This report explores how both cultural prejudice and structural barriers must be addressed for effective pandemic responses, especially within marginalised groups.
As of 29th April 2020, Singapore has reported 15,641 cases of COVID-19 since the first community transmission on 4th February. Nearly 83% of these cases are from clusters in dormitories where foreign workers reside. For context, an estimated 200,000 out of the 284,300 foreign construction workers live in 43 purpose-built dormitories. In contrast, the same exponential rise in cases has not been observed for non-dormitory dwellings, as shown in the figure below.
Social distancing measures were implemented in stages across the country as community spread of the virus began to increase. Since 23rd January 2020, the Ministry of Manpower (MOM) provided regular advice to dormitory operators to put in place preventive measures to mitigate the risk of infection of COVID-19 amongst residents. For example, increasing the frequency with which premises are cleaned, regularly monitoring residents closely for fever and respiratory symptoms, and reminding residents to maintain good hygiene. Mass gatherings were later suspended.
The first COVID-19 case originating from a dormitory was on 9th February. Between 28th March and 12th April, despite efforts to quarantine infected dormitory workers and before asymptomatic transmission was realised, the number of dormitory cases grew to 831. This could be attributed to increased testing, but still signifies an exponential rise.
Ahead of the first major dormitory outbreak, Transient Workers Count Too (TWC2), a non-profit organisation advocating for migrant rights, highlighted the inefficacy of applying social distancing measures applied to general residents to dormitories such as remaining in one’s own home/room and urged contingency plans be made to address the reality of dormitory clusters. In a statement released by TWC2, they said:
“Currently, foreign workers are housed 12 to 20 men per room in double-decker beds. They are transported to work on the back of lorries sitting shoulder to shoulder. Neither of these conditions conforms with social distancing.”
- TWC2, Strait Times Forum, March 23rd 2020
The social distancing measures in dormitories as outlined above continued to concentrate on reducing mass gatherings and encouraging workers to remain in rooms without considering information about minimum living space requirements.
Hence, TWC2 and other groups like the Humanitarian Organisation for Migrant Economics (HOME) and the Centre for Culture-Centred Approach to Research and Evaluation (CARE) have been calling attention to the overcrowded living conditions. In a recent ethnographic study on low-wage migrant workers by CARE, one worker said that even a 1-metre distance was difficult to maintain given the high density of people. Another worker said, “They are saying you need to do those things, washing hands and not go outside together. There’s no point when there are so many workers in a room” (Researchers reveal COVID-19 concern for Singapore’s migrant workers | Voxy.co.nz, 2020).
It is interesting to note that while foreign domestic workers also congregate in large numbers in similar spots, the spread among this group has not been the same. This is likely because they live in residential neighbourhoods and are not subject to the social-distancing limitations that dormitory workers face.
During the outbreak, there has been a noted increase in existing xenophobia and views that the transmission was caused because of the ‘poor hygiene’ and ‘backward culture’ of migrant workers. Comments by the MOM are defensive, implying that the risk of transmission is connected to behaviour rather than structural limitations. These comments further exacerbated the rising impression among the general community that the outbreaks in dormitories was due to the negligence of the workers themselves.
“It is not as if we have not done anything to try and manage the situation at the dorms…
…within dorms, workers interact with each other very regularly, very closely – they’re like family, so the risk of transmission was always there.”
- Josephine Teo, Minister of Manpower (The Straits Times, 2020)
Furthermore, the Minister for National Development, Mr Lawrence Wong, cited not having the luxury of the benefit of hindsight as a reason for the current situation (Haolie, 2020).
However, a leaf from Singapore’s own history book might have served to inform today’s pandemic response. In the early 1900s, Singapore, then a British colony, suffered from very high death rates attributed to disease transmission from overcrowding and poor sanitation. Three-storey houses were blocked out into several smaller rooms and up to a hundred people lived in these spaces, ‘rabbit warrens of humanity’. Smallpox, dysentery, and malaria outbreaks were rampant. Dr. Lim Boon Kheng’s findings linked the rise of disease to overcrowding and resulting sanitation conditions. The colonial discourse was that it was not to do with the lack of provision of facilities, but that the Asian people were an unsanitary race, which was the popular view at the time. Opening up the shophouses in the centre to improve ventilation was a short-term solution that was described as “too little too late.” Improvements to health outcomes only began to occur with a large intervention of planned public housing across the country in the 1960s (Age of Innovation, 2020).
Returning to the present situation, more than 20 of the 43 dormitories are under quarantine. Reports on cultural incompatibility and poor quality of food have been long-standing issues that continue to be relevant. The reality of being locked in a room with ten or more people coupled with language barriers, compounded by heath care workers being unable to communicate vital information , the fear of the unknown, stigmatisation, and loss of work create a distressing situation that has a disproportionate impact on this vulnerable group.
Thousands of workers were moved to army camps after the dormitory outbreaks began. Currently, expo halls have been converted into health facilities to house the large number of COVID-19 patients continuing to emerge from the dormitories in order to ease the burden on hospitals. Some even have robot dogs to administer medication to the sick. These delayed actions beg a simple question: couldn’t such preventive measures have been put into place before the outbreak when the very real risk of a cluster in dormitories was obvious?
Workers living in dormitories in Singapore today, are an almost invisible, separate community. Instead of reporting dormitory cases as clusters under community transmission, they are reported separately as work-permit holders in dorms and those living outside dorms, distinct from ‘community cases’. This solidifies the image of the migrant workers living in dormitories as somehow different and separate from the rest of Singapore. To address this situation, a report released by CARE outlines solutions to COVID-19 with regard to structural constraints, transparent communication and voicing platforms, and mental health among Singapore’s low-wage migrant workers.
Learnings from the current situation demonstrate that risk mitigation is key to pandemic preparedness. Often heard is that we are only as strong as our weakest link. As this case has shown, it is vital for governments to be reflexive and communicate and work with advocacy and grassroots groups who give a voice to marginalised groups and make visible the realities of structural barriers to otherwise seemingly sound measures. This will help ensure pandemic responses and interventions are effective.
By Iman Hameed
A contributor and member of the Cov360 team.
30 April 2020
References
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