Why is the Somali diaspora so badly hit by COVID-19?
The Somali community in Europe has lost many lives to the coronavirus. We are significantly over-represented in infection and death figures.
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In early March, some of our extended Somali family returned to London from Umra (a semi-pilgrimage) in Saudi Arabia with a fever. A few days later at our local mosque, many people were coughing and sneezing, I presumed with a seasonal cold. The following weekend, my wife and mother-in-law attended a community wedding, where everyone hugged and shook hands.
I don’t know if I was infected via any of these interactions, but later that month I felt so weak I almost collapsed on my way home from work. My wife said she felt like her legs were dragging round “several kilos of stones”. We both developed a fever, difficulty breathing and lost our sense of taste and smell. My pregnant sister-in-law fell ill too as did my mother-in-law. Only our six-year-old stayed healthy.
“You’ve got COVID-19,” an NHS doctor diagnosed over the phone.
Thankfully, we all recovered but many sadly have not – particularly in communities like ours, which have been disproportionately hard hit. Around Europe, statistics suggest the Somali diaspora have been more likely to catch and die from the coronavirus than the general population.
Six of the first fifteen deaths in Stockholm were of Somali origin, and the community remains over-represented in Sweden’s death toll. In mid-April, 6% of positive tests in Norway – or 425 confirmed cases – were Somali-born residents, more than ten times their share of the population. In Finland’s capital Helsinki, 17% of positive tests – or 200 confirmed cases – were Somalis, again ten times their share of the city’s population.
In the UK, black people are nearly twice as likely to die from the coronavirus as white people, even taking into account factors such as age, where people live, and some measures of deprivation and prior health conditions. There is no hard data about infection rates specifically within the Somali community. But several high-profile members of the diaspora in London – such as Somalia’s former prime minister Nur Hussain Hassan and much-loved musician Ahmed Ismail Hussein Hudeidi – have tragically succumbed to the virus.
Anecdotal evidence also supports this. Dr Samira Hassan, a Somali-born GP in the UK, says an alarming number of Somalis have died or are in critical condition. Abdirachid Fidow from the Anti-Tribalism Movement believes virtually every Somali in London has lost someone to COVID-19. “Many of the older Somali men I knew who used to socialise in community restaurants in my local area have gone,” he says.
The UK government has launched a review into the vast inequality in vulnerability to COVID-19 among ethnic minorities including black people. Its report is due by the end of this month. Regarding the particular susceptibility of the Somali diaspora, a number of factors could be responsible.
Before the pandemic, members of the Somali community would often meet in large gatherings in mosques. It is also common for many generations of families to live together in often cramped households. Both of these practices have helped the diaspora to be resilient and for members to support one another.
I have observed my mother in-law’s irreplaceable and positive influence on my daughter’s grasp of our language, cultural acquisition and sense of belonging. However, these practices may have also increased transmission in the early stages.
Somalis’ nomadic culture and travel between European countries may have also contributed to the virus’ spread among the community before lockdowns were imposed. My own London home, for example, has often been a transit point for travelling friends and relatives.
Moreover, the closeness of family ties may have also made social distancing more difficult. Mohamed Ibrahim, a community leader in London, told a UK news channel that Somalis feel compelled to visit sick relatives or bereaved families. Social distancing is “alien to us”, he said.
Most of Europe’s Somali community has arrived as refugees since the 1990s. Many fled Somalia’s civil war and spent many years in refugee camps. This generation carry the scars of trauma and often faced new anxieties after arriving in Europe around issues such as unemployment, discrimination and housing difficulties. All these experiences may have contributed to underlying health conditions among community elders.
Mohamed Ali, at the Centre for Global Health at Kings College London, also suggests that a lack of healthy eating in a different cultural context, lack of exercise, and vitamin D deficiencies could be factors adding to the community’s vulnerability.
Distrust of authorities
Rumours tend to have more currency in communities that lack trust in authorities. This is one problem faced in many migrant communities. I have heard Somalis being urged not to go to hospitals because, they are told, they will be left without proper care, that a lack of interpreters may lead to them being prescribed the wrong medication, or that if their condition deteriorates they will be euthanised and prevented from receiving a proper burial.
The misinformation feeds off real tragic cases such as that of 13-year-old Ismail Mohamed Abdulwahab. He died of the virus alone in hospital and his family was not allowed to attend his funeral as they had to self-isolate.
As Dr Hina Shahid told UK reporters, many people from Somali, Sudanese, Bengali and Pakistani communities “may not trust information coming from professionals”.
Like many other migrant groups, Somalis are over-represented in essential frontline jobs such as nurses, carers, drivers and cleaners, all of whom have a high risk of exposure to the virus. In London, for instance, black and Asian people make up 34% of the working population, but account for 54% of people working in food retail, 48% of health and social care workers, and 44% of transport staff.
This is partly related to socio-economic factors. Many migrants are in lower income brackets, which also means they are more likely to live in poor and crowded neighbourhoods where existing health conditions may be more prevalent and where the coronavirus may be able to spread more quickly.
The reason for the higher death and infection rate among the Somali diaspora likely lies in these factors as well as others. Unfortunately, no single solution addresses all these problems, but some initial actions can be taken.
Among other things, the Somali community should speak publicly about the impact of the pandemic and the challenges they face. Authorities should develop and disseminate information campaigns in the Somali language. And the government should set up specialist teams to research both the reasons ethnic minorities are disproportionately affected by COVID-19 as well as well the longer-term consequences on their mental health, education, employment, housing and social integration as these effects of the pandemic are likely to be just as profound.
Thanks Dr Yusuf for sharing your views on this. The issues raised are well covered in the media… the solutions you put forward are all good that we the #somalis should talk about this seriously and the authorities should pay attention to housing issues etc. So, we are reporting, discussing and telling others to pay attention. But what else, what actions, is there for us (somalis) to do? Over to you all Somalis.. I don’t have answers yet, but am thinking and still at questioning stage.
Disclaimer: this does NOT mean I don’t believe Covid19 exists or have conspiracy theories…just saying:-
As with the TB epidemic of over 100 years ago, the poor were more at risk because of malnutrition and crowding. Also, the tenements had poor ventilation. Wearing masks all the time increases the risk by rebreathing virus and thereby increasing virus load. The masks also lower blood oxygen which is a risk factor for coronavirus. It may also be that in Europe the Somalis may live in more air pollution which damages the lungs. Wuhan has high pollution. There were protests about it over the summer. As a German scientist said their high death rates (Chinese) from that virus were due to lungs damaged for decades. Northern Italy also has high air pollution. The article did not state the death rate but I would not be surprised if it were, in that population, the same as for the flu. I would also, not be surprised if that population also has a high prevalence of TB and that that would predispose to a high coronavirus death rate. There are 1.8 million TB deaths per year worldwide and 1.8 billion cases of it. TB is high in Africa. If they live in crowded tenements in Europe they would be more at risk with school closures. Food for thought!