Authors: Zoha Anjum and Nidhi Nagabhatla
As water-bearers and care-providers, women and girls carry the burden of fulfilling water needs of their households. Water collection often exposes women to attacks from wild animals, sexual assault and severe health outcomes (Pommells et al., 2018). In 2017, more than 140 million people relied on contaminated surface water for drinking, sanitation and hygiene (WASH) needs (World Health Organization & UNICEF, 2019). Contact with waterborne pathogens can lead to both acute (i.e., waterborne infections) and chronic (e.g., malnutrition and growth stunting) conditions for individuals (Pouramin et al., 2020).
At the outset of the COVID-19 pandemic, several public health interventions were implemented to mitigate the spread of the virus. Examples included partial/complete lockdowns, wide enforcement of physical distancing, and recommendations for facemasks use and frequent handwashing (World Health Organization, 2020). However, these recommendations were far from reality for communities that lack access to WASH and/or reside in overcrowded spaces, where clean water is a luxury and physical distancing is impossible. The impact of COVID-19 on individuals and communities has been unequal. The vulnerable are further burdened, not just economically, but for provisions essential for survival and good health.
Migrant and refugee populations, particularly women, are at most risk
Globally, approximately 79.5 million individuals were forcibly displaced as of 2019 (The UN Refugee Agency, 2019). Human displacement is typically pursued to escape conflict, seek better access to resources and economics or in response to environmental and climate triggers. Water crises can be a major driver of human migration as polluted water, no access and/or lack of WASH service supply may force people to migrate. These aspects apply to the displaced populations and those hosted in refugee camps (Singh et al., 2020). For undocumented migrants and refugees, poor or lacking access to healthcare may lead to a higher number of COVID-19 infections and consequently, a higher mortality. Besides, overcrowding and lack of access to handwashing stations among informal settlements and refugee camps are a recipe for cascading health outcomes – if COVID-19 strikes. It is likely that COVID-19 has made these populations even more susceptible due to their living conditions – their burdens multiplied and resources crunched (Singh et al., 2020). Therefore, the call for better access to WASH and healthcare remains crucial to implement adequate prevention strategies and maintain sufficient resources to treat the sick during the pandemic.
COVID-19 has compromised women’s access to WASH
COVID-19 has flagged WASH as a crucial concern, especially for women and vulnerable populations including migrants and refugees (Fuhrman et al., 2020; Singh et al., 2020). The 2019 Joint Monitoring Report reflected that 8 of 10 individuals that lacked access to basic water services resided in rural areas and half of them lived in the least developed countries. More than 70% that lack access to basic sanitation facilities were in rural areas and of which, a third were based in the least developed countries (World Health Organization & UNICEF, 2019). This situation may have worsened in the past few months as a greater quantity of water and more sanitation facilities may be required to practice frequent handwashing for COVID-19 prevention. Surprisingly, only 60% of the world’s population has access to soap and water within their household, which highlights that the recommendation to frequently wash hands cannot be universally adopted (World Health Organization & UNICEF, 2019).
For women that are still continuing to fetch water from off-site waterpoints or using communal toilets, which may be the case for many migrant and rural populations, the waiting time at the waterpoint/toilet site may make it difficult to practice physical distancing (Centre for Policy Research, 2020). Furthermore, women’s access to safe menstrual hygiene management (MHM) may also be limited due to disruptions in the supply-chain or stigma that prevents women from asking their male relatives to purchase pads for them (Anjum et al., 2019; Centre for Policy Research, 2020). Women and girls dwelling in informal settlements and camps, where they may not have had access to safe MHM prior to COVID-19, may find it difficult to wash their reusable pads given the elevated water needs for handwashing. Use of non-reusable pads may increase the waste at the settlement area and improperly-washed pads may expose young girls and women to poor physical, mental and psychosocial health outcomes (Anjum et al., 2019; Pouramin et al., 2020).
COVID-19 has impacted women’s socio-economic wellbeing
Enforcement of complete lockdowns has consequences for household incomes, particularly for daily wage earners or uninsured/migrant workers. For families that rely on paid water service, this may force them to consume unsafe water, thus leading to a heightened waterborne disease burden. Households with a higher income are more likely to be able to afford and buy safe water from water vendors or water-provider companies, leading to an inequitable access to water where richer individuals can afford to keep themselves protected from COVID-19 and waterborne diseases; whereas, poor individuals do not have adequate resources to even survive.
Socio-economic impacts of COVID-19 are worse for women who were already working precarious jobs, earning less than a living wage, or residing in informal settlements (UN Women, 2020b). For migrant women working abroad, the travel bans may prevent women from returning to their families and expose them to exploitation, human rights violation and social isolation in a foreign place (UN Women, 2020a). School closures have led to higher childcare and home-schooling needs (Centre for Policy Research, 2020). Disruption in education has also induced serious consequences for women and girls as education is a way for them to seek social mobility within the society. For girls residing in refugee camps, the consequences are even worse as they are only half as likely to enrol in secondary school compared to their male counterparts (Anne-Birgitte Albrectsen & Stefania Giannini, 2020). It is likely that some of the girls may never return to school even after the pandemic has ended, thereby jeopardising the progress made towards the Sustainable Development Goal (SDG) 4 (Quality Education) and 5 (Gender Equality) targets.
COVID-19 has threatened women’s health and safety
Globally, women form most of the healthcare workforce. Hence, women are at a higher risk of contracting COVID-19 virus from their workplace. When access to WASH at healthcare facilities is inadequate, women are exposed to other contagious pathogens as well. Substantial risks to health and safety exist even for women who are not healthcare workers. Since the lockdowns were imposed, women have been subjected to gender-based violence, sexual exploitation, and abuse (UN Women, 2020b). There has also been a greater risk of female genital mutilation (FGM) due to the closure of schools where girls are usually safer (Kate Hodal, 2020). In some cultures, FGM is considered a rite of passage which needs to be performed before the girls are married. COVID-19 school closures have provided the optimal time to get these procedures done; thus, risking the lives of young girls.
The situation women face can vary depending on the settings of their dwelling. In high stress environments such as refugee camps, lack of economic opportunity and material deprivation may expose women to vulnerable situations, wherein women may be forced to engage in transactional sex (sex in exchange of sanitary pads, food, water etc.) as a survival mechanism (Williams et al., 2018). This may lead to unintended pregnancies and sexually-transmitted diseases. COVID-19 may exacerbate these situations compromising girls’ and women’s safety and dignity (Williams et al., 2018).
COVID-19 has also had an impact on women’s mental health. For women, physical distancing from loved ones, fear of the virus and lacking social support during a pandemic will affect their mental health (UN Women, 2020b). Furthermore, other barriers to access, violence, increased responsibilities and other factors discussed above may also be a source of stress (UN Women, 2020a).
Women, COVID-19, WASH and the SDGs
The interlinkage of the pandemic, gender and WASH will impact the future of many SDGs and related targets in a mixed manner (Figure 1). The “leaving no one behind” vision in this context sounds more relevant than ever. The COVID-19 pandemic has halted the global economy, which may push people further below the poverty line. This has implications for the SDG 1 (No poverty), 2 (Zero hunger), 4 (Quality education), and 10 (Reduced inequalities) due to disruptions in income and education (United Nations, 2020).
The prevention and treatment of the COVID-19 virus is fundamentally reliant on uninterrupted and equitable access to WASH (SDG 6) and to good health and healthcare (SDG 3). As noted, women are disproportionately affected by the pandemic and therefore, any progress made towards SDG 5 (Gender equality) will be affected and should be reviewed considering multifaceted impacts of the pandemic.
Figure 1: Interlinkages in gender, water and COVID-19 and the SDG agenda
The way forward
The pandemic has exposed the inequities and exacerbated the fragility of our existing health and welfare systems. At the same time, it presents an opportunity to reform our systems and approaches to provide universal access to WASH and healthcare. The road to recovery must be based on an equitable, inclusive and gender-sensitive approach, where women and other vulnerable groups form the centre of the COVID-19 response discussion and planning, especially in humanitarian emergencies. For supporting pandemic-related interventions, the need for data, disaggregated by gender, age and circumstances, is evident (UN Women, 2020a). To conclude, women need to be actively involved while keeping their roles, responsibilities and social norms in mind (Fuhrman et al., 2020). The lessons for addressing COVID-19 can go a long way to tackle gender inequalities, WASH access and needs of mainstream and migrant communities if interlinkages are carefully noted and tactically handled.
About the Autors
Zoha Anjum is a current Doctor of Dental Surgery student at the University of Toronto (Canada) and a global health researcher. Prior to her dental education, Zoha completed her Master of Public Health from McMaster University, alongside her graduate diploma in Water Without Borders from the United Nations University, Institute of Water, Environment & Health. She has research experience in issues pertaining to access to WASH, menstrual hygiene management, women’s health and challenges specific to marginalized and vulnerable populations. With both her dental education and global health expertise, Zoha is hoping to practice as a clinician scientist and provide evidence-based care to her patients while investigating broader-scale global health issues specific to WASH and women. Outside of her academic pursuits, Zoha contributes to numerous initiatives, including but not limited to, Visions of Science (a Canada-based not-for-profit that promotes STEM learning among marginalized youth) as a program facilitator, the 9th World Water Forum as a action and consultative group member and Tayaba Organization (a Pakistani welfare organization that provides water wheels to individuals with poor access to water) as a content writer.
Nidhi Nagabhatla is a Principal Researcher (Water Security) at UNU INWEH, Canada. She specializes in systems thinking and decision/learning support interfaces, and science-policy interfacing within the context of water-energy-food nexus, trade-offs in inter-sectoral water allocations, solutions to complexities in transboundary water management, trends, and impacts of water-driven migration. She leads the Water Security and Nexus project-an initiative that supports decision-makers and the development community in applying the water security agenda. In doing so, her recent research has extensively focused on gender burdens in the water sector for the most vulnerable, WASH, water, and climate crisis driven human mobility, peace, and political security links to water governance in conflict settings. Besides, programmatic responsibilities, she serves the capacity building coordinator for the institution and directs the youth-related programs aiming to build ‘Future Water Leaders’. She is also the Co-Director of the Water Without Program, a collaborative graduate program in water, environment, and health between McMaster University and the UNU-INWEH.
References
Anjum, Z., Pouramin, P., Glickman, T., & Nagabhatla, N. (2019). A Synthesis Report Analyzing Menstrual Hygiene Management Within a Humanitarian Crisis. OIDA International Journal of Sustainable Development, 12(05), 61–72.
Anne-Birgitte Albrectsen, & Stefania Giannini. (2020, March 31). COVID-19 School Closures Around the World Will Hit Girls Hardest. Plan International. https://plan-international.org/blog/2020/03/covid-19-school-closures-hit-girls-hardest
Fuhrman, S., Kalyanpur, A., Friedman, S., & Tran, N. T. (2020). Gendered implications of the COVID-19 pandemic for policies and programmes in humanitarian settings. BMJ Global Health, 5(5), e002624. https://doi.org/10.1136/bmjgh-2020-002624
Kate Hodal. (2020, June 16). Why coronavirus has placed millions more girls at risk of FGM | Global development | The Guardian. The Guardian. https://www.theguardian.com/global-development/2020/jun/16/coronavirus-millions-more-girls-risk-fgm?utm_source=Global%20Health%20NOW%20Main%20List&utm_campaign=0a01d6674a-EMAIL_CAMPAIGN_2020_06_15_01_35&utm_medium=email&utm_term=0_8d0d062dbd-0a01d6674a-2989629&fbclid=IwAR1lzR09w_StXw5viYWQm_WsZYRJPf6iusRZJ_UhoPCFfBOUOjOilZS0ggA
Kathleen O’Reilly, Madhu Krishna, Sujoy Mojumdar, Arundati Muralidharan, Bharti, Tripti Singh, & Anju Dwivedi. (2020). CORP webinar on Impacts of COVID-19: Gender inequities in WASH. Centre for Policy Research. https://www.cprindia.org/events/8833
Pommells, M., Schuster-Wallace, C., Watt, S., & Mulawa, Z. (2018). Gender Violence as a Water, Sanitation, and Hygiene Risk: Uncovering Violence Against Women and Girls as It Pertains to Poor WaSH Access. Violence Against Women, 24(15), 1851–1862. https://doi.org/10.1177/1077801218754410
Pouramin, P., Nagabhatla, N., & Miletto, M. (2020). A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health. Frontiers in Water, 2. https://doi.org/10.3389/frwa.2020.00006
Singh, L., Singh, N. S., Maldonado, B. N., Tweed, S., Blanchet, K., & Graham, W. J. (2020). What does ‘leave no one behind’ mean for humanitarian crises-affected populations in the COVID-19 pandemic? BMJ Global Health, 5(4), e002540. https://doi.org/10.1136/bmjgh-2020-002540
The UN Refugee Agency. (2019). 1 per cent of humanity displaced: UNHCR Global Trends report – UNHCR Philippines. UNHCR. https://www.unhcr.org/ph/19443-globaltrends2019.html
UN Women. (2020b). UN Secretary-General’s policy brief: The impact of COVID-19 on women. United Nations. https://www.unwomen.org/en/digital-library/publications/2020/04/policy-brief-the-impact-of-covid-19-on-women
UN Women Asia. (2020a). The First 100 Days of the COVID-19 Outbreak in Asia and the Pacific | UN Women – Asia-Pacific. UN Women. https://asiapacific.unwomen.org/en/digital-library/publications/2020/04/the-first-100-days-of-the-covid-19-outbreak-in-asia-and-the-pacific
UNSDG. (2020, March). Shared responsibility, global solidarity: Responding to the socio-economic impacts of COVID-19. UNSDG United Nations. https://unsdg.un.org/resources/shared-responsibility-global-solidarity-responding-socio-economic-impacts-covid-19
Williams, T. P., Chopra, V., & Chikanya, S. R. (2018). “It isn’t that we’re prostitutes”: Child protection and sexual exploitation of adolescent girls within and beyond refugee camps in Rwanda. Child Abuse & Neglect, 86, 158–166. https://doi.org/10.1016/j.chiabu.2018.09.015
World Health Organization. (2020, April). Coronavirus disease (COVID-19) advice for the public. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
World Health Organization, & UNICEF. (2019). Progress on household drinking water, sanitation and hygiene I 2000-2017. World Health Organization. https://www.who.int/water_sanitation_health/publications/jmp-2019-full-report.pdf?ua=1
