I met Ismail Adewale carrying two buckets of water, which he bought for 10 naira (about a quarter of a cent each) from a community water source in Lagos, Nigeria, where he lives. He was with two other friends on this daily chore, picking up water that's used for everything from washing clothes and plates to cooking and bathing.
For Adewale and many Nigerians, water is too precious a resource to be used only to wash your hands, especially not as thoroughly or as often as the World Health Organization (WHO) advises with the coronavirus pandemic sweeping the globe. If sanitation is so important to containing the potentially deadly outbreak, what are people without consistent access to clean water supposed to do?
The first coronavirus case in Africa was in Egypt, on Valentine’s Day. According to WHO, as of Thursday, the continent has 2,100 cases and 31 deaths across 39 countries. Some nations have taken aggressive action already; Lagos has closed its schools. But in most African cities, there are pockets of the poor communities that don’t have amenities like clean tap water. In 2017, 395 million Africans lacked access to drinking water, and 704 million Africans didn't have basic sanitation services.
It is a common sight in Lagos, a city of 21 million people, to see young men pushing carts containing kegs of water to be sold to residents. Nairobi, Kenya’s capital, which has 2.5 million people living in shanties, has water-supply challenges as well. Lagos, Nairobi, and South Africa's Johannesburg also house some of the largest slums on the continent: Makoko, Kibera and Soweto. These could become dangerous hotspots as the coronavirus expands its reach.
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“The current state of water, sanitation and hygiene in Sierra Leone poses a huge risk for the coronavirus to spread rapidly, and the sad thing is, its fragile health system is not prepared for it either,” said Martina Mchenga, an economist and Overseas Development Institute fellow in Sierra Leone.
So far the available solutions described by WHO make sense within a Western social construct, but not an African one. Social distancing is impossible for those who live in so-called “informal settlements,” where bathrooms and toilets are shared, and where they must line up to fetch water. Space, and the ability to have space to oneself, is a privilege only the upper class can afford.
The coronavirus in Africa hasn't resulted in the sorts of deaths seen in places like China or Italy, but it's likely to strain health care systems on the continent that have already dealt with outbreaks of fatal illnesses. The Democratic Republic of Congo just finished tackling the last case of the Ebola virus after an 18-month fight, and continues to deal with a largely underreported measles epidemic—and it now has 48 cases of the coronavirus. According to the World Economic Forum, Nigeria is battling “the world’s largest epidemic of Lassa fever, a viral disease deadlier than coronavirus.” South Africa’s health system, which many would rate as one of the best on the continent, is already struggling with hundreds of cases of COVID-19. Currently, South Africa has implemented a 21-day lockdown.
If the pandemic spreads, the effects could be brutal. “I do not think that low-income countries can afford and let alone sustain a lockdown,” Mchenga said. “Since the African continent is largely a donor-dependent continent, the economic effects of coronavirus in developed countries will surely trickle down to us as well.” In an environment where there is likely to be no bailout for ordinary citizens, this is especially concerning.
“Many emerging African economies do not have the means to withstand the economic downturn resulting from this outbreak,” said Lagos-based Cheikh Eteka Traore, a public health and diversity consultant who’s worked primarily in the infectious disease areas of HIV and TB around the continent. He added that he’d seen how the weak health systems coped with both TB and HIV pandemics, and “outbreaks of another virus on a big scale in Africa would threaten the progress already made.”
Socrates Mbamalu is a writer and journalist. Follow him on Twitter.