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22 April 2020

Coronavirus hits the Global South

The humanitarian and economic disaster facing poorer countries as they grapple with the Covid-19 pandemic.   

By Jeremy Cliffe

Social distancing was never going to be easy in the favela da Maré. Some 140,000 people live in this Brazilian slum, perched on a marshy strip of land between Rio de Janeiro’s seafront and its airport. Bounded by low, ramshackle buildings, the alleys are narrow and darkened by the tangles of wires hanging across them. After a period of quiet, they are once more full of life. “People are taking to the streets in all the neighbourhoods… and in Maré it is no different,” says historian Cláudia Rose. 

That, says Rose, the director of the Maré Museum, is partly because of the actions of Brazil’s right-wing president Jair Bolsonaro: “In the first weeks, residents reacted well to the lockdown. But Bolsonaro being seen on TV, visiting a fair and shaking people’s hands, was a trigger for people in Maré to leave home too.” This, in a country where the number of daily new cases has doubled in the past week. 

“Large poor communities like the favela da Rocinha [another Rio slum] and the favela da Maré cause us great concern,” says Margareth Dalcolmo, one of Brazil’s top pulmonologists. “These are areas with such precarious health situations that their level of tuberculosis, for example, is equivalent to that in Bangladesh. The favelas receive no help, even in terms of access to sanitation and drinking water. In these communities, mortality and levels of coronavirus transmission are especially high.”


It is sometimes suggested that the Global South is less prone to coronavirus than North America, Europe and China. After all, the virus is most dangerous to older people with comorbidities and some scientists have suggested it thrives in cooler regions (though this has been disputed). It seems to spread fastest in global cities wired into international networks of people and commerce: Wuhan, New York City, Milan, Paris, London. All of which might suggest that the Global South will be spared its blows. The populations of Latin America, Africa, the Middle East and southern and South-East Asia tend to be younger, live in warmer climes and be less exposed to global movements of people.

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But that is a dangerous fallacy. Even if the Global South does have benefits of climate and demographics, other countervailing factors make it more vulnerable to the spread of the virus: denser cities, poorer sanitation, less effective state machineries, more people with pre-existing conditions, weaker collective immune systems and health systems. At the time of writing, Brazil officially has 40,800 cases, but the testing rate is extremely low so the actual figure is almost certainly much higher. One group of researchers estimates that reported cases are just 8 per cent of the total, which would put the current figure at around half a million. And although there are relatively few reported cases in Africa, the spread of coronavirus there is accelerating. A new UN report warns that in the worst-case scenario, without effective measures to stop the virus’s spread, it could infect 1.2 billion on the continent, out of a total population of 1.3 billion – and that as many as 3.3 million Africans could die from it. Then there are the indirect, but possibly yet more deleterious effects: the jobs lost, the businesses destroyed, the soaring government debt and capital flight. It is entirely possible that coronavirus will prompt an unprecedented economic and humanitarian crisis.

Poorer countries do not know any less about infectious diseases than the rich world. Quite the opposite, as many have more recent experience of pandemics. The Ebola outbreak in West Africa five years ago – which in a cruel twist of fate had almost been beaten just as Covid-19 struck – has given countries in that region a head start, rather as the Sars epidemic did for some (much richer) east Asian states. Some countries, such as Sierra Leone and Liberia, set up new virology institutes and established contact-tracing and quarantine norms during that period, which they can now redeploy.

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But that does not take away from the likelihood that health systems in the Global South will be overwhelmed. According to a 2016 report from the World Bank, of the 45 countries in sub-Saharan Africa, 34 spend $200 or less per capita on healthcare annually and five spend less than $50 per capita; Britain by contrast spends around $4,000. South Sudan (population: 11 million) has just four ventilators and 24 ICU beds, and Sierra Leone (population: eight million) has 13 ventilators, while in South America, Venezuela (population: 28 million) has 84 ICU beds and 90 per cent of hospitals are out of medicine and critical supplies. In 2017 the World Health Organisation (WHO) estimated that half the world’s population, overwhelmingly in the Global South, lacks access to essential healthcare. 

Because there is no cure for coronavirus, medical professionals can at best support an individual’s immune system to fight it off. So it also matters that patients in the Global South often have immune systems weakened by measles, tuberculosis, malnutrition, Aids or other diseases. Relatively young populations and warm weather will not compensate for such problems.

Brazil’s health system is struggling to cope. “I don’t see Brazil very far from a situation like that faced by Italy and Spain in the coming weeks,” says Margareth Dalcolmo. “But we are already getting to the saturation of the system… in the state of Amazonas there are no more beds.” 

Indonesia has 7,000 reported coronavirus cases (though the London-based Centre for Mathematical Modelling of Infectious Diseases estimates that this figure is about 2 per cent of the nation’s actual total) but, again, there are insufficient beds and its health system is already at the brink of collapse. India’s 1.3 billion people went into the biggest lockdown in history on 24 March but the country is still bracing for the virus’s main impact. Thiagarajan Sundararaman, a public health expert in Puducherry, says: “test kits, ventilators, oxygen supplies [and] protective equipment” are all in desperately short supply. In many cases, those infected are simply dying at home without medical attention. In Guayaquil, Ecuador’s largest city and the centre of its coronavirus outbreak, bodies have been left on pavements by relatives fearful of contagion.

Most worrying of all is the plight of those people who do not even have a conventional government, such as those in conflict zones. Commenting on war-torn Idlib province in Syria, the International Crisis Group warns: “Many people fleeing clashes sleep in fields or under trees, and basic hygiene and social distancing practices are made impossible by the lack of running water or soap as well as cramped living spaces.” 

Refugee camps are a particular risk. On 18 April the death of an Iraqi asylum seeker with coronavirus symptoms in a camp, already five times over capacity, on the Greek island of Chios prompted riots. Fear of the disease is rife in the Kutupalong camp in Cox’s Bazar, Bangladesh, which is home to almost one million Rohingyas fleeing persecution in Myanmar: the camp has the capacity to isolate at most 700 of them.

The brutal reality is that the Global South simply cannot afford for large numbers of people to become infected. Even more than the rich world, it has to “flatten the curve” as forcefully and as quickly as possible. The problem is that this, too, is more difficult.


In Ikeja, the capital of Lagos State – a region of Nigeria home to 35 million people, more than 85 per cent of whom live in the eponymous metropolis – the coronavirus lockdown is holding. The heavy traffic that usually clogs the roads is non-existent. In its place are checkpoints manned by police units, and barricades made of tyres and planks blocking major roads. But in Oyingbo, another district of Lagos 20 kilometres away, the lockdown order is no more than a suggestion. The market there may be less busy than usual – the smell of rotten waste and farm produce has been replaced by that of the crayfish sold by a few women sitting under umbrellas by the roadside – but commerce goes on. “This is my family business and if we don’t make money, we can’t feed our children,” says Geraldine Nwankwo. She is playing the board games she sells while waiting for customers. “The government has not said anything about feeding us, but is saying we should stay at home.”

The lockdowns imposed in the Global North are not an option in much of the Global South. Many there lack the money to buy and stockpile substantial amounts of food. Many also live too close together to social distance, in flats or houses too full to “self-isolate at home”, and shop at markets too busy to keep away from others. Preventing concentrations of people is harder in societies where religion and politics often involve mass gatherings, and more of life is lived communally (on 18 April 100,000 people crammed on to roads around the funeral of a popular Islamic preacher in Bangladesh’s Brahmanbaria district). 

Welfare states do not have the resources to provide a substitute income for those deprived of their normal earnings. “The policemen came to threaten us when we opened our shops… and we had to pay them 1,000 naira [£2.08] to allow us to remain open,” says Femi Mojeed, a Lagos electronics store owner. “I would rather catch the virus than be unable to feed my family.” 


Where lockdowns are enforced, other problems arise. In Alaknanda, a middle-class neighbourhood of Delhi in India, panic buying (especially of wheat, instant noodles and biscuits, says one shop owner) has given way to a slump in sales as supplies dry up. “My earnings have become half in the last three weeks,” says Hari Om, a fruit seller who is consequently charging more for his remaining produce. “What can I do? I have to survive too.” Aashi Thakur, a beautician, is similarly worried. “I am a widow. I have two dependent sons and a home loan. I could pay the salaries of my helpers for March but with no money coming in, how will I pay them for April?” Customers are staying away, she says. The city government distributes packets of cooked rice and chickpea curry for the destitute, but there is not enough to go around. 

Much worse off still are India’s estimated 100 million internal migrant workers. Narendra Modi’s announcement of lockdown led to television footage of people trudging down highways, bags perched on their heads, fear and fatigue on their faces as they returned home to the countryside. Other migrants have ended up stranded in the cities where they have moved, far from home and with little support. One of these is Savita Banskar, a 25-year-old from a village in Chhatarpur district in central India who, fleeing drought, moved with her family to work on a construction site 300km away in Bhopal. “My husband and two children are here with me. Another child, a boy, is in my village,” she says over a crackling phone line: “We have no work. The contractor says he can’t pay us and we have run out of money. Once in a while, we get some rice, wheat, oil, turmeric. Yesterday, I ate one chapati and salt.” Banskar has no local ID papers and so cannot buy food at subsidised rates.

The combination of the difficulty of enforcing curve-flattening measures and the suffering they cause when they are enforced means they are only being patchily applied. Imran Khan, Pakistan’s prime minister, announced last month that his country would not impose a lockdown. “If we shut down the cities we will save them from corona at one end, but they will die from hunger on the other side,” he said. (He later ordered a lockdown, albeit one heeded inconsistently.)

In South Africa it was announced that the lockdown will begin to lift – slowly, and in stages – from 30 April, after riots broke out over food shortages. In Nigeria, meanwhile, the government is under pressure to emulate nearby Ghana by loosening its restrictions. “The government needs to open the streets,” says Godwin Omazin, a father of three whose water delivery job now pays just 300 naira (£0.62) a day where it used to bring in 1,000, “because plenty of people will die from hunger instead of the virus.”


The greatest pain in the Global South may be yet to come: not just from the virus but from the wider economic crash that it is causing. That fallout is coming in two waves. The first will be the cost of domestic slowdowns. “The effect of the lockdown is going to be disastrous, and its costs staggeringly high,” says Ashwini Deshpande, an economist at Ashoka University in northern India. “The rabi [spring grain crops] is waiting to be harvested,” she says, citing the agriculture-heavy Indian state of Punjab. “Any disruption to this will have disastrous consequences for farming incomes as well as food supply for consumers.”

Less economic activity means lower tax receipts for governments at precisely the time when they are spending more. In Brazil, the economist and former finance minister Rubens Ricupero observes that the crisis is sidelining prevailing free-market instincts in the economy ministry (“only Keynesian-educated economists are prepared to face an economic depression”) and opening the spending taps. On 13 April, Brazil’s lower parliamentary house approved a $15.5bn aid package for city and state governments. That comes on top of a $24bn programme of healthcare and income support approved last month. 

Other countries, too, are spending more. “Nigeria’s non-discretionary spending is going through the roof,” says Adedayo Bakare, an economist at Afrinvest. “The government can really not bear the cost of this pandemic.”

Then, on top of the costs of its domestic lockdowns and slowdowns, come the effects of the global economic crash. As growth plunges elsewhere, demand for some of the commodity exports that poorer countries rely on is falling. The global oil price has fallen below $20 a barrel, its lowest in 18 years. This is disastrous for countries such as Nigeria where government finances depend on an oil price nearer $100. 

Falls in the prices of copper (particularly hurting countries like Zambia and Chile), flowers (Kenya, Ethiopia) and tin (Bolivia, Myanmar) have hit other commodity-dependent economies. India’s exports, especially food products, metals and engineering goods, fell by a record 35 per cent in March. There, and in other popular travel destinations such as Thailand and Mexico, the collapse of the tourism sector will be particularly painful. The International Monetary Fund (IMF) is forecasting Indian growth of 1.9 per cent this year (down from a projected 5.8 per cent) and contractions of 3.4 per cent in Nigeria and 5 per cent in Brazil. These figures may come to be seen as highly optimistic as the year goes on. 

Foreign investment, too, is collapsing as investors dump emerging-market stocks and bonds – worth $83.3bn in March alone – and stampede to safer, rich-world markets. In the first 90 days of 2020 the cumulative outflow of foreign funds was greater than in the whole of 2008 (previously the worst on record). The South African rand fell in value by 32 per cent against the dollar over that period; the Mexican peso by 24 per cent, the Brazilian real by 23 per cent and the Indonesian rupiah by 14 per cent. 

Meanwhile emerging-market bond yields (the return investors demand for lending) have risen and in the past days both Zambia and Ecuador have said they are having problems making debt payments and requested restructuring. Others will certainly follow: after a long borrowing boom, 76 emerging market governments have, according to the Financial Times, some $40bn of repayments to make to international lenders this year. An unprecedented 102 of the IMF’s 189 member countries have already asked the fund for financial help.


Where this could all lead is almost too grim to contemplate: debt defaults, soaring unemployment, mass impoverishment, famines and “existential” (as Ethiopian Prime Minister Abiy Ahmed has put it) damage to economies. Divides between the Global South and North, and indeed within individual societies in the Global South, could worsen as those who can afford to pay their way out of lockdowns – with testing, contract tracing, bio-surveillance and so on – pull ahead of those still deeply affected by the virus and its economic fallout. 

Social disorder could break out, warns the International Crisis Group, anger over coronavirus’s effects and perceptions of mismanagement by governments potentially leading to “widespread desperation and disorder”. Governments may fall – or hold on to power by using the cover of the crisis to orchestrate authoritarian crackdowns. The geopolitical tectonics of the Global South will shift too: poor, insolvent countries will turn to China for bailouts that will inevitably come with diplomatic strings. 

This could be where the virus leads us, but it does not have to be. As daunting as the challenges are, it is still in the power of the international community to alleviate and shorten the looming economic and humanitarian crisis among the world’s poorest people. Sanctions can be lifted to limit the pain suffered by those living under governments, such as Iran’s or Venezuela’s, at odds with the West. Social media platforms can be co-opted for the purpose of combating misinformation and spreading health facts instead. 

Most of all, greater financial help can be given. The IMF has already called for lenders to suspend debt interest and committed its full $1trn lending capacity to helping the worst affected countries. A group of European and African leaders have called for the fund to issue special drawing rights for poor countries to help them plug their shortage of dollars. 

But a campaign is also building for something even more drastic: rather than saddling the poor countries with additional debt, to write off their debts altogether in a historic “jubilee”. This has, in fact, been a demand of anti-poverty campaigners for decades. But if not now, then when?

Reporting by Oluwatosin Adeshokan in Lagos; Patralekha Chatterjee in Delhi; and Carlos Tautz in Rio de Janeiro 

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This article appears in the 22 Apr 2020 issue of the New Statesman, The coronavirus timebomb