COMMENT | Emerging humanitarian Covid-19 crisis in Sabah

COMMENT | Yesterday, a lockdown was extended until Nov 9 for Sabah, making it over a month that the state will face serious hardship as its citizens wrestle to get the virus under control.

At the same time, 889 cases of Covid-19 were reported on Oct 24, with a total of 9,408 cases since the start of the month. A total of 90 Sabahans have died from Covid - a death rate of over seven times higher than the national average. The seriousness of Covid-19 that has been the call of multiple analyses has come to the fore.

This piece continues to draw attention to the key issues in Sabah's Covid-19 crisis, with particular attention to the challenging socio-economic conditions on the ground. Beyond the health dimensions, Sabah’s Covid-19 crisis is much larger, as it is affecting livelihoods and exposing the serious socio-economic vulnerabilities and long-term neglect of this state. It is now an emerging humanitarian crisis. 

As will be argued below, assistance needs to go beyond healthcare to assure that Sabahans have the resources to survive the crisis and are in positions to recover when the health situation is stabilised.

Rise in cases expected

Our focus starts with a look at the health situation. By all indications, the case numbers in Sabah will increase. The trajectory, based on recent positive infections, point to the reality that Sabah alone may cross the 1,000 case number mark. 

Deaths sadly will also likely cross a threshold of over 100 Sabahans. This means that the strain on healthcare facilities – and the accompanying fear and anxiety – will intensify, as the risk of further lives being lost from Covid remains serious.

Wide community spread

This is reinforced by persistent trends showing that nearly a third of the cases remain unlinked. The share of unlinked cases yesterday dropped due to the high cases in the Kepayan prison (allowing for clear tracing), but despite all the hard work being done - and it is very hard work - a large number of cases still cannot be traced.

This month, from Oct 1-24, a total of 4,177 out of the 9,408 cases – or 44.4 percent - of the Sabah cases are unlinked – almost every other person. The virus is widespread in the community, emphasising that the need to adopt new approaches is more pressing than ever.

To address this health crisis, four herald calls need to be urgently acted on.

More resources: A ‘surge of federal resources’ is needed. This needs to address the inadequate personnel, equipment, beds and serious backlog in testing, which is costing lives and destroying livelihoods. Current levels of funding are just not enough. A crucial part of the resources needed is stronger ties with professional experts and local civil society leaders who can offer new ideas to address the ongoing crisis. Additional personnel from West Malaysia is needed to support hospitals and contact tracing efforts.

Testing: Second, more widespread testing is needed. The Health Ministry’s refusal to follow international recommendations of ‘test, test, test’ is misguided. Affordable and mobile tests are readily available, and they should be carried out. Without proper testing, the situation will continue to worsen and will not be able to be properly controlled, given the degree of community spread.

Transparency: Third is the need for greater transparency in data. There have been conflicting reports regarding the Sabah state and federal government on bed availability and these differences have raised concerns. The Health Ministry needs to properly cooperate with local authorities, provide positivity rates weekly by state and district not in broad unusable bands, report turnaround on tests by state and show admission and severity rates. 

This is the time for outreach, not retreat. Sharing (non-personal) data will allow for stronger collaboration to address the crisis in Sabah and prepare proactively for other parts of Malaysia.

Frontliner support: Finally, there is a need to appreciate the toll that this crisis is placing on the brave and dedicated medical frontliners. There is a high rate of infection among medical staff, and many in the field are reaching a breaking point. 

There needs to be more rotation of personnel and relief as the crisis is one for a longer haul - most certainly much longer than the few weeks that was originally suggested when the crisis was being brought to public attention. This only further emphasises that more needs to be done, especially at the federal level. There needs to be more investment in people responding to the virus for the protection of the people facing the virus.

Greater local engagement

As the crisis has continued, there have been overall positive developments this week. We have seen three marked shifts:

Greater state intervention: The Gabungan Rakyat Sabah (GRS) state government has stepped up, with a more honest recognition of the issues and greater engagement. Ministers have been open about the strain on health facilities and need to move toward self-isolation as there is not enough space in existing facilities. Improved communication has been accompanied by a better appreciation of the seriousness of the situation on the ground. 

 There is still more than can be done by the state leadership, with an appointment of a health minister or state task force, but credit should be given to the greater interventions by the state government.

Broadening civil society engagement: At the same time, the engagement of civil society organisations has broadened. Support for health care professionals has been heartening and extensive. It is the less publicised efforts, however, that are especially impactful, as thousands are being fed by the kindness of strangers. As will be noted below, the socio-economic effects of the crisis extend beyond the health issues, but also reinforce pressures on the health system.

Calling out uneven and gaps in federal support: We have seen at the federal level broader engagement by the army and the police, including the opening up of an army hospital in Tawau and outreach and awareness campaigns by the police about the difficult circumstances on the ground. 

These organisations can play a supporting role in the mobilisation effort but given the reality of undocumented persons and deep distrust of the federal government, cannot play a leading role. There needs to be a stronger collaboration, with civil society leadership and participation at the fore.

While the Health Ministry continues to report support to Sabah – and this support is real and extremely important - there is a growing gap between what is needed and being provided. These concerns are being raised publicly, notably on social media as public accountability is playing an important role in the crisis in Sabah.

Perceived gaps, however, are fueling dissatisfaction among the public and unnecessary defensiveness responses. As tensions rise and conditions worsen, the need for improving cooperation and greater respect for and appreciation of the local conditions are needed more than ever. A key step moving forward remains greater decentralisation of the effort, as the crisis has moved beyond what officials in KL are fully capable of addressing without greater outreach and local participation.

Sabah’s real economic challenges

Sabah’s Covid-19 situation transcends health. A crucial part of this is recognising the difficult economic circumstances on the ground. Many of these are the product of failings in policy in the past, with the crisis bringing deep vulnerabilities to the surface. Socio-economic conditions are worsening with the lockdown. 

Even before 2020, Sabah’s economy had been in a tight spot. The state’s relatively high reliance on commodity-related economic activity (roughly half of the Sabah economy in 2019 was derived from commodity agriculture and mining), along with a sizable tourism sector, means that a large share of Sabah’s economy is subject to the whims of the global economy. 

Over the past two years, global trade tensions and lower world commodity prices have dampened Sabah’s agricultural and mining sectors, bringing Sabah’s GDP growth down from 8.1 percent in 2017 to a just 0.5 percent in 2019. At the same time, longer-term challenges like elevated levels of unemployment, poverty and issues with access to basic infrastructure in certain districts remain urgent.

Sabah’s Covid-19 crisis reinforces these negative existing trends. In fact, initial reports suggest it already has. The large global and domestic demand shocks brought upon by the pandemic have already decimated economic activity in the large swathes of the Sabah economy. Hotels are being sold. Stores and businesses shut down. 

Despite past half-hearted attempts at stimulus by both the federal and Sabah state governments (which was poorly and unevenly implemented), economic growth in the state will almost certainly be deeply negative in 2020.

Yet, while the macroeconomic trends are concerning, it is the negative effects on workers and households that are even more frightening. Everyday Sabahans are struggling. While real-time state-level employment data is lacking, recent JobsMalaysia data suggests that workers in Sabah have not fared well. Since the movement control order was enacted in March 2020, the share of unemployed active registrants on the JobsMalaysia portal in Sabah has risen. 

At the same time, job opportunities have become scarcer, with job listings in Sabah declining by about 70 percent in 2020 compared to the same period last year. This figure of a 70 percent decline is worth repeating – as it is deeply troubling.

Looking at the types of jobs that are affected, the data suggests that in Sabah, just like in the rest of the country, the negative impacts of the pandemic have been highly uneven. Elementary and/or lower-skilled occupations have been the most heavily impacted by far, with Sabah’s listings of job openings for elementary occupations, machine operators and trade workers declining by more than 35,000 jobs in 2020 compared with the same period last year. 

By industry, many of these ‘lost’ jobs are in the agriculture, forestry and fishing sector - which employs more workers than any other sector in Sabah. In 2019, the agriculture-related sectors accounted for more than a quarter of the total employment in the state. 

The pandemic has worsened negative trends. For example, the negative effects of the contraction of the tourist sector have been hardest felt in Kota Kinabalu, where job loss there is real. Hotels and food and beverage businesses are struggling just to hold on. Other sectors are also struggling. With Shell declaring this week it will move its oil and gas operations to Sarawak, this decision has hit hard when the state is already being hard hit.

More recently, with the persistent serious health situation, Sabah’s Covid-19 has extended from the economy into society. Sabah has the most people living in poverty in the country, 19.5 percent of households, estimated about 450,300 persons. 

Based on the data from the Statistics Department 2019 household survey, we look at the share of those with incomes under RM3,000 as well as those below the poverty line of RM2,208, pointing to those who are vulnerable and most vulnerable in a time of economic contraction.

Conservatively this figure reaches 33 percent of households with a minimal estimate of 743,000 people. This is one out of every three Sabahans. This excludes those who have lost their jobs. A more accurate figure of those vulnerable is likely even higher. Many of the national figures leave out the undocumented persons who reach an estimated one million.

These disturbing numbers suggest that there is a humanitarian crisis emerging from the economic contraction tied to Covid-19. This is being confirmed by reports from the field of serious hunger and deprivation. Many Sabahans are starving and more will starve without financial support. 

The complexities on the ground have made the distribution of food aid challenging, and there has been inadequate cooperation and support to strengthen local civil society networks to give them access to communities who distrust officials, especially federal officials.

No matter what lenses are used to levy blame for the crisis, the buck stops with the federal government which has allowed this vulnerability and suffering to continue, and for weeks refused to acknowledge that a crisis was unfolding.

Vulnerability extends throughout Sabah, but eight districts, detailed below, have more than half of their populations facing dire circumstances with two of these - Pitas and Tongod - having over 70 percent affected.

Keep in mind that hunger feeds desperation and will contribute to a worsening the health situation. Some infected may not have the strength to even get tested, as the risks of deaths coming from other dimensions of the crisis are on the horizon. More holistic and inclusive interventions are needed.

Humanitarian financial response

These sorts of crisis intervention cannot be effectively carried out under an ‘emergency rule’ situation being articulated by Muhyiddin Yassin’s government, a situation that takes away rights and the alternative voices and potentially disempowers civil society that is crucial for outreach as a humanitarian crisis unfolds. 

What is needed instead are special measures that harnessed emergency aid and assistance, that work and respect people and recognise the unique and challenging circumstances ahead - an inclusive approach that appreciates urgency, does not replicate the delays to date and builds trust on the ground

Beyond the needed greater health resources, an urgent package of financial assistance earmarked for Sabah is needed - one that is accountable and transparent to prevent graft and corruption (another reason for accountability and oversight that cannot be assured under an ‘emergency rule'). 

There needs to be a discussion on these issues in Parliament and in the state assembly. This special relief for Sabah should be distributed as soon as possible. Given Sabah’s contributions to oil and gas revenue, one alternative is a special allocation of the royalty revenue or other shares of funds from oil and gas income in the state. Civil society groups will not be able to sustain support for the growing humanitarian and persistently grave crisis.

Delays in responding allowed the Sabah's Covid-19 crisis to deepen. Timely and holistic interventions can help stop the damage from Covid-19 from further evolving into a humanitarian crisis and scarring Sabah and Malaysia. 

BRIDGET WELSH is a Senior Research Associate at the Hu Fu Centre for East Asia Democratic Studies, a Senior Associate Fellow of The Habibie Centre, and a University Fellow of Charles Darwin University. She currently is an Honorary Research Associate of the University of Nottingham, Malaysia's Asia Research Institute (Unari) based in Kuala Lumpur.

CALVIN CHENG is an Analyst in the Economics, Trade and Regional Integration programme at the Institute of Strategic and International Studies (ISIS) Malaysia, where his research interests centres around economic development and social assistance. He tweets economics and more at @calvinchengkw and can be reached at [email protected].

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.