COVID-19 in French-speaking sub-Saharan Africa. Part I – Findings

  • Pr Jacques Barrier
  • 10 Apr 2020

  • Editorial
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Pandemic Lockdown Reflections

To break the transmission chain, preventive measures are essential. The most effective is social distancing between infected or potentially infected individuals and those who are not. Without further debating the preferred distance (1m or 1.50m), the value of different types of masks according to their supposed performance or the categories of population that must wear them, global authoritarian lockdown has been the leading measure. It was imposed from the outset in China and Europe with the aim of slowing down the development of the pandemic, in order to allow for timely implementation of health protection, adapted care structures and to protect fragile people.

The technical means that can be implemented for prevention and treatment (ICU beds, masks, gloves, diagnostic tests, etc.) and the nursing staff are of paramount importance. This problem is not specific to Africa, but what are the satisfactory solutions in developing countries with constrained financial resources and a limited number of healthcare workers (for example, hospital structures in Kinshasa, a city of nearly 12 million inhabitants, had only about fifty ventilators at the beginning of the epidemic)?

Organising social distancing is proving difficult in many African countries. Many countries decided early on closing schools and universities as a first measure (for example at the beginning of March in Senegal). The next steps were authoritarian measures of lockdown or even curfews. Curfews were imposed quickly (e.g. very early in Ivory Coast, Burkina Faso, Senegal).

Apparently, there was relative acceptance in wealthy circles. In the large urban centres,  lockdown of people who are older and from the highest socio-cultural groups seems to be spontaneous, through self-responsibility, despite professional and social regulation difficulties. It should be remembered that the possibility of teleworking is still reserved for the elite in large urban centres (administrations and large companies).

Implementation has proved difficult and often impossible in working class areas, particularly in the countryside, for cultural and economic reasons.

At the cultural level: African living together is essential. In popular cultures of touch and orality, how can a certain distance between people be respected, especially when refusal of contact is experienced as an insult? When we eat from the same dish, close together? When we think that the isolated individual is in danger and that only the group can save us?

On the economic level: global lockdown measures are refused for existential reasons in countries where the economy is mainly made up of the informal sector. One testimonial sums up the problem: "in Senegal, a large part of the population lives day to day, forced to go and get their food and that of their family in daily activities. The economic and nutritional consequences of lockdown would be huge for this population".There are many testimonials of more or less vehement refusal to comply with authorities and the mandatory closure of shops or other commercial establishments. In practice, almost everywhere, village markets and large city markets persist because they are indispensable to the life and survival of the population. A few symbolic measures are of course applied without any problem: here in Mali, before entering and leaving shops, it is compulsory to wash hands, which is impossible in markets.

The population is young in Africa. These young people are not very receptive to restrictive measures. To take an example, the Malagasy population is a young population with an average age under 20 years, the majority of whom are already working and have an immediate resistance to the simple idea of lockdown.

Furthermore, how can these authoritarian decisions be implemented in the countryside? Indeed, the forces of law and order are insufficient or even absent, which is another obstacle. This inadequacy makes inter-urban boundaries and international borders very porous.

There is also an economic fear in the early stages of liberal or planned economies. There are differences between politicians who advocate either safeguarding economic activity at all costs or taking a break or rebuilding the economic system (sic). Some African governments insist on the need to keep the economy alive because "only Western states can afford to put the economy on hold by organizing an extended lockdown until the end of the crisis".

Public transport, which is indispensable to the majority of Africans for any journey (buses, bush taxis), poses a real problem of social distancing. While there may be absolute bans on travel outside cities, or on certain major routes, urban transport poses a problem of incomprehension with regard to the challenges of everyday life (this is noted by most members of the group).

Returning to the village disrupts the implementation of lockdown: as long as they remain possible, as long as the roads remain open, rushes from the large, densely populated cities (for example in Abidjan when the lockdown was announced) to the villages of origin have been observed (one can imagine the potential spread of the virus...). It is not simply a desire of nature, or for better subsistence or even survival, because returning to the village, to the community of origin, to the family, has always been important in African culture whenever an existential, personal or group problem arises.

Respect for the Elders, bearers of the word and masters of custom and palaver, has retained a social importance almost everywhere. It is they, the wise men, who are under threat. Deep respect for the elderly is real in some countries, but the consequences may be opposite. For example, people over 60 years of age are invited to stop moving around in Benin, which is a good measure. But funerals cannot be avoided (importance of the ancestral rite "the Ancestors are more important than the disease") which poses a major problem (lack of social distancing, contact with the dead). Proximity will of course have to be avoided at the end of life and during funerals; we have seen that this was often not possible Ebola. It should be noted that it has been decided to limit the number of people allowed to attend a funeral (e.g. about 20 in Ivory Coast, which is already a lot).

It was noted that areas that had experienced previous outbreaks (e.g. cholera or Ebola) adapt more easily to lockdown or curfews.

Immediate psychosocial consequences of lockdown as it has started in various African countries.

From the outset, overall lockdown imposed by the authorities has been experienced as very difficult if not impossible in many areas of African countries, the overcrowded peripheral areas of major urban centres and the countryside.

Part II – Recommendations