When a bar of soap is a life-saving luxury

As nations around the world fight the coronavirus pandemic with mass lockdowns and travel bans, UN experts warn that about 3-billion people lack even the most basic weapons to protect themselves: soap and running water.

The outbreak has infected about 286,400 people and killed 11,884, scorching through populations across the globe after emerging in China late last year.

Europe has become the centre of the battle against the virus, closing borders and sequestering millions of people in their homes, but concerns are rising for developing nations with fragile health care systems.

Countries across Africa and Asia have heavily restricted travel, imposed quarantines and closed schools, with fears for impoverished communities as infections begin to grow.

But one of the most fundamental practices individuals can adopt to shield themselves from Covid-19 — thorough hand washing — remains inaccessible for many.

Using household survey data, the UN Children's Fund (Unicef) estimates that 40% of the world's population, or 3-billion people, do not have the means to wash their hands at home.

Sam Godfrey, Unicef chief of water and sanitation in East and Southern Africa, said communities lack easily accessible running water, are unable to buy soap or do not realise its vital role in preventing illness.

“Even for the front line workers, the health workers, there remains a challenge also in terms of understanding the importance of hand washing,” he said.

With the first infections in the region often coming from those who have travelled internationally, Godfrey described the outbreak as “almost like a rich man's disease for Africa, which, of course, will end up with the poor man suffering the most”.

Those living in high-density areas, as well as the large refugee populations in camps and urban areas in the Horn of Africa, are particularly at risk because they may be malnourished or have underlying health problems. And they often lack sanitation.

In Sub-Saharan Africa, 63% of people in urban areas — 258-million people — lack access to hand washing, according to the Unicef figures. In Central and South Asia this figure is 22%, or 153-million people.

But at Mathare, in Nairobi, Kenya, on Thursday, people shrugged off the risk.

“Have you seen any of those people in hospital come from the slum? That is a disease for the rich,” said Ishmail Ayegah, a bicycle repairman.

The World Health Organisation (WHO) has sounded the alarm about the potentially devastating consequences of an outbreak that has pushed even wealthy nations to the limit.

“As the virus moves to low-income countries, we're deeply concerned about the impact it could have among populations with high HIV prevalence, or among malnourished children,” said WHO chief Tedros Adhanom Ghebreyesus.

The pandemic has caused fears of soap shortages. Unicef is distributing supply for a million people, but Godfrey said replenishing stocks has become a challenge in countries that import soap from China and India.

Soap may have been around for centuries but it is still the best and cheapest way to scrub viruses off hands, experts say.

This “fantastic” substance detaches the virus from skin, said Evariste Kouassi-Komlan, a Unicef regional director for water, sanitation and hygiene.

In the case of the coronavirus it can also break apart the virus itself. Hand sanitisers are only recommended when soap and water are unavailable.

Godfrey said communities in parts of Africa can draw on experiences and lessons from tackling major outbreaks like ebola and cholera.

In the Democratic Republic of the Congo, ebola stopped people from shaking hands, so they started bumping elbows.

“So there was social acceptance but without having to touch the palms of the hands, which were the areas where potentially there could have been a transfer of the virus,” he said.

“The ebola handshake has become the corona handshake.”