Health responses to COVID-19 in the Artisanal and Small-Scale Gold Mining sector: Mitigating the risk of infiltration, spread and severity
By Mareike Kroll, Kevin Telmer - April 28, 2020
Summary
The looming third wave of the COVID-19 pandemic is likely going to have devastating impacts in many countries in the Global South, with far worse health outcomes and economic implications. While formal and informal income sources in LMICs are collapsing, the Artisanal and Small-scale Gold Mining (ASGM) sector offers a rare and desperately needed income opportunity due to the stable or rising international gold price. At the same time, artisanal mining communities can be considered as most-affected and at-risk group according to the UN Global Humanitarian Response Plan COVID-19. While they face similar challenges and vulnerabilities as many other rural and impoverished communities in LMICs, they can be assisted very cheaply to cope better with the pandemic by maintaining or reactivating gold supply chains that offer miners a fair price.
Along with that, an effective health program needs to be delivered to mitigate the risk of COVID-19 infiltration, spread and severity in those communities. Community approaches have to mitigate the risk of infiltration of the coronavirus by providing health education and behavioral advice for gold traders. In artisanal mining communities, ASGM organizations with projects on the ground can provide health education. These campaigns need to be based on community engagement and trustful relationships in order to achieve compliance. A health sector-based response in artisanal mining communities can be more challenging due to the limited capacities of local clinics. However, the improvement of communication systems and financial, logistical and infrastructural support can help to maximize the use of local capacities.
The use of these existing and trusted stakeholder networks and supply chains in the ASGM sector to deliver health education and to support access to health care and preventive infrastructure, together with the facilitation of fair income for communities, can provide a meaningful response to COVID-19 and help to mitigate the impact on lives and livelihoods.
COVID-19 in the Global South
While Europe and North America are currently facing the highest number of confirmed COVID-19 infections and fatalities, there is little doubt left that the looming third wave of the COVID-19 pandemic is going to have devastating impacts in the Global South, especially in Sub-Saharan Africa, but also South and South East Asia and South America, with far worse health outcomes and economic implications[i].
COVID-19 cases seem to slowly spread from urban and central areas of Low- and Middle-Income Countries (LMICs) to their peripheries. The real picture, however, will remain difficult to know in many countries due to lack of testing capacities. Remarkably, the indirect impacts of COVID-19 – especially loss of income and food security – have reached many rural regions even before the first case of COVID-19 was confirmed. According to recent estimates from the World Food Program and the World Bank, the pandemic might push an additional 265 million people into hunger[ii] and 49 million people into extreme poverty[iii] by the end of 2020. Potential humanitarian crises have already been reported in parts of Colombia and Burkina Faso.
This situation presents governments with a challenging balancing act. They must weigh putting in place strict public health measures designed to prevent and slow down the spread of the virus against the risk of permitting the virus spread by allowing people to work and feed themselves, all the while knowing that many people won’t be able to receive treatment.
Despite some rumours that countries with younger populations might be less vulnerable to COVID-19, the impact could be even more devastating due to the sheer number of people in the Global South suffering from underlying medical conditions that can increase the severity of the virus. These include conditions such as malnutrition, tuberculosis, HIV/AIDS, hypertension or diabetes. These diseases have either immunocompromising effects or they weaken central organs such as the heart; pneumonia increases the risk of heart failure.
Lack of access to treatment is likely going to cause higher fatality rates: On an average, 14% of patients suffer from a severe form of COVID-19 and might require hospitalization, 7.3% develop a critical disease (e.g., respiratory shock) requiring critical care[iv]. Burkina Faso for example only has a total of 11 ventilators in the whole country[v], Papua New Guinea has 14[vi] to treat patients with acute respiratory distress. Against this background, some governments’ swift decision to lockdown their countries is understandable (see PNG).
Why focus on ASGM communities?
The Artisanal and Small-scale Gold Mining (ASGM) sector offers a rare and desperately needed income opportunity in the face of otherwise collapsing formal and informal income sources in LMICs. This is due to strong and ongoing global gold demand and a stable or rising international gold price – even despite observed local price drops in several ASGM countries. Since the ASGM sector occupies remote and impoverished areas in over 80 LMICs, it also offers a strong, pre-existing infrastructure and a network through which income can continue to flow to communities – and through which health assistance can be delivered. Recognizing this, countries such as Colombia have included gold mining in the list of essential activities that are not subject to shut down, recognizing that many rural households depend on income from gold.
But even if governments impose a lockdown in ASGM regions, it is quite likely that some miners won’t comply simply because they need to earn money in order to eat. In some Conflict Affected and High-Risk Areas (CAHRAs) such as those in Central Africa, the protection of artisanal mining sites from criminal groups is another factor to consider in maintaining ASGM activities and legitimate supply chains – with the aim of preventing these from falling backwards into the wrong hands.
ASGM operations, often viewed as challenging to engage with, in fact offer good opportunities to fight COVID-19 now and to make the sector more resilient for possible future crises. Regardless of why people keep mining, we should make sure that operations and supply chains are safe and do not create favourable conditions for disease transmission. Furthermore, under the current context, it is more important than ever that we strive to help miners receive a fair price for their gold and not be exploited by illicit traders. Reactivated supply chains can therefore support the fight against hunger and potentially even assist in COVID-19 preparedness and response.
Another argument for focusing on artisanal gold mining communities is their high vulnerability. According to the UN Global Humanitarian Response Plan COVID-19 (2020: 16)[vii], these communities can be considered as a most affected and at-risk group when they are located in remote areas with limited access to health care, live as informal workers on a hand-to-mouth basis without any income security, and/or are migrant workers with frequent work-related travels. Mining communities located in remote areas have restricted access to health care services, limiting the opportunities for early screening, access to health information, and adequate treatment. Sparse infrastructure and health knowledge can impede preventive measures such as protocols for hygiene and social distancing. Occupational and livelihood-related risk factors such as silicosis, tuberculosis, and mercury intoxication can increase the severity of COVID-19 due to pre-existing damage of lungs and other central organs (heart, kidneys)[viii]. Furthermore, shifts and tensions in artisanal mining communities caused by an influx of predominantly male workers could easily aggravate gender inequalities, making women and girls even more vulnerable.
This defines artisanal gold mining communities clearly as a highly vulnerable group, but since they are only one of many in remote, rural and impoverished areas of LMICs, are there strategic reasons to target these communities for assistance? We believe there are. Funding and supporting a COVID-19 response in the ASGM sector offers a unique and cost-efficient opportunity to fight hunger – not only among miners, but also their families and people working in the secondary economy. It is also good strategic value now and for the future to aim to avoid losing the progress made by recent development efforts in the sector. It would be costly to slip backwards on responsible mining practices and fair trading arrangements put in place over the last decade. These strategic advantages for the ASGM sector are manifest in strategic priority 2.1 of the UN Humanitarian Response Plan[ix]:
“Preserve the ability of the most vulnerable and affected people to meet the additional food consumption and other basic needs caused by the pandemic, through their productive activities and access to social safety nets and humanitarian assistance.”
All things considered, ASGM communities will in many ways be affected by COVID-19 similarly to other rural communities, except that communities only relying on mining without subsistence or commercial agriculture are considerably at higher risk of food insecurity. However, because they are able to produce what is at this moment, a commodity with highly resilient value and with well-established commercial networks, they can be assisted very cheaply to help them to cope better with the pandemic.
Yet, this is only possible if the gold supply chain remains in-tact and miners can sell their gold, which has unfortunately not been the case in many ASGM communities. Along with the maintenance of supply chains, an effective health program needs to be delivered to mitigate the risk of COVID-19 infiltration, spread and severity in those communities. So, what does a COVID-19 response look like in the artisanal gold mining sector?
A COVID-19 response for the Artisanal Gold Mining Sector
While encouraging governments and the private sector to maintain or reactivate gold supply chains in order to ensure artisanal gold miners can receive fair incomes, we also need to seriously consider the potential consequences of doing so for the containment and control of COVID-19. First and foremost, any response must be in line with national public health policies. Following that, existing and trusted gold supply chain networks and stakeholder interactions could be used to transport necessary goods and information both ways in order to manage the dynamically changing impacts of COVID-19 on health (level of transmission: from no detected cases to community transmission) and livelihoods (income, food security and other emerging issues).
A COVID-19 response in artisanal gold mining can be carried out on two levels: (i) as a community response at mining sites and in mining communities, and (ii) as a health sector-based response.
Community approaches should focus on preventing the infiltration of coronavirus into communities and preventing transmission within communities.
Prevention of infiltration: health education for gold traders
Infected gold traders from urban centres or rural communities – who might or might not show typical symptoms – could potentially spread the coronavirus in rural and isolated artisanal gold mining communities. Therefore, gold traders and gold shop owners should receive training on COVID-19 transmission, symptoms, prevention. Some of this training can be delivered by, for example, organisations with artisanal mining projects on the ground. Gold traders, while interacting with ASGM communities, should be advised to conduct self-monitoring for symptoms, wear protective equipment (mask[x], gloves/hand sanitizer to clean hands), and separate themselves from clients by an adequate distance and/or with barriers like those used in many grocery stores.
Prevention of community transmission: health education for communities
The risk of disease transmission at artisanal gold mining sites depends on the type of mining operation and increases with factors like the number of people working at one site, tool sharing practices, and the presence of non-local workers that have recently travelled from other localities.
Photo 1: Alluvial mining operations in Wau, Papua New Guinea, often only consist of a small group of workers from the same village or household, working dispersed in along the river, which reduces the risk of virus transmission at work (photo: Mareike Kroll, AGC)
Photo 2: Many hard rock operations in Burkina Faso (here: Doudou) consist of larger groups of artisanal miners with higher population density at the mine site, which can potentially increase the risk of virus transmission at work (photo: AGC)
Interventions need to focus on health education and provision of health equipment. COVID-19 containment is highly dependent on the compliance of the population to follow community-based measures such as social distancing, self-isolation and improved hygiene, especially in remote areas with limited abilities of the government to enforce rules through police and military. Information flowing up from AGC’s many local networks indicate that remote artisanal gold mining communities have limited access to information, and this increases the risk of the spread of misinformation and fear/panic.
Therefore, it is important to provide communities with accurate information on COVID-19. Locally connected organizations (e.g., NGOs, miners’ associations) should provide mining communities with information on COVID-19 to increase awareness and avoid common misconceptions, for example in the form of formal trainings, informal discussions, and flyers or posters considering different levels of literacy. This information could also be provided by gold traders visiting communities if they have gone through a proper training of trainers. Materials could also be made available in gold shops and comptoirs. Whenever possible training sessions should be conducted in collaboration with health authorities, health workers from local clinics, or international organisations (IOs) such as Doctors without Borders[xi] who have started a COVID-19 response in several countries with artisanal gold mining sectors.
A lot of useful materials on COVID-19 have been developed by the WHO, other IOs, national health authorities and NGOs (a selection of links will follow soon). Unlike the very specific occupational risk factors in artisanal gold mining such as mercury intoxication, there is no need to reinvent the wheel and produce more materials with respect to COVID-19. It may be necessary, though, to translate materials into some regional languages or transform it into radio broadcasts to reach remote communities.
Furthermore, it could be useful to develop some occupation specific examples of disease prevention behavior, say around mine shafts for example, if there is clearly need and capacity. For example, in sites with crowded work (see photo 2) and on-site living conditions, miners conducting a specific task (e.g., digging in the pit, processing) could form a household and keep their distance to other groups. In case one member of this “household” becomes sick, the whole group would have to self-isolate.
The more critical task is to present the information in a way that artisanal mining communities can understand so that they are able to implement suggested protective measures. Resource availability, feasibility and communities’ concerns must be seriously considered. Depending on the social cohesion within communities, lack of trust in authorities (government, public health sector, police, NGOs) might put local key artisanal gold mining stakeholders in a better position to reach out to these vulnerable communities.
Lessons learned from the Ebola outbreak in 2014 in West Africa show that trust is crucial for communities to reconsider misbeliefs and to seek healthcare when needed, instead of hiding symptoms because of fear of stigmatization or wrong information[xii].
Applying a community engagement approach is therefore critical to ensure that communities’ needs are considered and that they have access to trusted and accurate information (UN 2020). Importantly, communities might sometimes have more appropriate solutions to mitigate transmission risks in their community that fit better in their daily realities. WHO[xiii] has developed a guidance on how to develop a risk communication and community engagement plan when working with specific communities on COVID-19.
Aside from information, ASGM communities will also need support in acquiring protective equipment such as soap, hand sanitizers, hand washing stations at artisanal mining sites and in communities, and masks. Ways to do this might involve mining bosses being mandated to make these items available for their workers or gold traders selling subsidized equipment to miners thereby making use of the gold supply chain as a supply chain of preventative health equipment. Some communities have started to produce their own protective equipment, and this is generally to be encouraged. However, if people do not know how and why to wear masks, or if masks delivered for free are monopolized by one individual, adverse outcomes could occur. These need to be detected and adjusted for; a community engagement approach that is accompanied by health education is therefore needed.
Lastly, existing supply chain infrastructure and networks could be used to a certain extent to collect health information on the impacts of COVID-19 in remote rural communities. This could identify needs with respect to COVID-19 preparedness, response and livelihood impacts. However, reporting formats must be transparent and clearly structured including who provides information and how information is collected, to generate knowledge for evidence-based decision making. This information network could also help to communicate health needs of remote communities to public health authorities, or to international health NGOs that have a presence in country.
COVID-19 response mechanisms in artisanal gold mining cannot rely on an already overburdened health-care sector. Rather, support for the health care sector will need to be generated in order to provide this type of response. Access to health care is usually very limited in artisanal gold mining communities and the existing health workforce, as meager as it is, will certainly be completely occupied by COVID-19 preparedness and response (screening, testing, isolation and treatment). Certainly, any attempt to keep gold supply chains alive cannot put additional pressure on the health care systems. For example, the screening of miners by health workers for fever and other symptoms before entering a mining site is probably difficult to implement in many settings due to shortage of health staff and would in any case risk using valuable health care resources[xiv].
A health sector-based response will differ from country to country, depending on the architecture and capacities of the national health care system. It is crucial to work in line with national public health protocols and not to simply duplicate existing efforts. From a health information perspective, a collaboration and communication system between clinics and artisanal mining communities could be strengthened so that clinics are informed about identified needs, and vice versa whereby communities are informed about clinics’ capacities and when to seek care. High expectations that lead to community dissatisfaction and mistrust (e.g., the demand for a quick cure through a shot) need to be mitigated to avoid attrition of the use of local clinics. Organizations involved in artisanal mining projects could provide logistical and technical support to improve patient flow to COVID-19 testing and treatment centers.
Another possibility is to provide financial, logistical or infrastructural support for clinics to support adequate treatment, especially in areas with ongoing community transmission. In remote artisanal mining communities with limited access to essential medical supplies, gold supply chains could be used to transport small quantities of essentials. If supply chains are reactivated and government tax revenues are flowing, these could be rededicated for example to the purchase of COVID-19 related medical equipment or other preventative measures. It is possible to consider an emergency health contribution derived from gold production, although that would need to come from trusted actors and be supported by the communities themselves due to a possible mistrust in local authorities and institutions.
The type of medical equipment that can be deployed for a health care-based response will depend on the availability of resources and needs and can range from COVID-19 preparedness to provision of critical care. In the early stages of preparation, this could mainly include protective equipment for health workers (masks, gloves, visors, disinfectants, disposable cloths) as an essential step to keep routine operations going without fear of staff contracting an infection.
Screening the population has proven to be an effective strategy. Rapid diagnostic tests that do not require a laboratory for analysis (a lab is likely not available in a small rural clinic, and transport to the next city might take a very long time) or contactless thermometers could be extremely valuable for this step. If artisanal gold mining communities do not have access to health care at all, mobile COVID-19 clinics that serve several mining sites within one region for COVID-19 screening and treatment can be quickly created, providing funds can be secured. In the medium and long-term, those mobile clinics could dedicate their resources to other occupational and livelihood related risks.
Treatment of patients with severe or critical symptoms is the most challenging part of a health sector-based response because it requires isolation wards, respirators, drugs for symptomatic treatment and other costly equipment. Sadly, these are not likely to be realistic facilities to consider for many remote rural artisanal gold mining communities unless large amounts of funds and expertise were to somehow be made available. And even then, the purchase of some medical equipment is likely to be difficult due to limited supplies. Logistical support to transport patients requiring critical care to dedicated COVID-19 treatment centers in surrounding cities might be a starting point.
Overall, a health response to COVID-19 for the artisanal gold mining sector should focus on: (i) improved collaboration between mining communities, mining organisations and the health care sector to communicate needs and information as well as to maximize the use of existing capacities, (ii) community engagement-based health education campaigns to ensure what is available is understood and well utilized; and (iii) the implementation of disease prevention measures with the clear understanding that there will be few critical treatment capabilities.
The use of these existing and trusted stakeholder networks and supply chains in the ASGM sector to deliver health education and support access to health care and preventive infrastructure as well as the possibility to generate income for communities through maintained or reactivated supply chains can provide a meaningful response to COVID-19 and help to mitigate the impact on lives and livelihoods.
[i] https://blogs.worldbank.org/opendata/impact-covid-19-coronavirus-global-poverty-why-sub-saharan-africa-might-be-region-hardest
[ii] https://www.wfp.org/news/wfp-chief-warns-hunger-pandemic-covid-19-spreads-statement-un-security-council
[iii] https://blogs.worldbank.org/opendata/impact-covid-19-coronavirus-global-poverty-why-sub-saharan-africa-might-be-region-hardest
[iv] https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-clinical-features-diagnosis-and-prevention#H3103904400
[v] https://www.nytimes.com/2020/04/18/world/africa/africa-coronavirus-ventilators.html
[vi] https://www.hrw.org/news/2020/04/09/papua-new-guineas-health-system-unprepared-covid-19
[vii] UN OCHA (2020). Global Humanitarian Response Plan COVID-19. Online: https://www.unocha.org/sites/unocha/files/Global-Humanitarian-Response-Plan-COVID-19.pdf
[viii] While acute elemental mercury intoxication can cause acute lung damage, respiratory impacts usually resolve. However, miners with a minimum of 5 to 20 years of dust exposure can suffer from silicosis weakening the lungs. Chronic elemental mercury intoxication can cause kidney impairment, chronic methylmercury intoxication cardiovascular problems such as myocardial infarction, coronary heart disease or high blood pressure. According to recent research (see footnote iv), cardiovascular diseases, chronic lung diseases and chronic kidney diseases have been associated with severe illness and mortality in COVID-19 patients.
[ix] UN OCHA (2020). Global Humanitarian Response Plan COVID-19. Online: https://www.unocha.org/sites/unocha/files/Global-Humanitarian-Response-Plan-COVID-19.pdf
[x] The use of masks in communities is a controversial topic and the WHO advises against wearing masks by healthy individuals in communities due to different potential risks (Source: https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak). Since ASGM communities are highly vulnerable especially due to limited access to health care, the risk of infiltration by pre-symptomatic or asymptomatic gold traders can be considered as high; to avoid any misconceptions, a strong communication strategy should be developed to explain why certain individuals are wearing masks. In some countries with ASGM sector such as Burkina Faso, using masks in public is mandatory now.
[xi] https://www.msf.org/covid-19-depth
[xii] Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2015). Lessons learnt from the 2014 Ebola outbreak in West-Africa. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 20(1), 107–108. Online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354058/
[xiii] WHO (2020). Risk Communication and Community Engagement (RCCE) Action Plan Guidance COVID-19 preparedness and Response. Online: https://www.who.int/publications-detail/risk-communication-and-community-engagement-(rcce)-action-plan-guidance
[xiv] Preventative approaches such as screening for fever and other symptoms at mining sites have their limitations. Infected individuals can remain asymptomatic or spread the coronavirus already two to three days prior to symptom development (Up To Date, 2020).