One of the most striking facts coming out of the currently ongoing zika virus outbreak in Singapore is that the initial cases seemed to have been concentrated at one construction site in the Sims Drive area. Of the first 41 confirmed cases, 36 were workers at the Sims Oasis project (pictured above).
Within a week of the first confirmed case, the total number of cases have climbed to 215. It is not known how many of this new total are foreign workers. However, if previous experience with dengue outbreaks is any guide, they will be disproportionately affected. Zika and dengue are spread by the same types of mosquito, the Aedes aegypti and Aedes albopictus. As is chikungunya.
As far back as 2007, a report in the Straits Times noted that:
Foreign workers packed like sardines in crammed quarters. Foreign workers making up more than a third of dengue cases. Could there be a link between the two?
Singapore is in the midst of a dengue outbreak and 1,133 of the 3,216 cases involve foreign workers, says the National Environment Agency (NEA).
[snip]
Just this month, 409 foreign workers were infected, up from 283 last month – among them, a group of foreign workers living in rented apartments in Kim Keat.
— Straits Times, 30 June 2007, Dengue link with poor living quarters? Cached link.
The article suggested that “dismal living conditions” had a bearing on the rates of infection, particularly “walk-up apartments, shophouses and landed properties [that] are rented out to house foreign workers”. In Lorong 30 Geylang, the newspaper’s reporter saw a room made of cardboard sides and a zinc roof, shared by ten workers. It was “on a shophouse rooftop that is often flooded ankle-deep in rainwater.”
There are slums like this all over Singapore island, the newspaper said.
Six years later, Today newspaper reported on another dengue outbreak with a high number of construction workers affected.
A 1 km stretch along Geylang Road has emerged as a dengue hot spot, with 83 people coming down with the mosquito-borne disease since Nov 8.
[snip]
Geylang, which is known for its red-light district and eateries, is also home to numerous shoebox apartments and shophouses which see a steady stream of transient migrant workers drawn to the cheap rental.
Responding to queries, the NEA [National Environment Agency] said 90 per cent of the 83 people who fell ill were foreigners living in the area, with 23 being construction workers, as of last Friday.
— Today, 17 December 2013, A dengue hotspot in Geylang, 83 cases reported. Link.
When Chikungunya began to take root in Singapore, it too was largely centred on the foreign worker community. The first case was documented on 10 Jan 2008 in a “patient [who] had consulted a GP in Little India” (Singapore Society for Microbiology and Biotechnology, paper by Ng Lee Ching, 13 June 2008, link). There were a total of 690 documented cases in 2008, with 343 more in 2009. Then it disappeared from the local scene for a few years, re-emerging in 2013. A Straits Times story said:
More than 100 people have been infected by chikungunya in Singapore this year, a steep rise from just three to six annually for the past three years.
Most of the cases are in the Kranji-Sungei Kadut area, but a growing cluster has emerged in the Bukit Timah area.
[snip]
In the bigger cluster at Kranji-Sungei Kadut, however, most of the casualties are foreign workers living in dormitories.
— Straits Times, 7 May 2013, Steep rise in chikungunya cases this year. Link.)
Sungei Kadut industrial area
A poorly dated article, originally from the Straits Times, but archived at asiaone.com (link) reported that the 2013 outbreak of chikungunya began within a foreign worker community. Likely dated around March 2013, the report said that up to that point in time, there were 22 cases so far that year.
A spokesman for the Health Ministry (MOH) said all the 22 infected people were foreigners in the Kranji-Sungei Kadut area, and were aged between 21 and 47.
She said five of the 22 cases were imported, but the rest of the patients were likely to have caught the bug here.
[snip]
It was first alerted to four cases in Kranji-Sungei Kadut – involving three workers from India and one from China – between Feb 8 and March 12.A team was sent to investigate and screened 270 people who worked or lived in the area for the chikungunya virus. This exercise uncovered another 13 workers with the disease.
The MOH spokesman said: “Investigations revealed that the cases most likely acquired the infection locally, as they had not travelled out of Singapore recently.”
The mosquito-borne disease was unknown here until 2008, when the first locally infected case surfaced.
It took root quickly, and more than 1,000 people were infected between 2008 and 2009 – many of whom were also in the Kranji- Sungei Kadut area.
— asiaone.com, undated, 14 cases of chikungunya infection last week. Link
In this current zika outbreak, the first 36 cases of construction workers identified came from among 490 workers living in “temporary quarters” at the Sims Drive site. (Today, 30 August 2016, Zika outbreak: checks at construction sites stepped up). The authorities have urgently arranged for fogging of the site to exterminate mosquitoes.
They have also called on site operators to be more diligent in continuing control measures.
Unfortunately, these may not be sufficient. So long as substandard, makeshift accommodation is tolerated by the authorities, the problem will recur. This can be seen from the repeated outbreaks of dengue over the years. It is important that workers not be housed in on-site accommodation made of flimsy material, amidst broken earth and half-constructed drains where pools of stagnant water easily accumulate.
As for “slum houses” in Geylang, Little India and many other parts of Singapore, the problem is complicated by economics. It may be possible to inspect these places stringently and demand that (a) landlords upgrade the premises, and (b) reduce the number of occupants per room so that better housekeeping can be maintained, but doing so will result in the cost per bunk rising considerably.
Many foreign workers like living in these districts because they are closer to amenities, especially amenities that cater to their national community. It would create huge problems for them if rent rose sharply. A better solution would be to relook at the current ban on housing foreign workers in HDB flats. There are many older blocks that are no longer desired by Singaporeans. Instead of tearing them down, they can repurposed to house foreign workers. These would allow decent accommodation in well-built buildings, yet at a density that makes efficient use of land.