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How Govt failed Black, Pakistani & Bangladeshi communities during Covid-19 pandemic

14th May 2020
How Govt failed Black, Pakistani & Bangladeshi communities during Covid-19 pandemic

Muslim woman wearing a medical mask face protection equipment to protect against Coronavirus (Covid-19) during shopping in Church Street Market in London on May 2.

(Credit: İlyas Tayfun Salcı/Anadolu Agency)

Miqdad Asaria and Arzoo Ahmed

London, (The Muslim News): The Office for National Statistics (ONS) has published a report finding that people from Black, Pakistani and Bangladeshi communities are between 3.5 and 4 times more likely to die of Covid-19 as people from White communities in England.

Some of these excess deaths can be accounted for by the fact that people from these communities face discrimination in education and employment opportunities which have resulted in them having lower incomes and living in overcrowded housing in areas with high levels of air pollution.

Risk of Covid19 related death by ethnic group & sex, England and Wales, March 2 to April 10.

These factors have left them suffering with worse general health and experiencing a higher prevalence of chronic illnesses such as diabetes and heart disease making them more vulnerable to Covid-19. These are all serious structural race patterned inequalities that urgently need addressing.

Migrants and Refugees

Particularly vulnerable groups are recent migrants and refugees. A charity worker providing support for such groups has observed that:

“Refugees are facing challenges with language, access to healthcare and poverty, and are experiencing fear and insecurity. Refugees are often housed in cheaper accommodation in white working-class areas, causing isolation and loneliness. Black and Minority Ethnic (BAME) men are at higher risk of dying from Covid-19, and there may be many deaths occurring amongst refugee communities. Local authorities need to identify refugee deaths and ensure that their families are supported. With men at higher risk, women and children may be left more isolated, exacerbating their existing vulnerabilities.”

The ONS study also found that even after adjusting for the aforementioned structural factors — accounting for the fact the Black, Pakistani and Bangladeshi people typically live in more deprived neighbourhoods and suffer from more chronic illnesses — those from BAME communities are still dying at almost twice the rate of White people.

NHS Staff

A similar puzzle has been noted in the deaths among NHS staff who are typically healthier and economically better off than others. Of the NHS staff deaths reported so far 95 per cent of the doctors who have died and 71 per cent of the Nurses who have died have been from BAME backgrounds.

A manager of a GP surgery in the Northwest of England explained that:

“A quick search of GP Partner and doctor names on surgery websites will reveal that BAME healthcare professionals are on the frontline in the poorest areas.They can often only secure jobs in the most deprived communities or as locum doctors. Locum doctors, many of whom are BAME, are being called to work in Covid-19 hubs or on the frontline, being hired to do riskier work such as home visits, which requires face-to-face contact. This makes them more prone to getting Covid-19 because they are working in areas with the worst health, the worst access and higher levels of Covid-19.”

Other healthcare professionals have also commented on the lack of access to PPE among BAME staff which is causing fear amongst those risking their lives on the front line. A source providing PPE to doctors reported that:

‘Many BAME GPs are purchasing PPE with their own funds. They are buying brown paper bags and labelling them with the days of the week, and placing PPE used on Monday in the Monday paper bag, so that they can reuse it the following Monday.’

Given their increased risk and exposure to a more vulnerable population, it is imperative that BAME healthcare professionals are appropriately risk assessed and provided adequate protective equipment.

There are at least three reasons that may explain why we are seeing more deaths in BAME communities. First, it may be the case that they are more likely to catch the virus, second, or that they are experiencing the virus more severely, and finally it may be the case that they are having poorer outcomes on account of receiving worse treatment by the health service. Let us look at each of these possibilities in turn.

More likely to catch the virus

BAME people makeup 14 per cent of the population but are heavily over-represented in frontline jobs ranging from NHS staff to bus drivers and supermarket staff. As an example, 44 per cent of NHS doctors are from BAME communities. These frontline staff have had to continue to serve us putting their own lives at risk whilst the rest of us have been safely locked down protecting ourselves from the virus.

A BAME Londoner explained the reality of frontline workers sharing a household:

“My sister-in-law is a nursing associate in a local hospital and her husband is in logistics and product quality control at Amazon. Both are key workers and have been on the frontline during this pandemic. They have a 3-year-old daughter at home who is unable to start nursery this term because of the pandemic. My sister-in-law was worried about contracting Covid-19 and experienced very mild flu-like symptoms but was unable to be tested for Covid-19 as tests were not available for NHS workers at the time. A couple of weeks later her husband contracted the virus and it was only after she called into work to say that she would need to self-isolate for another two weeks that the hospital tested her husband. There is a short supply of nursing staff so this would enable the hospital to see if she could come back to work earlier.”

Given the increased risk in BAME communities, the Government ought to prioritise access to testing in such groups, especially key workers.


Economic fragility

Analysis by the TUC shows that people from BAME communities are also twice as likely as people from White communities to work in precarious roles such as temporary, agency and zero-hour contract roles. Many of these people have had to continue to work through lockdown exposed to the virus in order to pay rent and feed their families with little possibility of even sick pay should they be struck down by the virus let alone the idea of being furloughed at 80 per cent on the Government scheme.

One musician of Afro-Caribbean heritage explained:

“As an independent musician from the BAME community, I have had all work engagements cancelled from when the lockdown was announced (March 23) until November 2020. As a small business owner, I, unfortunately, fall into the category of people who are unable to receive support from the Government as I take a nominal dividend (instead of a salary) from my company to cover my expenses whilst I try to grow my business. As a result, I am now isolating with my elderly grandparents who need support. In addition to the financially precarious situation I now find myself in, I have experienced the loss of 10 extended family members who have all died due to the Coronavirus and I have two relatives in Connecticut who are both on life support machines.”

The National Zakat Foundation, which is providing financial assistance to those in greatest need, explains the impact of the pandemic on impoverished families, highlighting how fragile the economic resilience is amongst many Muslim families who come from BAME backgrounds:

“We have seen first-hand how the coronavirus outbreak has tipped thousands of Muslims, who are among the poorest faith communities in the UK, over the edge into desperation and poverty. Over the last few weeks, we have seen the highest demand for Zakat in our history, receiving nearly 3,000 applications for help in April alone. We provided £370k in direct grants to help people in need. This represents a 250 per cent increase in numbers compared to the previous month.”

Some quotes from the applicants to the charity exemplify the difficult economic situation many are facing:

“My husband is a self-employed taxi driver with no work throughout March, and I am unemployed. He is also now self-isolating.”

“On Zero hours (contract), work in the restaurant (which is) closed due to the coronavirus.”

“I am a single Mum with an 11-year-old son with learning disabilities. I struggle to go shopping due to health conditions. I am shopping locally at the corner shop which is more expensive. We are at home all the time now with Covid-19. My son has not been in school where he gets free school dinners every day. My bills have increased as I try to keep him occupied. I receive Universal Credit and I’m struggling with bills like higher water bills.”

More severe cases of the virus

People from BAME communities may also be getting more severe cases of Covid-19. It is well-established that people from BAME communities suffer from a high allostatic load. This is caused by repeated and chronic stress that gradually wears away at their immune systems and has been shown to make them more susceptible to a range of diseases. There is growing suspicion that this increased allostatic load may also be the reason that people from BAME communities are experiencing Covid-19 more severely.

Health system failures

There is much anecdotal evidence to suggest that the public health messaging put out by the Government has been poorly tailored to the needs and realities of the lives of people from BAME communities.

A Pakistani respondent in Manchester told us:

“Most of my extended family does not have a basic science education (GCSE level) as the school system in Pakistan didn’t talk about virus transmission or infectious diseases. They have very low levels of literacy in English, so they don’t understand SKY/BBC news.”

There is also evidence of gaps in the cultural competency within primary care either through the 111 service or GP practices.

A son explained the challenges they faced in trying to access help for their father in Birmingham who was experiencing Covid-19 symptoms:

“We initially received very little support from the GP practice and 111 services. They simply asked us to visit the hospital with very limited discussion or investigation over the phone. They attempted some form of triage with dad, but language barriers and dad’s heightened state of anxiety made this very difficult.”

He went on to explain how his dad experienced repeated admissions and discharge from hospital with very little information to the patient, family or GP about his condition, testing and the management or treatment required.

A daughter in London, caring for her 69-year-old mother who started displaying Covid-19 symptoms at the beginning of March, also experienced challenges whilst seeking help from the GP and subsequently 111. Her mother had been admitted to hospital in January for a suspected heart condition and had a bad experience which left her fearing a return to the hospital. Eight weeks later, her mother’s cough has settled, but she is extremely fatigued and has ongoing shortness of breath. She added:

“Whenever we have tried to speak to our GP for advice, we are met with a level of hostility and we feel like we are alone.”

Such experiences have resulted in BAME communities having reduced confidence in the health service and presenting to the hospital much later than they should, resulting in deaths that could have been prevented had they come to the hospital sooner.

Deaths in young people

We are also seeing the impact of Covid-19 on young people from the BAME community, with reports of deaths amongst young nurses, young mothers, and new mothers dying after giving birth. A funeral volunteer from Bolton shared his experiences of BAME Covid-19 deaths since he began volunteering over the last couple of months:

“A 27-year-old boy, with no underlying conditions, died in his sleep at home last week. It was confirmed that he had Covid-19. I also recently buried a friend from my childhood. He was 40-years-old and contracted Covid-19. Once he went on ventilation, his kidneys really took a hit. He leaves behind two young children.”

Government review

The deep-seated race-based structural inequalities that have been so starkly highlighted by the Covid-19 pandemic are killing large numbers of people from BAME communities and must urgently be addressed. There is a fear in the BAME community that the Government’s investigation into this issue, advised by Trevor Phillips, is likely to sidestep these key issues of structural inequality and the role of racism in perpetuating these. The terms of reference of the review from Public Health England state that:

“The review will not ascertain root causes of findings that are likely to be driven by complex interactions”.

There is a concern that they will instead find reasons to blame BAME communities for their own deaths, with these deaths being pinned on cultural and genetic factors.

As BAME communities reel from the horrific avoidable deaths such as that of Belly Mujinga, the ticket officer who died after being spat on by an infected passenger at London’s Victoria Station, there is a strong sense that the Government has failed BAME communities and will continue to do so.

Miqdad Asaria is Assistant Professorial Research Fellow,
at London School of Economics and Political Science and Arzoo Ahmed is a researcher

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