Already marginalized, indigenous peoples face unique challenges from COVID-19. Access to healthcare is limited, and indigenous peoples suffer higher rates of other diseases that make them more vulnerable to the pandemic. Some very isolated groups that have little interaction with outsiders have poorly developed immunity to infectious diseases. Yet outsiders are increasingly entering these areas, such as in Brazil where illegal logging and mining threatens not just the land but dramatically increases the risk for indigenous peoples, with some experts saying “ethnocide” is likely. Poor sanitation, limited provisions of other necessary items like soap, disinfectant, and even clean water, inadequately staffed medical facilities, combined with existing poverty, large multigenerational families living together, unemployment and reduced chances to retain work at home exacerbate the problems for indigenous people around the globe. This is all on top of tremendous discrimination, all of which are legacies of colonialism. Testing for COVID-19 is not widespread in areas where indigenous peoples live, nor is educational material about infectious diseases or protective materials like masks and gloves. Food insecurity, an existing problem, is worsening for indigenous peoples, according to the United Nations. Indigenous women suffer higher rates of domestic and sexual violence, both of which increase during crises of this sort. Access to help services is already sparse and jurisdictional issues on native lands mean police responses are slow if not existent.
This article will explore these issues in greater depth, showing how and why COVID-19 is disproportionately killing them but also the ways that stay at home orders and other responses are experienced differently. It will conclude with recommendations for the future. This is a shortened version of a chapter that will be included in a book I am co-editing with Dr. Pamela Hall, Coronavirus and Vulnerable People: Addressing the Divide in Harm and Responses and Implications for a More Peaceful World, to be published in PJSA’s Peace Studies: Edges and Innovations series with Cambridge Scholars Press.
Access to healthcare is limited on reservation land, and indigenous peoples suffer higher rates of other diseases that make them more vulnerable to the pandemic. According to a 2017 U.S. Census Bureau report, 19.2 percent of single-race American Indian and Alaska Native people lacked health insurance coverage in 2016, compared to 8.6 percent for the U.S. as a whole. The Indian Health Service, or IHS, is responsible for providing medical and other health-related services to enrolled Native American tribal members. But the money allocated to the IHS is insufficient for the size of the population it serves. Further, because so many Native Americans struggle with obesity, diabetes, asthma, and heart disease, healthcare systems on reservation lands are already taxed. These are some of the conditions that are said to make one more susceptible to coronavirus and for it to be a more severe case. Additionally, since reservations are often so large, hospitals and other resources are spread out, making it harder to get care. Navajo with the virus, which they call Dikos Ntsaaígíí, are sometimes having to be flown to Albuquerque, Flagstaff, and Phoenix, because there are only a dozen hospitals and part-time clinics on their land, which is not only very costly but takes more time and thus can be deadly.
That the federal government is involved in Native healthcare is the result of treaties negotiated with nations that have never been followed. In exchange for their land, the federal government is supposed to treat Native Nations as “domestic” and “dependent,” meaning they are sovereign yet the government has a duty of care. The Indian Health Service is one piece of that duty and according to Nations like the Navajo, it has been failing to meet its obligations from the beginning. The HIS serves 2.6 million people who are members of the 573 federally recognized American Indian and Alaska Native tribes. Before the global pandemic, the federal government spent $2,834 per person on healthcare in Indian Country. In contrast, it spends $9,404 on veteran health and $12,744 on Medicare. The Navajo have filed a suit against the HIS, arguing that the $2 trillion Coronavirus Aid, Relief, and Economic Security Act or CARES Act, which includes $8 billion to help tribes fight the coronavirus, is not ample. The Navajo Nation and 10 other tribes are involved in the suit. Next to New York and New Jersey, the Navajo, whose land is approximately the size of West Virginia, have the third highest rate of coronavirus infection. Just 4.6 percent of the population of Arizona, Native Americans constitute sixteen percent of that state’s coronavirus deaths. The suit alleges that CARES monies were going to for-profit companies rather than to Nations, and in late April, a federal judge halted the Trump administration’s move. Jonathan Nez, President of the Navajo Nation, said, “We are United States citizens but we’re not treated like that. You can hear the frustration, the tone of my voice. We once again have been forgotten by our own government.” V. Jones, writing for CNN, also attributes part of the problem of the spread of COVID-19 among Native people to “centuries of broken promises.”
Since the Navajo, like other Nations, are sovereign, they are able to negotiate on their own for equipment and supplies but still must compete for the limited testing, protective equipment, and ventilators needed to stop the spread of the virus and help those who are sick. Centuries of laws and court decisions have created a bureaucratic nightmare for this, so Nations must sometimes apply through state health departments, other times to the federal government but through varying agencies. The Navajo Area Indian Health Service must care not just for members of the Navajo Nation and San Juan Southern Paitue Tribe, but also Hopis, Zunis and other tribes in the area. In all, it has 222 hospital beds to serve 244,000 people. When they have asked for help, it has not always been forthcoming or even what is needed. When the Seattle Indian Health Board asked for coronavirus tests in mid-March, what they received three weeks later was body bags. While clearly a mistake, it did nothing to help. Abigail Echo-Hawk, the health board’s chief research officer, said, “This is a metaphor for what’s happening,” meaning that Native Americans were being largely forgotten and left to die.
Deep poverty contributes to the problem, as many also do not have routine clean water for hand washing, regular food, jobs, savings, and other necessities that can help protect from the virus. Estimates are that among the Navajo alone, some 15 to 40 percent of homes lack clean running water. According to the U.S. Census Bureau, while the poverty rate in 2016 was 14 percent nationally, 26.2 percent of single-race American Indian and Alaska Native people were in poverty. This is the highest of any racial group. Pine Ridge Reservation, Home to the Oglala Lakota, a tribe of the Sioux, perpetually contains the counties with the highest poverty rates. Unemployment rates are 80 to 90 percent, and there are virtually no jobs. The reservation lacks key infrastructure, and many children attend school only minimally or not at all. The reservation covers more than 2.8 million acres and has few medical facilities. Alcoholism rates are high, and a quarter of children are born with fetal alcohol syndrome. Life expectancy before the epidemic was 48 for men and 52 for women. Rates of tuberculosis and diabetes are eight times higher than the national average, and diabetes is associated with more fatal cases of coronavirus.
Native and indigenous women suffered from disproportionately high rates of domestic and sexual violence before the global pandemic. One study found that more than half of American Indian or Pacific Islander women had experienced sexual violence in their lifetime. The same is true of domestic violence. These women are 1.7 times more likely to have experienced violence in the last year than White women and two times as likely to have been raped in their lifetime. Ninety-six percent of the perpetrators are non-Native Americans, which means that tribal justice systems are not allowed to address the issue due to previous court cases and laws that infringe on tribal sovereignty (National Congress of American Indians, 2018). These problems have exacerbated under stay-at-home orders. One survey of 250 indigenous women in Canada found one fifth had reported experiencing physical or psychological violence in the past three months. Shelters are not a viable option now, as people are on order to stay home, in this case, often with their abusers. The Canadian government committed $30 million in funding to Women and Gender Equality Canada for shelters and sexual assault centers and another $10 million to Indigenous Services Canada’s network of 46 emergency shelters on reserve and in Yukon. However many of these are not run by or for indigenous women so women who need them will not go to them. Michelle Audette, who has worked on a national plan of action, ties the issue to colonialism. “Because we are facing the impact of colonialism,” she argues, “we are not a top priority and we can see it with COVID right now.” Prior research has shown spikes in domestic and sexual violence during crises, for instance, there was a 35 percent increase in women reporting psychological violence during and immediately after Hurricane Katrina and an increase of 98 percent of those reporting physical abuse. U.N. Secretary-General Antonio Guterres said on April 6, 2020 that some countries have seen rates of domestic abuse doubled. Even things like requirements to wear masks can be triggering of historical trauma related to colonialism.
Involvement with criminal justice is a risk factor for contracting COVID-19 that is also affecting Native peoples. The cases of Andrea Circle Bear and Valentina Blackhorse are illustrative. Circle Bear was incarcerated for a nonviolent drug offense when she caught the coronavirus. Pregnant at the time, she was placed on a ventilator the day before her cesarean section. She died four weeks later, never having met her daughter. Circle Bear was just 30. Blackhorse, 28, died after contracting the virus from her partner who worked at a detention center for the Navajo Department of Corrections.
One recommended method for curtailing the spread of COVID-19 is contact tracing, or following who an infected individual was in contact with to see patterns and quarantine or assist sick individuals earlier. Yet contact tracing is much more challenging on reservation lands. The Navajo, for instance, have employed 80 contact tracers but many of their people do not have phones to make contact. To physically track down individuals is far more laborious and takes more time.
Stay-at-home orders are difficult for many, but are particularly so for Native Americans. As was noted, many lack clean water, electricity and live in homes that are full of black mold. Approximately one quarter of Native Americans and Pacific Islanders were already food insecure, defined as not having regular, reliable access to the foods needed for good health. Not being able to get groceries, or doing so at huge risk, will only exacerbate the problem of food insecurity. Many Native people live in overcrowded homes that make social distancing difficult. Federal funding for housing in Indian Country, part of the government’s duty of care, has been blocked for decades. The Navajo have tried to social distance by issuing strict curfew orders that result in arrest if violated. Other Nations have set up physical roadblocks to keep away outsiders, measures largely taken because the federal government’s assistance has been too limited so more restrictive efforts have to be taken.
In the U.S., a significant concern among Native-Americans is that deaths of elders will result in loss of culture, as it is they that teach youth the language and customs of their people. Already the smallest racial minority in the U.S, as Moya-Smith (2020) put it, “when we lose an elder, we’ve truly been robbed of more than just a person — we’ve lost centuries of pre-white invasion knowledge and narrative.” Nations are trying to limit outsiders’ access so as to curtail the spread of the disease, but that means many cannot communicate with loved ones at all, as they lack phones or electricity to use technologies others are able to, like Facebook chats or Zoom meetings. Those that have phones are saving their battery power in case of emergency (Moya-Smith, 2020). Some Nations have created checkpoints at entries to reservation land. In South Dakota, Republican Governor Kristi Noem has ordered the Ogala Sioux and Cheyenne River Sioux to remove those that fall on state and federal highways and threatened a lawsuit if they did not comply. Not only does Noem’s order violate tribal sovereignty, it also violates existing agreements between the state and the Sioux governments. Harold Frazier, chairman of the Cheyenne River Sioux, responded, “we will not apologize for being an island of safety in a sea of uncertainty and death…You continuing to interfere in our efforts to do what science and facts dictate seriously undermine our ability to protect everyone on the reservation.” Oglala Sioux President Julian Bear Runner agreed, announcing “we have an inherent and sovereign right to protect the health of our people, and no one, man or woman, can dispute that right. Your threats of legal action are not helpful and do not intimidate us. The only way we can get through this is to work together as a nation.”
At the same time, tribal customs are resulting in increased danger as well. In New Mexico, Governor Val Panteah exempted religious gatherings from stay at home orders. Zuni Pueblo, both the Zia and the San Felipe, have been contracting cases of COVID-19 at high rates in part because many have participated in large group religious ceremonies. Panteah says that the state is going to try to test those who have done so, but limited tests make that a challenge. The virus has even hit the top two officials of the Zia.
“The sad truth is this is not the first time a pandemic has devastated Indian Country,” Jones writes. “Going back to the earliest days of colonization — and even as recently as the 1918 influenza pandemic, which was four times more lethal within the tribes — Native Americans have borne the worst of this country’s diseases.” But there are many things that can be done, both now and in the future. Many organizations are collecting donations of funds and supplies. We can demand that, for once, the government come through on its promises. Although monies were devoted to Nations in the CARES ACT, most had not received anything more than a month later. And much more is needed in relief for Indian Country. The government could also simplify the way that Nations must apply for help and equipment and unblock funding for housing. Further, there are simple solutions that would allow those living on reservations to vote, including mobile voting stations, translation services, and convenient ballot drop boxes.
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