Fear and stigma in the context of corona epidemic in Bangladesh

All epidemic outbreaks generate a considerable amount of fear, stigma and discrimination. The fear of being socially marginalised and stigmatised may cause people to deny early clinical symptoms and may contribute to their failure to seek timely medical care. Mitigating the fear and stigma directed toward persons infected with, and affected by, coronavirus is important in controlling its transmission and minimising damages.

With this background, we have carried out a rapid exploratory study to (a) conduct a rapid situation assessment of the localized nature of fear and stigma related incidences; (b) investigate the source of fear, stigma and rumour; and (c) to recommend possible culturally informed and socially relevant recommendations to mitigate the fear, stigma and discrimination towards corona victims or associates.

After a careful content analysis of fear and stigma-related media reports, people’s narratives and online behaviour, we attempted to develop a framework to understand the sources and pathways of fear and stigma in Bangladesh. We found that this fear and stigma nexus developed in eight distinctive phases as follows:

Phase of false safety: During the period of January to February 2020 while news of the corona outbreak was travelling from China to Europe, the prevailing narrative in Bangladesh symbolised the disease as a foreign one, associated it with the “immoral” lifestyle of Europeans and the “bizarre” food habits of the Chinese people. This narrative was particularly preached by Islamic preachers and wazirs. At the same time, a scientific denial was also confidently prognosticated by some physicians and scientists who promoted the idea that the coronavirus would not survive in Bangladesh due to the warm weather.

Formalising stigma: On 15 March, 142 migrants returned from Italy and were taken to the Ashkona Hajj camp, the makeshift quarantine zone. After they complained about the unsanitary conditions there, many of them were allowed to go home with advice to self-isolate. A seal was printed on their forearms to label them as returnees, and mentioning the end period of their quarantine time. Local government authorities also put red flags in front of the migrant returnees’ houses. This was the official endorsement of othering the migrant returnees as deviants which in other words was the beginning of formal stigmatisation of a particular group of people.

Community gaining “stigma power”: On 17 March 2020, with the country having 8 confirmed cases, the government closed all schools, for the remainder of March. The fear in the community was raised. There were incidences of attacking migrant returnees. Migrants were prohibited to enter local shops. Many of our respondents from rural/semi-rural areas confirmed transfer for “stigma power” into the hands of the community.

Awareness of proximity of the disease: On 18 March, Bangladesh reported its first coronavirus death. The patient was aged over 70 and had other morbidities. By the end of March, Bangladesh had reported 51 confirmed cases and five deaths. It started to become clear to the people that corona is no longer a distant probability, rather at their door-steps.

On the same day, tens of thousands joined the namaaz-e-janaza of an Islamic scholar in Brahmanbaria, thus seriously damaging the narrative of social distancing. These events generated a considerable amount of fear among the educated mass.

Community transmission and the liquefaction of fear: On March 21, the second coronavirus death in Bangladesh was announced. The death of this man in his 70s is likely the first known death from community transmission since how he got infected remained unknown as he and his family did not have any history of travel abroad. With such narratives of untraceable sources of infection, the fear of corona started to be “liquefied”.

The semiological disaster: On 23 March, the government declared a ten-day ‘chhuti’ or nationwide holiday for the period 26 March–4 April, ordering all public and private offices to be closed, with the exception of emergency services. For some unknown reason, the word ‘lockdown’ was not used. In a city where most of the population has active sources of origin and a prevailing culture of going to their village homes during holidays, the word “chhuti” created the same vibration. People evidently forgot the context and advisory of social distancing and rushed to the transport. This chaotic atmosphere fuelled the fear further. The threat to livelihood developed another layer of fear, which is more intense than the fear of death, particularly for the poor.

Phase of mistrust: On 5 April, Bangladesh reported 18 new cases, representing a 26% increase on the previous day. From then till the present day, the day-on-day increases have exceeded 20%, representing a steep rise in cases. Bangladesh crossed the figure of 100 confirmed cases on 6 April and 1,000 confirmed cases on 14 April. Bangladesh had extended a nationwide lockdown till 5 May and now has extended this till 13 May, as part of measures to stem the spread of coronavirus pandemic.

Meanwhile people were further confused with excessive and conflicting information (info-demic). Reports of mismanagement of cases in the dedicated corona hospital at Kurmitola, lack of PPE for the health providers, the closing of private hospitals, all of these generated an atmosphere of deep mistrust on the health system in the country.

Class-based fear and panic: From the second week of April several horrific fear and stigma related incidences started to emerge. For example, attacking and harassing corona patients, obstructing their burials, harassing health providers, deserting suspected family members in the jungle, etc. become regular features in different areas. It was as if corona patients were personifications of the unknown fear and needed to be punished. Anyone outside the neighbourhood -- para, moholla, elaka -- is subject to suspicion. Individual’s mobility and actions are now under strict public scrutiny.

Meanwhile, an inevitable structural fear towered up: the fear of hunger. People depending on the informal economy immediately lose their livelihoods and economists witness an emerging class of ‘new poor’ who previously lived on the margins of the middle class. The fear of losing class became prevalent in this population group. This is how all the structural fear has been derived into cultural fear of liquid nature.

The study reveal that the nature of fear shows an extraordinary mobility between structural and cultural patterns, and a cultural fear is relatively very difficult to be sourced and addressed, particularly in the time of an epidemic. During this time of uncertainty and unpredictable deaths, people have enough reasons for not sharing thoughts, anxieties and infections. Along with, the existing power structure in society is still in operation, and has been translated in different ways. People experience a loss in transparency and accountability, which leads them to mistrust information and believe in rumours. Of course, fear cannot be abolished as long as the virus persists, but the state can effectively address derivative fears within people, by being transparent, kind and positive.

The study recommends an immediate intervention into this situation, before the culture of fear and stigma cast a permanent scar on the management of COVID-19. It proposes a set of recommendations at macro, mezzo and micro levels, including, among others, legislative measures, a combined and careful supervision by local politicians, administrators, caregivers, health workers and religious leaders. At the same time, it is very important to carefully use the media against the incidences of stigmatisation.

Shahaduz Zaman: Medical anthropologist and public health physician, University of Sussex, UK. Email: [email protected]

Sumon Rahman: Media studies researcher. Email: [email protected]