War is an enticing, if overused metaphor. Athletes and sports fans are perhaps most guilty of equating their frivolous pursuits with armed struggle, but they are far from the only ones. And ever since the coronavirus brought 2020 to a screeching halt, comparisons with battle have abounded.
United States President Donald Trump triumphantly touted himself a “wartime president”. Queen Elizabeth II alluded to a “home front” in her national address to her subjects. China’s leader Xi Jinping effectively declared war on Covid-19.
Doctors, healthcare practitioners and essential workers such as teachers, police officers, bus drivers and more have been asked to carry out their duties on the “front line”. But they are fighting an enemy never encountered before. It is an invisible force that cannot be contained or pinned down by aerial bombardment. It has no interest in diplomatic talks.
“The virus does not discriminate,” said Michael Gove, a top-ranking United Kingdom cabinet minister, in late March, after his party leader Boris Johnson tested positive for Covid-19. That is not entirely true. While some may rankle at the incessant need to draw links between our current plight and conflicts from the past, the ways in which black medical workers are afflicted in the UK does bear a striking resemblance to the early days of the US involvement in the Vietnam War.
Before the protestations of civil rights leaders, African-American soldiers were being killed disproportionately in the jungles and rice paddies of Southeast Asia. Representing just 11% of the population in 1966, young black men accounted for more than 20% of casualties. Something eerily similar, if far more lopsided, is occurring today.
A protagonist in a war
Recent reports show that 97% of UK medical staff who have died from Covid-19 are from black or ethnic minority backgrounds, even though they make up less than 13% of the nation. Even accounting for overrepresentation in the National Health Service (NHS) – where black or ethnic minority people make up 44% of the overall staff – the numbers are staggering.
Black soldiers’ accounts from Vietnam attest to them being mistreated by commanding officers. They were often ordered to perform particularly dangerous tasks. Are we seeing history repeat itself?
“No, as far as I am aware, BAME [black, Asian and minority ethnic] doctors and nurses are being treated equally in the UK,” says Parag Pandya, a clinician in Swanscombe about 38km east of London. Originally from Gujarat in India, he has lived in his adopted country for 21 years. More than 70% of his colleagues at the healthcare centre where he works are of South Asian origin, though the patients they treat are almost exclusively white.
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Pandya thinks of himself as a protagonist in a war. His uncle Sharad Bhatt, who worked as a waiting list manager at a hospital, died from the virus on 24 March. This has only strengthened his resolve.
“I don’t consider my own safety, I just focus on getting the job done,” he says. “Like a soldier, I have accepted that I may lose my life. But the difference between myself and a soldier is that when that soldier returns home, he leaves the battlefield behind. Every day, I carry the risk of bringing the virus home to my wife and children. But if I’m going to do this, and my ethnicity puts me at risk, I’d like to know why.”
Waging a different campaign
Despite Pandya’s experience, there is some evidence to suggest that black, Asian or minority ethnic healthcare workers are waging a different campaign. A study by the British Medical Association published on 24 April found that “doctors with BAME backgrounds have been disproportionately affected by the chronic shortages of PPE (personal protective equipment) across the NHS”. It also stated that 64% of black, Asian or minority ethnic doctors questioned felt “pressured” to work with inadequate PPE compared with 33% of their white colleagues.
“Maybe black and brown doctors are less likely to complain,” Pandya offers as a way of explanation. “Many of us come from poor countries and so we are maybe more willing to work under extremely challenging circumstances. We are shaped by our backgrounds. But I can’t imagine any hospital in the country would consciously be putting a particular subset of their staff in danger in order to protect another.”
Whatever the reason, the fact remains that some people are more at risk than others. As a result of societal inequality, and the stress that comes from living in a racist society, people of black or ethnic minority backgrounds are more likely to suffer from diabetes, high blood pressure and obesity, afflictions that increase the likelihood of dying from Covid-19. Research also shows that a lack of vitamin D could be deadly in this fight. White people, with their lighter skin, absorb around 53% more of this potentially lifesaving resource through their skin. Some scientists have suggested that in the long northern winter where people spend most of their time indoors this could be a factor in explaining why some people are more at risk from the virus than others.
But there are no definite answers and the post-mortem will likely reveal myriad factors. One that is more difficult to quantify is the psychological drive that Pandya puts forward.
“Perhaps BAME healthcare workers are more likely to place themselves in harm’s way as a means to prove their value to a hostile society,” he suggests. “We live in a world where people make judgements based on what you look like. Maybe some people see this as an opportunity to shift damaging narratives.”
Outpost of progressive thought
This sentiment is shared by two Arab healthcare workers in the northern Israeli city of Haifa. The country’s fractured politics are left at the door of Rambam Hospital, where a multi-ethnic team dispels notions of disharmony.
“We’re a family,” says Yasmin Diab, a doctor who volunteered to be part of a specially created coronavirus task team. “Arab, Jew, Ethiopian, black, white… it doesn’t matter. We’re in this together.”
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This makes the hospital an outpost of progressive thought. Since Benjamin Netanyahu came to power in 1996 as Israel’s prime minister, he has labelled Arab politicians as terrorists, stripped Arabic of its status as an official language and most recently signed off on a law stating that Jews are the only citizens with the right to self-determination.
“It is difficult to reconcile the disparities that exist inside and outside of the hospital, but we are realistic,” says Zaher Azzam, a senior physician at the hospital and a widely respected figure around the country. “But we have hope that what we are doing here can prove to be a beacon. Our doctors treat all patients with the dignity their humanity deserves. Inside these walls, there are no differences.”
Like the UK, Israel’s ethnic minorities are overrepresented as workers in the healthcare system. Arabs make up around 20% of the country but account for half its pharmacists, a quarter of its nurses and more than a fifth of its doctors.
Black doctors’ association
If the inequities of the real world are kept at bay at Rambam, they certainly are not at the Moacyr do Carmo municipal hospital in Guanabara Bay, Brazil. Brazil is a notoriously racist society and there, much like in the rest of the country, who lives and dies is determined to a significant extent by skin colour.
Ionata Smikadi is one of the healthcare workers risking her life every day in the attempt to save others. With a master’s degree in sociology, she is now in the final stages of her medical residency. As a black woman, she is part of an extremely small minority in her field, where nurses, cleaners and other lower-paid staff are likely to be black.
Uncomfortable with the status quo, Smikadi helped found the Luiza Mahin Institute in December 2019. It is the first association of black doctors and students in the country and intends to advance the needs of black healthcare workers while aiming to increase the number of black students in medical schools. Recent events have necessitated their cause.
“I cried when Jair Bolsonaro was elected president [on 1 January 2019] and I haven’t stopped since,” Smikadi says. “He represents the worst parts of white supremacy in Brazil. His policies crush poor people and especially black people.”
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Bolsonaro, like other right-wing politicians around the world, has advocated reopening commerce in his country despite rising Covid-19 numbers. He has bragged about his perceived immunity as a result of his physical prowess and has led anti-lockdown protests. Brazil is now second only to the United States in terms of confirmed cases.
“If our leaders deny the reality, we are facing a much more difficult fight,” says Smikadi. “Last week I did not have a mask when treating patients. If I get sick, my whole family will suffer as my income is crucial. White doctors who work in private hospitals are better equipped and also have families who can support them if they can’t work. There are two Brazils and we live different lives.”
Around the world, and across racial and class lines, healthcare workers are often united by a singular drive. “We do this for no other reason but to help people,” Pandya says. Diab adds, “Being a doctor means I can forget about politics. All that matters is the patient in front of me.”
Despite her challenges, Smikadi encapsulates this sentiment. “I know it sounds messianic, but when you look into a person’s eyes and you know that they are alive because of you and your team, that makes everything else disappear. We do what we do because it makes a difference.”
When we emerge from the other side of this tunnel strewn with lost souls and economies turned to rubble, perhaps we will blink our eyes open in a new world. But history does not encourage an easy optimism. Those with their hands on the levers of power are unlikely to be injected with a conscience for the downtrodden among us. Worse catastrophes than this have yet to break the walls that separate rich and poor and divide a single humanity into racial hierarchies. But as this crisis unfolds those most at risk on the front lines need all the solidarity and support that they can get.