Overcrowded homeless camp a Covid-19 risk: Doctors Without Borders

Cape Town's lockdown camp for homeless people is a potential breeding ground for coronavirus and tuberculosis, says the international charity Doctors Without Borders.

“If anyone were to develop Covid-19 or TB in Strandfontein temporary relocation camp the chances for medical staff detecting it early are small, whereas the risk for transmission to many others is very high because of gross overcrowding and because the availability of screening and health care services is erratic,” said Dr Gilles van Cutsem, a senior TB/HIV adviser with the organisation, also known by its French name Médecins Sans Frontières (MSF).

“The danger of doing harm is great and this should alarm anyone,” said Van Cutsem, who visited the camp on Saturday. He was part of a team investigating health conditions at the shelter, where 1,500 homeless people have been relocated.

MSF called for the “phased decommissioning” of the camp, set up in marquees at Strandfontein Sports Ground, and said municipal authorities should invest more resources in shelters so they meet Covid-19 prevention criteria.

“MSF specifically promotes the development of smaller, community-based shelters sited closer to facilities that already provide certain required services, such as mental health care,” the organisation said.

The organisation said Tshwane initially opened similar large-scale, high-occupancy relocation camps but quickly changed its approach, “appreciating the risks of such unworkable set-ups”, and opened smaller shelters that were easier to manage.

“Johannesburg is following a similar strategy,” it said, but added that all the shelters it had assessed in the past fortnight faced common problems, including:

• Overcrowding and the impossibility of physical distancing indoors;
• Insufficient water and sanitation;
• Lack of Covid-19 related health promotion and education;
• Low levels of screening for Covid-19 and lack of reliable referrals for confirmatory testing and safe isolation;
• Erratic distribution of food; and
• The presence of heroin users suffering from withdrawal symptoms.

“The government is clear that Covid-19 infections are projected to continue rising until a peak in September, and we should therefore accept that Covid-19 transmission will not decrease over the short term,” said MSF's Tshwane co-ordinator, Musa Ndlovu.

“What does this mean for the people in temporary shelters, finding themselves in potential breeding grounds for Covid-19 during the extended lockdown and thereafter? The need for medium and longer-term alternative solutions could hardly be more urgent.”

Another common point across shelters was the presence of extremely vulnerable people with chronic conditions, increasing their risk of disease severity and death related to Covid-19.

Van Cutsem said: “Residents of Strandfontein include several elderly people — at least one with a severely altered mental state; several people with HIV, a known risk factor for TB and a potential risk factor for Covid-19; several people with severe mental health diseases such as schizophrenia and dementia; people with urinary and faecal incontinence; several people with chronic respiratory conditions; and several people with hypertension.”

The better temporary shelters and camps assessed by MSF tended to be “smaller facilities in communities where the community members offer support in the form of food or clothing for occupants, thereby enhancing the existing services and minimising risks of social stigma”.

MSF said it was also worried about whether people in camps such as the one at Strandfontein were there voluntarily.

Liesbeth Schockaert, the organisation's regional migration co-ordinator, said: “In addition to violating individual rights, it might further exacerbate the public health risk posed by Covid-19, because vulnerable people don’t all trust authorities and their legitimate fears of detention might force some underground, causing them to altogether avoid seeking care, even when needed.”

Gladys Bakubaku-Vos, the ANC social development spokesperson in the Western Cape provincial legislature, said the caucus was “alarmed but not surprised” by MSF's findings.

“They correspond with ANC assessments and come on the back of ANC calls for the camp to be closed,” she said. “There is no proper social distancing, hand sanitisers and warm water for showers. What is happening at Strandfontein has now become nothing less than a crime against humanity. Gross violations of human rights are taking place.

“We repeat our calls for the national command centre to take over the camp and set up intergovernmental control together with the province and city. Many churches and NGOs want to help. It’s time to act now.”