Spotlight on Médecins Sans Frontières UK

Each month, the HRC Blog features a significant individual or team from the Human Rights community to go under the Spotlight, answering questions put by students from the University of Essex.  This month, we feature the team from Médecins Sans Frontières (MSF) UK.

About MSF UK

Doctors-Without-BordersMSF is an international, medical humanitarian organisation working to save people’s lives in conflict zones, natural disasters and epidemics.  Independent, neutral and impartial, MSF aims to alleviate suffering, protect life and restore respect for human rights irrespective of religion or political affiliation.  As COVID-19 continues to spread, MSF teams are responding to the pandemic in more than 70 countries where they already have programmes, while opening projects in new countries as required.  In Yemen, for example, MSF is supporting the Ministry of Health to run Sanaa’s principal centre to treat coronavirus and is working across the country to support a collapsed health infrastructure during what the UN has described as the world’s worst humanitarian crisis.

Students’ Questions Answered

The students at Essex are really excited to have the opportunity to send in their questions to the team at MSF, to learn more about their humanitarian work and some of the challenges they face, particularly during this year of the COVID-19 pandemic.  We are honoured to have two members of the their team to share their expertise:

Elizabeth Harding (EH) is MSF UK’s humanitarian representative, having previously held operational positions in Sudan, South Sudan, Philippines, Myanmar, India, Somalia and Ethiopia.

Roz Scourse (RS) is a policy advisor for MSF’s Access Campaign which works to bring down barriers that keep people from getting the treatment they need to stay alive and healthy.




Coronavirus_greenWhat are the challenges MSF face in terms of humanitarian access in the COVID-19 context? For example, have you had any problems accessing countries that may have locked their borders?  

(EH): Finding ways to continue with our regular medical activities has been a challenge in the COVID-19 context. Challenges with getting staff and supplies to where they were needed were particularly acute in the first few months of the pandemic. In fact, most of the issues that we had regarding getting and maintaining access was more of an exacerbation of our challenges in ‘normal times’.  

In terms of the threat that Covid-19 poses for the people we serve, we know that social distancing is impossible in cramped camps like Moria on Lesbos, and hand hygiene is undoubtedly more challenging where there is no running water, for example. COVID-19 has shown how people who are already vulnerable are facing additional risks.  



What would you see as some of the solutions that need to be put in place during the pandemic so that much needed aid reaches those most in need? 

(EH): We need to ensure that regular health services continue, and that people can access them. Despite the pandemic, babies are still being born, children are still catching preventable diseases, and conflict is still causing life-threatening injuries. It’s crucial that these medical needs are not overlooked or deprioritised as this would have a lasting impact. 

Blockages like insecurity, fear and movement restrictions present challenges but we are finding ways to adapt and minimise their impact. For example, rather than implementing mass vaccination campaigns at fixed sites where people would gather, our team in Burkina Faso used a door-to-door strategy to ensure that measles vaccinations could continue.  



Dr Theo - MSF Congo

Dr Theo – MSF Congo – ebola intervention Image courtesy of Carl Theunis/MSF

How has your experiences of dealing with other exceptional circumstances/disasters, such as “Ebola” or “terrorism”, helped in your response to COVID-19? 

(EH): MSF has a long history of responding to epidemics and has been able to use this experience when responding to COVID-19. A crucial lesson learned from our experience responding to Ebola is that interventions must be targeted to the context – one size does not fit all.  

Ebola also showed us that any intervention must be based in community acceptance. Community acceptance of the intervention and any necessary restrictions is the cornerstone for any public health intervention. An understanding of the need to be tested and treated is crucial.

But clearly there are unique elements to this pandemic too. COVID-19 is affecting countries around the world, rather than existing as an outbreak in a single region. This brings with it more challenges in terms of the different reactions of different states and availability of supplies. 



Because of the pandemic, states have adopted state-centred approaches to regulations, giving them exceptional powers based on a medical emergency.  What were the consequences of this for MSF at the initial phase in the complete lockdown of humanitarian activities? 

(EH): While experiences differed across different countries, in some contexts it did became more difficult for staff to travel and for supplies to be sent where they were needed in the initial period.  In some places we had to adapt our response and to prioritise what we really needed to do.

Crucially, almost 85% of MSFs workforce in our projects are host-country staff who are locally hired and were able to continue providing medical care.



Giving birth in Dasht-e-Barchi

Giving birth in Dasht-e-Barchi, Afghanistan Image courtesy of Sandra Calligaro

I know MSF works very efficiently in developing countries, especially those with humanitarian emergencies arising. However, during the covid-19 pandemic developed countries have also complained that they do not have the resources to handle the crisis. Do you think that is true? Have you provided assistance or training in the UK ,for example, during the lockdowns? 

(EH): Our COVID-19 response has included interventions within Europe to meet very specific needs and gaps in support for particularly vulnerable populations including in France, Belgium, and the UK.  

In the UK we supported the COVID CARE centre for the homeless in London. This reflects MSF’s ambition to provide assistance according to the needs, irrespective of location. Our team in London were able to partner with other actors to fill a gap when needs were very high and then we were able to hand our programme over. This work in Europe did not divert from what we are doing elsewhere, with MSF present in over 70 countries.   



Are MSF doctors having to make decisions about who gets priority for treatment when hospitals are overwhelmed with COVID cases? If so, how are those decisions made? 

(EH): As a medical organisation, all care is done on a triage basis, so according to the urgency of the patient’s needs. In a lot of places where we work there is often limited resources so we have to adapt to work within such limitations, providing the best care possible and in the best interest of the patient.  

(RS):  Ideally, we would like to see a situation where these decisions don’t have to happen, and we don’t have shortages or the need to ration available treatments. In relation to COVID-19 medical tools (i.e. potential future treatments, ventilators, PPE etc.) we need to ensure there are no barriers that are artificially limiting supplies, such as intellectual property barriers and a lack of technology transfer from pharmaceutical companies. Past experiences have shown that when available supplies are limited, this can lead to nationalistic control and hoarding, and result in barriers to access predominantly for low- and middle-income countries (LMICs). We are already seeing this with COVID-19 vaccines. 

As a starting point, we need to ensure global open sharing of data and knowledge related to COVID-19 medical tools, and that all intellectual property related to COVID-19 technologies are waived. This has already been proposed by South Africa, India and other countries at the World Trade Organisation in order to maximise global supplies of COVID-19 technologies and bring down prices. All products should be openly licensed, and technology transfer should be pursued to ensure that other manufacturers around the world are able to start producing successful products. 



COVID_VaccineWill MSF get access to COVID-19 vaccines and how will the distribution of those vaccines to countries without stable governments, such as Yemen, be prioritised and managed? 

(RS): We are pushing for proportional shares of COVID-19 vaccines to be made available to populations in crisis‐affected humanitarian settings, including refugees, asylum seekers, marginalised communities and people living in conflict areas.  These are groups who have the least access to, or are excluded altogether from, national health services. A “global humanitarian buffer stock” was originally built into the design of the COVID-19 Vaccines Global Access Facility (COVAX), led by the World Health Organisation (WHO) and the Global Vaccine Alliance (Gavi), where 5% of supplies were to be dedicated to humanitarian needs.  However so far this has not materialised, especially since COVAX is struggling in general to secure enough doses of future COVID-19 vaccines. 

MSF is in discussions with WHO and others on how a humanitarian buffer stock could work, with supplies from COVAX or directly from companies or countries.  France have already committed to contributing some of their doses agreed through bilateral deals with companies to a humanitarian buffer stock. We are asking other high-income countries (HICs) with bilateral deals (e.g. UK, EU) to commit to the same. 

Countries such as Yemen are part of the COVAX Advance Market Commitment (AMC), which consists of 92 low and middle-income countries (LMICs) who will be able to receive donor support from other “self-financing” countries within the COVAX Facility, whose contributions will fund vaccine doses for these 92 LMICs. Allocation of doses should be in line with the WHO Fair Allocation Framework and aims to reach priority populations within all countries included.  However, this remains to be seen, largely because many HICs have made bilateral deals with companies for their COVID-19 vaccines outside of COVAX, leaving limited available global supplies for COVAX and therefore LMICs. 



The global health system seems to lack an international standard of response to global health crises, prompting a politicised and state-interest approach.  Every state regulates for itself, prioritising its own needs, leaving those in greatest need at the back of the queue.  However, IHL advocates a humanitarian principle of impartiality where help should go first to where it’s needed the most.  How is MSF able to reconcile IHL with political reality? 

(RS): In the area of access to medical treatments, diagnostics, and vaccines: MSF have been advocating for equitable access to COVID-19 medical tools, prioritising health-care workers globally and those at highest risk/of most need.  This has not materialised in many ways: HICs have pre-booked the vast majority of future COVID-19 vaccines, as well as issuing export bans on potential treatments (e.g. UK export ban on dexamethasone).  85% of the available global supplies of the Pfizer vaccine until the end of 2021 have already been sold to HICs, meaning there will be months if not years of delay before LMICs could have access (the Pfizer vaccine may not be the most appropriate for LMICs due to the cold chain requirements, but it demonstrates this issue). 80% of the Moderna vaccine have also been sold to HICs. 

As such, we are focusing on advocating for efforts which aim to maximise available supplies (e.g. IP waiver described above), as well as manufacture by developing countries so that in the medium to long term, they can supply to their own populations and regions.  This requires the lifting of IP barriers, but also technology transfers from companies producing these products to transfer this technology, knowledge and know-how to manufacturers who are able to produce. 




Measles intervention in Boso Manzi

Measles intervention in Boso Manzi – Image Courtesy of MSF/Caroline Thirion

How would you assess peoples’ ability to access healthcare in conflict areas at the moment? 

(EH): Conflict can undoubtedly hamper people’s access to healthcare. Some of the key barriers for individuals to access healthcare in conflict areas include whether the person knows and feels comfortable to come to a health centre, as well as very practical considerations including overcoming distance in order to reach care, and whether the routes available are safe. In some such settings, people can face limited options in terms of the type of care present (primary, secondary, maternity).

In conflict zones, as elsewhere, our teams consider the risk of acute health needs, for example trauma or epidemics (measles, diphtheria, cholera). These are made more challenging in situations of conflict where recent displacement or congested camp settings may also result in increased need for healthcare.



In MSF experience, what are some of the complementarities between public health and other frameworks such as international humanitarian law which contain fundamental legal protections including on the delivery of healthcare services?

(EH):  Elements of these frameworks very much influence MSF’s work around the world. While MSF is founded on the principles of independence, neutrality and impartiality, we are also guided by the principles of medical ethics and see the influence of public health and IHL in our work.  For example, under IHL, MSF expects access to medical care to be protected even in conflict zones, while public health approaches influence how we carry our work in conjunction with the communities we seek to serve.



What is the negotiating process when MSF enters war or conflict zones? What are the challenges of this process?

(EH): MSF teams try to communicate with all actors present in any given area, including the authorities, actors involved in the conflict, and the community. Our safe access depends upon the acceptance of all these actors.   Of course these discussions can be complicated but the security of the team and the acceptance of the community are vital.



MSF Mocha surgical hospital

MSF Mocha surgical hospital, Yemen – Image courtesy of Agnes Varraine-Leca/MSF

There is an increasing call to reduce the dependency of developing countries on foreign aid and, focus on strengthening the country’s autonomy to make decisions on their development priorities.  As an organisation working in areas of conflict zones, natural disasters and epidemics, how does MSF feel they could strengthen the healthcare system in these countries during these periods of transition? 

(EH): As a medical humanitarian organisation, MSF is designed to respond fast to emergencies. Our model, including our independent financial model, means that we can act quickly to help the people in greatest need. These are not normally intended as long-term responses, but as critical responses to meet urgent needs. Our medical teams step in where the needs are acute, and close projects or hand over to other actors when this acute phase ends.

The majority of our projects involve working with the existing health systems to provide support, supplies and to build capacity – for example, in Sana’a, Yemen, MSF supported the Ministry of Health to run the city’s principle centre to treat COVID-19.



When you are working in a country like Yemen, so politically fractured, what are the issues with negotiating access/delivery of supplies etc?  

(EH): In negotiating access and the unhindered delivery of medical care, MSF commitment to its principles of independence, impartiality, and neutrality is crucial. These principles enable us to offer assistance based solely on our assessment of medical need.

Wherever we go, we make sure that people in the communities where we’re working understand that we will provide assistance to anyone who needs it. We run radio campaigns and hold meetings with everyone from government ministers to local armed groups, community elders to women’s groups.

Gaining their acceptance is key to our being able to work in difficult environments such as Afghanistan, Democratic Republic of Congo, and Yemen.



Drones targetWhat transparency is there from western governments around their counter-terrorism activities in countries like Somalia, Pakistan and Yemen?  In particular, what processes are in place between MSF and the US for example regarding potential drone strike activity that might impact on your work or endanger your field staff?

(EH):  We expect states to uphold their responsibilities under IHL, which protects medical facilities against being targeted.  In areas of high risk we do as much as possible to inform all actors of where we’re working, what we’re doing and why we are there.  



When working in conflict zones, how do you ensure an equality of treatment for all sides, without intimidation from dominant political/tribal forces? 

(EH): In a conflict situation, we don’t take sides. We go where people’s medical needs are greatest. In the ward of one MSF field hospital, you might find wounded civilians alongside injured soldiers from opposing sides. Hostilities and weapons have to be left at the gate.   Wherever we work, we make sure that local people understand that MSF is politically neutral and will provide assistance to anyone who needs it. 


Analysis of India’s contact tracing application vis à vis digital rights

by Ritwik Prakash Srivastava


In the wake of COVID-19, the Indian government came up with a contact-tracing application Aarogya Setu (application). The Indian Prime Minister, Mr. Narendra Modi, in his address to the nation on 14 April 2020, urged the citizens to download the application to supplement the State’s struggle against the contagion. What started as a voluntary step, was first made mandatory for employees, including in the private sector, then a directive extended it to entire districts, and failure to comply resulted in a criminal penalty.

It brings to the forefront the conflict between public health and the right to privacy of an individual. While the effectiveness of contact-tracing has been proven, it is also pertinent that such a mechanism is developed within the frameworks of existing laws and a regard for human rights and constitutional rights. Interestingly enough the Supreme Court of India, in its landmark judgment of K.S. Puttaswamy v. Union of India (the judgement) in 2017, made the right to privacy a fundamental right in India. Even stating that “if the State preserves the anonymity of the individual it could legitimately assert a valid state interest in the preservation of public health…

This piece seeks to address the viability of the Indian government’s order of making the download of Aarogya Setu application mandatory, against the touchstone of the right to privacy.



The Court in its judgment recognised every individual’s right to decide for themselves the extent of information about them that could be shared with others. However, every fundamental right in India comes with its reasonable restrictions, and is not absolute (see Article 19 (2) of Constitution of India). Some of the grounds of restriction could be to preserve public order, maintain sovereignty and integrity of India, and security of the State. These restrictions have to be mandatorily in accordance with procedures established by law (see Maneka Gandhi v. Union of India).

As per paragraph 180 of the section of the judgement authored by the then Chief Justice of India, Justice Khehar, Justice R.K. Agrawal and Justice Dr D.Y. Chandrachud, before such restrictions on the right to privacy can be placed, the State must show the existence of a valid legislation, which permits the restriction to be put into place. Secondly, the restrain must be in pursuit of a legitimate aim; thirdly, it should have a rational nexus with the such aim; fourthly, it should be the least restrictive method to achieve such aim and lastly, it should be proportionate to the aim that is required to be achieved.

The Aarogya Setu application fails on the first prong itself. Not even the Epidemic Diseases Act, 1897, currently enforced in India, grants such permissions to the State. In the absence of any legislative framework to restrict its ambit, there is no guarantee that the sensitive data about individuals’ health and movement will not be used for mass surveillance, or will not be stored and used for profiling once the pandemic subsides.

Gerd Altmann from Pixabay

As the Terms and Conditions of Aarogya Setu stand currently, a user has no mechanism to seek deletion of their data uploaded on the servers of the application. Removal of the application merely means they cannot use the services, and not that they get their data erased. Without a comprehensive framework to regulate data protection, a contact tracing technology may as well mutate into a system of movement control and data profiling. The possibility of this becomes greater in the absence of any protocol which mandates a limit on the time for which such sensitive personal data of citizens can be stored by the government.

These shortcomings may have been eliminated if India had a dedicated privacy framework, as demanded in the judgement. However, even after substantial discussions and impending need of such a law, the framework is yet to be enacted, it currently exists merely as a bill. As far as international standards and European regulations on contact-tracing are concerned, the Aarogya Setu application fails on various counts.

The European Data Protection Board (“EDPB”) in its “Guidelines on the use of location data and contact tracing tools” (“Guidelines”). The foremost caveat the guidelines provide against contact-tracing is that are a grave intrusion into the privacy of an individual. The guidelines make it very clear that use of application must be voluntary. However, the orders of Indian government of mandatory download go directly against such a provision. There is an inherent lack of transparency on how the accumulated data is to be processed, or for how long it would remain in the possession of the government. The government has not shared any policies with respect to data retention and grievance redressal against the collected data.

A basic technical requirement any application which seeks to collect and process data is that of security. The guidelines mandate “state-of-the-art” cryptographic techniques to secure the data collected. However, there are already serious questions being raised at its sophistication when an ethical hacker took to Twitter to reveal the flaws with the application’s security. There have also been reports of the Aarogya Setu application exposing the users’ location data to third-party actors like YouTube.



Since the Supreme Court’s reasoning in the Puttaswamy judgement, the Indian government has had collisions with the concept of privacy multiple times. First with the nation-wide citizen identification scheme AADHAR, then with the inordinate delay in the delivery of the personal data protection law. While the current circumstances around the pandemic are nowhere near normal, the concerns arising out of unwarranted surveillance cannot be set aside.

The threat that the pandemic poses to digital rights was specifically addressed in a joint-statement issued by United Nations, the Inter-American Commission for Human Rights, and the Representative on Freedom of the Media of the Organization for Security and Co-operation in Europe. The joint-statement provided that the use of any technology for surveillance should  conform to the strictest standards of protections provided by the domestic law and the principles of international human rights.

New privacy concerns arise every day out of ever-developing technologies, be it in terms of facial recognition, mass surveillance, or tracking online activities of citizens.  The digital ecosystem has become an intricate part of the personal life of every citizen. While the current status quo with the Coronavirus pandemic is largely out of the ordinary, it is important nonetheless that the governments remember that privacy rights of citizens cannot be suppressed even during an unusual situation.  Now more than ever, it is important that any derogation from or limitation to digital rights remains lawful, and is appropriately scrutinised by the states and their respective courts.



Ritwik Prakash Srivastava Ritwik Prakash Srivastava is a third-year B.A.LL.B. (Hons.) student at National Law Institute University, Bhopal.  He is currently the Co-Convenor of the Centre for Research in International Law at NLIU, Bhopal. His research interests include technology and media law, cyber law, and public international law.  He may be reached at

Calamitous coronavirus xenophobia: A new-age predicament

by Tushar Behl and Medha Patil


Sunset Park, in southwest Brooklyn, houses New York City’s largest Chinese community. Chinese immigrants have settled and built their lives for more than two decades after being moved from Manhattan’s Chinatown due to the overflowing population. People from all over the city visit Sunset Park to buy fresh meat and eat at the authentic Chinese restaurants but it is no more. From the beginning of this pandemic, the Asian community across the world has been subjected to serious racial discrimination and xenophobia. The xenophobia compounded with general fears of COVID-19, the disease caused by the virus has taken a great toll on the livelihood of Chinese immigrants and workers, especially those in smaller communities.

This article examines contemporary issues faced by Asian Communities amidst the outbreak of the novel coronavirus by highlighting the previous historical instances of xenophobia, coupled with racism, its implications, and also proffering recommendations to address such prejudice.


The Problems

There are currently more than 12,964,809 cases of COVID-19 around the world, as evident from the WHO Coronavirus Disease Dashboard.  As of today, the majority of these cases are present in the United States of America (“USA”) since not long ago it surpassed China where the disease was first detected in November of 2019. Unfortunately, this divide that COVID-19 has created travelled great lengths and continues affecting the innocent Asian population.

Most recently, a single but highly derogatory remark made by President Trump in his press briefing at the White House stood out and captured a lot of angry attention. In the President’s note, the word “corona” had been replaced by the word “Chinese” which sparked a fury, too deep to be a mere offense. Critics have said that such a deliberate use could lead to increased discrimination and racism towards Asian-Americans who are a marginalized group with a long history of being painted as scapegoats in instances of public health crises.

This anti-Asian harassment is not just limited to the USA, rather, various international outlets have reported such cases in major white nations such as Canada, where Chinese-Canadian students have been isolated from local school districts; in Australia, where people have refused to get treatment from Asian doctors and in Germany, where an Asian woman was asked to move her “corona-riddled body” while she was on her train to work.

‘Sinophobia’ is another specific type of prejudice that is magnified by the news of coronavirus outbreak. It is a type of aggression against China, its population, or people of Chinese descent. In the past, President Chester A. Arthur signed the Chinese Exclusion Act of 1882 that banned the immigration of Chinese laborers to the USA for 10 years. President Donald Trump has also been restricting the immigration of Chinese students and scholars since 2018. Today, increasing migration means that a growing number of states have become or are becoming more multi-ethnic, and are confronted with the challenge of accommodating people from different cultures, races, religions, and languages.


Pandemics and Racism

Viral outbreaks or pandemics go hand in hand with racism. When we look into the past, dating back centuries, just like the xenophobic attacks and actions amidst COVID-19, the denigration of certain populations sounds more of a familiar symptom of virus-related outbreaks. These gruesome diseases, causing mass human suffering are often used to rationalize bias. For instance, yellow fever, one of the most dangerous infectious diseases, was pegged to the Africans initially, owing to the first epidemic reported in Yucatan in 1648. But later, the 1853 epidemic in the USA targeted European immigrants, since they were more vulnerable to it. On the other hand, the 2003 SARS outbreak in Toronto, billed the east-Asians.

Xenophobic reactions are not limited to Asians, it mostly depends on the origin of the disease. Reference can be taken from the Ebola virus, which was discovered near the Ebola River (Now, the Democratic Republic of Congo) in 1976, and soon the Africans were targeted with hate.

Although the WHO came through, by opting this practice of not naming the disease based on geographical location, an animal, an individual or a group of people, as it did in the case of Ebola and now COVID-19, xenophobia stimulates quickly, interlaces with politics and paint’s the ideology of people and their Governments.


What Does the Law State?

International human rights instruments generally prohibit racism and racial discrimination, the same cannot be said for xenophobia and resulting discrimination. Xenophobia itself is rarely mentioned in international instruments and distinctions made between citizens and aliens on the basis of race is predominantly rampant when it comes to exercising fundamental rights. It is therefore, sometimes expressly prohibited to make such a distinction which would in turn lead to hampering of such rights.

The ICESCR and ICCPR under Article 2, and the ECHR and IACHR under Article 1 respectively, enable protection against any form of racial discrimination but the same is silent when it comes xenophobia. Moreover, the status of Customary International Law is quite ambiguous than that of treaty law since there exists a divergence of opinion on whether the norms of xenophobia and discrimination have become part of Customary law.



The issue of racial discrimination and xenophobia has a tough influence on state legislations. Owing to such fundamental divergence in legal measures of various states, where one has adopted comprehensive anti-discrimination laws and the other has enacted a sectoral legislation, is problematic. Avoiding all forms of racial segregation and setting out a comprehensive legislation is the need of the hour since common human rights ideals are the main antidote to the persistence of racism.

The pandemic is taking a massive toll on people’s lives all over the world. A disease like COVID-19 does not discriminate while spreading and yet new cases of racial discrimination and xenophobia are coming up every day. Unfortunately, this divide, is in turn, causing additional damage to this existing calamitous situation. Therefore, our willingness to understand each other will protect us from fear and its disastrous consequences.



TUSHAR BEHL__1590856734_106.215.2.102
Tushar Behl LL.B. (Hons) is a 2020 Graduate from the School of Law, University of Petroleum and Energy Studies. He is an Advocate from India and currently working as a Research Associate at the Supreme Court of India. He is an avid reader, writer, and interested in International Relations and Politics. 

Medha Patil.
Medha Patil is a final year Law Student from Maharashtra National Law University, Nagpur, India.  She is an avid writer and interested in Human Rights and Public International Law.

Stranger than Fiction: Opportunities for a new narrative in Dominico-Haitian relations under Covid-19

by Maria Cristina Fumagalli and  Bridget Wooding

In May 2012, the Dominican writer Junot Díaz published ‘Monstro,’ a science-fictional short story which depicts the post-apocalyptic scenario of a mysterious viral outbreak in Haiti and its repercussions on the island of Hispaniola as a whole and in the Dominican Republic in particular. We will not provide a full analysis of the short story itself here — for more on ‘Monstro’ in the wider context of Hispaniola border relation see Fumagalli’s On the Edge: Writing the Border between Haiti and the Dominican Republic (LUP, 2015; 2018)– but, since Díaz’s dystopic future clearly resonated with the present of his 2012 readers and anticipates aspects of our current predicament, we will use it as a springboard to provide a quick snapshot of a ‘life as we know it’ to which, post-Covid-19, the island of Hispaniola cannot and should not return.

Taking place in a non-specified point in the future where most of the beaches of the Dominican Republic are submerged and the countryside is deserted because of the ‘Long Drought,’ ‘Monstro’ suggests that this lethal viral outbreak is concomitant, possibly even directly connected with environmental degradation and what is no longer possible to call ‘natural’ disasters since they are provoked or made much more severe by human action and political choices. ‘Monstro’ then informs us that the first Haitians to be infected are the ‘poorest of the poor,’ foregrounding the pernicious correlation between health and wealth and indirectly denouncing how political neglect increases the vulnerability of those who are not in a position to protect themselves. These poor, in fact, are housed in unspecified ‘relocation camps,’ a reference which evoked the precarious life conditions of those who were relocated in relief camps created in Haiti after the devastating 2010 earthquake which claimed the lives of hundreds of thousands and affected millions. These camps were still open when Díaz published his short story two years after the earthquake and, distressingly, on the tenth anniversary of the earthquake in January 2020, the Director of the International Organisation for Migration (IOM) in Haiti lamented that 30,000 earthquake survivors were still encamped in Haiti, without access to promised housing.

MONSTRO_camp earthquake displacees on golf course

A boy stands at a makeshift camp on the grounds of the Petionville Golf Course in Port-au-Prince, Haiti, January 26, 2010 (Photo. REUTERS).

In the Dominican Republic, Haiti is used as the negative foil in anti-Haitian, racist, and ultra-nationalistic discourses which offer a simplified artificial picture which posits the two countries and peoples sharing the island of Hispaniola as different and incompatible (i.e. Dominicans are white or mixed race; Haitians are black; Dominicans are Catholic, Haitians practise Voudou), demonize Haitians, and disenfranchise Dominicans of Haitian descent.  In the aftermath of the devastating 2010 earthquake, these discourses, capitalising on the strategically fomented fear of a Haitian invasion which (allegedly) perpetually threatens the Dominican Republic, warned that the Dominican apocalypse was impending due to the imminence of a stampede of desperate Haitians crossing the border into the country.  This stampede, which never happened in reality, is represented, in Diaz’s ‘Monstro,’ by a horde of Haitians who, infected by the virus and turned into an unmanageable, bloodthirsty, and homogenous mass of murderers and cannibals, are ominously moving in unison towards the border with the Dominican Republic.

When the Haitian horde reaches the border, Dominican authorities decide to close it and instruct the army to meet the “invaders […] with ultimate force’ to prevent the viral infection spreading to the Dominican Republic. Similarly, when faced with the 2011 Haitian outbreak of cholera which was to kill thousands of Haitians, the immediate answer of the government of the Dominican Republic was, as it is the case in Diaz’s ‘Monstro,’ to close the border, (allegedly) to prevent the spreading of this potentially lethal disease.  This pathologization of Haiti and the Haitians was not a novelty: in the early 1980s, for example, Haitians were classified by the United States’ Center for Disease Control (CDC) as a ‘risk category’ and HIV-carriers based on an erroneous identification of Haiti as the point of origin of AIDS.

In ‘Monstro,’ the spreading of this mysterious virus in Haiti is facilitated by international neglect: since “it was just poor Haitians types getting fucked up,” Díaz’s narrator explains, “once the initial bulla died down, only a couple of underfunded teams stayed on” to try to better understand the virus and mitigate its consequences.  Haiti had begun its long battle with the cholera epidemic only a year before the publication of ‘Monstro,’ but it was already becoming clear (staunch denials on the part of the UN notwithstanding) that the epidemic had been introduced in the country by a Nepalese contingent of the United Nations mobilised to assist the population after the earthquake. In May, in a letter to the United Nations secretary general, António Guterres, thirteen UN rights monitors strongly criticised the UN for its “deeply disappointing” failure to make amends for having brought cholera to Haiti. After highlighting the inadequacy of the UN response to the Haitian crisis, the lead signatory of the letter, Philip Alston, the UN monitor on extreme poverty and human rights, concluded that the UN’s reprehensible conduct could only be understood by accepting that “racism” must have played a part.

In a move that reveals how racism and colourism also go hand in hand with anti-Haitianism in the Dominican Republic, the popular name of the epidemic which, in Díaz’s short story, begins to manifest itself by making Haitians blacker, is ‘Negrura.’  We are informed that Haitian–Dominicans and Haitians living in the Dominican Republic began to be ‘deported over a freckle,’ a comment that openly criticises the way in which, over many years, the Dominican government has been using arbitrary deportations (often targeting dark-skinned individuals regardless of their legal status) as a means to control and regulate ‘Haitian’ immigration, and, more specifically, of the resumption of deportations after the cholera epidemic as a ‘prophylactic’ measure.



Face in limbo, camp Parc Cadeau, Haiti, December 4, 2015 (Photo. Michelle Siu)

Sadly, deportations continued to be used also after the publication of Diaz’s story in 2012.  On the 23rd September 2013, a ruling of the Dominican Constitutional Court ordered all birth registries from 1929 had to be audited for people who had been (allegedly) wrongly registered as Dominican citizens, de facto denationalizing over 133,000 Dominicans, mainly of Haitian descent.  The 2013 ruling was supported by the same well-established Dominican anti-Haitian racist ultra-nationalistic discourses which in the post-earthquake and post-cholera scenarios –but also on a myriad of many other occasions– had fomented hatred and paranoia, and demonized or pathologized Haiti, Haitians, and Dominicans of Haitian descent. A moratorium on deportations of Haitians with irregular migration status in the Dominican Republic took place during the eighteen months while a national regularization plan for foreigners was operated up until the middle of 2015, when registration for the plan lapsed. Deportations started up again in earnest. Unfortunately, the mix of euphemistically labelled “spontaneous returns” (often motivated by anti-Haitianism whipped up by elite nationalists), extra-official deportations and official deportations evidenced many of the shortcomings seen earlier in the process of deportations, when expulsions of Haitians had happened, en masse, from the Dominican Republic.  The humanitarian crisis derived from this intense cross-border movement is perhaps best exemplified by the camps established on the Haitian-Dominican border, such as the Parc Cadeau complex, where scholars suggest that, from a bio-politic prism, this forced displacement could be included in the “death zones of the world.”


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Masked mask, part of sculpture, Jean Philippe Moiseau, May 2020

Ironically, in 2020, before the first case of Covid-19 was detected in Haiti, it was the Haitian President Jovenel Moïse who unilaterally closed the land border with the Dominican Republic, mindful of the country’s long struggle against cholera which was only controlled in January 2019.  Paradoxically, Haiti had its lock-down first in the Americas before the arrival of Covid-19 and is one of the last countries assailed by the pandemic in the western hemisphere.  In the final months of 2019, in fact, Haiti was in lock-down, or peyi-lok, a creole epithet which alludes to the nationwide political and economic protests which, precipitated by anticorruption scandals revealed in mid-2018, paralysed the country. The Haiti-Dominican Republic border was not closed but most schools and businesses were shut down.

It is evident that the Covid-19 emergency constitutes a huge challenge for the island of Hispaniola, where health services in both countries are far from fit for purpose and containment and control will likely consist in a long haul. Haiti will be hard put to deal with coronavirus, due to a notorious lack of installed health services capacity and social distancing will be virtually impossible in urban areas because of overcrowded housing and informal labour patterns. Similarly, health services are weak in the neighbouring Dominican Republic and containment measures have not been uniformly applied despite a state of emergency having been decreed. On top of that, legislation adopted in the Dominican Republic in 2014 to restore the documents of denationalised persons has been unevenly and timidly applied, such that most of those affected by the operation of the law do not have their Dominican ID, hence have limitations on realising their rights to health and education and have been absent from ongoing social protection measures in place prior to the pandemic.  Likewise, hundreds of thousands of irregular migrants have, since 2014, engaged with the state in a regularisation programme only to find that they currently have a fragile or out-of-status legality. In these circumstances there is little incentive for them to come forward and stake claim to humanitarian aid from the authorities because they may fear deportation when the health crisis subsides.


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Masked Mask, Jean Philippe Moiseau, June 2020

The Dominican Republic and Haitian authorities have been correct in leaving a certain flexibility with the land border, enabling some 50,000 Haitians to return home since the pandemic was declared.  However, there is the danger that once more the border area between the two countries becomes instrumentalized as a temporary humanitarian corridor for the duration of the health crisis and the long term demands of cross-border workers may be yet again overlooked.

Despite all the challenges that it presents, however, the pandemic also provides opportunities to improve border relations and finally address the predicament of segments of the populations in precarious legality like Haitian migrants and denationalised Dominicans of Haitian ancestry.  Social protection mechanisms activated by the Dominican authorities for humanitarian assistance and those made unemployed by the health crisis, in fact, do not cover persons living and working in the country without a Dominican ID document.  In order to be effective in the Dominican Republic, which has the worst mortality rate in the insular Caribbean, in fact, the Coronavirus response has to include those who have been routinely marginalised and neglected.

We have engaged, since 2013, in the development of artistic and literary projects (i.e. public talks, book launches, workshops, concerts, photographic exhibitions, artistic performances, publications in English, French, and Spanish, YouTube video) aimed at foregrounding and enhancing social and cultural unity in order to counter dominant discourses and pernicious racist and discriminatory practices which deny the existence of collaborative linkages and cultural continuities between the peoples and countries sharing the island of Hispaniola.  We are therefore fully alert to the notion that a post-Covid-19 return to ‘life as we know it’ whereby anti-Haitianism, deportations, and denationalization are the status quo, is to be firmly resisted and avoided and, as many other activists on the ground, we believe that policy advocacy must support different ways of sustainably including these side-lined groups, often ostracised because of their ethnicity, in order that they may fully belong in Dominican society, benefiting from risk management both now and in the future.



Maria_FumagalliMaria Cristina Fumagalli is Professor of Literature at the University of Essex. She is the author of On the Edge: Writing the Border between Haiti and the Dominican Republic (2015; 2018), the first cultural and literary history of the region, and, more recently, of the chapter   “‘When Dialogue is No Longer Possible, What Still Exists Is the Mystery of Hope’: Migration and Citizenship in the Dominican Republic in Film, Theatre and Performance” in Border Transgression and Reconfiguration of Caribbean Spaces. Moïse, Myriam & Fred Réno (Eds). NY: Palgrave MacMillan (2020). She is Investigadora Asociada of Observatory Caribbean Migrants (OBMICA), Santo Domingo.

Bridget_WoodingBridget Wooding is a researcher, advocate, writer, trainer, and expert witness on migration related issues. She coordinates the Observatory for Caribbean Migrants (OBMICA), based in Santo Domingo (, since 2009. She is the author of numerous publications, including books and articles on nationality matters and the migration dynamics affecting the Dominican Republic, the island of Hispaniola, the insular Caribbean, and respective Diasporas. She is the author of the chapter “The seeds of Anger: Contemporary issues in forced migration across the Dominican-Haitian border” in Border Transgression and Reconfiguration of Caribbean Spaces. Moïse, Myriam & Fred Réno (Eds). NY: Palgrave MacMillan (2020).

Protecting the rights of sex workers during a pandemic

by Astha Madan Grover


The COVID-19 pandemic has exposed many of the the pre-existing inequalities in society. It has disproportionately affected already marginalized communities that live outside societal protection mechanisms, often in financially precarious situations.  Sex workers are one such community whose rights need to be protected and respected.  Sex workers are entitled to human rights which include labour rights under the aegis of international protection frameworks.

From an International Law Perspective, the United Nations Charter (1945) obligates all UN bodies and agencies to promote and respect the “dignity and worth of the human person”, and The Convention on the Elimination of all Forms of Discrimination Against Women (1979) safeguards the right of female sex workers against discrimination.  It also grants them the right to social and economic security, right to privacy, the right to work, the right to freedom from stigma and prejudice and equal protection from the law and freedom from discrimination.  Recent research by Human Rights Watch shows that the criminalisation of sex work increases the vulnerability of sex workers, because attackers perceive them as easy targets due to stigmatization by law enforcement agencies.  Criminalisation has also been found to restrict sex workers’ right to health.



Issues faced by sex workers due to COVID-19

Unfortunately, due to the COVID-19 pandemic, sex workers are facing increased harassment and discrimination due to a lack of access to emergency social protection programmes as well as financial difficulties.  In most countries, given the criminalization of some or all aspects of sex work, the informal sector is unable to grant them benefits, such as access to national social protection schemes.  Migrant sex workers also face the risk of deportation due to lack of work permits.

Workers can also get pushed into compromising situations, where they are taken to work with clients who may not have their safety or best interests in mind.  They lower the price to attract more clients so they can support themselves.  Workers may also stay on with abusive partners to avoid homelessness.  Sex workers, who still engage with clients may contract the virus despite taking precautions such as checking for fever and taking the client’s travel history.

Many workers live in shared accommodation,  which enables the rapid spread of the virus.  Sex workers, including those working in brothels, are usually self-employed.  They receive no remuneration for the period during which they do not get work.  Workers are unable to provide for their families due to the lack of clients and may have no other employment prospects as many of them have been forced into prostitution from a young age.

The HIV epidemic is an ever-present threat to sex workers and it has now been added to by COVID-19.  HIV, though does not spread through the air and can be prevented by using protection while engaging in sexual intercourse.  HIV can also be treated through the use of antiretroviral therapy (ART).  While it does not completely cure patients, it does enable them to live long and healthy lives.


Measures taken worldwide to protect sex workers

Germany legalised sex work in 2002 and has over 200,000 practising sex workers.  The government ordered the closure of all brothels and other ‘non-essential’ businesses such as clubs and bars on the 14th of March.  Susanne Wilp, the spokesperson for the Association of Erotic and Sexual Services Providers, states that business has gone down by 90% and due to their lack of income, they face homelessness.  A similar fate is being faced by sex workers in Amsterdam, where sex work is also legal.

Japan has allowed sex workers to apply for governmental aid in some cases.  However, the requirements for applications are rigid and will force workers to ‘out’ themselves to their communities.  Employers are eligible for subsidies, if their employees have to stay home to care for children during school closures, and sex workers can also receive cash handouts.  (Though the requirements do not clearly state whether the handout is for those who have lost a portion of their income or those who have been dismissed entirely.)  The rigid rules require workers to show proof of income, which is difficult to show as they are usually paid under the table.  Many sex workers do not report their occupation or entire income on their tax returns due to a fear of repercussions and a sense of stigma.  Admitting non-disclosure of income could lead to its own set of consequences.

Thailand has made sex workers eligible for grants in the government’s pandemic relief package and the Malaysian government is providing housing and monthly remuneration for the homeless; most of whom are sex workers.  These workers have to hide their occupation to receive the benefits as sex work is illegal in Malaysia despite being practised widely.


The Way Forward

Taking sex work online is one way for workers to protect themselves during the pandemic.  This is done through photos, videos, video conferencing, and phone sex.  However, this kind of work has its limitations as well.  Workers may not have the required equipment or technical know-how to facilitate work this way.  Workers with an existing base of online followers find it easier to monetize their online services.  In addition, posting online may compromise the privacy of workers who may not want to reveal the nature of their work to family and friends.  Performing online may also not be a viable solution for workers with children and families at home.  A lack of consistent internet access may also hinder the ability to perform online.  Moreover, workers earn less working online and laws are not designed to protect these workers from privacy breaches and dangerous clients they could encounter as a result of working online.

UNAIDS and the Global Network of Sex Work Projects have called on countries to take action to protect the health and human rights of sex workers.  These measures should include access to national social security schemes, unemployment benefits and financial aid, providing healthcare services to migrant sex workers, appropriating emergency housing for homeless sex workers, halting prosecution and arrests for all sex work-related activities, ending the use of criminal law, promoting COVID-19 testing and providing visa extensions to migrant sex workers.

Sex workers need more allies. Global bodies such as Amnesty International and the World Health Organisation support their demands for legalization and decriminalisation.  Sex worker rights should matter to everyone who cares about gender inequality, migration, public health or poverty.  The need to protect sex workers during this pandemic is incredibly important as they are one of the most marginalised groups in society. Sex workers must be included in the decision-making process when it comes to legislation and programmes that can impact them.  They should have the right to work safely and on their terms and this includes protection during a world-wide pandemic.



Astha Madan Grover - Photo (1)Astha is a second-year law student at the National University of Juridical Sciences, Kolkata.  She has a keen interest in public policy, gender law, and public health.