At first glance, Bangladesh’ COVID-19 situation is relatively not bad: only 98,489 cases and 1305 related deaths have been confirmed by June 17, 2020, in a country with about 165 million people. The numbers are, however, significantly underestimated as there are not enough testing kits available, especially outside the large cities. In addition, the virus, that also affected a number of returnees from Europe and Middle East (Hossain et al., 2020), started to spread rather late in the country. Unlike during the 1918 influenza, having a young population as Bangladesh has (median age 27.6) would reduce the virus death rate during this current pandemic. However, high population density, poverty and inequality, limited access to clean water and an underfunded health care system, high internal and international migration coupled with significant climate change effects are well known factors that will negatively affect how the country is going to fare through this pandemic.
In order to control the spread of the virus, the Bangladeshi government aimed to enhance its population support through physical distancing, home and institutional quarantine, area lockdown, enhanced diagnostic capacity, leaves for officials to maintain home quarantine, and remote office activities (Islam et al., 2020). Movement restrictions have been enforced with the help of the military and public transportation was suspended from March 26 to reduce the spread of the virus (Anwar et al, 2020). Furthermore, the government offered stimulus packages and other types of safety nets based on people’s socioeconomic situation (Islam et al., 2020). However, limited attention has been paid to structural characteristics of the society that affects the success of these programs.
Firstly, migration: the distribution of COVID-19 cases has been highly skewed at the beginning of the crisis, as large urban areas such as Dhaka and Narayanganj were affected by the virus early on and became hotspots for COVID-19. These densely populated urban areas are also magnets for internal migrants, places where people displaced by poverty and environmental hazards move in search for a better life.
When the Bangladeshi government announced the implementation of a lockdown effective 26 March in Dhaka, the presence (and potential behaviors) of a large migrant population was not considered. Following the announcement, an estimated 11 million people left the city (Rahman, 2020) to go back to their areas of origin. Only two weeks later, the owners of garment plants reopened their plants, and workers were requested to be back to their workstation on the first week of April 2020. No transportation was provided, so workers walked hundred miles to save their jobs (Muktadir, 2020). However, once they reached the cities, they were sent back as garments owners had to give up reopening their plants because of government regulations. According to the Bangladesh Garment and Manufacturers and Exporters Association (BGMEA), there are around 2.26 million ready-made garment (RMG) workers in Bangladesh (Hossain et al.,2020). This back and forth move of workers between their workplace and home led to a rapid, extended spread of COVID-19 in the country.
Rising sea levels, flooding, water and soil salinity, (Crane, 2018; Haider, 2019) and crop failures (Roy et al., 2018) are all environmental issues that are increasingly prevalent due to climate change effects in Bangladesh, one of the most climate-vulnerable countries in the world (Ahsan, 2014). These factors push people to move seasonally or permanently to the larger urban areas (Mayers, 2002; Gray & Mueller, 2012. Several studies show that an important portion of the slum dwellers come from environmentally degraded areas, left following a disaster or moved to Dhaka due to the impacts of climate change (Swapanal et all, 2017’ McNamara et al., 2015; Ayeb-Karlsson, 2016 ). For some migration is a choice, but for many it is a survival strategy (DePaul, 2012): 70% of the slum dwellers in urban Dhaka are people displaced due to environmental hazards (Friedman, 2009). Bangladesh also hosts around one million Rohingyas refugees. They currently live in cramped camps in environmentally threated areas, where physical distancing is also impossible to implement (The Guardian, 2020).
Secondly, social structure and extreme poverty: maintenance of physical distancing and home quarantine is challenging for low-income households, which do not have adequate dwelling conditions and savings to live off while in quarantine. Access to safe water is another problem strongly related to social structure. There are about five million people who lack access to safe drinking water and 85 million without access to safe water for sanitation in Bangladesh. This is due to both rising sea level and ground water pollution due to arsenic contamination. Frequent washing with clean water and soap is one of the key recommended measures to prevent infection from COVID-19, but it might not be possible for many poor people in Bangladesh. In addition, limited availability of clean water decreases agricultural production, contributing to malnourishment which, in turn, makes the human body less able to defend itself from the virus.
Thirdly, underfunding of the health care system is increasing the risk of a devastating COVID-19 epidemy in Bangladesh (Anwar et al., 2020). Lack of reliable data on infections, victims and their contacts, opportunities for proper diagnosis and availability of health care facilities prepared to treat people with acute symptoms are all working against a proper response to this outbreak. There are five doctors and two nurses per 10,000 people in Bangladesh (Ahmed et al., 2011) and only 192 intensive care units (ICUs) (Dhaka Tribune) in the entire country, a number so limited that it is insufficient to meet population needs even in normal times. The country only has 21 COVID-19 diagnosis centers for 165 million people (Hossain et al., 2020c).The quality of health care is very poor, especially in small cities and rural areas (Dahab et al., 2020).
So far, there are only a very few countries such as New Zealand, Germany and Vietnam have been able to confront COVID-19 effectively (NPR, 2020). None of these countries have the additional challenges that Bangladesh has: an underfunded health care system, limited access to clean water, high population density, environmental migration and, generally, environmental degradation. Experience shows that in more and less affluent countries, effective responses to the pandemic are built on evidence-based approaches that bring together policy makers and scientists.
About the authors
Monir Hssain is a faculty at the Department of Sociology and Social Work in The People’s University of Bangladesh. He has an MA in Sociology from Texas Tech University and he will start his PhD in Medical Sociology at the University of Alabama at Birmingham this fall (2020). He was a research and development fellow of Early Concern Society for Childhood Research and Development in Bangladesh. His research focuses on social and environmental determinants of health and the effects of climate change on natural resources availability.
Hosne Tilat Mahal is a faculty at Sociology & Social Work in The People’s University of Bangladesh. She is an MA student in Sociology at Texas Tech University where she is also a Helen DeVitt Jones Graduate Fellow. Her research interests focus on climate change, food security and energy nexus.
Cristina Bradatan, PhD is associate professor of Sociology at Texas Tech University and a faculty associate to the South-Central Climate Science Center. She was a Fulbright scholar in Romania (2018), worked as a science specialist within the USAID Global Climate Change Office in Washington, DC (2013-14) and served as a review editor for the Fourth National Climate Assessment (NCA4). Her research is at the intersection between population dynamics and environment, with a focus on the climate change adaptation.
This article is part of the IOM Series on The COVID-19 Pandemic, Migration and the Environment.