COVID-19 in Bangladesh: an especially difficult time for an invisible population

Abstract

COVID-19 pandemic has caused huge impact on public health and economy of Bangladesh. Population groups such as persons with disabilities are experiencing the worse outcomes in terms of managing their livelihoods, health and well-being. In this paper, we utilized publicly available information and data obtained from an ongoing research study conducted by BRAC University to discuss possible impacts of COVID-19 on the lives of persons with disabilities in Bangladesh. The paper focuses on documenting the livelihood struggles of persons with disabilities during the pandemic and the challenges experienced by them while accessing formal health care services and social safety nets. We also recommend strategies that can be implemented to minimize the impacts and improve the overall well-being of persons with disabilities during this unparalleled crisis situation.

Keywords:

• COVID-19
• Bangladesh
• persons with disabilities
• strategies moving forward

Introduction

The first case of COVID-19 in Bangladesh was confirmed on March 8, 2020 and as of April 14, 2021 there have been 697,985 confirmed cases with 9,891 deaths. Globally, Bangladesh now ranks number 33 in terms of number of COVID-19 infections as per the information available in the Worldometer website.¹ Like many other countries, the country is struggling to minimize the risk of transmission and deaths despite having been taken significant efforts such as lockdown, closure of educational institutions and a ban on social/mass gatherings. From a health systems perspective, the major challenges experienced by the country include shortage of intensive care unit (ICU) beds, oxygen supply and insufficient supply of personal protective equipment (PPE) designed to protect the wearers from infections (Anwar, Nasrullah, and Hosen 2020; Bodrud-Doza et al. 2020).

Bangladesh has a disability prevalence of 6.94% which suggest that there are about 11.4 million persons with disabilities in the country (BBS 2019). According to World Health Organization (WHO), persons with disabilities are at greater risk of contracting COVID-19 as many of them have pre-existing health conditions and require regular support, or are institutionalized. Besides, they may experience barriers in accessing COVID-19 related public health information (WHO 2020). In Bangladesh, they are more susceptible to the disease because of the preexisting vulnerabilities with respect to social isolation, poverty, increased dependency on other household members for livelihoods and non-equitable intra-household water, sanitation and hygiene access (Sen and Hoque 2017; Mactaggart et al. 2018).

Bangladesh is one of the first countries that adopted the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and as such, is committed towards ensuring the rights of persons with disabilities. Article 11 of the Convention asks states for ensuring the protection and safety of persons with disabilities in situations of risk and humanitarian emergencies. This is a commitment that is especially pertinent within the context of the current COVID-19 pandemic. The Government of Bangladesh has, as a party to the Convention, enacted the Rights and Protection of Persons with Disabilities Act 2013, as a policy instrument informed by its commitments to the Convention, and has also formulated a National Action Plan in 2018 for the implementation of strategic actions towards these commitments. However, preliminary data from our ongoing research study at BRAC University James P Grant School of Public Health (JPGSPH) and newspaper reports suggest that Bangladesh’s initiatives towards minimizing the impact of COVID-19 on the health and well-being of persons with disabilities are not up to the standard of being fully accessible and non-discriminatory. It is critical that the government takes immediate steps to ensure that all health and social services programme reach persons with disabilities and their families which would be beneficial for alleviating their plight and minimize the negative impacts of COVID-19.

Livelihood struggles of persons with disabilities during the COVID-19 pandemic

Our preliminary research findings from the ongoing study suggest that COVID-19 has negatively affected income and earnings of persons with disabilities and the food security status of their households. Such income loss and drastic impoverishment forced them seek financial assistance from friends, neighbours and relatives. A 34 years old male with multiple disability mentioned during interview:

“Corona is directly hitting my income. Not that I was wealthy before but I could at least buy food for the family. Now I am relying on help (meant begging) …I am disable but never asked for help but now I have no option other than asking for reliefs (breaks into tear).”

Food demand and security is linked to income. Hence, poor people’s loss of income-earning opportunities as a result of COVID-19 has a direct impact on consumption as noted in a Financial Express article on April 3, 2020. Since persons with disabilities have multiple burdens on their livelihoods, poverty being one of them, this current crisis has impacted their food consumption and livelihood drastically. Our findings suggest that persons with disabilities had to limit their food choices during COVID-19. The decrease in protein consumption was one of the major changes, followed by limiting frequency of meals (1-2 whole meals instead of 3-4). A 19 years old female with physical disability mentioned:

“We have been having just one meal a day. Where we had to cook over 2 kg rice each day, now we cook only around 1 kg. We have to eat the rice with only salt, rather than having it with curry or any other dish some days”

The challenges of accessing formal health care services and social safety nets

In Bangladesh, there are many attitudinal, structural and social barriers that hamper health and social service utilization by persons with disabilities. There is a lack of disability inclusive health care facilities and skilled health workforce who can provide appropriate health services to persons with disabilities (Talukdar et al. 2018). The current COVID-19 situation is making the situation worse as much of the health care resources are diverted towards dealing with the pandemic. Persons with disabilities are finding it difficult to access most relief aid programmes and social safety nets. A 33 years old woman with physical disability mentioned during interview:

“There was a gap in the quality of services before too, but now since there is a crisis in transportation and movement facility because of the nationwide shutdown, our problem has increased. It is difficult to seek service, even if it is something else other than Corona”.

The government of Bangladesh has introduced an allowance of BDT 700 (US$8.5) per month for financially insolvent persons with disabilities and, as of 2019, the number of beneficiaries for this was one million (Anwar, Cho, and Aziz 2019). However, not everyone with disability is receiving the allowance. Moreover, those who were receiving the service are now finding it difficult to collect the money because of mobility restrictions and difficulties with accessing transport and support in general. A 40 years old woman with physical disability mentioned the long waiting hours and being physically impaired have created so much discomfort for her:

“This time the authority maintained 3 feet distance to give the allowance money, but it took too long like 6-7 hours to receive the money. This was very difficult for me to wait so long”.

Concluding remarks: what needs to be done?

The state is responsible to ensure food security and livelihoods of vulnerable population groups including persons with disabilities. However, our preliminary research findings and a media report by The Business Standard on June 12, 2020 suggest that only a small percentage of persons with disabilities received government relief package and many of them did not go for collection of relief as they found it difficult to stand in queues, compete with crowds or travel the long distances. These challenges need to be addressed immediately. The Department of Social Services (DSS) is the responsible authority for the welfare of persons with disabilities. It maintains a database that includes information of more than 1.8 million disabled people in Bangladesh which could be used to streamline the process of delivering relief and other basic services to persons with disabilities.

Despite many significant efforts made by the government over the past two decades, persons with disabilities still suffer from a lack of access to education and health services and adequate social safety nets. The deeply rooted notions which stigmatize the very existence of persons with disabilities in the society along with the lack of inclusive mediums result in the long term alienation of persons with disabilities from the mainstream education and employment opportunities (United Nations 2019; Banks et al. 2021). As a result, the majority of them remain unemployed and when they are employed, it is in the informal sector. In pandemic and crisis situations such as COVID-19, which affected the economy of the world, this group relying on their informal income remains vulnerable and unattended (Banks et al. 2021).

The current Action Plan 2018 mentioned earlier does have components focusing on education, skills and employment, but to the best of our knowledge, full information on how the various bodies charged with implementing these components have integrated the same into their own operational plans and strategic actions, is not currently available. Evidence does need to be generated in a manner that has the meaningful participation of persons with disabilities themselves, is gender disaggregated, uses the highest standards of internationally accepted tools and methods (the Washington Group tools, for example) and includes the widest possible range of persons with varying disabilities, to inform the operational plans of the implementing bodies, and to adequately train and sensitize personnel in charge of the full and effective implementation of these measures. This is crucial not just for the current COVID-19 situation, but also for any such crisis in the future.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This study is funded by The Embassy of the Royal Kingdom of Netherlands in Dhaka, Bangladesh.

Notes

1 https://www.worldometers.info/coronavirus/