How the coronavirus pandemic exploits the worst aspects of extreme inequality

Hygiene kit distribution in Albatra camp for internally displaced people, Taiz, Yemen.

Hygiene kit distribution in Albatra camp for internally displaced people, Taiz, Yemen. Only 50 percent of health centers are functioning in the country, and those that are open face severe shortages of medicines, equipment and staff. Photo: Wael Algadi/Oxfam

Coronavirus threatens us all. But it preys most on the vulnerable. Nearly 3 billion people across the developing world do not have access to clean water, millions more do not have access to adequate healthcare and live in crowded slums or refugee camps where social isolation is impossible.

The pandemic has caused widespread suffering in rich countries, overwhelming some of the best healthcare systems in the world. But with the disease now spreading to many countries with high levels of poverty and inequality, its impact could be catastrophic and disproportionally affect women.

A devastating blow to people in poverty

Oxfam is acutely concerned about coronavirus establishing itself in poorer, developing countries with weaker public systems, where people are already suffering from a lack of adequate or affordable health care, or from food insecurity and high rates of malnutrition.

“This virus will starve us before it makes us sick.”

Micah Olywangu, taxi driver from Nairobi, Kenya

Within these countries many people live in informal urban settlements or ‘slums’ where there is often overcrowding and poor sanitation. This is a further challenge to social distancing, washing hands and tracing cases to stop the virus spreading further.


Trust Mugwagwa, Oxfam public health engineer, assisting local volunteers to distribute water in Harare suburbs. The provision of safe water remains a challenge in Zimbabwe, heightening the risk of disease and malnutrition. Only 49.4 per cent of water points across the country are fully functional. Photo: Tavonga Chikwaya/Oxfam

Half of the world’s population do not have access to basic health care. In Malawi there are just 25 intensive care beds and 7 ventilators for more than 18 million people. In Zambia, there is one doctor for 10,000 people.

Yet, right now, instead of investing every dollar into boosting their healthcare systems to defend against the onslaught of the virus, these countries have to use their precious resources to pay off external debt, which is due to be at least $400 billion in 2020 alone.

Safety out of reach

Existing inequalities dictate the economic impact of the crisis. Globally, two billion people work in the informal sector with no access to sick pay – the majority in poor countries.

The impact of the virus is likely to be much worse for poor, daily wage and informal workers, many of whom are women, who lack financial and social protection and are less able to cope with loss of earnings and rising prices of food and other essentials.

In many countries, markets have been disrupted and community quarantines have led to losses in income. Millions of workers have already been sent home without pay. Others in the lowest-paid and most insecure jobs can’t isolate themselves from the deadly virus.

Half a billion people at risk of poverty

• Between six and eight per cent of the global population could be forced into poverty as governments shut down entire economies to manage the spread of the virus.

• This could set back the fight against poverty by a decade, and as much as 30 years in some regions such as sub-Saharan Africa and the Middle East.

• The UN estimates that nearly half of all jobs in Africa could be lost.

• Over half the global population could be living in poverty in the aftermath of the pandemic.

Women on the frontline

Women will be the hardest hit as they make up 70 per cent of health workers globally and provide 75 percent of unpaid care, looking after children, the sick and the elderly. They are also more likely to be employed in precarious and poorly paid jobs that are most at risk. The economic crisis will affect them disproportionally.

We know that gender-based violence increases during times of crisis. During community quarantines or lockdowns, the incidence of domestic violence, marital rape, and other forms of gender-based violence is likely to go up but women may find themselves trapped without any recourse for reporting and obtaining help.

Agnes Adhiambo, 25, domestic worker, washes clothes in Mashimoni village, Mathare, Nairobi, Kenya.

Women will be more susceptible to getting infected in countries where they make up the majority of health workers and carry out most unpaid care work. Photo: Katie G. Nelson/Oxfam

A massive threat to life in conflict zones

Countries in conflicts or experiencing a humanitarian crisis are particularly vulnerable. Displacements, overcrowding in camps and informal urban settlements, lack of clean water and health facilities create a perfect storm of conditions that could spread coronavirus to large numbers of people considered to be high risk candidates.

“The death toll around the world is rising but this will be just the tip of the iceberg if and when the virus spreads to the world’s most vulnerable communities.”

Marta Valdes Garcia, Oxfam’s Coronavirus Response Operations Lead

The virus could be catastrophic for people and places hit by conflicts, like Yemen, Syria and South Sudan, who are already struggling with malnutrition and diseases like cholera.

Millions of people in countries across Africa are already suffering chronic and severe food shortages and will be equally hit hard by the disease and any restrictions needed to help deal with it.

Up to 250 people sharing one tap of water

We are most concerned about cases appearing in overcrowded camps for refugees or displaced people, where social distancing is impossible, health care is virtually non-existent, and there is hardly any clean water for people to wash their hands.

The standards for refugee camps were simply not designed to cope with a global pandemic. Refugees are sharing one tap between up to 250 people and many have less than 3.5 square meters of living space per person which means it will make it extremely difficult to contain a coronavirus outbreak.

The sprawling Rohingya refugee camp at Cox’s Bazar in Bangladesh is severely overcrowded with 40,000 people per square kilometer. Malnutrition and diseases like dysentery, cholera and typhoid are already a high risk, undermining the health of these communities. Photo: Abbie Trayler-Smith/Oxfam

In some cases, even these minimum requirements are not met. Moria camp on the Greek island of Lesbos was built for 3,000 people but now hosts nearly 20,000 people. There are up to 160 people using the same dirty toilet and over 500 people per one shower. In some parts of the camp, 325 people share one tap and there is no soap.

No one is safe until everyone is safe

The coronavirus pandemic harshly exploits our unequal world. While the richest in countries across the globe have access to healthcare and cash to get by, most of humanity face this crisis with neither. One in two of us struggle daily to survive. For people in poverty illness can be a death knell. 

“Without urgent, ambitious and historic action, we could easily see the biggest humanitarian crisis since World War Two.”

Jose Maria Vera, Oxfam International Interim Executive Director

We must act now and, on a scale, never seen before

We know that only ambitious and massive political action by our governments, acting together, can overcome this crisis. We must push our leaders to be decisive and bold. They must unleash a global emergency plan for public health to save lives, and the largest ever economic stimulus for people to help their families through this crisis.

We’re in this together. To beat the pandemic and avert harm to the lives of billions we need to act across all our countries and for every person. Fighting for some but not others is not an option. It only fuels risk for us all.