A migrant worker looks on from a swab isolation facility as he waits for his test results at a dormitory amid the coronavirus disease outbreak in Singapore May 15, 2020. Photo: AFP

SINGAPORE – Passing their days within a ringfence, Singapore’s foreign workers have spent the past four months coping with fears of contracting Covid-19 and the associated dread of being quarantined in perpetuity.

Confined to the cramped living conditions of their dormitories, signs abound that the pandemic has taken a heavy toll on the mental health of low-paid laborers in the island republic, which nonetheless has earned global praise for its comprehensive coronavirus handling.

Mass dormitories housing some 323,000 foreign workers emerged as the epicenter of the city-state’s outbreak after being put on lockdown in April when clusters were first identified.

While cases remained low among the population at large, infections in the dormitories rose dramatically and pushed Singapore’s caseload to one of the highest in Asia.

Singapore’s total number of Covid-19 cases now stands at 56,099, with dormitory infections accounting for around 95% of the total caseload. The asymmetric impact of the outbreak, moreover, has spotlighted the need for broader reform of dormitory standards and the uncomfortable realities of severe inequality in the wealthy city-state.

With scores of migrant workers kept in isolation even after testing negative for Covid-19, suicides and attempted suicides have been reported in recent weeks. Public health experts say that while the city-state’s coronavirus battle is still far from over, recent signs suggest it has begun to turn a corner.

Authorities declared all dormitories clear of infections on August 19 after testing all foreign workers. While around 18,600 workers are still serving out their quarantine period, 86% of all laborers in the construction, marine shipyard and process industries, where most are employed, are now back on the job.

Foreign workers wearing face masks as a preventive measure against the spread of the Covid-19 novel coronavirus look out from a fence of a workers’ dormitory in Singapore, April 2020. Photo: AFP 

Stringent safety measures still prevent workers from leaving their dormitories on rest days and mandate that they return to their living quarters immediately after work. However, small-scale trials beginning this month will allow residents in some dormitories to run personal errands without movement restrictions.

But the possibility of new outbreaks among migrants is still a risk that could see entire dormitory blocs go back under new precautionary quarantines. That, observers say, could further adversely impact the mental and emotional health of workers. Since May, at least two have committed suicide and five were detained after self-harming.

Earlier this month, Education Minister Lawrence Wong, co-chair of the multi-ministry task force set up to coordinate Singapore’s virus response, cautioned that cleared dormitories would not be “permanently Covid-safe” and said movement restrictions on foreign workers will stay in effect “as long as residual cases from the dorm clusters remain a concern.”

“In a pandemic, even the most vigilant nation will have cases,” said Benjamin Rolfe, an infectious disease specialist and chief executive officer of Singapore-based management consultancy Nascent Advisory Asia. “It is inevitable that new outbreaks will occur. The question is whether the nation can detect those cases and move rapidly to isolate them.”

On August 18, authorities announced that around 100 new cases had been detected among those who had already returned to work. The new cases were identified through mandatory fortnightly testing and resulted in some 7,000 workers re-entering quarantine, less than 2% of whom were found to be infected.

A single Covid-19 case in a cleared dormitory reported earlier this month resulted in 800 workers being put under renewed quarantine. Those who are assessed not to be at risk would have their quarantine orders subsequently rescinded, the Ministry of Manpower (MoM) and the Ministry of Health (MoH) said in relation to the spate of new post-clearance cases.

“We have quarantined the whole block in the first instance while the assessment is being made as a precautionary measure,” the ministries added. “While this approach could affect up to a few hundred migrant workers for each case, it ensures that we contain the detected case and minimize spreading that could end up affecting thousands of others.”

While public health experts and observers laud the comprehensive testing and stepped up vigilance of Singapore’s approach, many see the easing of movement restrictions, as well as a more robust provision of mental health services, as necessary for a holistic solution.

Foreign workers hang out along the corridor of the S11 Dormitory @ Punggol on April 6, 2020. Photo: AFP/Roslan Rahman

“What is reported in the media only scratches the surface of the huge mental health problems the workers are facing,” said Jolovan Wham, a labor and civil rights activist.

“The authorities need to allow workers who are not infected with the virus to leave the dormitories. It is highly discriminatory for the government to allow the rest of the community freedom of movement but not the migrant workers.”

Singapore has progressively resumed economic activities since its restrictive “circuit breaker” measures ended on June 5. Local transmissions outside the dormitories have remained low, even with shopping centers, cinemas and tourist attractions re-opened and religious gatherings of up to 100 people, up from 50 previously, now permitted.

A general election held in July did not result in a spike in cases, though Singapore continued to record between 200 and 400 new dormitory cases each day, an average that has only recently started to taper down since testing was completed. Even so, gaps in Singapore’s policy of ringfencing dormitories persist.

“Inevitably, the pandemic has thrown up a range of questions around inequality, living conditions and provision of essential services globally, including mental health services,” said Rolfe. “Undoubtedly, the government are already looking at future arrangements for overseas workers [as part of] substantial public health reforms post-pandemic.”

The MoM has said that while it has not observed an uptick in the number of suicides among migrant workers “compared to previous years”, Singapore’s multi-ministry task force is monitoring the situation closely and looking into better ways to support the mental and physical health needs of migrant workers, including through the provision of counseling.

“This continues to be a work in progress so I do not pretend that the work is completed [or] that we have a very comprehensive system of support,” the MoH’s director of medical services Kenneth Mak was reported as having said during an August 6 press conference.

The task force, he added, is committed to ensuring a “sustainable framework” to support the mental health of migrant workers that would remain in place after the outbreak ends.

“What is needed is a comprehensive approach towards allowing the migrant workers to return to the usual communal activities as before, but with the necessary safe management measures to minimize infection risks,” said Teo Yik Ying, dean of the National University of Singapore’s (NUS) Saw Swee Hock School of Public Health.

Health workers take a nasal swab test sample from a migrant worker to detect the COVID-19 novel coronavirus before the workers return to work in Singapore, June 10, 2020. Photo: AFP/Roslan Rahman

“This will be more effective in the long-run towards addressing the mental health issue of the migrant workers,” he added while noting that medical health posts have been set up at every dormitory to look after workers’ healthcare needs and several non-government organizations (NGOs) are also actively assisting to meet their mental health needs.

Though the possibility of new outbreaks remain, especially as migrant workers are gradually allowed to resume social activities within the community, Teo said surveillance measures introduced by authorities would help to manage risks.

“A suite of measures have been put in place, including sewage testing and fortnightly swab test screening, on top of infrastructural and process improvements to their living quarters in the dormitories,” he told Asia Times.  

“At the worksites of these migrant workers, there are stepped up procedures around cohorting and workforce segregating, so even if there is a recurrence of infections, it will be easier to contain the spread to other dormitories. However, the reality is that there is always the possibility of new outbreaks.”

From the start, Singapore’s handling of the dormitory outbreaks and reports of squalid living conditions of low-wage migrant workers, who are mostly from Bangladesh, India and China, prompted debate and criticism that authorities’ initial response overlooked warnings that overcrowded housing complexes were ripe for Covid-19 contagion.

Critics view the conditions that made workers susceptible to infection on such a massive scale as the consequence of an economic system that prioritizes growth-driven profits over health and safety. The city-state’s largest-ever humanitarian and public health crisis has also raised questions about Singapore’s culture of accountability relative to other developed Asian nations.

When questioned in Parliament in early May whether authorities would apologize for the large number of Covid-19 cases in dormitories, Manpower Minister Josephine Teo declined to do so and controversially remarked that she had “not come across one single migrant worker himself that has demanded an apology.”

“In any functioning democracy, a debacle of such proportions would have resulted in a resignation of the minister,” said Wham. Teo, a member of the ruling People’s Action Party (PAP), secured re-election in July in a group constituency with 65.3% of the vote and retained her labor ministry portfolio after a recent cabinet reshuffle.

Singapore’s Minister of Manpower Josephine Teo (L) visiting Westlite Papan dormitory for migrant workers who have recovered from the Covid-19 in Singapore, May 2020. Photo: AFP/Handout/Ministry of Manpower

In response to a query, the MoM referred Asia Times to a ministerial statement that Teo delivered to Parliament on May 4 in which she stated that if any foreign worker was unwell, “they got the same care as any Singaporean would” but also conceded “there were certainly hiccups along the way” as authorities responded to the “unprecedented” crisis.

In June, the government promised it would build new dormitories with improved amenities and increased living space for migrant workers within the next two years, which would feature more sick bays and isolation facilities that Teo said would “strengthen the resilience of the dormitories against pandemic risks.”

With one of the world’s lowest Covid-19 mortality rates and status as one of the top testers globally with 177,000 tests per million people, many health experts regard Singapore’s Covid-19 management as exemplary in the circumstances, with its comprehensive contact tracing regime earning particular global praise.

“Even at the height of the outbreak in April and May, acute hospital resources were never overwhelmed and this meant anyone infected with Covid-19 who needed stepped-up care in an acute hospital was able to receive it,” said Teo, who remarked that Singapore’s overall management of the health situation was among the world’s “more successful.”

Because the vast majority of those infected in Singapore have been young and healthy workers who contracted a milder form of the disease, fatalities have been low while close monitoring of patients has contributed to a smaller number of intensive care unit (ICU) cases, say experts. To date, just 27 people have died from Covid-19-related complications in the city-state.

“Undoubtedly, if you remove the situation with overseas workers, Singapore leads the world in both the timeliness and comprehensiveness of its response,” said Rolfe. “Singapore’s Achilles heel was, of course, overseas workers living in conditions conducive to transmission. No doubt this is under review.

“But I believe Singapore maintains a global reputation for an outstanding response.”