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A member of the Ukrainian State Border Guard Service wearing a protective mask is seen at the contact line between Ukrainian troops and pro-Moscow rebels in Mayorsk, Ukraine on 17 March, 2020 REUTERS/Gleb Garanich

COVID-19 and Conflict: Seven Trends to Watch

Deadly and disruptive as it already is, and terribly as it could yet worsen and spread, the 2020 coronavirus outbreak could also have political effects that last long after the contagion is contained. Crisis Group identifies seven points of particular concern.

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Overview

The COVID-19 pandemic unquestionably presents an era-defining challenge to public health and the global economy. Its political consequences, both short- and long-term, are less well understood.

The global outbreak has the potential to wreak havoc in fragile states, trigger widespread unrest and severely test international crisis management systems. Its implications are especially serious for those caught in the midst of conflict if, as seems likely, the disease disrupts humanitarian aid flows, limits peace operations and postpones or distracts conflict parties from nascent as well as ongoing efforts at diplomacy. Unscrupulous leaders may exploit the pandemic to advance their objectives in ways that exacerbate domestic or international crises – cracking down on dissent at home or escalating conflicts with rival states – on the assumption that they will get away with it while the world is otherwise occupied. COVID-19 has fuelled geopolitical friction, with the U.S. blaming China for the disease while Beijing tries to win friends by offering aid to affected countries, exacerbating existing great-power tensions that complicate cooperation on crisis management.

It is not yet clear when and where the virus will hit hardest, and how economic, social and political factors may converge to spark or aggravate crises. Nor is it guaranteed that the pandemic’s consequences will be entirely or uniformly negative for peace and security. Natural disasters have sometimes resulted in the diminution of conflicts, as rival parties have had to work together, or at least maintain calm, to focus on preserving and rebuilding their societies. There have been a few signs of governments trying to ease political tensions in the shadow of COVID-19 with, for example, the United Arab Emirates (UAE) and Kuwait offering Iran – centre of one of the worst initial outbreaks outside China – humanitarian assistance. If the pandemic is likely to worsen some crises internationally, it may also create windows to improve others.

Crisis Group is especially concerned with places where the global health challenge intersects with wars or political conditions that could give rise to new crises or exacerbate existing ones.

The coming months will be acutely risky, with the U.S. and European countries focusing on the domestic impact of COVID-19 just as the disease is likely to spread to poor and war-affected countries. With the exception of Iran, in its first phase COVID-19 mainly affected states – including China, South Korea and Italy – that had resources to manage the problem, albeit unevenly and at the cost of severe strains on their health systems and economies. To date, there have been fewer reported cases in countries with weaker health systems, lower state capability or significant internal conflict, where consequences of an outbreak could be overwhelming.

That is of little solace, however. The low numbers are almost certainly a function of insufficient testing or of a delay between the virus’s onset and its manifestation. Confirmed case numbers are ticking up in fragile parts of the Arab world and Africa. If countries struggle to put in place social distancing or other measures to stop the virus’s spread, or delay doing so, they could see spikes of cases like those now overwhelming parts of Europe, but with far fewer emergency care facilities available to save lives. The suffering that would cause is hard to overstate. If the disease spreads in densely packed urban centres in fragile states, it may be virtually impossible to control. The dramatic economic slowdown already under way will disrupt trade flows and create unemployment that will do damage at levels that are hard to forecast and grim to contemplate. A recession could take a particularly heavy toll on fragile states where there is greatest potential for unrest and conflict.

All governments face hard choices about how to manage the virus. Countries from the Schengen area to Sudan have already imposed border restrictions. Many are placing partial or blanket bans on public gatherings or insisting that citizens shelter at home. These are necessary but also costly measures, especially given projections that the pandemic could continue for well over a year until a vaccine becomes available. The economic impact of restricting movement for months on end is likely to be devastating. Lifting restrictions prematurely could risk new spikes in infections and require a return to isolation measures, further compounding the disease’s economic and political impact and requiring further injections of liquidity and fiscal stimulus by governments around the world.

These are universal problems, but as an organisation focusing on early warning and conflict prevention, Crisis Group is especially concerned with places where the global health challenge intersects with wars or political conditions – such as weak institutions, communal tensions, lack of trust in leaders and inter-state rivalries – that could give rise to new crises or exacerbate existing ones. We also hope to identify cases where the disease could, with effective diplomacy, stimulate reductions in tensions. This briefing, the first in a series of Crisis Group publications on COVID-19 and its effects on the conflict landscape, draws primarily from the input of our analysts across the globe, and identifies seven trends to watch during the pandemic.

I. The Vulnerability of Conflict-affected Populations

The populations of conflict-affected countries – whether those in war or suffering its after-effects – are likely to be especially vulnerable to outbreaks of disease.[fn]Except where otherwise noted, this briefing is based on observations from Crisis Group analysts between 1 and 21 March 2020. For previous studies of conflict, public health and pandemics, see Maire A. Connolly and David L. Heymann, “Deadly Comrade: War and Infectious Diseases”, The Lancet, vol. 360 (December 2002); Paul H. Wise and Michele Barry, “Civil War and the Global Threat of Pandemics”, Daedalus, vol. 146, no. 4 (Fall 2017); Nita Madhav, Ben Oppenheim, Mark Gallivan, Prime Mulembakani, Edward Rubin and Nathan Wolfe, “Pandemics: Risks, Impacts and Mitigation”, in D.Y. Jamieson et al. (eds.), Disease Control Priorities, vol. 9 (3rd edition) (Washington, 2017). In many cases, war or prolonged unrest, especially when compounded by mismanagement, corruption or foreign sanctions, have left national health systems profoundly ill-prepared for COVID-19.

In Libya, for example, the UN-backed government in Tripoli has pledged roughly $350 million to respond to the disease, but to what end is unclear: the health system has collapsed due to an outflow of foreign medics during the war.[fn]Libya’s Tripoli government declares emergency, shuts down ports, airports”, Reuters, 14 March 2020.Hide Footnote In Venezuela, as Crisis Group warned would happen in 2016, the standoff between the chavista government and opposition has hollowed out health services. COVID-19 is liable to overwhelm the country’s remaining hospitals very quickly.[fn]Crisis Group Latin America Briefing N°35, Venezuela: Edge of a Precipice, 24 June 2016.Hide Footnote In Iran, the government’s lethargic response compounded by the impact of U.S. sanctions has brought calamity: the virus reportedly is infecting nearly 50 people and taking five to six lives every hour.[fn]“U.S. to Iran: Coronavirus won’t save you from sanctions”, Reuters, 20 March 2020.Hide Footnote In Gaza, where a healthcare system weakened by years of blockade was ill equipped to serve the high-density population long before COVID-19, the Health Ministry is scrambling to gather the experts and obtain the supplies necessary for when the disease sweeps in. It appears to be an uphill climb: medical suppliers serving the region told Crisis Group that they had run out of key items even before the ministry announced two COVID cases on 21 March.

On top of such institutional problems, it can be hard to persuade populations with little trust in government or political leaders to follow public health directives. Reviewing the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone, Crisis Group noted that “the virus initially spread unchecked not only because of the weakness of epidemiological monitoring and inadequate health system capacity and response, but also because people were sceptical of what their governments were saying or asking them to do”.[fn]Crisis Group Africa Report N°232, The Politics Behind the Ebola Crisis, 28 October 2015.Hide Footnote The doubts stemmed in part from misinformation and poor advice about the contagion from the governments involved but also from recurrent political tensions in a region scarred by war in the previous decade.

In cases of active conflict, national and international medics and humanitarian actors may struggle to get relief to people in need. In 2019, the World Health Organization (WHO) and international NGOs struggled to contain an Ebola outbreak in the eastern Democratic Republic of the Congo (DRC), despite support from UN peacekeepers, due to violent local militias that blocked access to some affected areas. At times, combatants targeted doctors and medical facilities themselves. Although the Congolese authorities and WHO apparently succeeded in ending the outbreak in recent months, the disease lasted far longer and claimed far many more lives (with a confirmed 2,264 fatalities) than would have been the case in a stable area.[fn]“DRC Ebola Updates: Crisis Update – March 2020, MSF, 9 March 2020.Hide Footnote Security obstacles are similarly liable to hamper the COVID-19 response in places where hostilities continue.

The areas of active conflict at highest immediate risk of COVID-19 outbreaks may be north-western Syria, around the besieged enclave of Idlib, and Yemen

The areas of active conflict at highest immediate risk of COVID-19 outbreaks may be north-western Syria, around the besieged enclave of Idlib, and Yemen. Both countries have already experienced health crises during their civil wars, with violence impeding the international response to an outbreak of polio in Syria in 2013-2014 and cholera in Yemen from 2016 onward. UN officials have now raised the alarm about COVID-19 infecting the population of Idlib, where a Russian-backed offensive by government forces has systematically targeted hospitals and other medical facilities and led to the displacement of over one million people in the last six months alone.[fn]See also Evan Hill and Yousur Al-Hlou, “‘Wash our hands? Some people can’t wash their kids for a week’”, The New York Times, 20 March 2020.Hide Footnote Many people fleeing clashes sleep in fields or under trees, and basic hygiene and social distancing practices are made impossible by the lack of running water or soap as well as cramped living spaces. Delivery of vital test kits has been delayed by weeks. Humanitarian workers fear that an outbreak of the disease in Idlib would both overwhelm the province’s medical facilities and make it impossible to care for victims of war.

In Yemen, war since 2015 has decimated what even before was a very weak heath system. Over 24 million people already require humanitarian assistance.[fn]“Humanitarian crisis in Yemen remains the worst in the world, warns UN”, UN News, 14 February 2019.Hide Footnote After de facto authorities in the capital city of Sanaa and the internationally recognised government in Aden banned international flights to prevent the virus from spreading, international relief teams reduced their numbers to essential staff. A COVID-19 outbreak could rapidly overwhelm aid efforts and make one of the world’s most serious humanitarian catastrophes even more dire.

In Idlib, Yemen and beyond, internally displaced persons (IDPs), asylum seekers and refugees are particularly exposed to outbreaks of COVID-19, given their frequently squalid living conditions and limited access to health care. Data released by the UN High Commissioner for Refugees in 2019 suggest that over 70 million people fall into these categories of displacement globally, and the number has most likely risen since then, especially given events in Syria.[fn]“Worldwide displacement tops 70 million, UN refugee chief urges greater solidarity in response”, UN High Commissioner for Refugees, press release, 19 June 2019.Hide Footnote Whatever narrow avenues might have existed for displaced persons to move or be resettled to safer and more secure locations are, for all intents and purposes, now shut off due to COVID-19.

There is a long history of contagion spiking in IDP and refugee camps, a risk that now looms again, although in some areas medical services available in camps may be better than those for surrounding populations. UN officials are particularly concerned about the al-Hol camp in north-eastern Syria, home to over 70,000 people, including women and children who fled the Islamic State’s last territorial foothold as it collapsed, among them Syrians, Iraqis and approximately 10,000 nationals of other countries. As we wrote about the camp in the fall of 2019, it was already “a scene of humanitarian disaster, rampant with disease – its residents lacking adequate food, clean water, often cut off entirely from medical services”, leaving its population highly vulnerable to COVID-19.[fn]Crisis Group Middle East Report N°208, Women and Children First: Repatriating the Westerners Affiliated with ISIS, 18 November 2019, p. 4.

Also of concern are the Rohingya refugee camps in Bangladesh, where over one million people live in overcrowded conditions, with sanitation facilities and health care services limited to a bare minimum.[fn]See Crisis Group Asia Report N°303, A Sustainable Policy for Rohingya Refugees in Bangladesh, 27 December 2019.Hide Footnote A government ban on internet and mobile phone services in the camps limits access to vital preventive information, while high levels of malnutrition likely imply that both the refugees and local residents are more susceptible to the disease. Should COVID-19 reach the camps, humanitarian agencies expect it to spread like wildfire, potentially triggering a backlash from Bangladeshis who live in the surrounding areas and are already unnerved by the refugees’ prolonged stay.

In these cases – as for displaced communities in Iraq and elsewhere in the Middle East, Africa and Asia – there is a risk that IDPs and refugees facing large-scale outbreaks of COVID-19 in the camps where they reside may aim to flee again to safety, leading local populations or authorities to react forcefully to contain them, which creates the potential for escalating violence. States attempting to stop the spread of the disease are likely to view new refugee flows fearfully. Colombia and Brazil, for example, closed their borders with Venezuela after previously taking a relatively generous approach to those fleeing the crisis there, but the pressure to escape worsening poverty and health risks in Venezuela could force rising numbers of migrants to use illegal crossings.

The COVID-19 emergency could also exacerbate the humanitarian crisis in Central America tied in part to the Trump administration’s immigration policies, as well as the region’s already high levels of violent crime. Having announced the closure of its southern border to all non-essential traffic from 21 March, the U.S. may seek to strengthen efforts to halt the arrival of migrants and refugees from Central America and return them to host countries. El Salvador and Guatemala nevertheless suspended in mid-March all incoming flights of Central American deportees from the U.S. The service to Guatemala has since resumed, but it remains to be seen whether Washington can continue to export deportees when both these countries have grounded all other international passenger flights. 

At a time of grave threat to Central America’s fragile economies, moves to continue U.S. and Mexican deportation flights could expose growing numbers of displaced people to a frosty reception once they land, as locals may fear that the arrivals are spreading disease. Many deportees are likely to face the choice of heading back to the U.S. border, with the support of trafficking networks, or becoming victims or accomplices of the region’s pervasive criminal groups and street gangs.

In many cases, COVID-19’s impact on refugees and IDPs will be felt disproportionately by women, who often form the majority of displaced populations in conflict-afflicted regions. These women’s access to services and ability to feed their families are already deeply constrained by stigma relating to their ties (real or alleged) to armed groups. Exposed to sexual exploitation or abuse, with their rehabilitation or integration back into communities a low priority for feeble or indifferent governments, displaced women and children stand poised to be affected fast and first by the economic crises that will accompany the spread of the disease.

II. Damage to International Crisis Management and Conflict Resolution Mechanisms

One reason why refugee and IDP populations are likely to be especially vulnerable to COVID-19 is that the disease could severely weaken the capacity of international institutions to serve conflict-affected areas. WHO and other international officials fear that restrictions associated with the disease will impede humanitarian supply chains. But humanitarian agencies are not the only parts of the multilateral system under pressure due to the pandemic, which is also likely to curb peacemaking.

Travel restrictions have begun to weigh on international mediation efforts. UN envoys working in the Middle East have been blocked from travelling to and within the region due to airport closures. Regional organisations have suspended diplomatic initiatives in areas ranging from the South Caucasus to West Africa, while the envoy of the International Contact Group on Venezuela – a group of European and Latin American states looking for a diplomatic solution to the crisis there – had to cancel an already long-delayed trip to Caracas in early March for COVID-related reasons.[fn]A delegation of diplomats planning to visit Nagorno-Karabakh on behalf of the Organization for Security and Co-operation in Europe cancelled the trip, while West African leaders planning to visit Guinea to discuss a contentious referendum also called off their visit.
 Hide Footnote

A delegation of diplomats planning to visit Nagorno-Karabakh on behalf of the Organization for Security and Co-operation in Europe cancelled the trip, while West African leaders planning to visit Guinea to discuss a contentious referendum also called off their visit.
 

Hide Footnote The disease could affect crucial intra-Afghan peace talks planned as a follow-up to the February preliminary agreement between the U.S. and the Taliban, at least reducing the number of those who can participate (although limiting the group to real decision-makers and essential support staff could be conducive to serious talks).[fn]In a possible sign of progress, U.S. Representative for Afghanistan Reconciliation Zalmay Khalilzad tweeted on 22 March that the U.S. and Qatar had facilitated technical talks on prisoner releases between the Afghan government and Taliban “via Skype video conferencing”.Hide Footnote

Covid-19 means that international leaders, focused as they are on dramatic domestic issues, have little or no time to devote to conflicts or peace processes

More broadly, the disease means that international leaders, focused as they are on dramatic domestic issues, have little or no time to devote to conflicts or peace processes. European officials say that efforts to secure a ceasefire in Libya (a priority for Berlin and Brussels in February) are no longer receiving high-level attention. Diplomats working to prevent a deadly showdown in northern Yemen desperately need the time and energy of senior Saudi and U.S. officials but report that meetings with both are being cancelled or curtailed. Kenya’s president Uhuru Kenyatta called off a 16 March summit with counterparts from Ethiopia and Somalia that aimed to defuse dangerously escalating tensions between Nairobi and Mogadishu, with Kenyan officials citing their need to focus on efforts to halt the virus’s potential spread.[fn]“Kenya’s president cancels two foreign meetings over Covid-19”, The East African, 15 March 2020.Hide Footnote A summit between leaders of the EU and the “G5 Sahel countries” (Burkina Faso, Chad, Mali, Mauritania and Niger) will also be cancelled, dealing a blow to efforts to boost counter-terrorism operations in the region.

The disease could also affect multinational peacekeeping and security assistance efforts. In early March, the UN secretariat asked a group of nine peacekeeping troop contributors – including China and Italy – to suspend some or all unit rotations to blue helmet operations due to concerns about the spread of COVID-19.[fn]These initial restrictions reflected requests from host and transit countries (including Uganda, an important UN logistical hub) to the UN not to risk spreading the disease. UN Department of Operational Support correspondence with permanent representatives to the UN, 5 March 2020 (seen by Crisis Group, 9 March 2020).Hide Footnote UN operations have announced further limits to rotations since then, meaning that peacekeepers’ tours of duty will be extended for at least three months in tough mission settings such as the Central African Republic and South Sudan, potentially affecting their morale and effectiveness. A Security Council decision on setting up a new political mission to support Sudan’s transition to civilian rule appears likely to be postponed due to constraints on the Council’s meeting schedule to which its members agreed as part of virus containment measures.[fn]The Security Council postponed meetings from 16 March onward and has tested virtual meeting options, although diplomats will still meet occasionally to vote.Hide Footnote While these diplomatic and operational decisions will have no immediate impact on UN operations, a prolonged pandemic could make it difficult to find and deploy fresh forces and civilian personnel, wearing down missions.

If international organisations may struggle to handle the crisis, media outlets and NGOs may also find it hard to report on conflict and crises due to travel restrictions, even as many readers and viewers are likely at least temporarily to lose interest in non-COVID-19-related stories. Some authoritarian governments seem ready to use the crisis to limit media access. Egypt has, for example, censured Western reporters for their coverage of the disease inside the country – removing the credentials of a Guardian reporter – while China has sent home a number of leading U.S. correspondents. Crisis Group itself has had to place significant limits on our analysts’ ability to travel during the pandemic for their own safety. As this briefing illustrates, we are determined to keep a spotlight on conflicts – whether related to COVID-19 or not – and provide the best coverage possible, but our work will face inevitable constraints.

III. Risks to Social Order

COVID-19 could place great stress on societies and political systems, creating the potential for new outbreaks of violence. In the short term, the threat of disease is likely acting as a deterrent to popular unrest, as protesters avoid large gatherings. COVID-19’s emergence in China precipitated a decline in anti-Beijing protests in Hong Kong (although public discomfort with radical elements of the protest movement may also have been a factor).[fn]Helen Davidson, “Hong Kong: With coronavirus curbed, protests may return”, The Guardian, 15 March 2020.Hide Footnote There has been a decline, too, in the numbers of protesters taking to the streets in Algeria to challenge government corruption.[fn]“Algerians forego weekly protest amid coronavirus”, Reuters, 20 March 2020.Hide Footnote The Russian opposition largely acquiesced in the authorities’ move, ostensibly justified on health grounds, to block protests against President Vladimir Putin’s decision to rewrite the constitution to extend his tenure in office.[fn]“Coronavirus forces Putin critics to scale back protests before big vote”, Reuters, 20 March 2020.Hide Footnote At least one exception to this general caution occurred in Niger, where demonstrators took to the streets against rules barring protest, which the government extended by invoking COVID-19. Three civilians were killed by security forces on 15 March.

Yet the quiet in the streets may be a temporary and misleading phenomenon. The pandemic’s public health and economic consequences are liable to strain relations between governments and citizens, especially where health services buckle; preserving public order could prove challenging when security forces are overstretched and populations become increasingly frustrated with the government’s response to the disease.

Early signs of social disorder already can be seen. In Ukraine, protesters attacked buses carrying Ukrainian evacuees from Wuhan, China, in response to allegations that some were carrying the disease.[fn]“Coronavirus: Ukraine protesters attack buses carrying China evacuees”, BBC, 21 February 2020.Hide Footnote Prison breaks have been reported in Venezuela, Brazil and Italy, with inmates reacting violently to new restrictions associated with COVID-19, while in Colombia prison riots and a reported jailbreak over the perceived lack of protection from the disease resulted in the death of 23 inmates at La Modelo jail on 21 March. In Colombia as well, looters attacked food trucks headed for Venezuela, at least in part to protest the economic effects of the decision taken by both Bogotá and Caracas to close the Colombian-Venezuelan border for health reasons. Even reasonable precautions may inspire angry responses. In Peru, the authorities have arrested hundreds of citizens for breaking quarantine rules, in some cases leading to violence.

The disease’s catastrophic economic impact could well sow the seeds of future disorder.

More broadly, the disease’s catastrophic economic impact could well sow the seeds of future disorder. It could do so whether or not the countries in question have experienced major outbreaks of the disease, although the danger in those that have will be magnified. A global recession of as yet unknown scope lies ahead; pandemic-related transport restrictions will disrupt trade and food supplies; countless businesses will be forced to shut down; and unemployment levels are likely to soar.[fn]Some financial analysts are predicting a “severe global recession” resulting from the outbreak. The U.S. economy, to cite one example, is predicted to contract by 14 per cent in the second quarter of 2020. “Assessing the Fallout from the Coronavirus Pandemic”, JP Morgan, 20 March 2020.Hide Footnote

Governments that have close trading ties with China, especially some in Africa, are feeling the pain of the slowdown emanating from the original Wuhan outbreak.[fn]See, for example, Hannah Ryder and Angela Benefo, “China’s coronavirus slowdown: Which African economies will be hit hardest?”, The Diplomat, 19 March 2020.Hide Footnote Oil producers are already struggling with the collapse of energy prices. Countries like Nigeria, which has strong import/export links to China and relies on oil prices to prop up its public finances, are suffering. Abuja has reportedly considered cutting expenditures by 10 per cent in 2020, meaning that authorities may have to default on promises to raise the minimum wage.[fn]“Silk roadblock: coronavirus exposes Nigeria’s reliance on China”, Reuters, 6 March 2020.Hide Footnote Such austerity measures, combined with other economic effects of COVID-19 – such as the disappearance of tourists in areas that depend heavily on foreign visitors – could lead to economic shocks that last well beyond the immediate crisis, creating the potential for prolonged labour disturbances and social instability.

As Crisis Group noted at the start of 2020, the raucous protests of 2019 stemmed from a “pervasive sense of economic injustice” that could “set more cities ablaze this year”.[fn]Robert Malley, “10 Conflicts to Watch in 2020”, Crisis Group Commentary, 27 December 2019.Hide Footnote Anger over the effects of COVID-19 – and perceptions that governments are mismanaging them – could eventually trigger new demonstrations. The economic decline will have even more immediate effects on societies in low-income countries. Across large swathes of sub-Saharan Africa in particular, millions depend on their daily income to feed their families. An extended lockdown could rapidly create widespread desperation and disorder.

One further reason for worry is COVID-19’s clear potential to unleash xenophobic sentiment, especially in countries with large immigrant communities. Early in the crisis, Chinese labourers in Kenya faced harassment linked to suspicions that China Southern Airline flights were bringing the coronavirus into the country. Some Western politicians, notably U.S. President Donald Trump, have attempted to whip up resentment of Beijing with jibes about the “Chinese virus”. There is anecdotal evidence of an increase in prejudice toward people of Chinese ethnicity in the U.S. and other Western countries, and a serious risk that the diseases will fuel more racist and anti-foreigner violence.[fn]See for example Holly Yan, Natasha Chen and Dushyant Naresh, “What’s spreading faster than coronavirus in the U.S.? Racist assaults and ignorant attacks against Asians”, CNN, 21 February 2020.Hide Footnote

IV. Political Exploitation of the Crisis

Against this background of social pressures, there is ample room for political leaders to try to exploit COVID-19, either to solidify power at home or pursue their interests abroad. In the short term, many governments seem confused by the speed, reach and danger of the outbreak and, in some cases, the disease has infected political elites. An outbreak in Brazil’s isolated capital, Brasilia, has sickened a large number of officials and politicians. In Iran, there have been dozens of cases among senior officials and parliamentarians. In Burkina Faso, where the government is already struggling with the collapse of state authority in large parts of the country, a rash of cases has hit cabinet members. The secondvice president of the parliament was the first recorded fatality in sub-Saharan Africa. In such instances, the disease is more likely to weaken authorities’ ability to make decisions about both health issues and other pressing crises.

Nonetheless, as the crisis goes on, some leaders could order restrictive measures that make public health sense at the peak of the crisis and then extend them in the hope of quashing dissent once the disease declines. Such measures could include indefinite bans on large public gatherings – which many governments have already instituted to stop community spread of COVID-19 – to prevent public protests. Here again there are precedents from West Africa’s Ebola crisis: local civil society groups and opposition parties claim that the authorities prohibited meetings for longer than necessary as a way of suppressing legitimate protests.[fn]Crisis Group Report, The Politics Behind the Ebola Crisis, op. cit., p. 25.Hide Footnote A harbinger of what is to come may have appeared in Hungary, where Prime Minister Viktor Orban asked parliament on 21 March to indefinitely extend a state of emergency that prescribes five-year prison sentences for those disseminating false information or obstructing the state’s crisis response.[fn]“Hungary govt seeks to extend special powers amid coronavirus crisis”, Reuters, 21 March 2020.Hide Footnote

There is ample room for political leaders to try to exploit COVID-19.

Elections scheduled for the first half of 2020, and perhaps later, are also liable to be postponed; here too, the immediate public health justification may be valid but the temptation to use the virus as a pretext for further delays and narrowing of political space could well exist. Indeed, there are likely to be good practical reasons for delaying voting in such cases. In addition to complicating domestic planning, the pandemic will obstruct the deployment of international electoral support and, where planned, observation missions. Still, opposition parties are likely to suspect foul play, especially in countries where political trust is low, there has been recent instability, or the government enjoys dubious legitimacy or has a history of manipulating electoral calendars.

Again, there are already examples. The interim president in Bolivia, Jeanine Añez, announced on 21 March that the presidential election planned for 3 May to find a full-time replacement for Evo Morales – whom the military ousted after controversial polls in 2019 – would be delayed to an unspecified future date. In Sri Lanka, an Election Commission decision to postpone parliamentary elections for public health reasons could grant President Gotabaya Rajapaksa – a hardline nationalist associated with human rights abuses directed at minorities and political critics – enhanced powers. Although Rajapaksa initially wanted the polls to go ahead (reflecting expectations of a landslide victory), should he refuse to recall parliament while elections remain on hold, the length and legality of his interim powers may well stir controversy.

Some leaders may also see COVID-19 as cover to embark on destabilising foreign adventures, whether to deflect domestic discontent or because they sense they will face little pushback amid the global health crisis. No such case has yet surfaced, and there is a risk that analysts will now attribute crises to COVID-19 that are better explained by other factors. Still, at a time when the pandemic is distracting major powers and multilateral organisations, some leaders may surmise that they can assert themselves in ways that they would otherwise deem too risky. A spate of attacks against U.S. targets by Iranian-backed Shiite militias in Iraq may well be part of a pre-existing effort by Tehran to push the U.S. out of the Middle East. But with Iran’s leadership already under enormous domestic pressure, the toll taken by the coronavirus might also affect its calculus. As we wrote, “feeling besieged and with no obvious diplomatic exit ramp, Iran might conclude that only a confrontation with the United States might change a trajectory that’s heading in a very dangerous direction”.[fn]Robert Malley and Ali Vaez, “The coronavirus is a diplomatic opportunity for the United States and Iran”, Foreign Policy, 17 March 2020.Hide Footnote

Similarly, the crisis may create openings for jihadist groups to launch new offensives against weakened governments in Africa and the Middle East. To date, neither ISIS nor any of al-Qaeda’s various branches has displayed a clear strategic vision relating to the pandemic (although ISIS has circulated health guidance to its militants on how to deal with the disease based on sayings by the Prophet Muhammad).[fn]“ISIS tells terrorists to steer clear of coronavirus-stricken Europe”, Politico, 15 March 2020.Hide Footnote Nonetheless, as Crisis Group has previously argued, jihadist forces tend to “exploit disorder”, gaining territory and adherents where conflicts already exist or weak states face social turmoil.[fn]Crisis Group Special Report N°1, Exploiting Disorder: Al-Qaeda and the Islamic State, 14 March 2016.Hide Footnote ISIS, for example, used the post-2011 chaos in Syria to gain a level of power that would otherwise have been impossible. It is possible that social and political disorder may create similar openings for jihadist actors as the crisis goes on. Conversely, those groups – such as al-Shabaab in Somalia – that control significant swathes of territory could, like governments, face a surge of public discontent if they cannot keep COVID-19 in check.[fn]Al-Shabaab’s performance in handling famines in 2011 and 2017 – both exacerbated by conflict and the group’s restrictions on aid – offers scant reassurance as to how it might handle the present pandemic. See Crisis Group Africa Briefing N°125, Instruments of Pain (III): Conflict and Famine in Somalia, 9 May 2017.Hide Footnote

V. A Turning Point in Major Power Relations?

The potential effects of COVID-19 on specific trouble spots is magnified by the fact that the global system was already in the midst of realignment.[fn]Malley, “10 Conflicts to Watch in 2020,” op. cit.Hide Footnote The current moment thus stands apart from other, still relatively recent, international crises. When the financial crash prompted a global economic downturn in 2008, the U.S. still held enough clout to shape the international response through the G20, although Washington was careful to involve Beijing in the process. In 2014, the U.S. took charge of a belated multilateral response to the West Africa Ebola crisis helped by countries ranging from the UK and France to China and Cuba.[fn]See Ted Piccone, “Ebola could bring U.S. and Cuba together”, The Brookings Institution, 31 October 2014.Hide Footnote Today, the U.S. – whose international influence already had considerably weakened – has simultaneously mishandled its domestic response to COVID-19, failed to bring other nations together and stirred up international resentment. President Donald Trump has not only harped on the disease’s Chinese origins but also criticised the EU for bungling its containment.

China, by contrast, after having to cope with the consequences of the initial outbreak, its early and costly decision to hold back information, and its own uneven response, and having sought at times to blame the U.S. by waging an irresponsible misinformation campaign, now sees in the health crisis an opportunity to gain influence over other states through humanitarian gestures.[fn]See Conor Finnegan, “False claims about origins of the coronavirus cause spat between the U.S., China”, ABC, 13 March 2020. Some Chinese diplomats appear uncomfortable with Beijing’s insinuations that COVID-19 came from the U.S. See “Spat between Chinese diplomats shows internal split over Trump”, Bloomberg, 23 March 2020.Hide Footnote China has kicked its diplomatic machine into high gear to position itself as leading the international response to potential widespread outbreaks of COVID-19 on the African continent.[fn]For example, see Laura Zhou, “Will China’s support for nations fighting Covid-19 improve its global image?”, South China Morning Post, 22 March 2020.Hide Footnote On 16 March, Chinese billionaire Jack Ma announced that his foundation would give 20,000 testing kits, 100,000 masks and a thousand units of protective gear to each of the continent’s 54 countries. He said it would channel the donations through Ethiopia, with Prime Minister Abiy Ahmed, the 2019 Nobel Peace Prize winner, coordinating distribution.[fn]“As virus spreads, Africa gets supplies from China’s Jack Ma”, Associated Press, 22 March 2020.Hide Footnote On 19 March, Beijing further bolstered its diplomacy on the subject, announcing plans to build an African Centre for Disease Prevention and Control research facility in Nairobi.[fn]“Kenya to host Sh8 billion Africa disease control centre”, The Standard, 19 March 2020.Hide Footnote Beijing has also rolled out offers of assistance to EU members, blunting European criticisms of its initial handling of the contagion in Wuhan.[fn]“China steps up support for European countries hardest hit by coronavirus”, South China Morning Post, 18 March 2020. On the effects of Chinese aid on European perceptions, see Steven Erlanger, “In this crisis, U.S. sheds its role as global leader”, The New York Times, 22 March 2020.Hide Footnote

Despite the WHO’s pleas for unity, the pandemic is taking on a divisive geopolitical hue

Overall, despite the WHO’s pleas for unity, the pandemic is taking on a divisive geopolitical hue. Some leaders have framed it very clearly in these terms. Serbian President Aleksandar Vučić, for example, declared that – lacking any real support from the EU – “all my personal hopes are focused on China and its president”.[fn]Julija Simic, “Serbia turns to China due to ‘lack of EU solidarity’ on coronavirus”, Euractiv, 18 March 2020.Hide Footnote While Riyadh, which currently presides over the G20, has called for a “virtual summit” of leaders (similar to one already held by the G7), the crisis could increase tensions among Washington, Beijing and other powers. EU experts have warned that Russia is spreading disinformation about COVID-19 in Western countries.[fn]“Russia deploying coronavirus disinformation to sow panic in West, EU document says”, Reuters, 18 March 2020.Hide Footnote Jockeying among the big powers to take advantage of the general disarray could not only complicate technical cooperation against COVID-19, but also make it harder for the powers to agree on how to handle the political disputes it creates or exacerbates.

More broadly, the coronavirus and how it will be dealt with is likely to have a profound influence on the shape of the multilateral order that will emerge in its aftermath. It is too early to assess those implications. For now, one can discern two competing narratives gaining currency – one in which the lesson is that countries ought to come together to better defeat COVID-19, and one in which the lesson is that countries need to stand apart in order to better protect themselves from it.[fn]Yuval Noah Harari calls this the choice between “nationalist isolation and global solidarity”. “The world after coronavirus”, Financial Times, 20 March 2020.Hide Footnote The crisis also represents a stark test of the competing claims of liberal and illiberal states to better manage extreme social distress. As the pandemic unfolds, it will test not only the operational capacities of organisations like the UN and WHO, but also basic assumptions about the values and political bargains that underpin them.

VI. Opportunities to Be Seized

While the warning signs associated with COVID-19 are significant, there are also glimmers of hope. The scale of the outbreak creates room for humanitarian gestures between rivals. The UAE has, for example, airlifted over 30 tonnes of humanitarian aid to Iran to deal with the disease (Bahrain, by contrast, took the opportunity to accuse the Islamic Republic of “biological aggression”).[fn]Nafisa Eltahir and Lisa Barrington, “Bahrain accuses Iran of ‘biological aggression’, Gulf states try to curb coronavirus”, Reuters, 12 March 2020.Hide Footnote States with closer relations with Iran, including Kuwait and Qatar, have also proffered assistance. President Trump wrote to North Korea’s leader, Kim Jong-un, expressing willingness to help Pyongyang confront the disease, prompting a message of gratitude in response.[fn]Choe Sang-Hun, “Trump writes to Kim Jong-un offering help in virus fight, North Korea says”, The New York Times, 21 March 2020.Hide Footnote Despite closing its border with Venezuela, the Colombian government has also had its first official contact with Caracas in over a year under the aegis of the teleconference mediated by the Pan American Health Organization to discuss a joint health care response in border areas. Anti-chavista politicians have also taken tentative steps to work with their rivals to address the crisis, as occurred in the border state of Táchira.

Two other examples: in the Caucasus, the U.S. sent its first aid to the secessionist Georgian region of Abkhazia in over a decade to help counter COVID-19 even though Abkhaz authorities are coordinating with Moscow rather than Tbilisi over the disease. In the Philippines, the normally hawkish President Rodrigo Duterte announced a one-month unilateral ceasefire with communist rebels, to allow government forces time to focus on the pandemic.[fn]“Duterte asks NPA for ceasefire during coronavirus lockdown”, Rappler.com, 17 March 2020.Hide Footnote

As the devastation spreads and economies shrink, pressures may grow on governments and opposition in polarised situations to find common ground.

These are only relatively small positive steps. But as the devastation spreads and economies shrink, pressures may grow on governments and opposition in polarised situations to find common ground if that is a condition for stability and receiving international assistance. Academic surveys show that warring parties frequently respond to natural disasters with agreements to reduce violence. A similar dynamic may apply in some conflicts in the face of COVID-19, although the scale of the crisis – and its emerging impact on international diplomacy – could make it hard for outside mediators and multilateral organisations to support peacemaking efforts as they could in more normal times.[fn]See Joakim Kreutz, “From Tremors to Talks: Do Natural Disasters Produce Ripe Moments for Resolving Separatist Conflicts?”, International Interactions, vol. 8, no. 4 (2012).Hide Footnote

Earlier this month, Crisis Group pressed the U.S. and Iran to seize this moment and reach a mutually beneficial understanding: Tehran would release all its dual national or foreign detainees (who face real risks from the disease in Iranian prisons) while Washington would loosen its sanctions (which are exacerbating the harrowing humanitarian situation Iran faces as a result of its own mismanagement of the COVID-19 crisis).[fn]Malley and Vaez, “The coronavirus is a diplomatic opportunity for the United States and Iran”, op. cit.Hide Footnote Since then, Tehran has made concessions on prisoners – swapping a French detainee for an Iranian held in France and allowing a British-Iranian prisoner to leave jail temporarily. While the U.S. has said it would send humanitarian assistance to Iran, the Islamic Republic’s leadership promptly rejected the offer as disingenuous, pointing to the fact that U.S. sanctions remain fully in place. Supreme Leader Ayatollah Ali Khamenei has cited conspiracy theories blaming the U.S. for the illness.[fn]Jon Gambrell, “Iran leader refuses U.S. help to fight COVID-19, citing conspiracy theory”, Associated Press, 22 March 2020.Hide Footnote

VII. Potential Crisis Mitigation Measures

Looking ahead, governments will have to decide whether to support more cooperative approaches to handling the crisis, not only in global public health terms but also as a political and security challenge. All leaders face pressure to focus on and spend money and political capital on domestic priorities, and in particular to ignore conflict risks in weak states that may seem hard to resolve or simply not important enough to worry about. But there will be a day after, and if the coming period is not dealt with wisely, it could be marked by major disruptions in already conflict-ridden areas, the eruption of new violence and a far more fragile multilateral system. In addition to following the negative and positive trends noted above, Crisis Group will also be watching to see if states and multilateral institutions take preventive and mitigating measures to limit the pandemic’s impact on peace and security.

In that spirit, and to mitigate the possibility that COVID-19 brings about a new generation of security crises, governments aiming to limit the pandemic’s impact could consider the following steps:

  • Follow needs assessments from the UN, the International Committee of the Red Cross and other relevant agencies, and inject essential COVID-19-related funding into humanitarian support, especially for refugees and IDPs, factoring in the disproportionate risks for displaced women;
     
  • Work with the UN, International Monetary Fund and World Bank – which have already started to mobilise funds to address health system failures and economic jolts resulting from COVID-19 – to assess the social and political shocks potentially arising from the pandemic to governments in weak states, and offer financial aid and debt relief;
     
  • Offer sanctions relief to states affected by COVID-19 and that are under sanctions, through multilateral frameworks such as the EU or UN, or through the suspension of unilateral sanctions, as appropriate if only temporarily, on humanitarian grounds, and remove any obstacles to the delivery of humanitarian goods;
     
  • Try to keep peace processes and conflict prevention efforts alive by working with UN envoys and other mediators to, for example, maintain secure electronic communications with conflict parties;
     
  • Where authorities delay elections or other polls for legitimate COVID-19 related reasons, offer outside support – such as declarations of extra-electoral assistance once the disease subsides, or quiet diplomacy between the parties – to reassure citizens that they will eventually get to vote;
     
  • Where possible, establish or strengthen diplomatic back channels among states and non-state actors most affected by the crisis to communicate over potential escalatory risks in tense regions;
     
  • Invest in efforts led by the WHO, independent media, non-governmental organisations and civil society to share impartial news about COVID-19 in weak states to counter rumour and political manipulation of the crisis as well as to keep a spotlight on conflicts that require international help.
     

The COVID-19 pandemic threatens to be long and draining. It will make diplomacy, and especially crisis diplomacy, harder. But it is crucial to keep channels of communication – and a spirit of cooperation – intact in a period when the international system seems as ready as ever to fragment.

New York/Brussels, 24 March 2020

Women wearing protective face masks talk outside a market, as the coronavirus disease (COVID-19) pandemic continues, in Karachi, Pakistan July 28, 2020. REUTERS/Akhtar Soomro
Briefing 162 / Asia

Pakistan’s COVID-19 Crisis

A federal government misstep – lifting a lockdown too soon – has placed Pakistan among the twelve countries hardest hit by coronavirus. Nor has the economy recovered as intended. Authorities should let provinces make more health decisions and focus on helping citizens in need.

What’s new? Hoping to mitigate COVID-19’s economic toll, Imran Khan’s Pakistan Tehreek-e-Insaf government lifted a countrywide lockdown in May, leading to a spike in cases. August could see another surge since the public, misled by the clergy and mixed messaging from the government itself, may disregard precautions during religious festivities and ceremonies.

Why does it matter? Climbing infection rates could overwhelm ill-equipped health systems and hinder economic recovery. If citizens are denied health care or adequate aid as the economy contracts, public anger is likely to mount, potentially threatening social order. Militants could take advantage, as they have in the past.

What should be done? The federal government should guide provinces on pandemic policy and help reinforce their health systems but also permit them to devise their own local strategies guided by medical experts. It should work with the parliamentary opposition on its response, particularly on providing a safety net to vulnerable parts of society.

I. Overview

On 9 May, the Pakistan Tehreek-e-Insaf government almost completely lifted a nationwide lockdown it had imposed in late March to counter COVID-19. Pakistan subsequently saw a surge in cases, placing it among the top twelve pandemic-affected countries worldwide. The government justifies the easing of nationwide restrictions on economic grounds; indeed, the lockdown’s toll on the most vulnerable, workers and the poor has been brutal. Yet signs of economic recovery since it was lifted are few, while the virus threatens to overwhelm ill-equipped and under-funded health systems. Rising anger and alienation among citizens could threaten social order, potentially giving militants an opening to gain support. The federal government should revise its approach. It should seek consensus with political rivals on its coronavirus strategy, pay greater heed to public health experts, if feasible step up aid to families unable to get by and give the provinces more leeway to lead local efforts to deal with the public health crisis.

The government’s mixed messaging and misinformation from some religious leaders mean that many Pakistanis disregard public health advice.

The government’s mixed messaging and misinformation from some religious leaders mean that many Pakistanis disregard public health advice. Prime Minister Imran Khan’s initial downplaying of the pandemic’s health risks led to widespread public disregard for social distancing procedures. The removal of restrictions on communal prayers in mosques also increased the risks of new virus clusters. Many clerics advocate religious practices that undercut physical distancing and other preventive measures; they tell worshippers that piety alone, and not health practices, will determine their fate. The federal government’s easing of lockdown measures, despite warnings by the political opposition and medical professionals that transmissions would surge, and the further lifting of the lockdown, on 9 May, encouraged public complacency. Though the government now urges people to respect social distancing rules, these calls are largely ignored. Many believe that the pandemic is over.

The federal government’s adoption of what it calls a “smart lockdowns” strategy may not be enough. The strategy entails removing restrictions in specific areas within cities or regions where the authorities assess that case rates are relatively low and imposing them where they are high. But poor data and low testing rates have hampered efforts to “track, trace and quarantine”, which involve identifying and isolating virus carriers and their contacts and placing hot-spots under quarantine, and are essential to curbing the virus. With COVID-19 spreading in densely populated cities such as Karachi, Lahore and Peshawar, limited closures are unlikely to prevent contagion. While city hospitals are better prepared to deal with the pandemic than some weeks ago, they could again be overwhelmed should cases surge in August, particularly if citizens ignore precautions during Eidul Azha celebrations and the month of Muharram, when large mourning processions are held. The virus has also spread to rural regions, where the health infrastructure is even weaker.

The federal government’s centralised decision-making has often made things worse. It has refused to share authority, even though the constitution grants the provinces responsibility for the health sector. Islamabad’s pandemic policies, devised by the top political and military leadership, have prevailed over provincial preferences, with court rulings strengthening centralised control. The Pakistan Peoples Party’s government in Sindh, the sole opposition-led province, has promoted rigorous restrictions, for instance, but has been unable to implement them in the face of Islamabad’s resistance. The federal government has also been reluctant to work with parliament or main opposition parties to forge a united response. The acrimony is rooted in contested mid-2018 elections, though the opposition has repeatedly offered to assist the government in containing the pandemic.

The public health crisis and economic downturn could be devastating, particularly if people feel it is mismanaged.

The public health crisis and economic downturn could be devastating, particularly if people feel it is mismanaged. Anger at the government and social tensions will mount if citizens sense that the government is not adequately looking after their health and wellbeing. In the past, militant groups have exploited such opportunities to gain local support.

While COVID-19 leaves Pakistan’s government few good options, some steps could minimise harm to lives and livelihoods. The prime minister’s fears about the toll of lockdowns are well justified. Yet the economy is unlikely to start moving unless the authorities can keep the virus at bay. Adapting the smart lockdown strategy might avoid the pain of a prolonged lockdown while still saving lives. This could mean allowing provinces, if medical experts so advise, to lock down entire cities and urban districts for short periods, instead of limiting them to partial closures. More broadly, the government should guide the country’s response but give provinces leeway to devise policies tailored to local needs. Bolstering the provinces’ health capacity – particularly testing – should remain a top priority. Emergency assistance to families that fall under the poverty line and unemployed workers remains critical. Prime Minister Imran Khan’s – and the country’s – interests would also be best served by working with the opposition to forge consensus on managing the consequences of an unprecedented and potentially destabilising health crisis.

II. Responding to the Pandemic

A. Early Missteps

As happened in many other countries, early missteps overshadowed the Pakistan Tehreek-e-Insaf government’s response. In February, the government refused to repatriate hundreds of Pakistani students in Wuhan, China, fearing they would spread the virus. In itself, the decision appears to have been sensible, though perhaps the government could have brought them home but quarantined them. Yet despite its caution with citizens in Wuhan, it failed to properly screen inbound travellers, many of whom carried the virus.[fn]International flights continued to operate until 21 March.Hide Footnote  The first confirmed COVID-19 case in Pakistan was that of a Karachi student returning from pilgrimage in Iran on 26 February. Shia pilgrims coming home from Iran, at the time the region’s worst-hit country, formed the first major cluster of imported infections. The government quarantined hundreds of pilgrims in overcrowded, unhygienic conditions near the Iranian border but then allowed them to leave for their home provinces without adequate testing or isolation, spreading the virus throughout the country.[fn]Between 28 February and 15 April, 7,000 pilgrims returned from Iran, 6,800 through the Taftan border crossing, where many were initially quarantined. “7,000 pilgrims have returned from Iran since February: FO”, Dawn, 19 April 2020.Hide Footnote

The first major cluster of locally transmitted infections occurred when the ruling party’s Punjab government delayed a decision to cancel the Sunni proselytising group Tableeghi Jamaat’s major annual congregation (ijtema), due to take place for five days from 11 March. The organisers ultimately cancelled the ijtema, but only on 12 March, by which time an estimated 100,000 believers, including around 3,000 foreigners, had already set up camp together in close quarters. Had the Punjab government given “clear instructions”, a Tableeghi Jamaat follower said, “the event would not have happened”.[fn]The Punjab police put numbers at 70,000 to 80,000. Other estimates were as high as 250,000. Asif Chaudhry, “Tableeghi Jamaat in hot water in Pakistan too for Covid-19 spread”, Dawn, 8 April 2020.Hide Footnote  After its cancellation, most participants left, but a few hundred stayed on at the organisation’s Raiwind headquarters. They, too, were allowed to leave for their home provinces without being tested or isolated; Tableeghi Jamaat members also went on preaching missions throughout the country. Large clusters of virus transmission in at least two provinces, Punjab and Sindh, have been traced to Tableeghi Jamaat members who had participated in the Raiwind ijtema.[fn]“Limiting the spread,” Dawn, 2 April 2020; “27 per cent of Pakistan’s Covid-19 cases linked to Raiwind Ijtema: report”, The Express Tribune, 23 April 2020.Hide Footnote

B. Pandemic Policy in Pakistan’s Fractured Polity

The Pakistan Tehreek-e-Insaf government was slow to respond as the pandemic spread.

The Pakistan Tehreek-e-Insaf government was slow to respond as the pandemic spread. The first cabinet meeting devoted to the subject was held on 13 March, weeks after the confirmed case in Karachi.[fn]“Pakistan closes western borders, bans public gatherings as coronavirus cases rise to 28”, Dawn, 13 March 2020.Hide Footnote  The federal government’s approach was then shaped by an adversarial relationship with the opposition and an overreliance on the military’s support.

At a time when political consensus was most needed in forging a national response to the pandemic, the federal government’s relationship with the two largest opposition parties, Nawaz Sharif’s Pakistan Muslim League and Bilawal Bhutto Zardari’s Pakistan Peoples Party, was strained. The antagonism had its roots in the contested July 2018 elections. Both main opposition parties attributed Imran Khan’s victory to manipulation. After forming a government with a razor-thin majority, and entering into coalitions with smaller parties, Imran Khan’s survival tactics have been twofold: to consolidate ties with the country’s powerful military, and to weaken opposition parties by targeting their top leaders, including by charging and imprisoning them on corruption allegations.

By mid-March, as cases of local transmission began to mount, particularly in large, densely populated cities such as Karachi, Lahore and Peshawar, both opposition parties offered to cooperate to counter the pandemic. The federal government, however, chose to sideline parliament, where the opposition had a strong presence.[fn]Because of the political discord, a special pandemic-related parliamentary committee has been dysfunctional since it was set up on 26 March. Composed of both the federal parliament’s houses, with ruling and opposition party representatives, it was meant to review, monitor and oversee issues related to COVID-19 and its impact on the economy.Hide Footnote  Tensions over the direction of pandemic policy also increased between the centre and Sindh (of which Karachi is the capital), the sole opposition-led province.

On 23 March, Sindh’s Pakistan Peoples Party government was the first to impose a province-wide lockdown. Warning of the health dangers, the provincial government urged the centre to devise a national strategy, including through robust shutdown measures. Addressing the nation on 23 March, Prime Minister Khan, who himself holds the federal health portfolio, initially ruled out a countrywide closure, saying it would adversely affect the poor and working class.[fn]“PM rules out lockdown, disapproves of panic buying”, Dawn, 23 March 2020.Hide Footnote  Calling for national consensus and coordinated efforts before the health crisis turned into “a catastrophe”, Pakistan Peoples Party leader Bhutto Zardari responded, “If we are a poor country, we need to lock down more quickly”.[fn]“If we really care about the poor”, he said, “we need to move faster because the poor are more threatened”. “Bilawal wonders at PM decision of not ordering countrywide lockdown”, Dawn, 23 March 2020.Hide Footnote  The military weighed in, supporting a lockdown and deploying troops countrywide to assist civilian administrations in enforcing it. Hours after the prime minister’s address, the federal government reversed course, agreeing to impose a nationwide shutdown, which it subsequently extended until 31 May.

The initial responses of Pakistan’s four provincial governments varied. Sindh was quick in imposing stringent restrictions on non-essential businesses and public movement. Though hindered by limited resources, it also began to aggressively test people and isolate positive cases.[fn]Editorial, “Sindh leads the way”, Dawn, 28 March 2020; Talat Masood, “Leadership is facing its real test”, The Express Tribune, 2 April 2020.Hide Footnote  The three ruling party-controlled provinces, Balochistan, Khyber Pakhtunkhwa and Punjab, also imposed lockdowns. Yet, apparently guided by the prime minister’s aversion to these measures, they opted for looser restrictions, particularly in Punjab, which soon allowed several types of businesses to reopen.

Tense relations between the government and its rivals also hindered coordination between the capital and opposition-held Sindh and among provinces themselves.

Tense relations between the government and its rivals also hindered coordination between the capital and opposition-held Sindh and among provinces themselves. The Sindh government held the federal leadership responsible for hampering its response. It argues that Islamabad’s support was insufficient, whether in assisting provincial safety protection schemes or providing pandemic-related medical equipment, which, according to the Sindh government, was available but not equitably distributed.[fn]Amir Wasim, “Barbs fly in NA over fight against Covid-19”, Dawn, 12 May 2020; “PPP calls federal govt “incompetent’, blames it for virus spread”, The News, 2 May 2020.Hide Footnote  Inter-provincial coordination was also poor, echoing friction between Khan and his opponents.[fn]Maleeha Lodhi, “Fault lines in focus”, Dawn, 11 May 2020. Dr Lodhi was Pakistan’s permanent representative to the UN (February 2015-October 2019), and twice appointed Pakistan’s ambassador to the U.S. See also “Sindh’s Murtaza Wahab says federal govt ‘didn’t take lead’ over coronavirus pandemic”, The News, 29 March 2020; “Sindh refutes centre’s claim of providing medical equipment”, Dawn, 17 May 2020.Hide Footnote  The three ruling party-held provinces seemingly took their lead from Islamabad’s aversion to working with Sindh.[fn]Fizza Batool, “Pakistan’s Covid-19 political divide”, South Asian Voices, 12 May 2020.Hide Footnote

Much decision-making related to the pandemic has taken place in the federal capital. The main bodies responsible, set up in mid-March, reflect the government and military leadership’s preference for a centralised approach. On 13 March, the National Security Committee, the apex civil-military body, set up a National Coordination Committee for COVID-19, chaired by the prime minister and including Army Chief Qamar Javed Bajwa, the four provincial chief ministers and senior military officers. The National Command and Operation Centre, which sends the committee recommendations on pandemic policy, is headed by the federal minister for planning and development and includes relevant federal and provincial ministers and also several senior military officers.

The stated objective of setting up these two bodies was to bring the federal and provincial governments and military leadership together.[fn]The National Coordination Committee includes the director general of Inter-Services Intelligence directorate, the military’s premier intelligence agency, and the director general of military operations. The command and cooperation centre, according to a military spokesperson, was formed “to collect, analyse and collate information received from the provinces and forward recommendations” to the coordination committee so that it could “make timely decisions”. “Can’t afford ‘indefinite’ lockdown: DG ISPR”, The Express Tribune, 4 April 2020; “Corona has economic, psycho-social impacts: General Qamar Javed Bajwa”, The News, 23 April 2020. See also Zeeshan Ahmed, “A look inside Pakistan’s Covid-19 response”, The Express Tribune, 2 May 2020.Hide Footnote  In principle, responsibility for the health sector lies with the provinces, not the capital.[fn]The 2010 constitutional amendment, which restored federal parliamentary democracy after a decade of military rule, gives provinces this mandate.Hide Footnote  In practice, however, the top political and military leadership in the centre controls pandemic policy, often overriding provincial concerns, not just in opposition-led Sindh but also in the three ruling party-led federal units.

On 14 April, Prime Minister Khan extended the nationwide lockdown until 30 April but also relaxed restrictions. Several non-essential industries, including construction, reopened. Khan said there was “98 per cent consensus among all provinces and the centre on the reopening of some sectors”.[fn]“PM Imran Khan extends lockdown for two weeks”, The Express Tribune, 14 April 2020.Hide Footnote  Yet the Sindh government, disagreeing, opted to retain stricter measures for another two weeks. While acknowledging that it was constitutionally empowered to so, the federal minister in charge of pandemic response warned the provincial government against resisting Islamabad’s directives.[fn]“PM extends lockdown for two weeks”, The Express Tribune, 15 April 2020; “Centre assails Sindh govt over ‘stricter’ lockdown”, Dawn, 16 April 2020.Hide Footnote  Judicial intervention then strengthened the centre’s control over pandemic policy. In a suo moto (on its own volition) hearing on the virus crisis in mid-April, the Supreme Court chief justice called for a uniform policy, warning Sindh not to close businesses and services that generate revenue for the federation. The Sindh government then gave in to the centre’s wishes.[fn]“Sindh can’t close entities paying taxes to centre: SC”, The Express Tribune, 4 May 2020.Hide Footnote

C. Mixed Messaging and the Power of the Pulpit

The federal government’s mixed messaging about the pandemic left the public confused about its gravity.

The mid-April decision to ease the lockdown and the federal government’s mixed messaging about the pandemic left the public confused about its gravity. Early in the crisis, in a televised address on 17 March, Prime Minister Khan had downplayed health risks. “There is no reason to worry”, he said, since 90 per cent of the infected would have mild flu-type symptoms and 97 per cent would recover fully.[fn]“PM Imran tells nation to prepare for a coronavirus epidemic, rules out lockdown”, Dawn, 17 March 2020. See also Khurram Hussain, “Addressing the confusion”, Dawn, 2 April 2020.Hide Footnote  A mid-April decision to reopen mosques for communal prayers further muddled the state’s message.

When the nationwide lockdown was first imposed, provincial governments barred mosques from holding communal prayers. Mosques remained open but only five mosque administrators could participate in prayers. The police were tasked with enforcing the restrictions, which were largely respected in major cities. When clerics violated the curbs in Karachi, for example, police temporarily detained most offenders; charges were lodged against others for inciting violence against police officers.[fn]“Prayer leader, six others sent to jail on judicial remand in Sindh”, The Express Tribune, 5 April 2020.Hide Footnote  As a result, most mosques in Sindh’s cities complied with the health restrictions.[fn]“Has the federal govt erred by not closing mosques in Ramadan?”, Pakistan Today, 30 April 2020.Hide Footnote

In contrast, Islamabad’s police registered cases but made no arrests when Lal (Red) mosque’s hardline clerics openly violated restrictions. Clerical leader Abdul Aziz released footage of large congregations attending Friday prayers.[fn]Kalbe Ali, “More than 50 clerics warn govt not to further restrictions on prayer congregations”, Dawn, 14 April 2020.Hide Footnote  When the police tried to barricade the mosque’s entrance, female madrasa students blocked the road.[fn]In early June, the federal government reportedly reached agreement with Abdul Aziz, mediated by the leader of a banned sectarian group; the police were to remove blockades in return for Aziz’s commitment to vacate the mosque. “Capital administration, former Lal Masjid cleric reach agreement”, Dawn, 3 June 2020.Hide Footnote  The Khan government might have hesitated in taking action against the Lal Masjid clerics, fearing a repeat of the bloody July 2007 standoff, when a military operation against heavily armed jihadists in the mosque left 100 militants and eleven soldiers dead.[fn]For details of the Lal Masjid operation, see Crisis Group Asia Report N°164, Pakistan: The Militant Jihadi Challenge, 11 March 2009.Hide Footnote  Yet in refraining from taking action, it risked creating a major virus cluster in both the federal capital and its twin city, Rawalpindi.

On 18 April, without consulting provincial governments, President Arif Alvi agreed with major religious leaders to reopen mosques nationwide for communal, including taraweeh (special Ramadan), prayers – but under conditions.[fn]Several senior clerics had warned the federal government against retaining restrictions on mosques. “More than 50 clerics warn govt not to further restrictions on prayer congregations”, Dawn, 14 April 2020.Hide Footnote  The agreement specified safety and health precautions, including social distancing, and tasked mosque administrations with enforcing them. To violate the measures, the president said, “would be like a sin because all ulema and mashaikh (religious scholars and spiritual leaders) have agreed” to them.[fn]“PTI govt, Ulema agree on SOPs for Ramazan amid coronavirus outbreak”, The Express Tribune, 19 April 2020.Hide Footnote  Justifying the decision, Prime Minister Khan said he was heeding popular demand. “Pakistan is an independent nation”, he said. “Ramadan is a month of worship, and people want to go to mosques”. His government “could not forcibly tell them not to do so”.[fn]“‘We are an independent nation’: PM Khan responds to questions over keeping mosques open”, Dawn, 21 April 2020. On 21 April, prominent doctors called on the government and religious leaders to reconsider their agreement, warning that removing curbs on communal prayers would create viral clusters and “unwanted loss of lives”. “Failure to close mosques, control virus in Pakistan may be bad for entire Muslim ummah: doctors”, The News, 21 April 2020.Hide Footnote

Yet many clerics have flouted the agreement’s terms. During Ramadan, when mosque attendance is at its highest, clerics made little effort to enforce the protocols.[fn]A survey of mosques in Punjab and the federal capital during Ramadan found that 85 per cent had violated health and safety protocols. Kamila Hayat, “Duel till death”, The News, 30 April 2020; “Violations of SOPs for mosques aggravates virus situation in KP”, Dawn, 6 May 2020.Hide Footnote  Thousands prayed in packed mosques, ignoring health measures and creating new hot-spots of viral infection.[fn]“Violations of SOPs for mosques aggravates situation in KP”, Dawn, 6 May 2020.Hide Footnote  Many clerics appear to have told worshippers to demonstrate piety by praying shoulder to shoulder, warning that the pandemic is a punishment for erring Muslims’ sins, arguing that the faithful are immune and that life and death are in God’s hands alone.[fn]In an Al Jazeera interview, Lal Masjid cleric Aziz said, “In our [religious leaders’] opinion, this is a punishment from God, and is coming because we have filled the world with sins”. Another religious leader said, “there is no coronavirus. This is just a movement to try and target religion and mosques”. Yet another insisted that the only way to get rid of the virus would be to seek forgiveness from God through prayers in mosques. “Pakistanis gather for Friday prayers defying coronavirus advisory”, Al Jazeera, 17 April 2020; “Mosques remain closed amid strict lockdown”, The Express Tribune, 4 April 2020; “‘God is with us’: Many Muslims flout the coronavirus ban in mosques”, Reuters, 13 April 2020; Kalbe Ali, “More than 50 clerics warn govt not to further restrictions on prayer congregations”, Dawn, 14 April 2020.Hide Footnote  As a result, many who regularly attend mosques either believe they will not contract the virus or that prayer will protect them.[fn]A mid-April survey found that 82 per cent believed that ablution for prayers would prevent infection and 87 per cent that communal prayers could not cause contagion. “Survey shows whopping majority thinks inhaling steam, ablution wards off COVID-19”, The News, 12 April 2020.Hide Footnote  Many also chose not to get tested or treated due to religious and social stigma attached to the disease.[fn]Crisis Group telephone interviews, health professionals, Karachi, Islamabad, May 2020.Hide Footnote

III. The Economy, Health Policy and Social Support

On 9 May, after extending relatively weak pandemic-related restrictions for two weeks, the federal government ended the lockdown. Prime Minister Khan insisted that the decision was taken with the provinces’ consensus, but Sindh’s chief minister said Islamabad imposed its will.[fn]“Sindh CM didn’t announce lifting lockdown from Monday, Bilawal”, The Express Tribune, 9 May 2020; Syed Irfan Raza, “Record Covid-19 cases reported in single day”, Dawn, 9 May 2020.Hide Footnote  The Punjab and Balochistan governments, held by the ruling party, also warned against lifting restrictions.[fn]Raza, “Record Covid-19 cases reported in single day”; “Relaxed curbs will mean 1.1.m cases by July”, The Express Tribune, 9 May 2020.Hide Footnote  The judiciary again weighed in. On 19 May, during the coronavirus suo moto case hearings, the Supreme Court noted that provinces were constitutionally bound to follow Islamabad’s directives.[fn]In a June interview, Sindh’s spokesperson noted, “the court said provinces have to follow the lead and advice of the centre. We never stood a chance [after that]”. Dawn TV, 10 June 2020; “Provinces are bound to follow Centre’s directives: SC”, The Express Tribune, 19 May 2020.Hide Footnote

Though the federal government said it would lift the lockdown in phases, by mid-June the country was almost fully open for business. Schools remained closed but all markets and shopping centres were operating and restrictions on most non-essential businesses had been removed. Borders with Iran and Afghanistan were reopened, domestic and international flights resumed, and several train services started up again, as did local public transport. Punjab reopened shrines that traditionally attract large numbers.

Prime Minister Khan’s justifications for lifting the lockdown were twofold: the burden on the poor and working class, and the adverse impact on the national economy. Announcing the National Coordination Committee’s decision to cancel the closures on 7 May, he said, “We are doing it because people are facing extreme difficulties. Small business owners, daily wage earners and labourers are suffering. We fear that small and medium-sized industries might vanish completely if we don’t lift the lockdown”.[fn]“Govt to end lockdown from 9th in phases”, The Express Tribune, 8 May 2020.Hide Footnote  A week earlier, preparing the ground for the announcement, the federal minister heading the National Command and Operation Centre said the government’s revenues would otherwise fall by 30-35 per cent.[fn]“Lockdown to be further eased, says PM Khan”, Dawn, 1 May 2020.Hide Footnote

The pandemic has seriously compounded Pakistan’s already grave economic challenges.

The pandemic has seriously compounded Pakistan’s already grave economic challenges. Pakistan’s economy was in dire straits even before COVID-19. Since the Khan government assumed office, large-scale manufacturing has declined, exports have fallen, the budget deficit has widened and unemployment has increased.[fn]Sharoo Malik, “Taking stock: The PTI government’s economic performance in its first year”, South Asian Voices, 8 September 2019; “Pakistan premier’s first year: economic hit and miss”, Dawn, 19 August 2020; Hina Ayra, “Pakistan’s economic options during the coronavirus crisis”, The Express Tribune, 3 April 2020. See also editorial, “GDP growth”, The News, 18 May 2020.Hide Footnote  A former finance minister and financial expert had estimated economic growth in the Khan’s government’s first year at 1.9 per cent, the lowest in a decade.[fn]“Hafiz Pasha says GDP growth is 1.9 per cent”, The News, 8 February 2020. Dr Hafiz Pasha, the former finance minister, is now chair of the Panel of Economists, an independent body advising the government.Hide Footnote  Now, exports to traditional markets – Europe, the U.S., China and the Middle East – are fast declining.[fn]Syed Haris Ahmed, “With lockdowns everywhere, export is a difficult job”, The Express Tribune, 6 April 2020; “Pakistan’s deficit and poverty rate to soar due to coronavirus, govt estimates”, Reuters, 14 May 2020.Hide Footnote  Remittances, a vital source of foreign exchange, are likely to shrink as thousands of workers in the Gulf come home. The government estimates that the gross domestic product will contract by 0.38 per cent for the fiscal year 2019-2020. The World Bank has forecast even sharper drops of 2.6 per cent for 2019-2020 and 0.2 per cent for 2020-2021.[fn]The economy has contracted for the first time since 1951-1952. Pakistan Economic Survey 2019-20; “Global Economic Prospects”, The World Bank, June 2020.Hide Footnote

If the government’s goal in lifting the lockdown was to get the economy moving, little suggests that is happening, even as numbers of new cases mount. Indeed, it has become ever clearer that economic growth depends on curbing the virus. On 22 April, days after the lockdown was first eased, the World Health Organisation’s director general had warned, “Without effective interventions [in Pakistan], there could be an estimated 200K+ cases by mid-July. The impact on the economy could be devastating, doubling the number of people living in poverty”.[fn]“WHO, PMA advise for total lockdown”, The News, 24 April 2020.Hide Footnote  Four months on, signs of economic recovery are still few.

The federal government has provided emergency assistance to families in need, including food subsidies and support, but for many this aid is barely enough. The Ehsaas emergency cash program (the renamed Benazir Income Support Program) provides financial assistance to an estimated twelve million families that fall under the poverty line.[fn]Set up in mid-2008, the federally funded Benazir Income Support Program, the country’s largest social safety net, provides cash assistance exclusively through women to economically vulnerable families.Hide Footnote  Islamabad began the scheme on 9 April and extended it the following month to provide a similar amount to four million unemployed workers.[fn]“PM launches cash disbursal program for workers today”, Dawn, 18 May 2020.Hide Footnote  Yet the lump sum cash transfer of approximately $75 to cover four months of expenses hardly covers food costs.

Such support could well be critical for months. According to Prime Minister Khan, the cash disbursement program can only be a temporary solution, which is why the lockdown was lifted. “There’s no way the government can give out handouts to feed people for that long”.[fn]“Millions would have starved if lockdown wasn’t lifted: PM Khan”, Dawn TV, 21 May 2020.Hide Footnote  Yet with the pandemic continuing to hinder any economic recovery, the need for state assistance appears likely to increase further. A prominent public health expert and demographer noted: “There is no choice but to provide the essentials like food, water and health care for the poorest 20 per cent of the population for the next few months. ... [t]he counterfactual is skyrocketing poverty, malnutrition and deaths of key household members that will be difficult to repair financially and emotionally”.[fn]Zeba Sattar, “Lives not worth saving”, Dawn, 13 June 2020. As Pakistan country director of the Population Council, Dr Sattar evaluates health delivery services. According to the World Food Program, 39.6 per cent of the population faces food insecurity, and Pakistan has the second highest rate of malnutrition in South Asia.Hide Footnote

At the same time, the government’s financial resources are strained, though foreign aid should help. Donors have earmarked additional assistance to help Pakistan cope with the pandemic’s economic impact, including through social protection programs for families in need. The government looks set to receive billions of dollars in pandemic-related aid.[fn]The government will likely receive $1.5 to $2 billion in temporary debt relief from G20 member counties; the International Monetary Fund allocated $1.4 billion through its Rapid Financing Instrument, to mitigate the economic impact of the pandemic; the World Bank restored Pakistan’s budgetary support and granted a $500 million loan for pandemic-related health care and social safety nets; the Asian Development Bank approved a $500 million loan for the government’s health and economic response, including social protection for the poor. Bilateral donors, such as Germany, have also extended assistance, with Berlin providing 0.5 million euros to help Pakistan overcome the pandemic’s socio-economic impact at the local level. “Germany backs Pakistan’s efforts to mitigate socio-economic impact of Covid-19”, Dawn, 27 July 2020; “Pakistan to receive $500m loan from ADB to help fight coronavirus, ‘protect poor’”, The News, 10 June 2020; “WB okays $500m loan to help government fight Covid-19”, Dawn, 23 May 2020; “Pakistan wins $1.4b IMF emergency loan”, The Express Tribune, 17 April 2020; Arsalaan Asif Soomro, “Can Pakistan’s economy endure the ramifications of COVID-19?”, The Express Tribune, 15 April 2020.Hide Footnote

The dire economic situation risks playing into militants’ hands, particularly if social support measures fall short. As unemployment rises further and more citizens fall under the poverty line, such groups could exploit the ensuing social discord. If the state fails to deliver, they could have new opportunities to win recruits by tapping economic desperation and social grievances or extending assistance through existing or renamed charities, as they have in the past.[fn]Militant groups have in the past enhanced their local appeal by providing food and other assistance through their charity wings, including after the 2005 earthquake in Pakistan and Pakistan-administered Kashmir. See Crisis Group Asia Briefing N°46, Pakistan: Political Impact of the Earthquake, 15 March 2006.Hide Footnote

IV. Health Systems in a Pandemic

Pakistan’s under-funded health care system is ill equipped to deal with an unprecedented public health emergency.[fn]There are around six hospital beds, 9.8 doctors and five nurses per 100,000 population in Pakistan. Health expenditure is among the lowest in the world, estimated by the World Health Organisation at 2.9 per cent of GDP. “Time to step up”, The News, 23 March 2020.Hide Footnote  Medical professionals have repeatedly called for a stringent nationwide lockdown until transmission rates decline. But the government, concerned about the economic costs, rejects their advice. In some cases, ruling-party leaders have even dismissed concerns as partisan. When positive COVID-19 cases increased by 40 per cent nationwide soon after the lockdown was eased in mid-April, Karachi-based health experts and doctors called for stricter restrictions, warning that major hospitals in the city were overstretched.[fn]“Covid-19 cases up by 40% in five days, doctors”, The Express Tribune, 23 April 2020; “WHO, PMA advise for total lockdown”, op. cit.Hide Footnote  A ruling-party leader accused them of criticising the federal government on behalf of the Pakistan Peoples Party opposition.[fn]“Gill accuses Sindh govt of politicising corona situation thru doctors”, The News, 24 April 2020. Shahbaz Gill has since, in mid-May, been appointed the prime minister’s special assistant on political communication. Also Iftikhar A. Khan, “PPP asks centre to stop playing ‘pandemic politics’”, Dawn, 25 April 2020.Hide Footnote  Professional bodies of doctors countrywide have issued similar calls for a nationwide closure to contain the disease’s spread both before 9 May and afterward.[fn]“Doctors demand strict lockdown, urge religious scholars to review decision to open mosques”, Dawn, 22 April 2020; Amer Malik, “Health care in a fix”, The News, 31 May 2020.Hide Footnote

While the decision on when to lift the lockdown would always involve difficult trade-offs, the government appears to have moved too early.

While the decision on when to lift the lockdown would always involve difficult trade-offs, the government appears to have moved too early. Retaining a nationwide lockdown indefinitely would not have been feasible for economic reasons and due to public fatigue. As Prime Minister Khan says, the lockdown took a heavy toll on impoverished Pakistanis, who survive at subsistence level and need handouts if they cannot leave their homes to work. A protracted nationwide lockdown would have risked fuelling public anger as much as the health emergency. Yet reopening the economy and the country as early as was done, without adequate testing, tracing, isolating and treating the infected, led to a sharp spike in cases. By 9 May, when the lockdown was lifted, the total number of cases was around 29,000 and the death toll was 637. About six weeks later, the total number of cases were more than 175,000; the death toll stood at over 3,000.[fn]“Sindh reports highest single day increase nationwide; nationwide tally soars to 28,818”, The Express Tribune, 9 May 2020; “Pakistan crosses 3,000 deaths due to COVID-19”, Newsweek Pakistan, 18 June 2020; “Pakistan reports 4,471 cases of Covid-19 in a day”, The Nation, 22 June 2020.Hide Footnote

In early June, the World Health Organisation’s Pakistan country head recommended imposing targeted and intermittent two-week-on, two-week-off lockdowns. His letter to the Punjab health minister noted that the country met none of the prerequisites for fully lifting restrictions, including containing disease transmission, detecting, testing, isolating and treating all cases, minimising hot-spots and ensuring preventive measures in workplaces and other public spaces.[fn]“WHO recommends ‘intermittent, targeted’ lockdowns in Pakistan”, The Express Tribune, 9 June 2020.Hide Footnote  Health experts were quick to support his recommendation. But the prime minister’s health adviser said the WHO had assessed Pakistan’s situation through a “health lens” and that the government has “to make tough policy choices to strike a balance between lives and livelihoods”.[fn]“WHO says Pakistan meets no pre-requisite for easing restrictions, recommends ‘intermittent lockdown’”, Dawn, 9 June 2020; “Corona killing four an hour in Pakistan”, The News, 11 June 2020.Hide Footnote

Instead, the federal government has opted for what it calls “smart lockdowns”, a policy it adopted when easing pandemic-related restrictions in mid-April. Its limited lockdowns differ from those recommended by the WHO in that they apply only to specific localities within cities or rural districts where positive cases are high. The government eased or removed them altogether in low-risk areas.[fn]Inter-Services Intelligence, the military’s main intelligence arm, has been tasked with tracing infected persons and their contacts through geo-fencing and phone monitoring systems that it uses for counter-terrorism purposes. Ramsha Jahangir, “Over 5,000 people at risk of contracting Covid-19 identified by track system”, Dawn, 2 May 2020.Hide Footnote  In mid-June, provincial governments imposed two-week lockdowns in areas of cities such as Karachi, Lahore and Peshawar.[fn]On 15 June, the National Command and Operation Centre identified virus clusters in twenty cities across the country. According to a press release from his office, Prime Minister Khan had directed the provincial governments to impose smart lockdowns “in sensitive areas keeping in view ground realities to maintain a balance between economic activities and preventive measures”. Syed Irfan Raza, “PM satisfied with virus testing kits, PPE availability”, Dawn, 16 June 2020.Hide Footnote  The government argues that such limited lockdowns can contain virus spread without economic hardship.

By 2 August, Pakistan had around 280,200 registered cases and close to 6,000 deaths, ranking thirteenth among COVID-19 affected countries globally (in terms of total cases).[fn]See Pakistan’s official COVID-19 website or the Worldometers website for numbers. The death toll is likely under-counted since many families, fearing the religious and social stigma of the disease, do not report infections or seek treatment. The Khyber Pakhtunkhwa government, for instance, is investigating declining mortality figures, to check if patients are dying unrecorded at home. “Govt probing causes of decline in Covid-19 deaths”, Dawn, 23 July 2020.Hide Footnote  According to official statistics, the daily number of confirmed cases has declined considerably since mid-July. The government attributes the reduction to its smart lockdowns.[fn]The prime minister’s health adviser said the government had managed to contain the pandemic through the smart lockdown strategy. “Pakistan’s preparation and response to the coronavirus outbreak has been one of the best in the world”. “Over 204,000 recover from disease as curve flattens”, The Express Tribune, 20 July 2020.Hide Footnote  Yet reduced testing may also partly explain it: official data shows daily nationwide testing rates dropping from on average around 28,500 in June to fewer than 22,00o in July.[fn]In June, the WHO had recommended that Pakistan increased daily testing capacity to 50,000. Daily test numbers, however, fell from the end of June. By 2 August, according to the Worldometers website, Pakistan had conducted 2,010,170 tests for around 220 million citizens: 9,086 per one million population. See also “Pakistan: Situation Report (as of 10 June 2020)”, UN Office for the Coordination of Humanitarian Affairs.Hide Footnote

The smart lockdown’s “track, trace and quarantine” strategy, which involves tracing and isolating virus carriers and their contacts and placing viral hot-spots under quarantine, is hampered by poor data and low testing rates.[fn]Crisis Group interviews, doctors, Karachi, July 2020.Hide Footnote  In June, the minister overseeing the pandemic response had said that authorities would increase daily testing capacity to 100,000 by July.[fn]“Just in a month: Pakistan faced 242pc surge in deaths”, The News, 15 June 2020.Hide Footnote  According to the National Command Operation Centre, testing capacity had increased to over 70,000 by early July.[fn]Calling for increased testing, a doctors’ forum said that the government’s figures of confirmed cases are “not representative of the actual ground situation”, “Doctors’ forum stresses need to enhance Covid-19 testing in Pakistan”, Dawn, 12 July 2020; “Covid-19: Data shows Pakistan utilising only a third of its testing capacity”, The News, 8 July 2020.Hide Footnote  Yet less than one third of that capacity is now being used.[fn]Observers offer various reasons for the decline in testing: international travellers are no longer tested on arrival; groups that were previously targeted, such as Tableeghi Jamaat, journalists and government officials, are no longer tested systematically; tests’ costs mean they are used only for patients with serious symptoms; and, with numbers declining, fewer tests are necessary.Hide Footnote  With the virus appearing in many localities in densely populated cities, limited lockdowns of a few blocks of a city or a part of a rural district appear unlikely to contain it. A Pakistani expert on viral diseases said, “Incomplete lockdowns mean the virus has a chance of finding new hosts”.[fn]Tufail Ahmed, “Containing pandemic: Don’t bother with partial lockdowns, says expert”, The Express Tribune, 16 June 2020.Hide Footnote

The forthcoming religious holidays threaten another uptick. The lifting of nationwide restrictions during Ramadan in June and for Eidul Fitr contributed to the first surge of infections as massive crowds shopped in markets and large congregations prayed in mosques. The government and doctors fear the virus could once again peak should the public disregard safety measures in August during Eidul Azha festivities and in Muharram, when large mourning processions are held.[fn]Prime Minister Khan said, “if we are careless on Eidul Azha, the virus could spread again and there could be a fresh spike of infections”. “PM warns of virus spike of SOPs violated on Eid”, Dawn, 10 July 2020.Hide Footnote  Spiralling numbers of cases could once again overwhelm hospitals and clinics. With case numbers increasing substantially in smaller cities and rural regions, their weaker health facilities could soon be overrun.

V. Conclusion

Chairing a meeting of the National Coordination Council on 1 June, Prime Minister Khan said, “a lockdown isn’t a solution or treatment. … Nothing can be done about it. The virus will spread, and our death toll will also rise” until a vaccine is found. He added, “If we have to live successfully with the virus, it is the responsibility of the people. If they take precautionary measures, we can tackle the virus and live with it”.[fn]Khan also decided to further ease the few remaining restrictions, including on domestic tourism. “Pakistan to ease lockdown, open more businesses amid surging COVID-19 infections”, The News, 1 June 2020; “PM Khan bats for unlocking economy, eases coronavirus lockdown”, The Express Tribune, 2 June 2020.Hide Footnote  Placing the onus of preventing contagion on citizens also appears at the heart of a new strategy, “Living with the Pandemic”, discussed by the Command and Operation Centre a day earlier.[fn]“88 deaths, 3,039 new cases in a single day: Provinces differ over smart lockdown”, The News, 1 June 2020; “NCOC mulls over ‘living with the pandemic strategy’ to cope with coronavirus”, The News, 30 May 2020.Hide Footnote

Mixed and confused signalling by Prime Minister Khan and his top advisers early in the crisis mean that people often now ignore their calls to observe social distancing and other health guidelines. Many still believe that the pandemic has ended, and largely brush off calls for responsible public behaviour. Public health specialists also warn that “leaving people to determine the rules of restoring normality could prove fatal if growth in cases and deaths continues at average rates or may even increase further”.[fn]“Easing Lockdown in Pakistan: Inevitable but Potentially Catastrophic”, Institute of Public Health, Jinnah Sindh Medical University, May 2020.Hide Footnote

A rethink is urgently needed. Federal policy should be based on the best available medical advice, even while factoring in social and economic costs. The government should continue to guide the provinces on pandemic policy, including by helping them shore up health facilities and making preventive measures, such as enforcing the use of face masks outdoors. Yet Islamabad should also allow provincial authorities to devise tailored strategies, guided by medical experts, as they confront new challenges. Not only is health a provincial responsibility, but provincial leaders are better placed to adapt to local needs. Both federal and provincial authorities should also prioritise funding for the health sector.

Islamabad could consider revising its smart lockdown strategy. If deemed necessary, and based on medical advice, provinces should be allowed to shut down entire cities and rural districts with high infection rates for limited periods to interrupt virus transmission. In areas where the virus transmission rate is lower, they should enhance testing, contact tracing and treating the infected. Lockdowns along these lines should be better able to contain virus spread without too onerous a burden on the economy.

Efforts to build the capacity of health care facilities to prevent a repeat of the crisis in June, when cases surged, should continue. In June, intensive care units and beds in major cities like Karachi, Lahore and Peshawar reached or neared capacity.[fn]By early June, critical care wards for COVID-19 patients in some of Karachi’s major government and private hospitals were full to capacity. Hospitals in Lahore were also under strain. Crisis Group telephone interviews, doctors, nurses, Karachi, Lahore, June 2020.Hide Footnote  The provinces have since bolstered health facilities for COVID-related cases, including with federal assistance.[fn]“NDMA reaches target of 2,000 oxygenated beds in hospitals across Pakistan”, The Express Tribune, 22 July; “Sindh has 253 million beds for Covid-19 patients”, The Express Tribune, 14 July 2020.Hide Footnote  Pressures on hospitals have also eased since patients with moderate symptoms are now isolated at home. Yet another sharp surge of infections could once again overwhelm that capacity.

Lastly, instead of bypassing parliament, the federal government should work with the opposition. The parliament should play a more active role, particularly with regard to fiscal and other assistance for the most vulnerable sections of the population. The federal government’s continued targeting of top opposition leaders, including through the National Accountability Bureau, is particularly unhelpful. The Khan government itself would benefit from mending fences with its rivals. The military leadership might be an equal, if not dominant, partner in the pandemic response. Yet citizens will hold the elected leadership accountable if the pandemic response falters. Sharing responsibility with opposition leaders for what are difficult and contentious decisions would not only benefit Pakistan’s body politic but also make sense for the premier himself. The alternative is that COVID-19 leaves a weakened federal government even more reliant on the military to retain power.

Karachi/Islamabad/Brussels, 7 August 2020