Overview of the Crisis
South Africa reported it fist case of COVID-19 on 5 March 2020. While the first cases were imported, local transmission has led to a rapid increase in the number of cases. As of 21 April 2020, more than 3,400 cases and 58 deaths had been confirmed. On 15 March, President Cyril Ramaphosa declared a national state of disaster, and the government has since taken several measures to curb the spread of the virus, including closing borders, implementing strict social distancing measures and a 35-day nation-wide lockdown. These measures, along with the global economic shock caused by the pandemic, are expected to generate rising needs requiring an immediate and urgent response. Although South Africa is considered an upper-middle-income country, the amount of disparities—social, economic, and gender—make the country particularly vulnerable during this emergency. For example, 33 per cent of the urban population is concentrated in overcrowded slums; if the novel coronavirus is to strike this population, the probability of excess morbidity and mortality is a very real prospect. Furthermore, as a strategic regional business/ socio-economic hub and key to the region’s socio-economic stability, a crisis in South Africa could have devastating broader regional consequences.
The public health emergency is unfolding into protection challenges which affect people and communities that are marginalized or in situations of vulnerability. Experiences in other countries has shown that the pandemic is highly likely to compound existing gender inequalities and increase risks of gender-based violence (GBV). Considering South Africa’s existing challenge with GBV this is expected to escalate during and post the lockdown. According to the Demographic Health survey, one in five women (17 per cent) aged 18 to 24 had experienced violence from a partner in the past 12 months, 6 per cent of women older than 18 experienced sexual violence by a partner whilst a woman is murdered every four hours in South Africa where half of the cases identified were perpetuated by an intimate partner.
The pandemic will have devastating consequences for people living with HIV AIDS (the highest number globally- more than 7.5 million) who are particularly vulnerable to the impact of the virus. Some 2.5 million among them who are HIV-positive but not on antiretroviral (ARV) drugs, including many of the 1.5 million people living with HIV/ AIDS (PLHIV) who are aged 50 years old or older and an estimated 500,000 people who have low CD4 counts are extremely vulnerable.
Many PLHIV also belong to marginalized populations such as sex workers, men who have sex with men (MSM), transgender people, people who inject drugs (PWID) and people in prisons. According to available data, HIV prevalence in these populations is much higher than general population and antiretroviral therapy (ART) coverage much lower. For example, while 2018 ART coverage among adult men, 15-years-old and above, was estimated to be 57 per cent, it was only 44 per cent among men who have sex with men, and much lower among people who inject drugs. Beyond access to ART, these marginalized populations face issues such as not being part of the formal economy. Further, there are more than an estimated 300,000 people who have active TB infections in South Africa, with more than half of them (177,000) having a dual HIV and TB infection. Among all people with active tuberculosis (TB) infections, there are 73,000 who are not yet diagnosed or notified of their disease, generally called “missing TB cases.” It is estimated that there more than 72,000 people living with both HIV and active TB infection who are not receiving ART or TB treatment, putting them at a double risk.
Despite its standing as an upper-middle income country, nearly half of all households across the country struggle to meet their basic food needs and are particularly vulnerable to disruptions in market dynamics. Informal labourers, and small farmers, especially women, that do not have access to social grants, are particularly vulnerable.
The latest quarterly Labour force survey (Q4 2019) indicates that nearly 20 per cent of the country’s workers, approximately 3 million people, work in the informal sector and would require assistance to compensate for income losses from movement restrictions that prevent them from earning their livelihoods, with lasting effects on community resilience and social cohesion. Small scale farmers have a high dependence on their produce for both consumption and income generation that subsidizes their additional expenses. Any disruption to their activity places them in a situation where they will constitute one of the key vulnerable sectors. While the Department of Agriculture Land Reform and Rural Development launched a 1.2 billion Rand grant facility for small scale farmers to face supply side constraints due to lockdown, more needs to be done to complement the government’s initiative by reaching out to vulnerable farmers and households that will be unable to apply for the grants.
Over 13.8 million people live below the food poverty line, making less than 561 South African Rand (about US$29.3) per person/month (in April 2019 prices), meaning that they are unable to afford the daily minimum required daily energy intake, according to 2015 statistics.
The consequence of this are risks of malnutrition particularly for children which have negative long-term effects on their health and educational outcomes. The pandemic is expected to impact negatively on this already persistent food insecurity. This is particularly alarming given that currently the prevalence of stunting and malnutrition among children under age 5 is 27 per cent (1,5 million) and 2.5 per cent (360,500) respectively, according to UNICEF. The impacts of the COVID-19 pandemic on the nutritional status of children and women are expected to include: significant undermining of the current efforts on breastfeeding due to inaccurate information about mother-to-child viral transmission; a significant impact on the quality of children’s and women’s diets (frequency, quantity and diversity) due to disrupted food systems (access to food) and a hike in food prices; and an increase in the number of undernourished children in need of therapeutic feeding and care due to poorer breastfeeding practices, poorer diets, increased morbidity, and disrupted primary health care systems.
Many of the 273,488 refugees and asylum seekers live in crowded conditions, the scale of the outbreak could be massive, particularly for this vulnerable group, according to UN-Habitat. The country has more than 2,700 informal settlements with an estimated number of 6.8 million people3 . Informal settlements in South Africa are characterized by profound inequalities in access to basic services such as water, sanitation, and electricity. There is concern that if informal settlements are hit by COVID-19, the result could be extremely high infection rates given the poor access to water and sanitation, as well as the population density. According to the South Africa Reserve Bank, preliminary estimates suggest South Africa could lose about 370,000 jobs this year, on a net basis, with business insolvencies increasing by roughly 1,600 firms as the economy contracts. Such impact has the potential for triggering xenophobia, racism and discrimination on migrants as competition over scarce jobs intensify.
The closure of schools for an extended period will impact children’s well-being and have a longer-term impact on inequalities, as the most vulnerable families may not send children (particularly adolescent girls) back to school. Nearly 13.1 million learners have been affected by the closure of schools. While distance-learning mechanisms are being attempted, they will not reach all children and youth, and those without internet access or adult supervision will be disadvantaged. Furthermore, 9 million children who normally benefit from school feeding, will be vulnerable during protracted school closure. School health programmes have been disrupted posing further health challenges for children. Children in lockdown situations are prone to heightened violence and abuse, including online. GBV is a major concern affecting women and girls who are locked down in unsafe homes. An estimated 600,000 migrant children live in South Africa. These children are particularly vulnerable to potential exclusion from safety nets and services. Equally, there is a need to ensure the right to education for the approximately 55,000 refugee and asylumseeker children not affected.