Public health and migration: from the Postcolonial era to COVID-19

By Ranabir Samaddar, Distinguished Chair in Migration and Forced Migration Studies, Calcutta Research Group

This blog is part of a series on tackling COVID-19 in developing countries. Visit the OECD dedicated page to access the OECD’s data, analysis and recommendations on the health, economic, financial and societal impacts of COVID-19 worldwide.

Photo: Juan Alberto Casado, Shutterstock

I wrote The Postcolonial Age of Migration in 2016-2019. It came out just two months ago as the pandemic continued (and continues) to rage in India and around the world. Global mobility came to a screeching halt and I have not yet seen the book in print. Locked down in my house and aware that the book had come out, I was driven to reflect on what I had written: did I do justice to our age, which I had described as the postcolonial age of migration? The book time and again goes back to colonial histories of war, plunder, changes in land use pattern, peasant dispossession, primitive accumulation, and their continuities in our time. Against this backdrop, the book discusses how the colonial practices of violence and border building are being reproduced today on a global scale. Wars, famines, and ecological changes are major driving factors behind migration and forced migration flows today. They also influence patterns of labour mobility. Yet as I reflected, the overwhelming reality of the COVID-19 pandemic brought home the realisation that the book does not account for epidemiological disasters as an integral part of the colonial history of migration and the postcolonial age of migration. The absence of any concern for migrant workers and refugees in public health structures should have been discussed. The book speaks of refugees’ health concerns in camps, yet the broader perspective of migrants and public health is absent.

India’s history of epidemics, including its current handling of COVID-19, offers insights both into the country’s poor public health infrastructure and the postcolonial age of migration. The present situation of COVID-19 has evoked comparisons with the well-known 1897 plague in colonial Bombay. Thousands fled the city, spreading the disease in the process. Public health infrastructure was zero. Residents locked themselves in their houses in fear of plague-control officers who could pick any one up, put them in quarantine, and separate children from their families. Over the next twenty years, about 10 million people died of the disease in the country. Other infectious diseases such as cholera, smallpox, malaria, tuberculosis, and influenza accompanied the plague. Malaria killed millions over the years, and an estimated 5 percent of the country’s population perished in the influenza epidemic of 1918-19. Yet, as one commentator put it, “Then, as now, only one out of a handful of deadly afflictions, the one that most directly threatened commerce, trade, and the accumulation of capital—was identified as a crisis”. A plague associated with dense urban formations threatened commerce and trade, say, more than malaria did. The bubonic plague became the government of Bombay’s priority for the next two decades.

Today, the country has witnessed masses of internal migrant labourers returning home on foot, a growing hunger crisis, stockyards and storages overflowing with millions of tons of food surplus, and power being exercised arbitrarily across the country. This is a call back to the Epidemic Diseases Act of 1897. In the outbreak of the plague epidemic, the city of Bombay came to a halt. Thousands of workers (300,000 according to chronicles on that time) left the city.

This only fuelled the crisis further. As a response, the Bombay Improvement Trust was formed to give its “reputation” of being hygienic back to the city. Yet in those efforts, the policy focus was on making the city “clean” rather than setting up and improving public health infrastructure. Where cleaning the city was seen as a “public” endeavour, protecting people’s health was not so much a “public” priority. The countrywide lockdown for the last few months has not come hand in hand with efforts to strengthen public health infrastructure either. In other words, we are waiting for the epidemic to pass and attempting to reduce the scope of contagion, while tolerating a “minimum number of deaths”, including collateral deaths such as of migrants who had been pushed to travel home by road or by rail. These include nearly 100 deaths of migrants travelling by train – by government admission – and another nearly 200 killed in road accidents. However, these are very conservative estimates as there was no collective/governmental effort to collate the data on deaths of migrants on roads and trains in April-July 2020.  

Social Darwinism perfectly describes the economic policies that have followed the pandemic. Disease does not act alone. It acts in unison with a policy of eroding public health infrastructure. Moreover, pushing migrant workers to the fence and robbing them of access to public distribution of food, public health provisions, and employment in public works to tide over the crisis, has become willingly or unwillingly a part of the disease control strategy. In this context, migrants are made to be seen like a virus that spreads disease. The migrant’s body is depicted as suspect. Like the virus, the migrant in country after country symbolises the enemy from the outside. This in turn legitimises all kinds of governmental prohibitions and restrictions around the world on migrants and refugees.

Thus, the range of policy challenges in coping with the pandemic arises from the ignorance of the phenomenon of mobility – of pathogens and of workers. Indeed the idea that the threat is from outside not only makes a law and order centric approach to cope with the epidemic possible, it also explains how the “migrant crisis” and the “public health crisis” have come together. There is no doubt that any account of the postcolonial imprints on the current age of migration will be incomplete without an examination of the interrelated notions of public health and refugee and migration flows.

Well-meaning people have offered suggestions to improve public health, like the need for more ICU beds or ventilators. But they focus less on how to expand the scope of the “public”. Why does the idea of public health exclude migrants in the first place? Why did India not think of its large numbers of migrant workers when it announced the lockdown and why did it not expand public health services to migrants? Why does a migrant worker’s entitlement to health protection in one state not enable him/her to access protection in another state? These questions  reveal the inequalities that hide behind the notion of “public”.  

 On the other hand, consider these experiences: in several states, food security suddenly became the top priority for cash-strapped local governments – panchayats, municipalities, corporations, and state governments. Tackling hunger in the wake of the lockdown, even among migrant worker families, became an obvious endeavour among the lower levels of power and politics. Meanwhile, activists, trade unionists, local councillors, academics, students and youth, village leaders and philanthropists joined hands or formed independent groups to come to the aid of migrant workers, out of job informal workers, and other vulnerable sections of society. In slums and other poor urban areas, local associations took on the role of local vigilantes protecting the settlements, ensuring sanitation and safety. All these experiences reflect on the postcolonial age of migration – now in times of a pandemic. But the question is: will the world of policy and decision makers take these experiences on-board in reimagining truly inclusive policies for public health?