The COVID-AM blog is a partnership between the UMI 3157 iGLOBES and the Institut des Amériques, coordinated by François-Michel Le Tourneau, Deputy Director and Marion Magnan, researcher at the Institute. About the blog.

by Audrey Célestine, Professor at  Université de Lille, CERAPS, junior member of IUF; Stéphanie Guyon, Professor at the Université de Picardie (CURAPP).

On a map published mid-Mars, at the beginning of the pandemic, it looked like the territories of the Americas the most hit by COVID-19 were Martinique, Guadeloupe and Porto-Rico.

The possibility of an epidemic in these territories brought on bigger worries than in France not only because of the structural caracteristics, but also because of more contextual elements tied to the recent political situation. Though the level and living conditions are rather better than in neighboring countries, these territories have a number of weaknesses (hospital  structures, health of the populations), leading to fears of catastrophic consequences, justified today when looking at the health situation in French Guiana. Furthermore, these French territories are plagued by major social crises that bear witness to not only a certain defiance toward the government and its capacity to act in the interest of the populations, but also to economic, social and demographic problems that the local and national authorities are struggling to resolve.

STRUCTURAL PROBLEMS

If, in terms of number of ICU beds, Martinique is in a similar situation as France's regions, the state of Cayenne and Guadeloupe's hospitals are all the more worrisome. In Cayenne, there are only 15 ICU beds (23 if you count the ones for continuous care, so one bed per 12 000 inhabitants against 1 bed for 3500 inhabitants in France and even more if you take into account the increase in capacity they did in March and April). In fact, the hospital issue was one of the main concerns of the 2017 general strike in French Guiana. In Guadeloupe, a November 2017 fire greatly reduced hospital capacity.

Then it is the general health of these territories' populations that reinforce the risks of a health disaster if there is a severe epidemic. Martinique and Guadeloupe are aging territories, where the elderly are not as healthy as those in France. The factors of comorbidity, such as cardio-vascular disease and obesity, are also at much higher levels (over 40% of the population of the two islands suffer from hypertension, against 31% at the national level, diabetes reaches about 11% on the two islands against 5% at the national level, excess weight and obesity are also significantly higher than in France). In French Guiana, the population is younger, however the prevalence of certain pathologies, comorbidity factors such as diabetes, uncontrolled HIV infections and also respiratory diseases, is quite high (the prevalence of diabetes is 8%, so double France's, HIV-AIDS is over 1%).

The caracteristics of local economies in the Antilles is also a major concern. Local economies partially depend on tourism and therefore people traveling. For the past several years, Martinique and Guadeloupe have had an increase in transit tourism from the cruises, a phenomena that was accentuated in 2017, redirecting to these islands stops that were originally intended for the islands that were hit by the Irma and Maria cyclones in 2017, such as Porto-Rico and Saint-Martin. This dependence on tourism creates the first vulnerability to the virus since it encourages its spread, and a second one with the paralysis of activities which will have a very strong economic impact later, increasing the population's vulnerabilities.

HEALTH CONCERNS AND DEFIANCE TOWARD THE GOVERNMENT

On top of these structural concerns, tensions because of the health scandales, in particular one on chlordecone in the Antilles. This product, used for several decades on local banana plantations, has contaminated the agricultural lands of the islands on a long-term basis and is linked to record level cases of cancer, particularly prostate, breast and endometriosis. It is estimated that the organisms of close to 92% of the inhabitants of these territories have chlordecone. Protests on this subject started in the early 2000s, but have only been circulated at the national level in the last three to four years[1]. The whole process and the decisions taken around the issue of chordecone in the past as in the recent period- on the maximum limit of residu in agricultural products, the level of contamination of running water, the installation of local test laboratories- have exacerbated the defiance to authorities and the suspicion of collusion between the highest level of governement and the "béké" groups, owners of the banana plantations[2].

Among the groups mobilized these past months, the militants in Martinique named RVN - displaying a Red-Green-Black flag, national emblem for some of Martinique's separatists since the 1990s[3] and largely reengaged since the intensification of the anti-chlordecone protests - particularly targeted symbolic places of the economic strength of these groups, for instance calling for the boycott of shopping centers and large retailers. The start of the year 2020 was marked by confrontations between the militants and the police forces at the Fort-de-France courthouse. In February, during the Carnival, several chants vehemently criticized the government's action on the "poisoning" of Martinique and Guadeloupe's populations. In general, there is mistrust in the government's capacity to protect the health of the citizens of these territories[4].

A MANAGEMENT OF THE HEALTH CRISIS SPECIFIC TO THE OVERSEAS DEPARTMENTS

Though the calendar for the management of the crisis in overseas departments was the same as France's - the different territories were on lockdown on March 17 like France though most of the territories were not in phase 3 of the epidemic -, specific measures and plans were put in place.

So in French Guiana, the handling of the crisis was more territorialized than in France and the inhabitants subjected to more coercive measures. The indigenous village lokono de Cécilia - first cluster identified in the department which regrettably had the first victim of the epidemic[5] - was quarantined and its inhabitants put on strict lockdown. In the areas affected, systematic screening and lockdown of people in their homes or at the hotel were put in place early on - right during the lockdown period. These measures helped control the spread of the virus coming from imported cases from the Antilles and France in March and April. With the growth of the epidemic in Brazil, since the beginning of May, the virus has spread east of French Guiana and it is all of the eastern region of French Guiana (St Georges and Camopi) which was again put in lockdown. A health checkpoint was put in place on Cayenne's road to stop the epidemic, only travel for urgent matters are authorized 4 hours per day by presenting a justification and after a control of the passengers by the roadblock's health personnel. When French Guiana went to stage 3 of the epidemic on June 15, it provoked new sector lockdown measures in many towns in accordance with the intensity of the virus' spread and the vulnerability of the inhabitants, curfews were put in place in most of French Guiana's towns and the sale of alcohol after 4pm was forbidden. Along with these measures came a massive testing campaign; in proportion the number of tests given in French Guiana was 6 times higher than in all of France, and contact tracing was also more encouraged than there.

In Martinique and Guadeloupe, the prefects' actions to protect the population were deemed too slow during the first two weeks in March, especially with respect to access to the territory by transatlantic flights and cruise ships. Protests to stop these arrivals were organized at the Fort-de-France airport. When the national lockdown started, and faced with a rapid increase of cases in the second half of March however, specific decisions were taken at the beginning of April, a curfew was put in place from 8pm to 5am and a ban on beaches on the two islands. Arrivals to the islands were severely limited and 14 day quarantines in dedicated spaces were imposed. These measures, specific to the overseas departments, was strongly criticized both for its relative uselessness, several people having been able to return home, but also for the requirement that individuals do it in a space they had not chosen. In fact, the Constitutional Council found that, when the public health emergency order was extended, the measure imposed on the overseas departments was a deprivation of liberty and therefore unconstitutional. Starting in May, all overseas departments required people to have "urgent family or professional reasons" to go to overseas departments.

AND LOCAL POLITICAL AND CIVIC REACTIONS

Concerning the handling of the crisis in the territories, there were different types of rallying from groups of citizens and local political groups. In Martinique, the Groupe Révolution Socialiste put together proposals and requests (on the isolation of the sick people, the involvement of the population in the fight against COVID-19, the mobilization of local media, help for small local farmers specifically)[6], facing the pandemic, the "government's shortcomings" and the lack of coordination between municipalities and central governmental services. Different players expressed their discontent with the handling of the crisis in Martinique and Guadeloupe. So, the associations, ASSAUPAMAR - association écologiste et anticoloniale and the MIR-Martinique attacked the government for reckless endangerment, failure to help a person in danger and involuntary homicide. Several days later, the Fort-de-France administrative court rejected the request formulated by ASSAUPAMAR, the CSTM and the MIR to demand authorities do a systematic screening, a massive order of chloriquine and protections for the healthcare workers and the population.

In Guadeloupe, an order by the Basse-Terre court entered by the UGTG required the hospital and the ARS (Agence Régional de Santé) to order Covid-19 tests and treatments "in sufficient quantities", before being partially cancelled by the State Council. Then it was the curfews and the ban on beaches that were attacked by groups of lawyers, successfully with the first one. Though they did not always win in court, the actions against the hospital, ARS and the prefect were ways to point the finger on the shortcomings of the government's actions and to extend the criticisms to the handling of serious health issues in these territories.

POLICIES AS USUAL: EXEMPTION AND SPECIFICITY AT THE CORE OF THE MANAGEMENT OF THE CRISIS OVERSEAS

Though the situation is slowly coming back to normal in Martinique and Guadeloupe, with a limited increase for now of the number of cases since reopening, French Guiana has gone to stage 3 of the epidemic since June 15 and will stay in a state of medical emergency until October. The COVID-19 crisis reveals, as in many other countries, the economic, social issues and preexisting structural problems. It's no surprise that, among the French overseas territories, it's French Guiana and Mayotte, the two most impoverished territories and in which controlling migratory flows is the most difficult, that are the most impacted today. To mitigate these structural problems, the government is putting in place a specific crisis management plan, much more specific, territorialized and coercive than in France.

For Martinique and Guadeloupe, the health crisis has deepened the mistrust of the government's capacity to protect the health of the overseas inhabitants. Though there is a very gradual return to flights with France, a number of sectors are still in fact affected by the health and political situation. Almost none of the schools of the islands have restarted, mayors from most towns allude to a lack of equipment in order to respect the health measures. The water supply being shut off numerous times during a drought period, and faced with failing community networks, makes it close to impossible to reopen in some towns, especially rural. For the three territories, the handling of the health crisis was based on, as is often the case, the use of specific and derogatory measures, important indicators of the government's extension overseas[7].