In Colombia, a national quarantine due to the Corona pandemic was installed on March 25th. A few days earlier, several non-governmental and community-based organizations had already published an alert statement in the city of Medellín – the second largest city of Colombia, awarded multiple times for its innovative urban policy. In this statement, they called for special attention to people living in informal settlements and peripheral areas: Existing inequalities and various forms of discrimination are exacerbated by the increasing precarisation of informality through current preventive measures. Residents of marginalized neighbourhoods get deprived of livelihoods that they have built up independently. The intersections of oppressions expose those people to deadly risks. A basic income and health protection are urgently needed.
“Latin America could become the biggest victim of the COVID-19 virus,” headlines the New York Times in mid-March, before the situation in the USA itself escalated. Background of the alarming message is the evident lack of a viable health care system. Data indicates that the average total investment (public and private) in health per inhabitant in Latin America is far below the OECD countries, but also lags behind the average in the Middle East or North Africa. Colombia is a case in point: In OECD countries, the public health sector represents an average of 6.6% of GDP. In Colombia, it is 4.2%. For example, compared to the Italian health care system, which collapsed dramatically during the pandemic, the funding of the Colombian system is based on a GDP that reaches just around 18% of Italy’s GDP, while both countries have comparable population sizes. In an interview with BBC Mundo, former Colombian Health Minister Alejandro Gaviria points out: “You can’t ask them to do what European systems can’t do.” And the poor investment rate is not the only problem causing particular vulnerabilities in the current situation of the pandemic. Apart from the weakly funded public health system, other circumstances such as non-communicable diseases, infectious diseases, and high rates of violence put the systems under pressure. Furthermore, the access to health care is largely marked by class-division, manifested also in spatial patterns of center and periphery. The health situation is therefore much more complex than, for example in Northern Europe.
The inequality of the pandemic
The existing structures of inequality aggravate the vulnerability of the poorest in the pandemic crisis. To understand this particular impact, one needs to understand informality also. Medellín’s informal settlements can be described as unplanned neighbourhoods and precarious human conditions. Contrary to essentialist media discourses, which often allude to causal connections between urban informality and violence, chaos or helplessness, which is simply wrong, economic precariousness is certainly a characteristic. The term urban informality is thus central to “reflections on the description and analysis of the precarious situation of a global urban majority.” It is therefore important to classify correctly.
Colombia and Latin America in general show that distinctions must always be made between different contexts. Self-organization and collective organization strongly characterize urban informality there, as Raúl Zibechi has analyzed in peripheral and marginalized urban territories across the continent. Moreover, Calogero und Schütte have pointed out that informality often coexists with a tolerated and elitist form of urban informality “from above”. This takes the shape, for example, of powerful ways of land appropriation: “The difference lies precisely in the tolerance and promotion of elitist informality ‘from above’ and the illegalization or criminalization of subaltern practices of space appropriation.” Such differences not only currently come to light in an extreme way, but render much more fatal consequences for the poor and deepen the gaps. Residents of Colombia’s various marginalized, informal districts and neighbourhoods now have to adapt to emergency measures such as business closures and quarantine, which, in the context of informal working conditions directly threaten their lives: “For households that earn barely enough income each day to buy a day’s worth of food, the risks of such isolation will not be bearable for long.” Closures and quarantine are measures that do not mean existential problems for the most privileged – apart from the rising danger of family or sexual violence.
It is evident how central housing or habitat is in this crisis. Different measures are needed to ensure that local contexts and different habitats are taken into account with their particularities. The American philosopher Judith Butler, in an interview with the Chilean newspaper La Tercera, made this point explicit in the context of the pandemic: “There should be other forms of shelter that do not depend on a false idea of home.” What she refers to is that, fueled by the increased pressure on housing due to a globalizing neo-liberal urban development model, measures against Corona put extreme pressures on those people whose socio-economic situation or forms of housing do not meet the norm that these measures are based on. This is not specific for the global south. Many politicians in the global north, too, seem to assume a wealthy single family household as the norm when conceptualizing protection measures against the pandemic. Many people whose situation is different are simply not taken into account by the state authorities: For example, refugees on Lesbos in Greece are left to their own luck, or else homeless people, as in the Frankfurt “Bahnhofsviertel”, the district around the main train station. Activists from Project Shelter or the local Right to the city alliance are therefore demonstrating in Frankfurt for the right to shelter for homeless migrants. They demand a self-managed center for refugees and propose to use empty hotels to give homeless people decent protection – these claims are not new but currently extremely urgent.
In sum, measures taken to contain the Corona virus are extremely selective and many sharpen the existing patterns of discrimination.
In this sense, in Germany as in Colombia, inequality is running deeper right now – whether it is regarding housing, infrastructure, wages, or access to health care. In this vein, the African American Policy Forum explains: “While this virus knows no gender, race, age or class, it is the structures before its arrival that channel the disproportionate distribution of misery and devastation to those most vulnerable due to social organization.”
In fact, these effects can be observed in Medellin like in a magnifying glass.
The situation in the informal settlements in Medellín
In Colombian Medellín, Corona dramatically reveals the structural inequalities and the territorial injustice in particular, i.e. an unequal distribution of resources within the city. On April 15, 22 days after the “quarantine for life” was decreed, “a new day of protests is taking place (…) in Medellín. The claims are: food and medicine to confront the quarantine due to Corona. Hunger is rampant in barrios populares [low-income neighbourhoods] of the city. The protesters, wearing red rags, continue to demand the attention of the local and national government.”
The protests took place especially in informal settlements which had been built by the inhabitants themselves, in the absence of the state. Some of the settlements are part of those (altogether 52) formed in Medellín in the mid-1990s, when masses of people arrived in the city who were displaced in the Colombian armed conflict. Over the past 25 years they have formed community organizations to organize their lives and to work together for their rights. Currently, these organizations give voice to the settlements’ population which faces higher levels of risk in relation to their rights to health, food and work: Those who live on the outskirts tend to work in informal jobs, are disconnected from public home services, and are in special need of medical assistance.
In one of the protests in the city of Medellín, people used empty pans to indicate hunger – a symbol frequently used in Latin American social protests. Many people including elderly, indigenous, displaced victims of the armed conflict demonstrated together in order to denounce that they were not included in any of the social assistance programs, nor were they able to access the digital platform “Medellín te cuida” (Medellín takes care of you), created by the Mayor’s Office to identify the population in need, because internet access is not available in their parts of the city.
The protest wave has been caused by the slow response of President Duque who had announced an investment but took two weeks to sign a decree which allocates just a minimum of resources, equaling 1% of the country’s GDP. The local authorities, under pressure by the affected communities, confirmed that the size of the population in situations of poverty and extreme poverty is not even known and will therefore not be reached. When a group of public servants was sent to the neighborhoods and settlements to make an assessment of the situation, 20,000 poor were identified in one day only, demonstrating the magnitude of the problem.
With the contingency of Corona, intersections of different forms of structural discrimination, poverty and territorial injustice are further revealed. For example, there is a clearly uneven distribution of disabilities in the city: according to the Secretary of Health of Medellín, 68% of the population with a disability live in the districts of estrato one and two (poor parts of the city) while only 4.7% are found in the estrato four, five and six (medium and high economic areas). In the quarantine this means that they are confined to their homes without any guarantee of adequate food and health care to protect their lives and dignity. What is more, there is no political will to ensure timely and continuous care or remove access barriers.
Women in precarious living conditions are in a particularly difficult situation at the moment so that it comes at no surprise that they represent the main group of protesters. Women are mostly in charge of domestic work and care. They face hunger because they cannot go to work, and they experience increasing domestic violence. Since March 24th, more than 100 cases of abuse of women have been reported. Complying with the obligations to prevent the spread of Corona requires that the victims of violence are forced to be confined precisely with those who abuse them – a situation that affects women worldwide, of course, but especially so in overcrowded settlements.
Confronted with the state authorities’ ignorance and inaction, civil society actors have taken a step forward in response to the Corona crisis in Colombia, just as the communities in their territories have done. They are generating proposals to immediately address the state of emergency. Non-Governmental Organizations and the academic sector have raised public debates and shaped initiatives such as the so-called “Medellín without hunger”, aimed at implementing a basic income that protects families in extreme poverty, poverty and vulnerability, for a duration of 6 months. Other proposals call for a rights-based approach to the crisis, recognizing its structural causes. Although Medellín’s city authorities like to present the city as the most innovative in Colombia, the current pandemic casts light on the structural inequalities and territorial injustice that has continued.
The right to health – and its social conditions
Unequal access to health systems is a general problem, but it has become much more deadly in the current crisis. In many Latin American countries, private spending on health care is very high because public systems are not in place. The Pan American Health Organization (PAHO) estimates that about 30% of the region’s population does not have any access to health care for economic reasons.
Geographical barriers and, above all, the lack of infrastructure or its unequal distribution, are also major obstacles, for the rural population, but also for the marginal and informal urban districts. In Colombia, rural clinics are not able to handle a pandemic. The rural population will have to use clinics in the nearest cities, which increases the pressure on the systems there.
Hence, Corona and its consequences, beyond age and pre-existing physical conditions, does not affect everyone equally. Multiple structural inequalities condition the spread of the virus: “In countries where there is no universal health insurance, lack of payment means that people cannot pay hospital bills for themselves and their families. They may therefore be reluctant to seek help until they are seriously ill, which increases the burden on the health system and can even accelerate the spread of the virus”, write researchers at the Institute of Development Studies (IDS) in an article on the link between Corona and informal work. Thus, the structural inequality remains systemically relevant in these times – no longer exclusively for the benefit of the few, but above all to the disadvantage of the many – and is deadly for the most marginalized. These people are exposed to higher risks of death because authorities and governments knowingly fail in delivering public goods and services. Seventy-five years after the WHO declared the human right to health, the social reality still belies the egalitarian promise in many parts of the world, and definitely in Medellín.