All entries for June 2020

June 09, 2020

Healthcare workers ‘at the frontline’ of COVID–19

Doctors

Image created by Kevin Kobsic. Submitted for United Nations Global Call Out To Creatives - help stop the spread of COVID-19.

Written by Dr Sharifah Sekalala

In Susan Sontag’s seminal essay on ‘Illness as Metaphor’ (1978), she argued that military metaphors profoundly shape our responses to public health crises. ‘Fighting’ against a disease positions it as an ‘enemy’ that must be defeated, and risks stigmatising those who ‘lose their battle’ as weak or lacking courage. In the same way, describing healthcare workers at the ‘frontline’ of an offensive invokes warlike language, and the gendered nature of this discourse may lead us to misperceive the complexity of caring during a crisis.

There has been no shortage of military metaphors relating to Coronavirus (COVID-19) pandemic in the United Kingdom (UK). The prime minister, Boris Johnson, talked of a fight in which everyone is directly enlisted, and, on his return from hospital after contracting COVID-19, he referred to the coronavirus as “an unexpected and invisible mugger”, which he praised for being “suitably muscular”. Likewise, the Queen, in a rare speechin April 2020, drew on the phrase “We’ll meet again”, taken from the 1939 British song popularised by singer Vera Lynn, which invokes the idea of soldiers leaving their families to go and fight in a war.

However, these metaphors are a blunt instrument. They are designed to garner public support, and tend to emphasise the part played in the response to COVID-19 by men, overlooking serious and structural gendered inequities in healthcare. Many speeches have mentioned doctors and nurses, but, as in war, the generals at the top are valorised for their heroism, while those in the trenches at the frontline are forgotten. These most vulnerable and exposed healthcare workers are (unlike frontline troops in war) predominantly female and are overrepresented by those from poor socio-economic and racial backgrounds. For many weeks the UK government even refused to release data on BAME deaths, making it harder to know who exactly was dying. Carers in care homes were also not given Personal Protective Equipment (PPE) until there was a public outcry.

In the UK, healthcare workers have been hailed as heroes, and the country is out on the streets every week clapping for them. The prime minister has even named his newly-born son after one of them, and they have been given preferential treatment by many retailers, with some restaurants even providing them with free meals. But who exactly are the people shouldering the sharp end of the burden of COVID-19? Occasionally, we read headlines about particularly brave surgeons or nurses – far less often about healthcare workers, who constitute the vast majority of those risking their lives every day to support the healthcare system. The entire system is also being sustained by largely women carers who are now doing much more caring at homeas children are off school even when they are still working remotely.

Care work in the UK is grossly underpaid and largely unrecognised. Many cleaners and healthcare workers are no longer directly paid by the NHS, and therefore do not enjoy the same employment rights as NHS workers. They are not unionised and therefore they cannot demand health and safety measures that many other workers take for granted. Many are migrants and consequently in a weak position to articulate their rights when they are violated. By celebrating carers as heroes we may make ourselves feels better while overlooking society’s responsibilities to them. Warlike rhetoric portrays the noble togetherness of a fight against this great evil, but many of the most vulnerable foot-soldiers would be better served by focusing attention on structural changes that would help the most disadvantaged of these people.

The way in which the aftermath of caring has been dealt with illustrates the erasure of some of these categories of carers. A UK backed scheme in which dependants of NHS carers who died from COVID-19 were automatically given indefinite leave to remain free of charge (giving dependants the right to remain in the UK without any time limit on their stay and allowing them to take up employment or study), had been limited to certain occupations such as doctors, radiographers, nurses, biochemists and phycologists leaving social care workers, hospital cleaners and porters ‘out in the cold’. It was only after an extensive outcry that the government relented and added these carers to this scheme.

The valorisation of certain kinds of carers is not unique to the UK and is a global problem. In the Ebola crisis in West Africa many international discussions focused primarily on the risks of violence faced by frontline health workers ‘in the field’, and the scarcity of professionally trained health workers. In so doing, the international community failed to recognise that caring during complex emergencies often necessitates that caring not only falls to professional carers but relies largely on non-professionals. This care work was gendered, and it often fell on women to provide it. Just as in the COVID-19 crisis, the Ebola crisis had different hierarchies of carers from those most protected from harm, to those least protected. The first category comprises international aid workers, primarily employed by humanitarian aid agencies (e.g. Oxfam, Mercy Corps, Doctors Without Borders (MSF), International Committee of the Red Cross, and foreign public health agencies such as Public Health England and the Centre for Disease Control. These international health workers retained a high level of autonomy in that they had clear contractual terms about the kind of work that they could reasonably be expected to do, and always had the option of leaving the country.

The second category, medical professionals at the domestic level, consisted of doctors, nurses and other highly trained domestic health workers, such as nurse aides, nurse assistants and midwives, referred to here as domestic nurses. In both West Africa and the Democratic Republic of the Congo, a severe shortage of domestic health workers, especially in the public health system, created an overreliance on nurses. In global health crises, domestic nurses are often the first responders, due to a shortage of local doctors. The nurses often worked in very poor conditions, lacked sufficient knowledge of haemorrhagic fevers, and in the early days of the epidemic often worked without PPE. Their vulnerability to infection was borne out by a systematic review(Selvaraj et al, 2018) of research on health workers in West Africa, which found that nurses and midwives — predominantly women — were particularly vulnerable to Ebola because of the intimate care they provided during the epidemic. In the West African crisis, nurses accounted for more than fifty percent of infected health workers. As employees of the state, the nurses had low bargaining power, though some managed to negotiate more lucrative employment with humanitarian aid agencies. Others had no choice but to remain at their stations in low-paid government hospitals, thereby, suffering differential and disadvantageous economic reward compared to the higher remuneration packages paid to foreign humanitarian workers and nurses who worked for humanitarian agencies. The third category was Community volunteers, such as Water and Sanitation (WASH) staff, who performed the highest risk jobs: cleaning and disposing of blood, vomit, waste, burying bodies, and educating local communities about the epidemiology of the disease. Many worked as cleaners in hospitals and treatment units, some washed clothing, while others (primarily traditional healers) helped wash and bury bodies. In the West African Ebola crisis, many of these staff were volunteers, and, although they received training, their lack of experience, and their poor work conditions, placed them at greater risk of contagion. As non-medical professionals, these community health workers fell between the category of professional workers and citizens. Due to their legal status as volunteers, their pay and working conditions were less favourable, making them particularly vulnerable.

Finally, there were individual carers in homes – who were predominantly women - who looked after families during and after the crisis. In a patriarchal culture, women’s primary designation as carers meant they were more likely to have responsibility of nursing and caring for extended families. They performed various care roles in homes, and sometimes, as a result of quarantine, had to leave their own home to reside near Treatment Units to care for loved ones in isolation — and then had to manage the precarity posed by living in temporary accommodation in a male-dominated environment.

The comparisons between the hierarchies in West Africa and those in the UK are startling and they must make us seriously rethink the ways in which caring is organised, recognised and compensated. We use the language of heroism to obscure; the very nature of the ‘hero’ identity requires that only a few people can be identified as such, and those that do meet the criteria require self-sacrifice in order to do so. In reality, both in the UK and globally, the group of people who provide care is much bigger. At the bottom are people who we have severely oppressed, and we owe it to these carers to move beyond the metaphors, and to examine and document the experiences of the categories of carers in the COVID-19 crisis if we are to remove the structural barriers to caring for them.


June 01, 2020

Global Insights – COVID–19: Climate Change and Energy

Global Insights Climate

Authors: Ann Fitz-Gerald, Simon Dalby, Selam Kidane Abebe, Caroline Kuzemko, Jatin Nathwani, Malini Ranganathan

Editors: Briony Jones and Maeve Moynihan

This post is part of a larger collection covering the Global Insights webinar series, hosted jointly by Balsillie School of International Affairs (Canada), the Department of Politics and International Studies at the University of Warwick (UK), the Institute for Strategic Affairs (Ethiopia), American University’s School of International Service (USA), and Konstanz University (Germany). Global Insights webinars take place every Thursday at 16:00h (BST). You can access a recording of this week’s webinar here.

Panellists: Ann Fitz-Gerald (Moderator – BSIA), Simon Dalby (Wilfrid Laurier University, BSIA), Selam Kidane Abebe (University of Reading), Caroline Kuzemko (University of Warwick), Jatin Nathwani (University of Waterloo, BSIA), Malini Ranganathan (American University)


As journalists around the world speak of a ‘dual-crisis,’ this Global Insights panel invited listeners to reflect on the COVID-19 crisis and the climate crisis. While the COVID-19 pandemic presents challenges for climate change, there are a number of promising opportunities to rebuild our societies for a more sustainable future.

How does the COVID-19 crisis intersect with climate change, certainly in the short to medium term?

The climate crisis and the COVID-19 pandemic very accurately reflect our deeply interconnected and rapidly globalizing world. The two crises intersect not only with one another, but with the stark inequalities that have come to define our world as well. Society has failed to appropriately prepare, and has been slow to respond to, both the pandemic and severe climactic events. Given this lack of preparation and response, those who are already at the margins of society are pushed further away. In this way, the pandemic is not only a double-crisis, but a triple-crisis at the intersection of health, climate change, and inequality. In the United States, the racial geographies of both the pandemic and of environmental harm are alarmingly similar. For example, in Chicago 30% of the population is African-American, yet people of color account for 50% of coronavirus deaths. Such deaths are concentrated in the Southwest part of the city, where coal plants and steel smelters have driven a rise in asthma and lung disease, making residents, most of whom are African-American, particularly vulnerable to COVID-19. The intersection of these crises demonstrates that people experience multiple threats simultaneously. As such, innovative, comprehensive, and multilateral responses are necessary.

Before COVID-19, how much progress, if any, did we have with this agenda?

Although pre-pandemic society may feel distant, that the clean energy agenda had made noticeable progress prior to the outbreak of COVID-19. Before the outbreak of coronavirus, many companies had already started to recognize the liabilities surrounding fossil fuels, and noticed that they have the opportunity to shift to renewable energy. Such changes present a positive narrative of the clean energy agenda, suggesting that the pandemic could provide a test-commitment for sustainable change. Sustainable energy could provide dual-pronged benefits of improved efficiency and reduced poverty. However, our societies continue to be built on fossil fuels. In 2020, 85% of global energy continues to come from fossil fuels, the same share that they occupied in 1990. Furthermore, at a multilateral level, international treaties on climate change have not necessarily sparked extraordinary change at a national level, as national politics and economic situations govern such decisions.

In light of COVID-19, what does this mean for the Green New Deal, Environmental and Health Justice, and the postponement of multilateral conversations?

This is a historic opportunity to transition to a low-carbon energy future through a ‘Green New Deal’ and restructure our economies for a sustainable future. As governments around the world develop stimulus packages and economic recovery plans, such plans must turn to renewables and sustainable change. There is a very good case to do so, as such investment can have strong returns in terms of jobs and economic growth. At a time when economies are shrinking and unemployment is rising quickly, renewable energy could provide not only a climate-friendly society, but new job opportunities. These opportunities can only be taken if stimulus packages include re-skilling opportunities for those leaving the fossil fuel industry. However, the postponement of multilateral discussions on climate change, such as the cancellation of COP26 in Glasgow for example, serves as a concerning challenge with respect to international treaties on climate change and the implementation of the Paris Agreement in 2021.

Are there any opportunities which COVID-19 throws up for climate change and the Cleaner Energy Agenda?

COVID-19 provides crucial and interesting opportunities for a shift to renewable energy, environmental justice, and health justice. Governments are now focused on how best to respond to and recover from the pandemic and have the unique opportunity to incorporate sustainable solutions into these plans. While the lockdown measures have allowed for cleaner air in places like New Delhi ecological regeneration in the natural world, we must not allow such imagery to distract from issues of environmental and health justice, such as the suffering of migrant laborers under India’s lockdown, many of whom were forced to return to their villages on account of the lack of social safety nets in cities. Once back in rural areas, however, they continue to face climate and environmental distress.

The COVID-19 crisis provides a unique opportunity to address both. The crisis allows societies to shift our gaze from individuals who have pre-existing conditions to societies that pre-dispose those particular groups to such conditions due to environmental factors, such as the case in Chicago above.

How do societies move forward during this liminal moment?

Whereas governmental financial support for the climate crisis was hard to come by, there is suddenly an incredible amount of capital available in the form of stimulus packages. Such funds can be used effectively to develop greener and more just societies that no longer rely on fossil fuels. However, if such stimulus monies are distributed to fossil fuel companies, as may happen in the United States for example, future consequences could be dire. Demand for coal, oil, and gas has declined, however such demand has not fallen for renewable energy, so it provides a greater share for energy than it did previously. Emissions have fallen 5% in the first quarter of 2020 when compared to 2019. While emissions may continue to decline by almost 8% as they did during the financial crisis of 2008, they may indeed return to normal as societies emerge from confinement stages of pandemic management. In order to make a more permanent shift, subsidies for fossil fuel companies must be removed and societies must take the social cost of carbon into account. Societies must continue to restructure social practices to continue emissions reduction for many years to come. For example, societies need to think systematically about a return to city-planning, transportation, and energy-efficiency at home and in the workplace. As governments move to address the pandemic nationally and multilaterally, the climate crisis must not be forgotten, and the situation in developing countries must be included in the recovery process.

Key Conclusions: Six pieces of advice for policy-makers

1. Develop legally mandated and politically consistent exits for low carbon societies.

2. Invest stimulus funding in renewable energy not fossil-fuels as we rebuild our economies.

3. Consider the collective multilateral global response as we build individual national responses.

4. Valorize and strengthen safety nets for essential workers in a greener economy, and think about health, environmental, and social justice together.

5. Create a just transition to greener economies by reskilling fossil fuel workers and phase out old systems appropriately.


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The Warwick Interdisciplinary Research Centre for International Development addresses urgent problems of inequality and social, political and economic change on a global level.

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