COVID 19: The Great Leveller? Or making street children even more vulnerable?

Published 04/20/2020 By Jess Clark

For street-connected children around the world, the COVID-19 pandemic brings new risks and challenges to already difficult lives. Despite early claims that the pandemic would act as a ‘great leveller’,[1] it has quickly become clear that COVID-19 poses a significant threat for the most marginalised and vulnerable in society. Street-connected children are amongst those who are most at risk as the pandemic spreads and governments respond.

Although almost all children who catch the disease seem to fight it off relatively unscathed,[2] children who spend large parts of their lives on the streets may be more at risk than most. Existing health inequalities shape both the risk of exposure as well as the susceptibility to disease during an influenza pandemic,[3] and many health issues that often afflict street-connected children could contribute to their vulnerability during the COVID-19 pandemic.

Infectious diseases, including respiratory infections such as pneumonia, have been shown to be more prevalent among children who live on the street than among their peers who live at home.[4] Asthma, a known pre-condition increasing the likelihood of developing more severe COVID-19 if infected[5] is also common among street-connected children and the homeless. For instance, a study in New York found that homeless youth were hospitalised with asthma at a rate 31 times higher than other youth.[6],[7] Poor nutrition, a problem faced by many street-connected children, can weaken the body’s immune response and increase health vulnerabilities, and this issue has been exacerbated by the disruption or suspension of many nutrition programmes that otherwise cater for undernourished children.[8]

These pre-existing health conditions mean that street-connected children are more susceptible and vulnerable than most children to contracting and becoming severely ill with COVID-19.

Despite this, many street-connected children are unable to carry out the basic precautions that everyone has been urged to take to protect themselves from the virus. Washing hands with soap and water is the first line of defence against COVID-19,[9] yet this essential practice remains out of reach for many street-connected children who do not have regular access to basic water and hygiene facilities.[10] Similarly, for children without a home to shelter in and reliant on begging or street trading to make enough money for their daily necessities, social distancing or self-isolation may not be possible. For many of them, following the containment measures currently being implemented by national governments across the globe is simply not a viable option.[11][12]

Poor access to information around COVID-19 is also likely to limit the health protective behaviours of street-connected children. Research conducted following previous pandemics and public health events such as SARS, Ebola and H1N1 demonstrates the danger posed by a lack of information, as well as the correlation between people knowing about the threat and acting to protect themselves.[13][14] This issue has been recognised by some organisations in the context of COVID-19, with UNICEF amongst others acting to spread knowledge and awareness to vulnerable communities.[15] street-connected children often lack access to appropriate information due to their street connection, which makes it more difficult for them to receive key information such as the existence of a pandemic, how they can protect themselves, how they can recognise symptoms and what to do if they think that they might be affected.[16]

The increased risk posed by the current situation builds upon existing vulnerabilities street-connected children face, many of which have been exacerbated by the pandemic, meaning that essential survival behaviours may no longer be possible.

For example, begging or street-trading requires contact with other people, and opportunities for these interactions are now limited due to the lockdowns that many countries around the world have implemented, restricting people’s movement outside their homes. While UNAIDS has called for governments and international bodies to ensure that responses to COVID-19 do not deprive people of their livelihood, work, shelter or food, we know that national responses have often resulted in harsh restrictions on opportunities for street-connected children to make money to survive.[17] [18]

As well as worsening their struggle to survive, preconceptions about street-connected children and their lives by populations around the world are leading to them being increasingly discriminated against during the pandemic. While street-connected children around the world are always subject to stigma,[19] organisations such as UNICEF and UNAIDS have underlined that COVID-19 is worsening forms of stigma and discrimination faced by many marginalised groups.[20][21] The fact that this is a new disease is provoking confusion, anxiety and fear amongst the public, which can be expressed through further stigmatisation of street-connected children. CSC network member Safe Society in India has noted that the already high levels of respiratory illness amongst street-connected children has led to discrimination from the public. Law enforcement practices associated with lockdowns, such as street ‘sweeps’,[22] are particularly harmful for street-connected children, criminalising their routine behaviour, and both reflect stigma and encourage it.

CSC network members are reporting that the COVID-19 pandemic is affecting their usual services, limiting their ability to reach and support vulnerable children. Two network members in Malawi and Zimbabwe have been forced to restrict outreach activities, while one network member in Nigeria, the Education for Purpose Initiative, reports being unable to find children in their usual settings and meeting places. Members in Vietnam, Indonesia and Zimbabwe have said that some drop-in and accommodation centres are seeing a large increase in demand while others are being forced to close or introduce restrictions. Other network members, including Safe Society in India and Glad’s House in Mombasa, Kenya, are having to introduce or increase distributions of food and sanitary supplies. The COVID-19 pandemic is making the work of these organisations more difficult or, in some cases, impossible, leaving many street-connected children at increased risk.

As the pandemic continues, street-connected children are in danger of losing their livelihoods, the lifelines provided by NGOs, and even, potentially, their lives.

We must now call for governments and societies to ensure that this vulnerable group is not forgotten as they plan their responses. CSC is working with our members to collect and share up-to-date information on how street-connected children, and the work of NGOs who exist to support them, are being affected. In these unprecedented circumstances, normal approaches and ways of working have been disrupted. There is an urgent need to identify and share practical responses that work to protect and support street-connected children, ensuring that organisations around the world are best equipped to continue their vital work.

Written by Nick Sharma, CSC Research Intern, and Shona Macleod, Research and Evaluation Officer at CSC

[1] Jones, Owen. 2020. “Coronavirus Is Not Some Great Leveller: It Is Exacerbating Inequality Right Now | Owen Jones”. The Guardian.

[2] Dong, Yuanyuan, Xi Mo, Yabin Hu, Xin Qi, Fan Jiang, Zhongyi Jiang, and Shilu Tong. 2020. “Epidemiology of COVID-19 Among Children in China.” Pediatrics.

[3] Kumar, S., and S. C. Quinn. 2011. “Existing Health Inequalities In India: Informing Preparedness Planning For An Influenza Pandemic”. Health Policy And Planning 27 (6): 516-526. https://doi:10.1093/heapol/czr075.

[4] Cumber, Samuel Nambile, and Joyce Mahlako Tsoka-Gwegweni. 2015. “The Health Profile of street-connected children in Africa: A Literature Review.” Journal of Public Health in Africa 6 (566): 85–90.

[5] National Institution for Health Care and Guidance. 2020. “COVID-19 rapid guideline: severe asthma.” NICE guideline NG166.

[6] Sakai-Bizmark, Rie, Ruey-Kang R. Chang, Laurie A. Mena, Eliza J. Webber, Emily H. Marr, and Kenny Y. Kwong. 2019. “Asthma Hospitalizations Among Homeless Children in New York State.” Pediatrics, 144 (2).

[7] Story, Alistair. 2013. “Slopes And Cliffs In Health Inequalities: Comparative Morbidity Of Housed And Homeless People”. The Lancet 382: S93. https://doi:10.1016/s0140-6736(13)62518-0.

[8] UNICEF. 2020. “Don’t Let Children Be The Hidden Victims Of COVID-19 Pandemic”.

[9] OHCHR. 2020. “COVID-19 Guidance”.

[10] UNICEF. 2020. “Protecting The Most Vulnerable Children From The Impact Of Coronavirus: An Agenda For Action”.

[11]UNAIDS. 2020. “Rights In The Time Of COVID-19”.

[12] Masinde, Andrew. 2020. “COVID-19: Are street-connected children Safe?”.

[13] UNAIDS. 2020. “Rights In The Time Of COVID-19”.

[14] Rubin, GJ, HWW Potts, and S Michie. 2010. “The Impact Of Communications About Swine Flu (Influenza A H1n1v) On Public Responses To The Outbreak: Results From 36 National Telephone Surveys In The UK.”. Health Technology Assessment 14 (34). doi:10.3310/hta14340-03.

[15] UNICEF. 2020. “Communities In Nigeria’S Largest City Learn How To Protect Themselves From COVID-19”.

[16] See our Explanatory Note for CSC Network Members on the Right to Access to Information in the context of COVID-19

[17] UNAIDS. 2020. “Rights In The Time Of COVID-19”.

[18] Wynne, Sian. 2020. “COVID-19 On The Streets”.

[19] Auerswald, Colette L., and Ariella Goldblatt. 2016. “Stigmatizing Beliefs Regarding Street-Connected Children And Youth”. JAMA Pediatrics 170 (5): 419. doi:10.1001/jamapediatrics.2016.0161.

[20] UNICEF. 2020. “Social Stigma Associated With COVID-19”.

[21] UNAIDS. 2020. “Rights In The Time Of COVID-19”.

[22] UN Special Rapporteur on the Right to Housing. 2020. “COVID-19 Guidance Note”.[2].pdf.