B I G C I T I E S N E T W O R K
The Vulnerability of Migrants Living in Large Urban Areas to COVID-19: Exacerbators and Mitigators
A Systematic Review
This systematic review will be presented at the European Public Health Conference 2022 in Berlin, organized by the European Public Health Association (EUPHA). The focus of this conference is on Strengthening health systems: improving population health and being prepared for the unexpected.
To explore exacerbating and mitigating factors of large urban areas on migrants’ vulnerabilities during the COVID-19 pandemic, CIRGH conducted a systematic review of peer-reviewed studies published between 2020-2022 and focused on migrants in urban areas with a population >500.000.
After screening 880 studies, 29 studies were included and categorized within the following thematic framework: 1) Underlying structural inequities, 2) governance and economic structure, 3) urban design, and 4) engagement of civil society organizations (CSOs). Exacerbating factors include pre-existing inequities (e.g. unemployment, financial instability, and barriers to healthcare access), exclusionary government responses (e.g. relief funds or unemployment benefits), and residential segregation. Mitigating factors include the engagement of CSOs and the implementation of innovative governance strategies (e.g. e-governance and use of teleservices). We recommend increased attention to pre-existing social inequities faced by migrants, inclusive governance strategies, and partnerships between government and CSOs to improve the design and delivery of services to migrants in large urban areas. More research is needed on how urban design can be utilized to mitigate the COVID-19 impacts on migrant communities. The factors identified in this systematic review should be considered as part of migrant-inclusive emergency preparedness to address the disproportionate impact of these crises on migrant communities.
Systematic Literature Review
(COVID-19 OR covid OR corona OR coronavirus OR sars-cov OR sars-cov-2) AND (migrant OR migrants OR Immigrant* OR Immigration OR newcomer* OR “asylum seeker*” OR asylee* OR “displaced person” OR “displaced people” OR “foreign born” OR “foreign worker*” OR “foreign domestic worker*” OR refugee* OR undocumented) AND (city OR urban OR cities OR metropolitan OR metropolis OR megacity OR suburb*)
We conducted a systematic literature review in PubMed, Web of Science, and the WHO COVID-19 database, which generated 880 results. Inclusion criteria encompassed English, peer-reviewed literature with a focus on COVID-19 effects on migrants in cities with populations > 500,000. Both quantitative and qualitative study designs were included. Due to the newly emerging topic, we also included review papers, commentaries, and perspective pieces. Exclusion criteria included study protocols, validations studies, and clinical studies focusing on additional comorbidities.
After screening titles, abstracts, methodologies, and full texts, 29 studies were included. Eligibility disputes were solved by a consensus decision among all reviewers. Eligible studies were then coded according to the following information: Methodological quality, research question, study design, study setting, population of interest, age and number of participants, main findings, limitations, and discussion. The methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist according to study type.
In line with evidence of urban factors influencing the COVID-19 impact and the main themes of eligible studies of our systematic review, we developed a thematic framework with four categories reflecting the main exacerbators and mitigators of COVID-19 impact on migrant communities in large urban areas: 1) Underlying structural inequities, 2) governance and economic structure, 3) urban design, and 4) engagement of CSOs. Each study was classified according to these themes based on their main key takeaways.
Key Study Findings
- Underlying socioeconomic inequities have exacerbated the impact of the pandemic on migrant groups in large urban areas. Unless these issues are addressed, migrants and other vulnerable populations will experience the same disproportionate impacts during the next pandemic or other health emergencies.
- Government responses, relief funds, and benefits often exclude migrants, further exacerbating inequities and disproportionate impacts. Governance strategies make a difference in mitigating the impact of COVID-19 on vulnerable groups, including migrants. Examples of effective strategies include: inclusive relief measures that provide migrants with basic financial and social support; suspension of policies and regulations that invoke fear and avoidance of services, particularly among undocumented migrants; support of local CSOs to fill gaps and complement municipal services; and e-governance initiatives that take into account the technology and connectivity challenges faced by migrant communities.
- The design of large urban areas can impact the exposure of vulnerable groups to health threats. In the case of COVID-19, urban areas with high levels of residential segregation place migrants and other vulnerable groups far outside the city center, therefore risking higher levels of infection among those groups. This is due to overcrowding in these neighborhoods, as well as the length and type of journeys people take to arrive at their places of employment.
- CSO engagement is a mitigating factor for the impact of COVID-19 among migrant groups in large urban areas. If adequately supported and financed, CSOs fill service gaps, bridge cultural divides, and strengthen community engagement in ways that protect migrant groups from exposure and increase access to preventive information and services.