities and working in the informal sector appear to be – by far – the most disadvantaged.

_______________________________________________________________________________________

COVID 19 AND SEX WORKERS, PEOPLE LIVING WITH HIV, AND LGBTQI COMMUNITIES

New Barriers to HIV Testing and Treatment among Men Who Have Sex with Men (MSMs) in Viet Nam
Nguyen Quoc Thanh, Viet Nam

June 2019On 30 March 2020, Vietnamese Prime Minister Nguyen Xuan Phuc declared the COVID-19 pandemic in Viet Nam. The next day, restriction of movement under the term “cách ly xã hội[59] social quarantine” was enforced on a national scale for a period of two weeks from 1 – 15 April. This was later extended to 23 April 2020.

The first COVID-19 case in Viet Nam was identified in Hanoi on 23 January 2020. As Hanoi and Ho Chi Minh City soon became the country’s biggest COVID-19 hotspots, many provinces undertook measures to monitor and control people’s movement from these two cities as early as mid-March, two weeks before the social quarantine was enforced. These measures included a 14-day quarantine at home or at local medical facilities for people who showed symptoms, or had been in close contact with identified COVID-19 patients. By April, side road check points were set up in many provinces during the social quarantine.

This case study presents how the pandemic has created new barriers to access to HIV testing and antiretroviral (ARV) medications in a way that guarantees confidentiality among MSMs (men who have sex with men) who are HIV-positive and live outside Hanoi. It is drawn from an interview with Nguyễn Đình Đức, head of Niềm Tin Xanh Hà Nội (A Blue Belief Hanoi, NTXHN)[60] which is a community-based organization (CBO) founded in 2008 in Hanoi. Its operation focuses on HIV/AIDS prevention and providing support for HIV-positive patients in accessing and continuing ARV treatment.

CBOs are one of three channels through which LGBTQ individuals access HIV/AIDS-related services and support. The other two are public hospitals that offer services and medications covered by national health insurance, and private clinics with paid services. The advantage of CBOs is the combination of free services, which include rapid HIV testing (that can be carried out at home or at community health service points), support in pre-exposure prophylaxis (PrEP) and ARV treatments with free medications, support in post-exposure prophylaxis (PEP) treatment, and greater confidentiality.

Lack of confidentiality is often the reason many HIV patients in provinces would prefer not to get treatment in their local medical facilities. They would instead travel once a month to CBOs in Hanoi to get tests and obtain medications. Furthermore, through CBOs services, the use of ARV medication does not appear on the patients’ medication list stored in the national health insurance system, therefore there is no risk of HIV status disclosure to their workplaces, local authorities, and surrounding community.

These benefits were erased during the period of social quarantine in March and April 2020, because travel to Hanoi was highly restricted. Delivery of rapid HIV test kits and medications was also stopped. As movement between provinces and Hanoi was limited and monitored, travelers leaving and entering given locations would be required to present appropriate documents. In some provinces, travelers coming back home from Hanoi were subjected to medical checks and eventual quarantine.

The measures taken to contain the spread of COVID-19 have had the unintended outcome of putting HIV patients at higher risk of stigmatization and discrimination as keeping their HIV status confidential became more challenging. Due to the sudden announcement of the nationwide quarantine, many HTXHN clients did not stock up on PrEP and ARV medications, so they faced difficulties in maintaining their treatment. Although three patients managed to purchase ARV medications, five had to discontinue PrEP curation temporarily.

During the quarantine period in April, many individuals reported their anxiety to NTXHN when their rapid test results at home became positive. The imposed movement restriction posed an important question as to how to ensure these individuals (those who had tested positive with rapid tests) who lived in remote areas could access further diagnostic tests to verify their HIV status and initiate ARV treatment without delay, while maintaining confidentiality. In contrast, patients living in Hanoi still had access to PrEP and ARV medications. When Bạch Mai Hospital, a major hospital in Hanoi was quarantined, NTXHN redirected 30 patients to other facilities with medication supply. It also supplied medications to five individuals living in provinces through post services. Other NTXHN services, such as HIV/AIDS-related consultation and mental health support for new HIV-positive individuals, were accessible through phone or online platforms.

The COVID-19 crisis revealed a “paradox” between two public health strategies – one that is meant to contain COVID-19 and another that aims to curb HIV. COVID-19’s strategy of testing, contact tracing, and isolation relies on access to personal data. In contrast, HIV/AIDS patients should not be isolated but protected, and their personal data must be kept confidential. In recent years, new programs that attempt to create safe space for the treatment of LGBT and HIV patients in hospitals have been implemented in bigger cities such as Hanoi and Ho Chi Minh City. However, these programs did not address the issue of unethical disclosure of patients’ data by health personnel. New initiatives are needed to provide the structure that would support LGBTQ and HIV patients, especially those living in rural areas, to overcome discrimination. An informal self-help, localised network of HIV patients may play a significant role in delivering and sharing medications in times of emergency. This “support group” could be imagined as a grassroots action, and it should work be supported by the local public health system and CBOs to facilitate medication supply and health information.

 

The Impact of COVID-19 on LGBTI and PLHIV communities in Thailand
Midnight Nike Panusart, Thailand 

Picture1By late March 2020, the Thai government realized that COVID-19 was getting more difficult to control. It announced a State of Emergency decree on 26 March. A week later, a curfew decree was issued, and people were forced to remain indoors between 10 p.m. and 4 a.m. A travel ban was also enforced, banning foreigners from entering the country. Compared to ordinary Thai citizens, the impact of a nationwide lockdown was more palpable among vulnerable groups such as sexual minorities, those living with HIV, sex workers, victims of gender-based violence, transgender people, the homeless, and ethnic minorities. The risks they face are not only a result of movement restrictions, but also the inability to access formal support.

For people living with HIV (PLHIV), one of the greatest impacts of COVID-19 has been their access to antiretroviral (ARV) drugs. Usually, patients go to hospitals directly to see the doctor and collect their ARV drugs. Given the lockdown measures, some hospitals began to deliver drugs through postal services. However, some PLHIV who have not disclosed their HIV status to their family, relatives, or friends prefer not to receive medication packages through post or any courier service and would rather obtain their medications directly from health facilities. As living with HIV is still a huge stigma that easily causes discrimination, PLHIV often choose not to access services closest to where they live for fear of disclosure of their HIV status. Many of them visit health facilitates in a different province. Due to cross-province travel restrictions during the pandemic, this was no longer possible. As a result, their adherence to their ARV regimen was interrupted. There were also reports of PLHIV having to borrow ARV drugs from friends during the lockdown period. Similarly, drug users who regularly travel to undergo methadone maintenance treatment (MMT) had their access restricted.

Many sex workers who are based in Bangkok reported being unable to earn a livelihood, running out of savings, and/or having to go back to their hometowns, as the bars and entertainment establishments were shut down. Others were trapped either in Bangkok or Pattaya City and did not have any option but to stay in the entertainment venues where they worked. Loss of income made them struggle to find decent accommodation. Although some sex workers were able to receive clients, their diminished negotiating power became weaker and their work assumed risks not just to HIV and STI, but also to COVID-19. As commercial sex is not recognized as “labor” under a legal premise, they were not able to access the government’s THB 5,000 relief scheme.

While many people saw remaining indoors as an opportunity for more family time, for others – particularly victims of domestic violence – the lockdown only put them at a higher risk for violence and abuse. Through engagement with other NGOs, we detected over 20 cases requiring physical rescue. Many more were likely unreported. The Emergency Decree and lockdown measures rendered rescue missions more challenging and, at times, impossible. In order to assist women and children who were victims of domestic abuse and violence, coordination between different agencies across provinces was crucial.

For transgender people, the COVID-19 outbreak and its corresponding measures have limited the sources for hormones and access to them. Lockdown also meant losing their usual sources of income. This has pushed some of them into “cyber-sex work.” Transgender women reported feeling reluctant to seek care from public hospitals in the midst of COVID-19 for fear of stigma and discrimination. One of the fears was that the public may associate them with the disease.

Based on an estimate by the Issarachon Foundation, there were almost 4,000 homeless individuals in Bangkok in 2018.[61] With the sudden arrival of COVID-19, the number has likely increased, though official data is unavailable. Many of those who are homeless do not possess ID cards, and therefore they are systematically excluded from the government relief scheme. To some extent, the Ministry of Social Development and Human Security has provided shelter and other forms of support, but the homeless cannot choose where to stay and little is known about the circumstances and standard of the designated place.

Other groups that have been adversely affected are the ethnic minorities. Mandatory closure of establishments and public places throughout the country left many of them with no option but to head back to their respective indigenous communities. With agriculture as the main source of livelihood, sources of income have become extremely limited for this community. There is also a huge concern about their ability to access information about COVID-19 and whether or not essential assistance offered to Thai citizens could reach them. Young indigenous LGBTQI people who are forced to return to their hometowns have reported being physically and/or verbally assaulted by family and community members as their sexual orientation and gender identity and expressions are in opposition to long-held beliefs and traditions. Some experienced outright abuse in the form of forced marriage or rape.

Our NGO has actively reached out to other local NGOs and international stakeholders such as United Nations (UN) agencies and diplomatic missions through online discussions in order to make the voices of these vulnerable groups heard. Forging collaboration is crucial in order to provide social and technical support to community-based organizations that offer services for PLHIV and the LGBTI community (e.g., community clinics in need of PPE). To date, initiatives that have taken place include fundraising, engagement with the private sector, and updating information on clinic operating days and hours to help people plan their trips accordingly during the lockdown period.[62]

I have been working in the field of HIV and LGBTI human rights for over ten years. Most of those years were spent in the nongovernmental sector, working with community organizations and networks across Asia and the Pacific. As a gay man, I feel that there is still so much to be done. HIV rates are still high among men having sex with men (MSM), 16 countries in Asia Pacific still have sodomy laws, and transgender people are still largely unrecognized. These groups live each day in fear, knowing that being different can come at great personal cost. To date, the 2030 Sustainable Development Goals and discussion on universal healthcare coverage still seem like distant goals.

 

DISCUSSION
Despite the seemingly diverse topics covered by these 11 case studies, they highlight a similar theme of how a global crisis – such as a pandemic – affects vulnerable groups and how policy responses often fail to consider and address their specific needs. Evolving evidence related to the trends and patterns of COVID-19 transmission indicates higher incidence rates among the migrants and socio-economically disadvantaged compared to the larger populations. Such inequality can be attributed to various social determinants of health such as educational status, access to healthcare, living and employment conditions, and social environment. As these vulnerable populations generally have a poorer health condition to begin with, COVID-19 amplifies this deficit, thus widening the health gap between them and mainstream society.

In times of crisis, whether economic, social, political, or environmental, children are almost always the most severely affected group. For instance, following the 2015 great earthquake in Nepal, there was a surge in cases of child trafficking as the loss of lives and property drove families into desperation and children were easily lured by traffickers who posed as labor recruiters or aid workers.[63] Similarly, the ongoing armed conflict between the Burmese military and ethnic minorities in Myanmar has caused thousands of children to be exploited as child soldiers or sent away by their families to work as domestic help in urban households.[64] These two scenarios demonstrate how children’s lives – in comparison to adults – can easily undergo sudden, major changes when a calamity strikes.

This report highlighted a number of heightened dangers that children face as a result of the COVID-19 pandemic such as malnutrition, online sexual exploitation, abuse and family violence, and psychological distress. While it is possible that all children, regardless of socio-economic status, may be exposed to these dangers, those from disadvantaged backgrounds are at much higher risk. Malnutrition and online sexual exploitation, as described in these studies, are clear examples. The former is a consequence of job loss or reduced income of the family breadwinners, a more common experience among informal workers, while the latter is known to be fuelled by poverty. Similarly, family violence or abuse is likely to be exacerbated during times of socio-economic crises with children often bearing the brunt.

The migrant populations (migrant workers, refugees, asylum-seekers, stateless persons, etc.) comprise another vulnerable group that has been severely impacted by COVID-19. As a result of the economic slowdown, many of them who are daily laborers and informal workers lose their jobs. Due to documentation issues and their second-class status, migrants often are excluded from the various social protection measures that citizens are entitled to, such as various economic relief schemes or access to certain services. Unable to enjoy the luxury of working from home and prevented from freely moving around to earn a living, they are forced to stay in squalid and crowded living quarters like dormitories, a catalyst for COVID-19 transmission. An additional challenge is the “scapegoating phenomenon” that often worsens in times of social unrest. Migrant populations are usually the first to be accused of being the culprit or cause of the problem and subsequently subjected to intense public scrutiny and harassment. This could be seen in the case of denigration and mistreatment of migrant workers and the Rohingya community in Malaysia, which has worsened during the COVID-19 pandemic.

Other groups heavily affected were informal workers; PWD; and frequently socially stigmatized populations such as PLHIV, sex workers, and LGBTQI communities. For informal workers and those living with disabilities, lockdown measures meant not only income loss but also restricted access to rehabilitation services and equipment (e.g., prostheses). Similarly, for PLHIV, sex workers, and LGBTQI communities, restricted movements have led to greater difficulties in accessing medications and other health-related services. On top of that, the stigma of being different could be easily amplified and translated into being wrongly associated with COVID-19 contagion.

Conclusion
The unequal burden of COVID-19 across different groups highlights existing inequities that have been long ignored. Crises such as a global pandemic, economic recession, and social unrest often widen the gap, exposing those already at the bottom of a hierarchy to greater vulnerabilities. Policy responses need to be inclusive and tailor-made in order to match the unique needs of different populations. Likewise, measures implemented to contain disease spread, such as nationwide lockdown, should be carefully planned and complemented by other support systems to minimize unintended consequences. The case studies in this report have demonstrated various scenarios of inequities as a consequence of unequal distribution of power, privilege, and resources. These inequities need to be recognized, and they urgently necessitate a global, collective action.

 

Endnotes

[1] Blumenshine, Philip, et al. “Pandemic Influenza Planning in the United States from a Health Disparities Perspective.” Emerging Infectious Diseases, vol. 14, no. 5, 2008, pp. 709–715.

[2] Hartley-Parkinson, Richard. “More than 300,000 Paedophiles May Exploit Coronavirus

Lockdown.” Metro, 3 Apr. 2020, metro.co.uk/2020/04/03/300000-paedophiles

will-exploit-coronavirus-lockdown-12502094/.

[3] Benson, Simon. “Police bust ‘horrific’ child sex abuse ring.” The Australian, 20 Apr. 2020, https://www.theaustralian.com.au/nation/police-bust-horrific-child-sex-abuse-ring-spread-across-five-states/news-story/0a6932c8799d2f8bdf73930509cd503d

[4] International Justice Mission, “The Philippines; The Problem: Online Sexual Exploitation of Children,” Fact Sheet, n.d.

[5] “Sex Trafficker in Lapu-Lapu Arrested.” Yahoo! News, 9 Apr. 2020, ph.news.yahoo.com/sex-trafficker-lapu-lapu-arrested-030300156.html.

[6] Rappler.com. “Trapped with Abusers, 7 Kids Rescued from Sex Trafficker in Luzon.” Rappler, 25 Apr. 2020, www.rappler.com/nation/258987-trapped-with-abusers-children-rescued-from-sex-trafficker-luzon?fbclid=IwAR3JXvLYDQb0HYzreetBs8FNIi9kVC2UqOLa64QIZIMsptNC9gDBFu0o0JQ.

[7] Ministry of National Development Planning Indonesia and United Nations Children’s Fund Indonesia. SDGs for children in Indonesia. Provincial snapshot: Nusa Tenggara Timur. Jakarta: United Children’s Fund; 2018.

[8] Kota, Dion. “Peduli Dengan Kondisi Gagal Panen Petani Di Selatan TTS, Ini Yang Dilakukan Bupati Epy Tahun.” Pos Kupang, Pos Kupang, 19 Apr. 2020, kupang.tribunnews.com/2020/04/20/peduli-dengan-kondisi-gagal-panen-petani-di-selatan-tts-ini-yang-dilakukan-bupati-epy-tahun and Lewanmeru, Oby. “Pemprov NTT Diminta Antisipasi Dampak Gagal Panen.” Pos Kupang, Pos Kupang, 18 Mar. 2020, kupang.tribunnews.com/2020/03/18/pemprov-ntt-diminta-antisipasi-dampak-gagal-panen.

[9] Lewanmeru, Oby. “DAMPAK CORONA: 6.518 Pekerja PHK, Pemprov NTT Siapkan Insentif.” Pos Kupang, Pos Kupang, 30 Apr. 2020, kupang.tribunnews.com/2020/04/30/dampak-corona-6518-pekerja-ntt-alami-phk-pemprov-siapkan-insentif?page=all.

[10] Stunting refers to the condition of a child who is too short for his or her age. These children can suffer severe irreversible physical and cognitive damage that accompanies stunted growth. The devastating effects of stunting can last a lifetime and even affect the next generation.

[11] Wasting refers to the condition of a child who is too thin for his or her height. Wasting is the result of recent, rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is possible.

[12] Indonesia Basic Health Survey 2018 (RISKESDAS 2018)

[13] (WFP-Bappenas 2017).

[14] “Child Helpline Cambodia: End Violence.” End Violence Against Children, www.end-violence.org/members/child-helpline-cambodia.

[15] Louis, Jillian. “COVID-19 and Cambodia’s Human Rights Concerns.” The ASEAN Post, 2 Apr. 2020, theaseanpost.com/article/covid-19-and-cambodias-human-rights-concerns.

[16] “Foreign Workforce Numbers.” Ministry of Manpower Singapore, www.mom.gov.sg/documents-and-publications/foreign-workforce-numbers.

[17] Phua, Rachel. “Situation at Larger Foreign Worker Dormitories Stable, but COVID-19 Picture in Smaller Dorms ‘Mixed’: Josephine Teo.” CNA, 4 May 2020, www.channelnewsasia.com/news/singapore/foreign-worker-dormitories-assess-mixed-results-covid-19-12699968.

[18] “Work Passes and Permits.” Ministry of Manpower Singapore, www.mom.gov.sg/passes-and-permits.

[19] “News Highlights.” Ministry of Health, 20 Apr. 2020, www.moh.gov.sg/news-highlights/details/1-426-new-cases-of-covid-19-infection.

[20] “Services Sector: Work Permit Requirements.” Ministry of Manpower Singapore, www.mom.gov.sg/passes-and-permits/work-permit-for-foreign-worker/sector-specific-rules/services-sector-requirements.

[21] “Structural Constraints, Voice Infrastructures, and Mental Health among Low-Wage Migrant Workers, in Singapore: Solutions for Addressing COVID19.” https://Www.massey.ac.nz

[22] “PM Lees Address on the COVID19 Situation in Singapore.” Gov.sg, https://www.gov.sg/article/pm-lees-address-on-the-covid-19-situation-in-singapore-21-april-2020.

[23] “Ministerial Statement by Mrs Josephine Teo, Minister for Manpower, 4 May 2020”, Ministry of Manpower.https://www.mom.gov.sg/newsroom/parliament-questions-and-replies/2020/0504-ministerial-statement-by-mrs-josephine-teo-minister-for-manpower-4-may-2020

[24] “Advisory on Salary Payment to Foreign Workers Residing in Dormitories.” Ministry of Manpower Singapore, 11 Apr. 2020, www.mom.gov.sg/covid-19/advisory-on-salary-payment-to-foreign-workers.

[25] “Ministerial Statement by Mrs Josephine Teo, Minister for Manpower, 4 May 2020.” Ministry of Manpower Singapore, www.mom.gov.sg/newsroom/parliament-questions-and-replies/2020/0504-ministerial-statement-by-mrs-josephine-teo-minister-for-manpower-4-may-2020.

 

[26] “Ministerial Statement by Mrs Josephine Teo, Minister for Manpower, 4 May 2020.” Ministry of Manpower Singapore, www.mom.gov.sg/newsroom/parliament-questions-and-replies/2020/0504-ministerial-statement-by-mrs-josephine-teo-minister-for-manpower-4-may-2020.

[27] “COVID-19 (Coronavirus Disease 2019).” MCI – Gov.SG, www.gov.sg/features/covid-19.

[28] “The Solidarity Wall.” Healthserve.org.sghttps://solidarity.healthserve.org.sg/

[29] “Translate for Singapore.” Translate for Singapore. https://translatefor.sg/.

[30] See, for example, “The way Singapore treats its foreign workers is not First World but Third World,” https://www.facebook.com/tommy.koh.752/posts/2477020985848840. Accessed 21 May 2020; “The dorms are not the problem”. Transient Workers Count Too, http://twc2.org.sg/2020/05/01/the-dorms-are-not-the-problem/.

[31] Mohan J. Dutta. “Structural constraints, voice infrastructures, and mental health among low-wage migrant workers in Singapore: Solutions for addressing COVID19,” Centre for Culture-centered Approach to Research and Evaluation, Massey University, April 2020, https://www.massey.ac.nz/~wwcare/wp-content/uploads/2020/04/CARE-White-Paper-Issue-8-April-2020.pdf.

[32] “Managing the coronavirus crisis: drawing the right lessons”. Academia.sghttps://www.academia.sg/academic-views/coronavirus-right-lessons/.

[33] Structural constraints, voice infrastructures, and mental health among low-wage migrant workers in Singapore: Solutions for Addressing COVID19. Massey.ac.nz. https://www.massey.ac.nz/~wwcare/wp-content/uploads/2020/04/CARE-White-Paper-Issue-8-April-2020.pdf.

[34] “Malaysia Detains Hundreds of Refugees and Migrants during COVID-19 Lockdown: Rights Groups.” CNA, 1 May 2020, www.channelnewsasia.com/news/asia/coronavirus-covid-19-migrants-detain-rights-groups-12695194.

[35] United Nations. “The Leader in Refugee Decision Support.” Refworld, www.refworld.org/

[36] DG of Health. “Kenyataan Akhbar 16 April 2020 – Situasi Semasa Jangkitan Penyakit Coronavirus 2019 (COVID-19) Di Malaysia.” From the Desk of the Director-General of Health Malaysia, 16 Apr. 2020, kpkesihatan.com/2020/04/16/kenyataan-akhbar-16-april-2020-situasi-semasa-jangkitan-penyakit-coronavirus-2019-covid-19-di-malaysia/.

[37] Chung, Nicholas. “Petisyen Anti-Rohingya Di Laman Web Diturunkan.” Free Malaysia Today, 28 Apr. 2020, www.freemalaysiatoday.com/category/bahasa/2020/04/28/petisyen-anti-rohingya-di-laman-web-diturunkan/.

[38] Bedi, Rashvinjeet S. “Please Don’t Hate Us, Rohingya Plead with Malaysians.” The Star Online, 26 Apr. 2020, www.thestar.com.my/news/focus/2020/04/26/please-don039t-hate-us-rohingya-plead-with-malaysians.

[39] Malaysia Migrant Raids ‘to Reduce Covid-19 Spread’.” BBC News, BBC, 2 May 2020, www.bbc.com/news/world-asia-52515000.

[40] Bernama. “Kluster Baharu COVID-19 Dikesan Di Depot Tahanan Imigresen, Bukit Jalil.” BERNAMA, www.bernama.com/bm/am/news.php?id=1843921.

[41] W;Pongpirul WA;Pongpirul K;Ratnarathon AC;Prasithsirikul. “Journey of a Thai Taxi Driver and Novel Coronavirus.” The New England Journal of Medicine, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32050060/.

[42] Ariyapruchya, Kiatipong, et al. “The Thai Economy: COVID-19, Poverty, and Social Protection.” World Bank Blogs, 28 Apr. 2020, blogs.worldbank.org/eastasiapacific/thai-economy-covid-19-poverty-and-social-protection.

[43] “Thailand’s Universal Coverage Scheme: Achievements and Challenges.” Health Insurance System Research Office, www.hisro.or.th/main/download/10UCS_Eng.pdf.

[44] “Software Disqualifies Millions of Poor from Govt Handout Scheme.” Thai PBS World, 2020, www.thaipbsworld.com/software-disqualifies-millions-of-poor-from-govt-handout-scheme.

[45] Bangkok Post Public Company Limited. “Stats Reveal High Rate of Suicide.” Https://Www.bangkokpost.com, 2019, www.bangkokpost.com/thailand/general/1785214/stats-reveal-high-rate-of-suicide.

[46] “PCG Strictly Screens Fishermen Before and After Fishing to Counter COVID19. Manila Bulletin. https://news.mb.com.ph/2020/03/24/pcg-strictly-screens-fishermen-before-after-fishing-tocounter-covid-19/

[47] Cator, Currie. “DA: Agriculture and Fisheries Workers Are Frontliners in COVID-19 Fight.” Cnn, 11 Apr. 2020, www.cnnphilippines.com/news/2020/4/11/da-agriculture-and-fisheries-players-workers-frontliners-coronavirus.html.

[48] Ocampo, Karl R. “Fishing Communities Bear Brunt of Lockdown.” INQUIRER.net, 15 Apr. 2020, business.inquirer.net/294753/fishing-communities-bear-brunt-of-lockdown.

[49] Gomez, Eireene Jairee. “BFAR Assures Nonstop Fight against Illegal Fishing.” The Manila Times, 7 Apr. 2020, www.manilatimes.net/2020/04/07/business/business-top/bfar-assures-nonstop-fightagainst-illegal-fishing/710527.

[50] “COVID 19 Outbreak Socio-Economic Impact on Small Scale Fisher and Aquaculture in Indonesia.” Focusweb.org. https://focusweb.org/covid-19-outbreak-socio-economic-impact-on-small-scale-fisher-andaquaculture-in-indonesia/

[51] Republic of the Philippines, Department of Labor and Employment, “Department Order No. 209 – Guidelines on the Adjustment Measures Program for affected workers dur to the Coronavirus Disease 2019,” 17 March 2020, https://www.dole.gov.ph/news/department-order-no-209-guidelines-on-the-adjustment-measures-program-for-affected-workers-due-to-the-coronavirus-disease-2019/

[52] FishForever is RARE’s innovative coastal fisheries program that pairs a community-based conservation approach with spatial management to restore and protect small-scale fisheries in the Philippines. The program solution is built on principles of behaviour change and combines managed access with marine sanctuaries.

[53] Rare Philippines municipal fisheries survey, April 2020

[54] “DA to Set in Motion ALPAS COVID-19 to Ease the Threat of Hunger.” Official Portal of the Department of Agriculture, 26 Mar. 2020, www.da.gov.ph/da-to-set-in-motion-alpas-covid-19-to-ease-the-threat-of-hunger/.

[55] Vietnam National survey on people with disabilities (2016)

[56] “Rapid Assessment of the Socio-Economic Impact of COVID-19 on Persons with Disabilities in Viet Nam: UNDP in Viet Nam.” UNDP, 11 May 2020, www.vn.undp.org/content/vietnam/en/home/library/democratic_governance/ImpactPwDs.html.

[57] ICRC Moveability, www.moveability.icrc.org/.

[58] This was a joint effort between NGO(s) and the government.

[59] The term “cách ly xã hội” (social quarantine) was later changed into “giãn cách xã hội” (social distancing). It can be defined as suspension of nonessential movement between all social and geographical units starting from families, villages, wards, districts, cities and provinces, and countries. Public transportation and major private delivery services also stopped their operations during this period.

[60] NTXHN supports clients living as far from Hanoi as in central and southern provinces and cities of Vietnam.

[61] “Numbers of Homeless and Sex Workers ‘Increasing in Bangkok’.” Https://Www.nationthailand.com, 24 Jan. 2019, www.nationthailand.com/national/30362905.

[62] “The COVID-19 Effect Series: Community Clinics in Thailand Strives to Provide HIV Services amid COVID-19.” APCOM, 18 May 2020, www.apcom.org/apcoms-the-covid-effect-series-thailand-based-community-clinics-continues-to-provide-hiv-services-amid-covid19/.

[63] “Nepal Earthquakes: UNICEF Speeds up Response to Prevent Child Trafficking.” UNICEF, 19 June 2015, www.unicef.org/media/media_82328.html.

[64] “Sold to Be Soldiers.” Human Rights Watch, 29 Apr. 2015, www.hrw.org/report/2007/10/31/sold-be-soldiers/recruitment-and-use-child-soldiers-burma.