Dr. Tlaleng Mofokeng, UN Special Rapporteur on the Right to Health, argues the COVID-19 pandemic has exposed many health systems as inadequately financed, underprepared for managing complex emergencies, and suffering from a lack of agility to respond without threatening the delivery of other health services.
This article originally appeared at COVID HQ Africa and is re-posted here with permission.
By the time South Africa went into hard lockdown in March 2020, I was completing a self-imposed quarantine as I had travelled to Geneva, Switzerland. I was leading a delegation to the human rights council to deposit a report prepared by the South African commission for gender equality (CGE) to the pre-working group of the Committee on the Elimination of discrimination against women (CEDAW).
Upon landing in South Africa, Switzerland was on the travel high risk list, as coronavirus that caused COVID-19 infection was still dynamic and emerging – it was the responsible thing to do. I had to confront all the possibilities, including the scariest, the real possibility of getting COVID-19, and even death. I even updated my ‘in-case-of-emergency’ contacts, and I thought I was prepared for the uncertainty. However, as the days went by, isolated in my own home, my mental health started to take a knock. I had anxiety about my family back in Qwa-Qwa, formerly Bantustan, in the Free State province, and many communities like them, particularly, the abnormal situation of frequent water cuts and lack of clean and safe water. It was all I could think about. The public health communication and campaigns were correctly emphasizing the need to wash hands regularly for 20 seconds, yet we have communities who do not even have a consistent supply of clean and safe water. How is it so easy for leaders to be so far removed from the experiences of millions of people? Even buying a sanitizer requires surplus money that many simply do not have.
A century ago, W. E. B. Du Bois recognized the connection between societal inequities and health inequities, raising several central arguments related to racism, poverty, and other social problems. The right to health is an inclusive right, and COVID-19 forced us to confront these existing structural fault lines that extend not only to timely and appropriate healthcare, but also to the underlying determinants of health. The right to health is interconnected and indivisible from other rights, such as the right to an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions. These entitlements include the right to a system of healthcare and the underlying social determinants of health.
“This global pandemic has further exposed the harsh conditions that many people were already living under. COVID-19 found many health systems inadequately financed, lacking in disaster planning, and suffering from a lack of agility to respond without threatening other health services.”
As a medical doctor, I also know the impact of a lack of safe and clean water, I spent many years working as a pediatric emergency medical officer, and treating children with diarrhoeal diseases. This global pandemic has further exposed the harsh conditions that many people were already living under. COVID-19 found many health systems inadequately financed, lacking in disaster planning, and suffering from a lack of agility to respond without threatening other health services.
It is impossible, and frankly irresponsible, to ignore how the virus’s impact has been worsened by public health policy that is devoid of a human rights approach and suffers from poor leadership at all levels of care, persisting socio-economic inequalities, systemic racism that continues to burden individuals, and structural discrimination. This has meant that despite lockdown regulations, many people could simply not afford to stay home and not work, and those ‘essential’ workers are some of the lowest paid workers, with no health insurance, and many of whom are from marginalized communities. Important to note that many of them are women in industries with poor or no labor protections. In addition, many women, gender-diverse persons, and children were entrapped, in lockdown, with their abusers. Absolute devastation.
At the 75th session of the General Assembly, in my capacity as the United Nations Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, I shared my vision to gain a deeper understanding on the negative impacts of coloniality, racism, and the oppressive structures embedded in the global health architecture, which disproportionately impact black people, indigenous peoples, and people of color, as well as those in developing countries. As per the mandate, the Special Rapporteur is tasked to apply a gender perspective in the execution of her mandate and to pay attention to the situation of “vulnerable and marginalized groups.”
In my response to oral questions posed by member States, I pointed out that the starting point for millions of people is unequal, and the negative impact of what health systems worldwide lack in resourcing; for example, testing kits took long to arrive in many countries, and others are still struggling with diagnostics technology, while others struggle to access care and therapeutics, including the vaccine. The pandemic does present an opportunity to address multilateralism and the multiple dimensions of structural racism that fundamentally cause health disparities as well as the embedded corruption in the health sector, where even before COVID-19, health budgets allocated for health services and related provisions, did not yield the results because of mal-administration and power imbalances with the relationship of recipients and donors of health aid.
As we look forward to a post-COVID-19 pandemic era, it is important to adhere to the public health advice on social distancing, wearing masks, and washing hands. The vaccine undeniably provides the global community an opportunity to save more lives. The only way to achieve this, though, is to ensure that vaccines that have been developed are fully accessible, acceptable, of quality, and available to all. Vaccine hoarding by richer countries will lead them to fall short of their intended outcome. It will only delay millions of people getting life saving medicines and lead to many more deaths.
Executive Director of UNAIDS, Ms. Winnie Byanyima, reminds us that “we have a commitment to stand up for the most vulnerable, even in the tough environment COVID-19 has put us in.”
“Contrary to the popular statement, COVID-19 is not an equalizer.”
Contrary to the popular statement, COVID-19 is not an equalizer. In fact, it is precisely because of historical and current human rights abuses and violations that States must be reminded of their obligations “to take positive measures that enable and assist individuals and communities to enjoy the right to health.”
The pandemic has continued the marginalization of millions of people who are in vulnerable situations, who are often neglected from health services, goods and facilities – those living in poverty, women, survivors of gender-based violence, indigenous peoples, people with disabilities, older persons, minority communities, internally displaced people, persons in overcrowded settings and in residential institutions, people in detention and prisons, people experiencing homelessness, migrants and refugees, people who use drugs, LGBTI, and gender-diverse persons.
For millions of people throughout the world, the full enjoyment of the right to the highest attainable standard of physical and mental health remains an unmet goal.
The loss, the bereavement, and anxiety as a result of this global pandemic, and for many people the worst disaster in their lifetime, must lead us to a better place as a global community. There is only one way out of this despair, it is through protection of human rights, international cooperation, solidarity, improved health systems that protect human rights, better transparency and accountability.
About the Author
Dr. Tlaleng Mofokeng is a doctor at the DISA Clinic in South Africa and the UN Special Rapporteur on the Right to Health. The views expressed here are personal and do not necessarily reflect the views of the United Nations.
– – –
This article originally appeared at COVID HQ Africa and is re-posted here with permission. The views and opinions are solely those of the author(s) and do not purport to reflect the opinions or views of COVID-19 Africa Watch or any affiliated organization. The original article is available here.