Discrimination, or fear of discrimination, can act as a barrier to inclusion and participation in response to an outbreak of infectious diseases. Discrimination forms as a part of social stigma that may arise in disease outbreaks and can often lead to minorities being branded as scapegoats who are perceived to ‘endanger’ the rest of the population. Such stigma can have detrimental effects on slowing the spread of infectious disease outbreaks and people’s access to information and treatment. In Mozambique, migrants returning from South Africa to their home country were met with suspicion and stigma in their home communities due to a fear that they would bring COVID-19 with them across the border.
In South Korea, members of Shincheonji Church of Jesus were concerned about the pandemic and rising cases of COVID-19 in their country. Although the church itself implemented measures to keep its congregation safe from COVID-19, its members avoided getting COVID-19 tests in fear of discrimination by the public. In February, the Shincheonji Church of Jesus became the centre of the largest outbreak of COVID-19 in South Korea, showing how fear and discrimination can lead to devastating consequences.
In India, 3000 members of the Islamic missionary movement Tablighi Jamaat, were forced to spend more than 40 days in quarantine after seven Indonesians visited their mosque. Current scientific evidence suggests that such an extended quarantine period is not necessary, but irrespective of this the Tablighi Jamaat members were not discharged until the government approved of their release. Similar discriminatory actions against ethnic minorities have been seen in Pakistan, Cambodia, South Korea and Israel.
Lacking identification documents or having a vulnerable legal status are challenges that minority groups may face in accessing information, testing and treatment for COVID-19. In Lebanon, migrant domestic workers from Ethiopia were denied testing at a hospital in Beirut as they did not have identification documents. Secondary impacts of not having proper identification documents include not being able to access COVID-19 relief measures, such as in Pakistan where financial assistance for the poor can not be received by undocumented migrants.
Exclusion from response efforts
Many minority groups experience long-term social injustice and discrimination which often leads to exclusion and marginalisation. Institutional and structural racism determine these disparities, and consequently, minority groups are often excluded from health policies. Calls have been made to make special considerations to mitigate the impact of COVID-19 on minority groups, but despite those efforts, minority groups have carried an unequal proportion of the pandemic’s effects so far.
Discrimination can be a barrier to accessing COVID-19 testing and treatment. The Taureg and Tabu minority groups in Libya have limited access to health care due to years of conflict, neglect and insecurities. Without appropriate health services, Southern Libyan minorities are left unprepared to tackle the COVID-19 pandemic.
Minority groups may also be excluded from the COVID-19 response efforts if information about the pandemic is shared in a language they do not speak fluently or through media they do not have equal access to. For example, in Norway, the lack of information about the COVID-19 pandemic reaching the Somali community was believed to be one of the reasons for the disproportionate number of confirmed COVID-19 cases among this community.
Exclusion from reporting
When collecting and disseminating socio-demographic data, there are often limited options available for reporting ethnicity, religion, languages and other categories related to social identity. The absence of such options results in artificial data sets that do not represent the true composition of the population and blinds authorities to the effect of disparities between communities. In a review of publications and national reports on COVID-19 outcomes in the UK, only 2 of 29 reports shared results disaggregated by ethnicity.
Image: Illustration by Mona Chabli
Minority groups are disproportionately represented within the world’s poorest populations. In Latin America, Afro-Descendants are 2.5 times more likely to be chronically poor and earn less for the same job as other Latin Americans. Poverty itself is a barrier to accessing information about COVID-19 through technology, such as mobile phones, televisions and computers. It is also a barrier to maintain COVID-19 preventative behaviours such as self-isolation, shielding and staying at home as much as possible as this might lead to a loss of income. Minority groups are vulnerable to the health impacts of COVID-19 and even more vulnerable to the potential economic fallout. Businesses going bankrupt and mandated lockdown orders by authorities due to the pandemic are leading to a loss of livelihood and income which leads to further risk of poverty. This can also act as a barrier to testing and treatment if there are any costs associated with accessing health care services.
Many minorities live in overcrowded housing and densely populated areas due to poverty. This makes COVID-19 preventative actions such as self-isolation or physical distancing challenging. Furthermore, many minority groups lack access to essential services such as water, sanitation and hygiene. This applies to many minority groups in high-income countries, such as the Roma in Europe and African Americans in the United States, as well as those in low- and middle-income countries. Inadequate access to improved water, sanitation and hygiene poses a significant challenge for preventing the transmission of coronavirus among minority households and communities.
The type of work a person engages in has a big impact on the risk of contracting COVID-19. While some people are able to conduct their work from home or carry out their jobs in a safe place, essential workers (also known as frontline, critical or key workers) and informal workers are forced to risk their own health by going to work and coming in contact with other people. Essential workers include, but are not limited to, those who work in health care (such as nurses and social workers), food service industry, public transportation, hospitality and retail. In many countries, minority workers are overrepresented in the “essential workers” category. This puts them at a higher risk of acquiring COVID-19 at work and leads to further risks for their families. Despite there being a high risk of contracting COVID-19 at work, employers have often failed to protect minority workers from COVID-19 and to provide adequate support if they have been exposed to the virus or fallen ill. There are often minimal or no laws and policies in place to protect informal workers, and this undermines their access to health services, COVID-19 prevention, testing and treatment services and equipment.
Those living with underlying medical problems such as diabetes, respiratory conditions, hypertension and cardiovascular diseases are at higher risk of experiencing complications and death due to COVID-19. Some minority groups experience disproportionate levels of comorbidities, putting them at increased risk if infected with COVID-19.
Around the world, minority groups are at increased risk of systematic violent repression, mass killing and genocide. Many minorities have fled from countries where they were a part of the majority until conflict forced them to flee their homes. Those who are living as refugees in a foreign country, such as Syrians in Turkey and South Sudanese refugees in Uganda, face unique challenges that require a context-adapted response. Minority groups living in camps and camp-like settings may also require special considerations when responding to COVID-19. Read our guidance for responding to COVID-19 in these settings here.
Want to know more about engaging minorities in COVID-19 response?
Written by: Astrid Hasund Thorseth
Reviewed by: Christopher Bachtrog, Sheillah N. Simiyu, Eva Niederberger
Last updated: 11.11.2020