Tight small spaces with tin roofs, multiple family members including senior citizens housed in a cramped 200 sq ft space, narrow lanes, communal spaces and a raging virus. At a time, when physical distancing is being seen as the only possible counter to the Corona Virus pandemic, across the world, people in low income settlements are struggling to bring in distance in their interactions. Along with abject material poverty, migrant and wage labor status and a weak social safety net, the physical constraints in urban slums are making the residents one of the most vulnerable groups.
Image courtesy Financial Express
Why physical distancing is difficult in slums
1. Tight spaces: In a slum or a ghetto, the sizes of houses do not allow for adequate physical distancing both within and outside the house. Large families live in confined spaces which will completely negates the possibility of quarantine or isolation if any symptoms show up.
2. Blurred public and private spaces: There is no clear demarcation of public and private spaces in a slum. It means that the boundaries of home are usually extended to outside the house and commonly accessed areas. This means that the lower sense of risk associated with the home environment extends to outside the house. This could impact critical behaviors like mask usage and hand washing.
3. Large involvement in essential service provision: A lot of lower income families are involved in the provision of essential services including sale of essentials, jobs in sanitation and health care departments and being engaged in essential construction related work. Such jobs require consistent interface with a large number of people and puts the neighborhood at an additional risk.
4. Lack of sanitation facilities: One of the critical problems associated with physical distancing is the lack of proper sanitation facilities in slums. Use of community toilets makes people regularly move out of their houses and physical distancing and adequate hygiene are both inadequate in such community toilets
5. Lack of drinking water facilities: Slums have a constant problem with access to water and have to usually either purchase it or have to collect it from common points. Apart from hampering lockdown efforts it also impedes regular hand-washing practices with water being strictly rationed.
What needs to be attempted:
1. Communication demarcating inside and outside: It is necessary to take the context of the space to mind and communicate about what constitutes inside and outside for residents. Considering the space crunch, only the physical house cannot be considered as the inside and the definition has to be extended to shared lanes or even a cluster that are accessed by people. Risk communication should be adjusted to these demarcations.
2. Think of cohorts, not households: Communication while being extremely localized, should be targeted towards cohorts and not households. Due to the communal nature of living, risk communication targeted towards cohorts would be beneficial in ensuring adequate checks from the community. It would also be helpful in acknowledging the fact that social engagements intended for the family actually extend to slightly larger groups. Communicating to cohorts would cover more actors who would otherwise be considered almost as family and by inference, outside the ambit of physical distancing.
3. Bring services closer to home: Physical distancing measures can be strictly enforced if the necessary travel for services can be minimized and services can be brought closer to home. This includes provision of more mobile toilets, delivery of water and groceries at the door-step etc.
4. Saturate the environment with cues: If bringing services closer is not possible to due to resource and logistical barriers, the common access points like community toilets, water collection and water purchase points etc. need to be re-designed with strong cues to enforce physical distancing. This includes putting nudges like physical distancing circles, mask usage communication, sanitizer dispensing points at the entrance and exit points.
5. Use trusted messengers: Physical distancing in a community with tight spaces and regular interaction will not be easy to come by. Especially when social interactions are key to economic ties. In such situations, using community leaders as a form of authority would be better to ensure buy-in of the messages. This could include corporators, religious leaders, teachers and other local elders.
6. Prepare people to deal with quarantine isolation and familiarizing facilities: The possibility of self-isolating or quarantining in the small settlements and crowded neighbourhoods for a at-risk individual is next to impossible. Therefore, most governments would move both all at-risk individuals including the family of an infected person to a quarantine facility away from the slum.
This is a huge flux and a scary transition for people as it takes away all aspects of familiarity. This could also lead to dissonance due to the asymptomatic natures of the disease and a dampened risk perception. The fear could also lead to under-reporting of symptoms.
The administration could look into anticipating this fear and talk of the possibility of quarantining outside the neighbourhood. The population should be socialised early and in small doses with the quarantine facilities, so that it does not completely seem unfamiliar in the eventuality of quarantining.
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