key: cord-0796221-tgraai9b
authors: Raju, Emmanuel; Dutta, Anwesha; Ayeb-Karlsson, Sonja
title: COVID-19 in India: Who are we leaving behind?
date: 2021-03-24
journal: Progress in disaster science
DOI: 10.1016/j.pdisas.2021.100163
sha: 079f35efe2182e4b219f3a363f5ebe63d3d2af0f
doc_id: 796221
cord_uid: tgraai9b

The COVID-19 pandemic has uncovered and intensified existing societal inequalities. People on the move and residents of urban slums and informal settlements are among some of the most affected groups in the Global South. Given the current living conditions of migrants, the WHO guidelines on how to prevent COVID-19 (such as handwashing, physical distancing and working from home) are challenging to nearly impossible in informal settlements. We use the case of India to highlight the challenges of migrants and urban slum dwellers during the COVID-19 response, and to provide human rights-based recommendations for immediate action to safeguard these vulnerable populations.

response with regard to people living in informal settlements, migrants, refugees and other ultravulnerable populations has been slow and inadequate. It reiterates serious concerns about health inequality, as well as people lacking human rights and dignity including access to basic services and infrastructures to survive the pandemic. Following the global trend and given the rising number of COVID-19 cases reported globally and in India, the Indian government announced a sudden and complete lockdown of the country on the 25 th March, 2020. At time of writing, the lockdown was slowly being relaxed in several phases across Indian states, while the rate of infection continued to grow. India was witnessing an exponential increase in COVID-19 infections. The country currently has the second most reported cases in the world with over 7M infected people. The reported infection and mortality rates are suggested to merely represent the tip of the iceberg due to the limited testing, tracing and uncertainties around registered causes of death (Chatterjee, 2020) . A country where well over 80% of the population works in the informal sector (ILO, 2018b) , the lockdown amounts to a substantial shutdown of economic activity. The International Labour Organisation has stated that "in Low-and Middle-Income Countries, hardhit sectors have a high proportion of workers in informal employment and workers with limited access to health services and social protection" (ILO, 2020, p.2) . A study undertaken across two major slums in the cities of Lucknow and Kanpur in Uttar Pradesh found that the lockdown severely impacted economic activities. 79% of households reported that at least one family member had lost their income source due to the economy shutdown, and additionally 56% experienced a decline in their incomes when compared to before the crisis (Armand et al.,2020) .

Without appropriate policy measures, casual workers will face a high risk of falling into poverty and will experience greater challenges to regain their livelihoods during a recovery period. In this article, we use the case of India to illustrate some of the challenges of urban migrants and people living in informal settlements 1 (or slums) during the COVID-19 response, and recommend effective measures for action, also keeping in mind future disasters and pandemics.

UN-Habitat recently reported how the impact and spread of COVID-19 have centered around urban areas. Over 1430 cities in 210 countries across the world are affected so far. According to the investigation, over 95% of the total COVID-19 positive cases can be found in urban spaces (UN-Habitat, 2020) . As of May 2020, the four megacities in India Delhi, Mumbai, Chennai and Kolkata comprised 40% of the total cases in the country (Ghosh et al., 2020) . Although the pandemic manifests an urban universality some cities are more vulnerable. Yet scholars have highlighted a severe lack of data regarding slums. This includes estimates of residents dwelling in informal settlements (which tend to vary significantly) and a dearth of information both prior to and during emergencies or shocks (Wilkinson et al.,2020) . Health data also remains scarce, including around distribution of risk factors, such as people with cardiovascular diseases, that would increase both susceptibility to and impact of COVID-19. Urban areas in the global south, such as cities in India, are more susceptible to the pandemic due to a variety of reasons including high population density, informal employment and income structures and weak health services.

Urban slum populations generally face all these risk factors (Mishra et al.,2020) . An essential feature of India's urbanisation has been the proliferation and persistence of informal settlements dotting their way through rapidly expanding urban centres. The 2011 census data shows that one of six urban Indians resides in a slum. These slums are often in close proximity to open drains or sewers. Furthermore, over 35% of slum households do not have access to clean drinking water (CSE, 2020) . Urban slums in India's mega cities are "a tale of two cities within one city" (Gupta and Guin, 2015, p.240) . One part of the urban population reaps the benefits of urban living while the other 'squatters' in poor and compromised living conditions. These living conditions are at times even worse than their rural counterparts (Gupta and Guin 2015) . Slums have been determined as 'unhealthy places' with a high risk of infectious diseases and injury (Ezeh et al., 2017) . (Over)crowding can result in increased transmission of infectious diseases, such as pneumonia, diarrhoea, and tuberculosis (Unger and Riley, 2007) . An outbreak of the contagious COVID-19 virus will therefore be deeply challenging to contain in most informal settlements of the Global South. This is because slums tend to be overpopulated and characterised by inadequate access to water, sanitation, waste management and health care services (Sclar, Garau and Carolini, 2005) . This often leads to poorer health outcomes on top of the inadequate housing (Rice, 2009) . A large proportion of the residents in informal settlements frequently suffer from chronic illnesses such as respiratory diseases, cancer, tuberculosis diabetes, and obesity. Research highlights that these pre-existing conditions may increase the impact COVID-19 could have on people's health and wellbeing (Mendenhall et al., 2017; Corburn et al., 2020) . These comorbidities have the potential to further exacerbate the impacts of a pandemic and make slums dwellers more vulnerable to COVID-19. The negative health outcomes are aggravated by notions of illegality and socio-economic exclusion that slum dwellers face (Ezeh et al., 2017; Ayeb-Karlsson 2020; Ayeb-Karlsson, Kniveton and Cannon, 2020) .

In terms of the infection itself, initial reports from the slums suggested low COVID-19 positive rates which subsequently were negated through seroprevalence surveys that were carried out across several slums in major Indian cities. For example, a study estimating the seroprevalence across representative slum and non-slum populations in the city of Mumbai, found that the positive test rate for IgG (immunoglobulin) antibodies to SARS-CoV-2 N-protein was 54.1% in slums and but only 16.1% in non-slums (Malani et al.,2020) . Similarly, seroprevalence was found to be 57.9% in DJ Halli slum in Bangalore where higher prevalence of comorbidities such as diabetes at 35.5% and hypertension at 16.6% exist (George et al., 2019) . The authors however urge for caution regarding actual discrepancy since slum residents more seldom tend to seek medical attention (George et al.,2021) .

Indian cities are described as dualistic in nature, composed of 1) the formal or Static City (of architecture and the elite), and 2) the informal or Kinetic City (of motion) (Mehrotra 2008). This informality for the urban poor is "a calculus for charting and dealing with uncertainty" (Diwadkar and Rao 2015 p.181). This informality refers to a range of behaviours and practices that are not regulated, nor controlled, by the state or formal institutions, including those related to J o u r n a l P r e -p r o o f income generation and service provision. To the urban poor, the informality, however, extends to deep uncertainty around access to public spaces, services and procurement (Chen et al., 2016) . Furthermore, it is widely-known that informal settlements are among the most vulnerable locations to disasters whether triggered by natural or biological hazards (such as the COVID-19 pandemic). People's vulnerability and inability to respond to stress is often rooted in social inequality, poverty (and informal employment), social exclusion, stigma, mistreatment that lead to strained physical and mental health (Satterthwaite et al., 2018; Ayeb-Karlsson, Kniveton and Cannon, 2020; Ayeb-Karlsson 2020) . In India, social factors such as marginalisation due to caste can increase people's vulnerability (Bosher, Penning-rowsell and Tapsell, 2007; Jha, 2015) . Research studies show that negative health outcomes can be aggravated by stigma and discrimination due to certain health conditions, such as mental disorders (Koschorke et al., 2014) . Social exclusion and discrimination put already vulnerable people at risk in extraordinary times such as now with the COVID-19 pandemic. The pace of urbanisation in the Global South puts challenges on the ability of urban systems to deliver on the aims of the Sustainable Development Goals (SDGs)including for sustainable cities and communities (SDG11) and for inclusive health and wellbeing (SDG3). Urban theorists, such as Scott and Stropper (2015) , claim that cities are more than physical spaces. Nonetheless, limited development efforts address urban planning failures or seek solutions to reduce social vulnerabilities (pre-existing as well as upcoming). The lack of attention to urban vulnerabilities during the COVID-19 outbreak is already proving fatal in many countries including India and other Lower and Middle Income Countries (Wilkinson et al., 2020; Raju and Ayeb-Karlsson, 2020) .

Slums in India are legally structured into slums recognised by the government as notified versus non-notified slums 2 . This classification results in differential access to essential services and outcomes relating to health, sanitation, and education (Agarwal and Taneja, 2005; Osrin et al., 2011; Subbaraman et al., 2012) . Approximately 59% of slums in India are non-notified, alienating its residents from accessing critical services (Nolan et al.,2017) . Most people living there are forced to come out of their homes and neighbourhoods to access basic human rights such as water and sanitation. The 2011 Indian census data showed that 26% of slum dwellers have to search for drinking water outside of their homes. Over half of them are forced to collect drinking water more than 100 metres away from their houses. Most of them also resident in oneroom dwellings. Research studies in Mumbai's Kaula Bandar slum, for example, show that the lack of access to water has severe implications on people's health, livelihood productivity and income (Subbaraman et al., 2012) . Despite the growing empirical evidence focusing on the increased amount of people exposed to urban disasters (Satterthwaite and Dodman 2013), disaster management planning (including for pandemics) often proposes inadequate and narrow disaster responses (Raju and van Niekerk 2020) . These responses tend to overlook fundamental problems, risks and vulnerabilities (often induced by development planning) including access to resources such as water, sanitation and health care.

Continuous and careful handwashing to prevent COVID-19 is not always an option for people due to these living conditions. Many slum dwellers lack access to drinking water and do not possess soap. Hand sanitizers are luxury items that people cannot afford. As slum households are lacking access to running water, people are forced to walk through narrow pathways to reach the nearest water sources. These slum pathways are often not even two meter wide making the recommended physical distancing guidelines impossible to follow (Raju and Ayeb-Karlsson, 2020) . Physical distancing is a critical response to the pandemic, but it assumes that people have adequate space, services and social safety nets to apply such guidelines.

The COVID-19 response guidelines advocated by different governments and international organisations includes 'working from home'. What defines the 'ability' to work from home is, however, unclear. Working from home requires a safe and sustained income. Something most slum dwellers in India do not possess. People in informal settlements depend on day labour and casual work. Moreover, their work is often carried out hands-on and in person which make it difficult for them to continue working while following social (physical) distancing regulations. Similar to the informality of the settlements, people's employment and economy are founded within the informal labour sector. Research suggests that social (physical) distancing lowers the spread of COVID-19 but not everyone can afford the luxury of working from home or not at all (Courtemenche et al., 2020; Weill et al., 2020) . Restricting people's movements often result in constraining their economic opportunities. These restrictions will have severe health and wellbeing impacts on already poor and vulnerable populations (such as those working in the informal sectors without secure employments). It has also been suggested that the benefits of social (physical) distancing are much smaller for populations in low-income settings than for people in high-income settings (Howell and Mobarak, 2020). Many fragile populations, including slum dwellers, cannot make economic sacrifices that will leave them starving. Tending to livelihood activities, ensuring an income and food security represent more of a concern than the possibility of contracting COVID-19.

Gender disparities coupled with mental health consequences are increasing with the pandemic as women are having to bear more unpaid work (Bijl, 2020) . This adds pressure upon the already fragile social and financial state of these urban spaces. It also ties into issues of food insecurity. People are having to choose between facing an increased COVID-19 infection risk and starvation. Moreover, governmental support services, such as money and food, provided by the Indian government have been slow and insufficient. The deliveries made through the Public Distribution System (PDS) to these informal settlements in the cities resulted in large queues and congested lanes. This further increased the infection spread. Adding to the concern, the India Meteorological Department estimated that this summer was warmer than usual in many parts of India (PTI, 2020). Most informal settlements have erratic or starved electricity connections. It is therefore difficult to anticipate that people will stay indoors without sufficient airflow or inadequate ventilation that exposes them to heat risks. It becomes imperative to take cognisance J o u r n a l P r e -p r o o f of and address the stark reality of urban inequality and future hazards while addressing the current pandemic (Raju 2020) .

The lockdown in India might have contained COVID-19 (for now), but it also created another sort of humanitarian crisis through the millions stagnated inter-state migrant workers. The majority of Indian migrant workers live in informal settlements. Seasonal and temporary migrants often move to settlements built around industrial sectors such as garment factories or construction sites. These temporary living arrangements are sometimes shared with relatives and social networks, other times accommodation is provided by the employer. Recent research studies carried out in Mumbai indicate that these "units have an average of seven to eight workers who live and work in cramped spaces with no fire exits and surrounded by hazardous chemicals and machines" (Parpiani, 2020) .

A large part of these urban seasonal and temporary migrant populations are socially vulnerable people fleeing poverty -in search for a better life. Caste plays an important role in India's social stratification. Social marginalisation and exclusion of 'lower' castes in the rural areas therefore often prevent people's development and progress. For example, people of 'lower-castes' are restricted access to resources and institutions which turn into a vicious inescapable circle of poverty (Bosher, Penning-rowsell and Tapsell, 2007; Santha et al., 2016) . Adding to this, people on the move tend to lack access to affordable and stable health care services, and often live in unsafe conditions that increases their vulnerability to health risks (Ezeh et al. 2017; Ayeb-Karlsson, Kniveton and Cannon, 2020) . Similarly to the characteristics of slum settings, these living and working conditions can be catastrophic for the spread of infectious diseases (Santha et al., 2016) .

Millions of people lost their only source of income with the COVID-19 lockdown closing down many industries and street operations all across India. The lockdown also introduced new travel, transport and physical distancing regulations. These new rules did not only prevent people from working but they also left migrants stranded in their current locations. The Public Distribution System in urban areas has also proved to be low (about 50%) leaving many urban poor without food sources (Roy, Boss and Pradhan, 2020). There is an urgent need to "expand the list of eligible households" during the pandemic (Roy, Boss and Pradhan, 2020).

Over 80% of people in India are employed within the informal sector (ILO, 2018b). Most of these jobs include temporary and seasonal work such as construction work, food-and street vendors, and rickshaw pullers. A majority of casual workers in urban areas are men tending to seasonal or temporary migration for work (Ayeb-Karlsson et al., 2016; Korra, 2017; Raju, 2019) . Few research investigations explore the impacts upon women who are left-behind becoming temporary (single) household-heads in the rural areas. Remittances play an important role in their survival and daily life. The COVID-19 crisis and lockdown will therefore have impacted the J o u r n a l P r e -p r o o f entire migrant household through their reduced or lacking incomes. It is likely that food insecurity and financial hardship extended from the stranded migrants to their female-headed households (Choitani, 2020) . This could also have an impact on the incidence of debt. It differs across states, however, data from an Action Aid study with informal workers indicates increasing incidence of debt during the lockdowns in some states (Action Aid, 2020).

The National Commission for Women in India reported a 94% increase of domestic violence cases during the lockdown (Nigam 2020) . Adding to this, migrant workers forced to walk hundreds of miles back to their villages were sometimes accompanied by pregnant spouses having to give birth along the way (News18, 2020) . As a result, some women died due to the lacking maternal health services (Nigam 2020) . The COVID-19 crisis has further aggravated the deprivation and denial of neo-natal healthcare, psychosocial support and inadequate nutrition to migrant women and children. Additionally, the government is yet to propose a comprehensive preparedness or response plan targeting women at risk of domestic abuse. Female employees in the informal work sector risk losing their work and income. This potential loss of recourses and access to the outside world could make them more susceptible to domestic violence. Research also outlines a link between increased financial hardship and domestic abuse in general (Dixit and Chavan 2020).

Approximately 62% of the wage employees are casual wageworkers 3 that have fallen between two stools in regard to paid leave, insurance and employment rights (ILO, 2018a). The Indian Finance Minister announced a COVID-19 support package on 26 th March to support vulnerable workers. As part of this package, the Indian government provided direct cash transfers through the existing scheme of Prime Minister's Garib Kalyan Yojana 4 to poor households. This money was targeting the elderly, widows, poor women and disabled and covered three months of advance payments to mitigate the immediate fall outs of the lockdown. However, a recent study by Pande et al. (2020) found that more than half of poor women in India were likely to be excluded from the cash transfer program. One out of five poor women reside in households that lack ration cards (a document that grants access to the food distribution system). Those who lack ration cards are also excluded from other alternative poverty support provision of cash or food. Besides this, the Prime Minister's Citizen Assistance and Relief in Emergency Situations Fund was created to solicit donations to help those in need. Individual states within India are carrying out relief operations largely consisting of cash transfers and distribution of food. These provisions, however, have been inadequate. Investing in social protection measures and systems during normal times have proven useful in states such as Kerala. Other urban local governments must follow by presenting similar development visions in the aftermath of the pandemic. Only by building robust social protection systems capable of timely local, national and international action will countries be able to fully recover after a disaster (Praharaj and Vaidya, 2020) . This upcoming COVID-19 recovery phase must be seen as an opportunity to reflect critically on response of cities and urban areas to the pandemic. It is clear that upcoming development efforts must be more inclusive.

Many migrant workers are not formally registered to avail support through these schemes forcing them to depend on NGOs. The majority of migrant workers do not possess the voter identification-or ration cards registered to their temporary addresses that would allow them to access the Public Distribution System (Agarwal 2016; Babu et al. 2017) . "In the absence of such proof, internal migrants are unable to claim social protection entitlements and remain excluded from government sponsored schemes and programmes" (Agarwal, 2016, p.8) . The Uttar Pradesh local government assured a one-off cash transfer of 1000INR (roughly $22) to its residents. This was barely enough to feed a family of five for five days. Furthermore, the state seems to be lacking data on their current informal sector workers, such as rickshaw pullers, construction workers and street vendors (Srivastava, 2020) . The local government in Delhi urged employers to continue paying wages and property owners to avoid evictions, but this mere appeal without sanctions did not result in action (Chandran, 2020) . Safeguarding measures for these unregistered migrants will be challenging but must be put in place. As soon as the lockdown was announced, a large number of migrant workers in the cities rushed to the trains and buses seeking to get home. This further heighted the risk of the COVID-19 spread in urban as well as rural areas that were already battling insufficient health care services (Bhagat et al. 2020) . Media captured images of overcrowded train-and bus stations filled with thousands of people trying to purchase tickets. Given the physical distancing guidelines, the sudden lockdown may have caused more harm than good as some individuals in these crowds were likely to already have been infected (Bhanot et al, 2021) . Those who failed getting on the last transportation services, started their long journey home by foot. Some of them were forced to walk over hundreds and in some instances even over a thousand kilometres to get home. Reports indicated how people collapsed along the roads due to heat and lack of resources such as food, water and shelter. People were hindered by restricted passages and barricades aimed at reducing infection spread. However, as people got stuck there, homeless while forced to wait in large crowds on the 'wrong' side of the blockades these measures may have increased rather than decreased the spread (Guru 2020). An incident in Uttar Pradesh described how a group of walking migrant workers were forced to squat along the road and sprayed with harmful disinfectants by health worker sanitation teams.

Migrant workers faced systematic discrimination before the pandemic including prejudice and stigmatisation resulting in difficulties to, for example, rent accommodation (Aajeevika Bureau, 2020) . It is clear that "pre-pandemic disparities across settlements in levels of infrastructural development inform the types of local challenges to social distancing noted by surveyed slum leaders" (Aurebach and Thachil, 2020, p.2). The structural human rights violations captured in videos and images during the pandemic outlined glimpses of the lack of empathy and human dignity faced by the migrants during the lockdown (BBC, 2020). The existing forms of structural vulnerabilities of migrants before the pandemic has been further exacerbated due to stigma (Bhanot et al, 2021) . During the pandemic, historical labour right violations and lack of social protection ended up putting migrant workers further at risk (Jayaram and Verma, 2020) . People were forced to walk home due to the sudden closures of state borders and transportation services. Meanwhile, the failure to provide people with adequate evacuation strategies or alternative ways J o u r n a l P r e -p r o o f to get home safely left them with no other option than to start walking. These harsh measures resulted in social tension triggering conflict partly related to the despair people felt around the lacking safeguarding measures. As soon as the first phase of lockdown was extended, images started pouring out from Mumbai illustrating migrants gathering in large numbers to seek transportation services to get home (The Print, 2020). It is still not clear whether the government's C-19 relief package supports migrants sufficiently. This was manifested in the mass exodus from cities towards people's respective villages. These movements also outlined the weak transportation services within cities as well as between rural and urban areas.

There need to be a clear distinction between previous social protection programmes and the immediate COVID-19 relief responses put in place. Unprecedented times require unprecedented solutions. Steps must be taken to ensure the health, safety, dignity and protection of all of India's (and the world's) migrant workers. The COVID-19 pandemic is far from over. Meanwhile, the current lack of social protection systems supporting vulnerable urban populations is proving to be fatal in many low and middle-income countries. The pandemic will have severe impacts on the chance of urban local governments to meet the SDGs. It is well known that disasters may not only set back development progress, but they also tend to lay the ground for new momentums of change and policy transformations. In this case, COVID-19 represents a unique global opportunity to build better cities. The recovery phase must allow space for local support networks to collectively grow and increase their capacity to respond to similar emergencies in the future. Their capacity to do so can be observed in the success stories of the pandemic, such as in the rapid responses in some favelas of Brazil or in urban informal settlements of Delhi and Mumbai in India (Vaz de Macedo, 2020; The Lancet, 2020; BMJ, 2020). These included the fast delivery of food and Personal Protective Equipment (PPE) to people living and working in the slums. People have inherent capacities which are manifested in various ways during difficult times (Rolsted and Raju, 2020) . In Kerala, civil society organisations have been able to provide services through the many volunteers (described as a "volunteer army") (Dutta and Fischer, 2020) . Across the world, volunteers have come forward during the pandemic to support the response efforts. Youths in the slums of Nairobi, for example, have used murals to communicate important messages during the pandemic to counter misinformation (UNHABITAT, 2020). Another example of local success is the remarkable containment of the spread of COVID-19 in Dharavi, home to approximately one million of Mumbai's slum residents, is a clear success story. Research show that slum-leaders continued their role as problem-solvers during the pandemic (Aurebach and Thachil, 2021). Cities represent social networks just as much as spaces. Slum-residents rely on each other and their social capital during 'normal' times as well as in crisis situations (Patel and Shah, 2020) . These social networks play an important role in supporting people during crises. As Mumbai's private health system collapsed due to the exponential pressure from the rapid rise in COVID -19 cases, a collaboration was formed between the municipality and local low-cost private-health practitioners. This effort eventually managed to cap the spread of the coronavirus in the Dharavi settlement (Bai et al.,2020; BMJ, 2020) .

Ultra-vulnerable groups during the COVID-19 pandemic (illustrated in this article with India as an overarching case study example) include those depending on casual work. Casual workers cannot afford to refrain to work, nor do they have the option to work from home. Living day by day without savings or assets to buffer against income losses while falling outside of social benefit systems. People on the move and residents in informal settlements also tend to struggle to access healthcare services. We must look at countries such as Portugal for inspiration here who have decided to temporarily grant migrants and asylum seekers full citizen rights throughout the COVID-19 pandemic (Moore and Kortsaris, 2020; Reuters, 2020) . These safeguarding and protection measures ensure that everyone can access free public healthcare facilities. Closer to India, the Malaysian government has urged paperless immigrants and foreigners lacking travel documentation (including the Rohingya refugees) to approach health centres carrying out COVID-19 tests (Daud, 2020) . Migrants in Thailand, regardless of their legal status, are similarly entitled to safe COVID-19 treatment covered by the Migrant Health Insurance Scheme and the Social Security Fund (Bhagat et al. 2020) .

All human beings have the right to a dignified and secure life free of the threat of disease, displacement, family break-up and risk of death. These human rights are organised into the right to safe food, drinking water, sufficient sanitation, adequate housing, healthy working conditions, and the right to prevention, treatment and control of diseases, as well as available, accessible, and acceptable public healthcare facilities (OHCHR & WHO 2008) . The Global Compact for Migration also particularly 'intends to reduce the risks and vulnerabilities migrants face at different stages of migration by respecting, protecting and fulfilling their human rights and providing them with care and assistance' (UNGA 2019, p.3). We must ensure that these human rights frameworks, already put in place, are followed throughout the COVID-19 pandemic. In some countries, such as in Singapore, the poor dwellings conditions of urban informal settlements resulted in an upsurge of COVID-19 cases among migrant workers (Koh 2020) , which was addressed quickly. National governments worldwide can support these fragile urban areas through the support of bottom-up approaches. These must include, but are not limited to, the mobilisation of grassroots leaders, youth groups and existing committees to communicate key health messages, spread awareness and ensure effective welfare measures through local expertise (Du, King and Chanchani, 2020; Wilkinson et al., 2020) . This will ensure peoplecentred participation in both containment and management of the pandemic while making the process inclusive rather than hierarchical, arbitrary and top-down. Following the 2015 SDGs, a new urban agenda was adopted in 2016 representing a collectively shared vision for the urban centres of the world. This was a call to turn cities more inclusive and provide equal opportunities for all its citizens. In order to move forward, urban planning strategies and implementations need to better consider the targets of the SDGs. The pandemic has shed light on existing social inequities and further emphasised the need for urban planners to better incorporate risk and work from more people-centred perspectives.

As the pandemic continues to unfold and as the vaccines are being rolled out, it provides an opportunity to reflect and adapt best practices from across the world to the local context. South Indian Kerala, for example, has already outlined a positive progress of organising community kitchens, escalating testing through kiosks, delivering food to anganwadi 5 children (as that often is their only meal for the day). The Supreme Court of India also passed a directive urging state governments to mobilise local leaders across faiths to visit quarantine centres and shelters to provide migrants and other vulnerable groups with counselling while reducing anxiety related to fear and deep uncertainty 6 . Establishing more trusted partnerships with people on a local level (while working against physical and psychological abuse and corruption) will pave the way for more people-centred policies, budget allocations and widen collective communication channels now as well as in the future.

Moving forward, we propose the following urban safeguarding measurements, recommendations and action points:

 Increasing the effectiveness and reach of the COVID-19 welfare and relief and recovery schemes to ultra-vulnerable groups including migrants and people residing in urban informal settlements.

 Setting-up mobile clinics around in close proximity to such vulnerable locations to provide immediate testing, isolation and treatment of people who test positive.

 Ensure free vaccine access to all keeping in mind the ultra-vulnerable groups.

 Improving access to water and sanitation, food and adequate shelter, and transportation facilities within urban areas. These efforts ought to be ensured throughout the pandemic as well as continued in its aftermath while focussing on achieving the SDGs.

 Supporting people on the move as well as those who find themselves stranded in urban areas or en route safe passages home to their families and loved ones.

 Targeting weaknesses in the disaster response capacities of urban local governments and strengthen their ability to better respond to emergencies in the future.

 Identifying vulnerable groups and creating inclusive city level COVID-19 response plans led by local leaders, entrusted figures and closely collaborating with urban local governments.

 Investing in city level public health care systems providing health services in normal times as well as during unprecedented moments.

J o u r n a l P r e -p r o o f  Involving urban disaster planners in the design and development of cities in the future to avoid building in unnecessary urban disaster risks.

 Reducing urban social inequalities by expanding access to social support systems and public health services in a collective and participatory manner.

 Allocating resources and support to local urban support bodies and NGOs to provide basic human rights for all including safe food, drinking water and sufficient sanitation, adequate housing, prevention, treatment and control of diseases, as well as public healthcare facilities.

The COVID-19 developments in India delicately illustrate how protection of migrants and other ultra-vulnerable urban populations have fallen between two stools. The lockdown should have been planned carefully and communicated more effectively in order to avoid unnecessary psychological stress and traumatic experiences. In these extremely uncertain and difficult global times, certain urban country contexts require particular attention, India's C-19 cases are still continuing to rise. Given the size and spread of the pandemic, safeguarding ultra-vulnerable populations throughout the lockdown's health and safety guidelines comes with considerable logistical challenges. The deep uncertainties around the upcoming timespan, developments and the ultimate effects (financial, social, psychological) of the COVID-19 crisis will make it difficult for governments to adequately support ultra-vulnerable populations, but we cannot give up. 'Building back better' will require all national governments to support their citizens in the best way possible, and especially people squeezed into fragile and cramped urban areas while lacking access to water, sanitation and healthcare services.

The global COVID-19 response and recovery will require countries who have resources to spare to invest them in supporting country contexts and populations that are struggling. It is clear that the overall COVID-19 guidelines have proved to be inadequate in certain fragile settings involving ultra-vulnerable populations. As this article illustrates, these include but are not limited to people on the move and residents in urban slums. Nobody should ever be forced to choose between whether to drink or wash their hands with limited sources of clean water, but even less so throughout a pandemic. These are not COVID-19 founded issues, but continuous denial of people's basic human rights that extends into poor urban policies and city planning. Every human being must be able to access water, food, shelter and acceptable public healthcare facilities. In this way, the COVID-19 pandemic has revealed (and exaggerated) social marginalisation and vulnerabilities within our societies, and particularly in densely populated cities, across the world. The response to the pandemic must include access to health and welfare measures for allnot further the stress for those already vulnerable. The only sustainable way

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The authors declare no conflict of interest. This research did not receive any specific funding from agencies in the public, commercial or not-for-profit sectors.The authors declare no competing interest.

 Courtemanche, C. et al. (2020)  Residents and migrants in slums require unique attention during and post COVID-19  Rights-based pandemic response is necessary to protect ultra-vulnerable populations  Memories and lessons learned from the COVID-19 developments can aid policymakers 1 Slums or Informal settlements "are residential areas where 1) inhabitants have no security of tenure vis-à-vis the land or dwellings they inhabit, with modalities ranging from squatting to informal rental housing, 2) the neighbourhoods usually lack, or are cut off from, basic services and city infrastructure and 3) the housing may not comply with current planning and building regulations, and is often situated in geographically and environmentally hazardous areas" (UN HABITAT 2015, p. 2), see: https://unhabitat.org/sites/default/files/download-managerfiles/Habitat-III-Issue-Paper-22_Informal-Settlements-2.0%20%282%29.pdf 2 The PDS is a system of management of scarcity through distribution of food grains at affordable prices. Over the years, PDS has become an important part of Government's policy for management of food economy in the country.3 A person who is casually engaged in another person's farm or non-farm enterprise (both household and nonhousehold) and, in return, has received a wage according to the terms of the daily or periodic work contract is a casual wage labourer. (As defined in the NSSO, 2014: Employment and Unemployment Situation in India, NSS Report No. 554(68/10/1), NSS 68th Round, July 2011-June 2012 (Ministry of Statistics & Programme Implementation, Government of India). 4 The Prime Minister's Garib Kalyan Yojna, started in 2016 was aimed at gathering "black"money through penalties and the deposits collected would be used for schemes of irrigation, housing, toilets, infrastructure, primary education, primary health, livelihood.For more information, see: https://www.business-standard.com/article/economy-policy/new-income-declarationscheme-explained-116112800654_1.html