'We must act now': UK Muslims bear brunt of Covid-19 amid government complacency
"There's a kind of gap in the NHS between management" and the Black, Asian and minority ethnic (BAME) staff, "almost like a colonial mindset," Binish, a Muslim nurse told Middle East Eye, referring to the UK's publicly funded National Health Service.
Recalling the hostility from white management during her training at a London hospital, she said: "It was hard to pinpoint... the ward manager and senior nurses didn't like the way I looked... I had comments about my hijab, like 'are you wearing too much material?'"
It took an emotional toll. Binish was also keenly aware that it could impact her career: "I was worried that I was not going to be signed off for clinical assessment... I wanted to exit the profession at that point."
The hostility from her managers compelled her to work twice as hard as her colleagues and not complain: "I had to prove myself; I'd stay twice as late. That's the pressure you feel being different."
The insecurity she experienced deterred her from raising concerns about her workload. "I remember being on a ward once where I was given four patients on a cardiac ward, all with chest drains... If you speak up, you feel that you will be labelled as the one that doesn't want to do hard work."
Binish was asked if she thought this "gap" was still playing out on the front lines of the coronavirus pandemic, preventing healthcare workers from ethnic minorities from raising concerns about prolonged exposure to the virus.
She thought for a moment and replied: "As nurses, we're taught that you should acknowledge your limitations, you should be able to verbalise it. In practice, that's different.
"If you're BAME there's an added pressure that you are going to stick out badly."
Visa trap
For many Muslim healthworkers on temporary work visas, this "gap" is more concrete and pernicious.
"We don't have the option to stay at home, our visa won't permit us... To work in hospital, we have to be on the front line," an Egyptian radiologist, working in the West Midlands on a temporary visa, told MEE.
"You can't afford to stay at home, even if you're high risk. I know a lot of people from the Muslim community who have asthma, diabetes.
'You can't afford to stay at home, even if you're high risk... I have to work because my salary would be deducted'
- Egyptian radiologist
"I am personally hypertensive, but I have to work because my salary would be deducted, and I'm not alone in this."
He explained that the restrictions of his Tier 2 visa could have repercussions on his family in the event of his death.
Putting it bluntly, he said: "If I died from Covid, my family would have to leave immediately."
Inconsistent advice
When asked to describe his workload during the pandemic, Salman Waqar, the general secretary of the British Islamic Medical Association (BIMA) responded wryly: "How long have you got?"
Throughout lockdown, charities like BIMA have been frenziedly deciphering, translating and relaying contradictory government advice to communities, a task made labyrinthine by the twists and turns in guidance.
Waqar was in and out of community briefings, reassuring panicked community members, even designing appropriate personal protective equipment (PPE) for religious minorities.
An Office for National Statistics report into Covid-19 mortalities by religious group recently revealed that the highest death toll was in the Muslim community.
This was no revelation to Waqar, who had written the guidance for their funerals.
"These deaths didn't occur in a vacuum," he told MEE.
"[They] reflect existing inequalities that have been present in society for a very long time. Covid has brought them sharply into focus."
Higher death rate
The figures came on the heels of a delayed, and initially censored report by the government's Public Health England (PHE) agency in June, which found that BAME Britons were up to twice as likely as white Britons to die if they contracted the coronavirus.
The report has at various stages drawn fierce criticism from Muslim community leaders.
The initial appointment of Trevor Phillips to the inquiry, a man previously suspended from the Labour Party for Islamophobic characterisations of the Muslim community as a "nation within a nation," elicited criticism from community leaders, who highlighted that the decision undermined the credibility of the report to British Muslims.
"The decision is particularly insensitive given that British Muslims overwhelmingly come from BAME communities and so many Muslim doctors have died at the front line of this pandemic," said Harun Khan, the secretary-general of the Muslim Council of Britain (MCB).
A section of the report containing 1,000 submissions by community stakeholders, among them the MCB, highlighting the role that "structural discrimination and racism" played in the excess deaths in the BAME community, was initially censored.
After drawing fire from the stakeholders, among them the MCB, who condemned the decision to ignore stakeholder evidence as "unacceptable," the inquiry was followed by a supplementary report which contained the community submissions.
'Inequalities in health status'
"The term BAME is so broad and useless," Zainab Gulamali, the public affairs manager for the MCB told MEE.
Even with the inclusion of stakeholder contributions, Gulamali argued, the remit of the report was too limited to reflect the experience of Muslim communities.
"It only looks at ethnicity... as one in three ethnic minorities is Muslim, we can extrapolate impacts on Muslim communities," she said.
While it neglected to include religious groups, the correlation the report established between socio-economic status and low health outcome is useful for understanding the impact of Covid-19 on British Muslims.
'Inequalities in health status and disease risk are associated with minority ethnic status'
- Public Health England report
The report's conclusion that "inequalities in health status and disease risk are associated with minority ethnic status" and that "the decreases in life expectancy and health outcomes are due to social, economic and structural determinants of health" is mirrored by previous studies of the health and socio-economic status of British Muslims.
'You can't ignore these things'
A 2014 study by the Joseph Rowntree Foundation documenting the risks of poverty in different religious groups found that Muslims were 50 per cent more likely to be found living in poverty.
According to a 2011 MCB report, entitled "British Muslims in numbers," 46 percent (1.22 million) of the Muslim population reside in the 10 percent most deprived areas, and 1.7 percent (46,000) in the 10 percent least deprived.
While the study emphasised these issues were not exclusive to the Muslim community, it correlated material deprivation prevalent among British Muslims with poor health outcomes.
Citing the 2010 Marmot review, which found that the reduction of health inequalities was a matter of social justice, the report concluded that, "the strategy of 'opting out' of establishing care provisions separately, is neither sustainable nor desirable. A public health policy needs to meet the needs of all sections of society."
In the absence of such a policy, throughout lockdown, it has been up to third-sector organisers like Waqar to plug the gaps in woolly guidelines and patchy provisions.
He has seen the resulting body count. "Covid made clear you can't ignore these things, because it can end up with people dying," Waqar said.
'Unable to challenge the hierarchical structures'
The PHE report identified that "ethnicity and income inequality are independently associated with Covid-19 mortality".
According to a 2011 census, only one in five of the Muslim population is in full employment.
Waqar identifies this economic insecurity as also playing a key role in the disproportionate death toll of Muslim healthworkers on the front line.
A 2014 survey of discrimination in governance and leadership in the NHS revealed a lack of career mobility for BAME healthcare workers, leading to a high concentration of healthworkers from ethnic minorities in lower paid roles on the "shop floor".
In the event of a pandemic, they would be on the front line. The first four deaths of Muslim doctors tell us this disparity is also applicable to Muslim healthworkers.
"Many of them are locum or temporary staff," explained Waqar.
"They feel unable to challenge the hierarchical structures in the NHS. We don't understand [how] the nuances of those relationships... play out in a clinical setting."
The death of Abdul Mabud Chowdhury, a consultant urologist at Homerton hospital who raised concerns about inadequate PPE gives us an indication.
Discriminatory employment visas also have a role to pay. "The NHS is an international workforce, many of them are here on temporary visas which are often sponsored by employers," said Waqar.
'Problematising faith'
The implementation of the government's Prevent policies, a counter-terrorism strategy, in healthcare could have also fostered this culture of hostility.
"The thinking that has underpinned Prevent, problematising faith, may share some of the characteristics of the same people that make life difficult on the front line," said Waqar.
What is the Prevent Strategy?
+ Show - HidePrevent is a programme within the British government's counter-terrorism strategy that aims to “safeguard and support those vulnerable to radicalisation, to stop them from becoming terrorists or supporting terrorism”.
It was publicly launched in the aftermath of the 2005 London bombings and was initially targeted squarely at Muslim communities, prompting continuing complaints of discrimination and concerns that the programme was being used to collect intelligence.
In 2011, Prevent's remit was expanded to cover all forms of extremism, defined by the government as “vocal or active opposition to fundamental British values, including democracy, the rule of law, individual liberty and mutual respect and tolerance of different faiths and beliefs.”
In 2015, the government introduced the Prevent Duty which requires public sector workers including doctors, teachers and even nursery staff to have “due regard to the need to prevent people being drawn into terrorism”.
A key element of Prevent is Channel, a programme that offers mentoring and support to people assessed to be at risk of becoming terrorists. Prevent referrals of some young children have proved contentious. 114 children under the age of 15 received Channel support in 2017/18.
Criticism of the Prevent Duty includes that it has had a “chilling effect” on free speech in classrooms and universities, and that it has turned public sector workers into informers who are expected to monitor pupils and patients for “signs of radicalisation”. Some critics have said that it may even be counter-productive.
Advocates argue that it is a form of safeguarding that has been effective in identifying and helping troubled individuals. They point to a growing number of far-right referrals as evidence that it is not discriminatory against Muslims.
In January 2019 the government bowed to pressure and announced that it would commission an independent review of Prevent. This was supposed to be completed by August 2020. After being forced to drop its first appointed reviewer, Lord Carlile, over his past advocacy for Prevent, it conceded that the review would be delayed.
In January 2021 it named William Shawcross as reviewer. Shawcross's appointment was also contentious and prompted many organisations to boycott the review. Further delays followed. Shawcross's review, calling for a renewed focus within Prevent on "the Islamist threat", was finally published in February 2023 - and immediately denounced by critics.
Medact, a London-based non-profit organisation that supports health professionals, recently issued a report which found that "the negative impacts of false positive Prevent referrals, including on physical and mental health, confidentiality and trust, are felt disproportionately by minority groups, which risks worsening existing health inequalities".
While the report was referring specifically to the impact on health outcomes for patients, the atmosphere of hostility it describes contextualises the stark examples of Islamophobia experienced by Binish and the Egyptian radiologist.
Lost in translation
When asked what had been the greatest obstacle in his community work through the pandemic, Waqar said simply: "Trust."
"Governments are not listening to communities; it's slow to react to them. It means that people feel that guidance doesn't apply for them," he said.
"Minority communities are aware of the disparity between one rule for some people and different ones for others.
'Minority communities are aware of the disparity between one rule for some people and different ones for others... Minority communities have seen the hypocrisies'
- Salman Waqar, British Islamic Medical Association
"They're not going to listen to guidance when they see the crowds at Bournemouth," he said, referring to a popular south coast resort that at times has drawn thousands of visitors during the pandemic. "Minority communities have seen the hypocrisies."
Pictures of crowded beaches at the resort had caused concern about the spread of the coronavirus, after the loosening of lockdown rules in early June.
According to Waqar, the inadequacy of effective government communication lay in its poor links with communities.
"The command and control response model they continue to adopt doesn't recognise the enormous strength of communities, the irony being that this is the government that proposed 'Big Society' thinking,” he said.
Data gap
"Underpinning all this is that we just don't have the data," Waqar said.
"We're having to infer from data around ethnicity... the data for religious minorities is not getting routinely reported and collected."
According to Gulamali of the MCB, sparse data has meant that diversity within religious groups is not captured.
"The only data we have [about the impact of Covid-19 on the Muslim community] is mortality rates... One of the things we called for was disaggregated data so we could understand the impact on specific communities."
Waqar attributed this paucity of information to a "squeamishness" about recording religious identity, but also to a dearth of mainstream research funding into ethnicity and religion.
The financial incentives are not there, he said.
"There are lots of papers examining South Asians and diabetes because it costs the NHS money," he said.
If the NHS is not talking about these things, he insisted, how could it deliver a holistic, human-centred service?
'We must act now'
"We've had so many reports," Waqar concluded wearily.
"The recommendations should have teeth: a delivery plan, dates and transparency... It's been given to the equalities minister, who wants to set up another inquiry," he said in disbelief.
"We're heading into a second wave" of the pandemic. "We can't wait for that inquiry."
The PHE report similarly concludes: "We must act now - Covid-19 did not create inequalities, these have been with us for a long time, we don't need more data or research to act. We must prevent any more harm being done."
Campaigners like Waqar do not need the data to understand that, for the British Muslim community, preventing this harm is a matter of life or death.
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