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Monday, March 30, 2020
Pakistan - Karachi: Why the Covid-19 crisis is an urban crisis
As
we brace ourselves for the Covid-19 epidemic in Pakistan, we are being
told to wash our hands and self-isolate. What if you are unable to do
any of these things? According to the Census 2017, Pakistan's population
is 207.8 million with an urban share of 75.6 million. The United
Nations asserts that in 2015, 45.5% of Pakistan's urban population was living in informal settlements. Thus, an estimated 34 million people in Pakistan live in katchi abadis or urban informal settlements, where water is scarce for the most basic of needs.
In Karachi — a city of over 16 million — approximately 60% of the
population lives in informal settlements with limited or no access to
clean water and sanitation. Let us compare this — for a moment — with
countries being devastated by Covid-19. For example, Italy and Spain,
where there is almost universal access to clean water, sanitation, soap
and antibacterial gels. Even with their comparatively tiny populations,
the virus has spread and killed at a pace no one could imagine. So with
northern health systems on the brink of collapse, will the spread of
Covid-19 in Pakistan bring urban informal settlements to the frontline
of the crisis?
The threat to Pakistan is palpable. As we anxiously await the impact
while self-isolating, the voices of the most vulnerable are barely
audible. What health threats do the 34 million people living in
Pakistan’s informal settlements face? What does this mean for the spread
of Covid-19 across the country? How can we leverage data for designing
urgent planning interventions that will actually work?
Access to water
While the instructions for containing the spread of the virus sound
fairly simple — wash your hands for 20 seconds with soap multiple times a
day — it is not an easy task for the majority of Pakistan's informal
settlements that are water deprived. Access to water varies massively.
People living in Karachi's Machar Colony, an informal settlement at a
considerable distance from the city centre, pay Rs7,000-8,000 a month in
water purchased through tankers and other informal means. Residents of
Gharibabad, near Karachi's PIDC, spend over Rs5,000 a month on the same.
For poor households, this is a very significant portion of their
earnings. The idea of using that water repeatedly for washing hands is a
luxury. Here are some basic calculations on daily water use for
maintaining hygiene:
Just for a single month, a household of eight would then require 750
additional gallons of water. This constitutes half of a 1,500 gallon
tanker, which costs at least a minimum PKR2,500 in a typical informal
settlement. The additional financial cost for basic protection against
Covid-19 by washing hands, would then be around PKR1,250 per month for
the family. While the figure does not seem very high in isolation, it
becomes a critical portion of their income in the absence of earned
daily wages amidst the current lockdown. Can a low-income family in an
informal settlement even be capable of providing for this additional
water expense in times when the same amount would be needed to buy
essential food items?
Cost alone (leaving aside logistical factors such as water
availability, transportation, waiting lines) — to perform hand washing
as per government recommendations — points to the absolute urgency of
making cheap water provision a top priority for informal settlements.
Without that intervention, the virus is likely to spread like wildfire,
the consequences of which are hard to imagine.
Such a sorry state of our existing water infrastructure is indicative of the larger problem. A 2016 International Development Research Centre (IDRC) report
investigated the state of infrastructure in Pakistan's urban informal
settlements. It concluded that a drastic overhaul is needed in urban
planning and services to enable infrastructural upgrading, especially
for public health and access to decent work. Unsanitary environments, in
densely populated areas, have devastating a impact on health and
livelihoods. For too long the health and social needs of such
populations have been invisible. Now — our lives are more interconnected
than ever — without addressing their needs, the whole city is at risk.
This brings us to the second recommended measure: social distancing.
Let’s look how practical this measure is, using existing spatial and
household data.
Density, space, data
The most critical input for tackling urban issues is data. What data
sets do we need right now? To phrase it another way: what data-sets —
open access and appropriate for secondary analyses by independent
researchers or institutions to supplement the meagre data visualisation
capacity of all tiers of government — actually exist, for Karachi, and
for urban Pakistan?
In Sindh province, the government estimates that there are 1,414 katchi abadis out of which 575 are in Karachi and 408 in Hyderabad. A 2008 World Bank study indicates there are a total 902 katchi abadis
in urban Punjab; 65 in Khyber Pakhtunkhwa, 55 in Balochistan and 52 in
Islamabad. With these sparse, and potentially out of date figures, we
can roughly estimate a total of 2488 informal settlements across
Pakistan's major urban centres. This data excludes the numerous goths
(approximately 900, as per an Orangi Pilot Project study and the Karachi
Strategic Development Plan 2020, that dot Karachi's periphery; areas
that are rapidly transforming into peri-urban settlements), with no
clear planning regulations, no formal mechanisms for service provisions,
often needing to tap into (siphoning) water and other public utilities
to survive.
In cities like Karachi, there is a double deficit: data on informal
settlements is either not collected regularly, and if it is, it is not
disaggregated — especially on social indicators such as health. How can
the various tiers of government tackle this crisis through emergency
plans if they do not have realistic and up-to-date figures on the number
of people living long-term in a ward or district? What about the number
and type of built structures they occupy? Their proximity and
interaction patterns that could facilitate the spread? The capacity and
effectiveness of the infrastructures serving them? Without this data
relief planning for Covid-19 becomes a guessing game at best. This
provides loopholes in the relief mechanisms — loopholes that can be
exploited for populistic provision rather than for where the need is
highest.
The most comprehensive and reliable data on demographics in Pakistan
is supposed to be gathered by the population census. Yet, reflecting on
the methodology adopted for the 2017 census, this crisis demonstrates
the ineffectiveness of the data: it collected de jure data on Pakistani
citizens, counting them in the wards/districts displayed on their CNICs,
and not where they were actually living. Such data quickly becomes
irrelevant for subsequent studies, and especially unusable for detailed
analysis on the realities of lives and processes in urban Pakistan. Take
the Covid-19 crisis: how can governments generate epidemiological
models to predict its spread in populations when there is no existing or
reliable data about them?
Based on work done by the Karachi Urban Lab over 18 months and
spanning 13 informal settlements in different districts of Karachi, our
findings reveal that people are living on plots as small as 20 square
yards. Households have an average family size of eight to nine people,
but barely accommodate a single room with a slab for a kitchen and a
toilet. In locations where people have expanded vertically, household
sizes go as high as 30 people per 80 square yards of plot. These
household numbers are higher than the average represented in the 2017
census. The reality is that social distancing is almost impossible to
implement in these settings. This kind of population density rings alarm
bells for the safety and security of these urban residents and for the
spread of Covid-19 across Pakistan. Coupling this constriction of
available space for the vast urban majority with a city-wide curfew or
extended lockdown hours spells disaster for people forced to confine
themselves to tiny, dense, interior spaces. In cases of smaller plots or
higher densities the scenario becomes even more unnerving. This,
coupled with studies which show
that 88% of the housing stock in the city consists of plot sizes 120
square yards or less, lies in strong contrast to people living in houses
sized 400-2000 square yards constituting only 2% of the housing stock.
Health and vulnerability
Dozens of informal settlements in Karachi have been under the threat
of eviction for the past 18 months. More than one thousand households
have already been rendered homeless in Karachi's District Central. Our
ongoing and participatory research with residents, shows that about 40%
of households in informal settlements have at least one family member
who requires special medical and social care. Adding to the staggering
numbers of immunocompromised individuals, there is a diversity of
medical, physical and social healthcare needs. About 70% of the persons
who need care can be categorised as persons with chronic illnesses who
are facing a heightened risk of contracting Covid-19.
The news of Covid-19 — added to eviction anxieties — has created very
high levels of psychological stress amongst residents in informal
settlements. The distress of managing the food, water and healthcare
needs of the family had already reached unprecedented levels but now the
lockdown is leading to further disruptions and distress disorders.
Psychological research repeatedly shows that stress weakens immunity.
Women and girls are particularly vulnerable to these stressors and
their impact. They are most likely to be trapped at home and absorbing
significantly higher levels of care work during the lockdown. Levels of
violence against women and girls have spiked in the lockdowns
in China, the UK and the USA — there are real concerns about the safety
and security of women and girls across Pakistan, but especially those
in crammed households suffering immense precariousness.
The insecurity, uncertainty, and stress puts residents of informal
settlements at high risk of immune-compromisation, compounding their
vulnerability to Covid-19. They are at the frontlines of this crisis.
Long-term planning
The Covid-19 pandemic should be an urgent wake-up call for urban
planners, bureaucrats and policymakers in Pakistan, to invest
substantially and meaningfully in understanding and levelling out the
highly unequal access to urban infrastructure services. Fragmented
governance and lack of accountability at multiple layers of government
have hindered inclusive planning efforts for decades. Residents of
informal settlements can no longer be invisible to policymakers — as
they are a critical part of the functioning of the city, and as some of
the most vulnerable people, they deserve due attention.
Simply put, the long-term effects of Covid-19 combined with impacts
of climate change, will take place in sites and at scales that involve
populations which have never been accounted for in previous planning
efforts. Here is a list of both urgent and long term recommendations:
Restore the local government system across Pakistan.
Immediately establish a coordination committee of representatives from provincial/local governments, NGOs and community leaders.
Include and account for high numbers of persons with healthcare needs.
Document up-to-date numbers and generate spatial data on populations
in each ward, with particular emphasis on informal settlements.
Prioritise emergency budgets to upgrade existing water
infrastructures and include emergency provision of cheap and clean water
in informal settlements.
This report has been co-authored by Adam Abdullah, Maheen Arif,
Soha Macktoom, Arsam Saleem, Muhammed Toheed, Dr Nausheen H Anwar, Dr
Gulnaz Anjum and Dr Amiera Sawas. Header image: People reach out to get a charity food handout
during a lockdown after Pakistan shut all markets, public places and
discouraged large gatherings amid an outbreak of the coronavirus disease
in Karachi, Pakistan on March 30, 2020. — Reuters
