None were spared. Men, women, and children sickened, took the disease and died in agony by hundreds, so that when the spring arrived and fresh food was procurable, there was scarcely a person left of all their numbers to get it. – an unidentified Squamish person describing 1770s smallpox epidemics.
It was almost as if the prime conditions for the outbreak of epidemics had been deliberately created. – Brian Titley, commenting on P.H. Bryce’s 1907 Report on the Indian Residential Schools of Manitoba and the North-West Territories.
During the global H1N1 pandemic , Indigenous populations… experienced disproportionate rates of hospitalization and experienced greater severity of symptoms in comparison to non-Indigenous populations…What these populations do share is a common experience of colonization that has resulted in and sustained disparities in health status and the social determinants of health… Indigenous approaches to the social determinants of health offer a significant contribution to health knowledge in centering holistic perspectives of health which may include consideration of the four aspects of self (body, heart, mind, spirit); the lifecycle; the importance of understanding our past, in the present for our future. – Billie Allan and Janet Smylie.
Disease and colonialism have historically been intertwined. Indigenous peoples’ experience with Covid-19 reflects a continuity from imperialist to neoliberal expansionism into ongoing settler colonialism. Many Indigenous communities lost vast numbers of people to the pathogens disseminated by European colonizers. Relationships were ruptured—most importantly, those between these communities and the life-sustaining world toward which they held reciprocating responsibilities.
There followed policies of dispossession, displacement, assimilation, and cultural suppression, with the residential school system as a centrepiece in Canada. Throughout, settler colonialism – predicated on the physical displacement and symbolic effacement of Indigenous peoples – remained a constant force.
These policies have meant Indigenous people have suffered disproportionately from viral contagions. In the words of historian Maureen Lux: “Biological invasion… was accompanied by military, cultural and economic invasions.” Their result? Intergenerational poverty, food and water insecurity, inadequate housing, violence, and trauma.
If the overall “trick” of settler colonialism is to convince settlers they are natives of the lands they subjugate, in the pandemic a further trick consists of treating colonialism’s consequences as so many particular cases of “disparities,” “susceptibilities,” or “local emergencies.” What might be called a “syndemic clustering” of settler colonialism, systemic racism and gender discrimination has been systematically obscured.
Indigenous people have come to expect this from settler governments. For Indigenous leadership, the current pandemic exposes the colonial roots of Indigenous ill health. It reveals how the settler-colonial nation-state shirks its responsibilities to recognize nation-to-nation treaty-based and constitutionally protected rights. It demonstrates how the gender intersectionalities, including those compellingly analyzed in the calls to action issued by the Truth and Reconciliation Commission and inquiries into Missing and Murdered Indigenous Women and Girls, have been repeatedly side-stepped in policy-making.
Canadian state policies treat urban Indigenous peoples as peripheral, even invisible. Settler colonial cities, offering access to trade routes and natural resources, were formed historically on ancestral Indigenous peoples’ homelands. And, perversely, because settlers fantasized that Indigenous peoples dwelt in static and bucolic woodland settings, both they and the states representing their interests disregarded Indigenous peoples who did not conform to such romantic stereotypes.
Yet Indigenous peoples have created resilient, stubbornly persistent networks of solidarity, even within Canadian cities indifferent, even hostile, towards them. Vibrant urban Indigenous communities, often overlooked or poorly understood, have sustained effective protective networks for their members.
Covid-19 has reinforced these settler-colonial realities. It has also opened opportunities for challenging them. Under conditions of “pandemic colonialism,” both the densely intersecting forces of settler colonialism, patriarchy, and white supremacy – and the self-determining, strengths-based and forward-looking orientation of Indigenous responses to the pandemic – can be glimpsed.
The rights of Indigenous peoples, as deﬁned within the International Covenant on Economic, Social and Cultural Rights and the United Nations Declaration on the Rights of Indigenous Peoples, are inalienable. They are not diminished or extinguished when Indigenous peoples move to and through urban space or take up residency there.
About 75% of Indigenous people live in cities and off-reserve in Canada. Only 10% of initial Covid-19 service support funding for Indigenous people was designated for them. The Canadian government, reluctantly cognizant of its treaty obligations to Indigenous peoples living in rural reservations, disregards the rights of Indigenous city-dwellers. Moreover, federally recognized Indigenous governments receive funding directly based on population, whereas urban Indigenous representative organizations must competitively apply for grants.
A false official dichotomy distinguishes between rural and urban Indigenous populations, one that hurts Indigenous people in general. It ignores the multiple social identities that shape Indigeneity and the mutually reinforcing inequities that co-constitute numerous systems of oppression.
Throughout the Covid-19 pandemic, Canada has claimed it is strenuously engaged with Indigenous leaders, respecting treaty rights, and striving to end inequities rooted in long-standing and racist policies. Yet its overall neglect of urban Indigenous people until well into the second year of the pandemic revealed just how partial was its approach.
Indigenous peoples’ engagement with urban places and urbanization processes do not stand separate from socio-economic structures, gender and age diversity, and disability status, among other intersections. This exacerbates the impacts of Covid-19 if relief is also not aimed at the systemic barriers faced by youth, Elders, and disabled, or for “Two-Spirit and LGBTQ + individuals, who are at higher risk for infection due to rates of poverty, social isolation, and systemic discrimination within the health care system.”
Often official documents acknowledge the colonial roots of current problems. For example, Public Health Ontario acknowledges that Indigenous communities “face health inequities associated with complex inﬂuences of colonization, residential schools and continued experiences of systemic racism.” These acknowledgements are significant. Yet they are also often undone in practice, as Indigenous peoples come to be understood, not as oppressed collectivities, but as risk-prone individuals. And provinces often obligingly offer cover to a federal government that seems bent on reneging on its treaty-based obligations.
Early in the current pandemic, the federal government’s initial relief strategy acknowledged two major issues in Indigenous communities exacerbated by Covid-19: income support and women’s shelters. This followed on news of the closing of Indigenous women’s shelters, notably one in Montreal. That shelter closed its doors after “multiple attempts to get local health and social services personnel to come test residents, and a frustrating ordeal getting assistance.” Extraordinarily, however, all of the shelter funding announced in 2020 excluded urban Indigenous communities, despite the fact that “Indigenous women and their children face violence and need shelter in off-reserve contexts.”
In 2020, the Native Women’s Association of Canada (NWAC) surveyed 750 people about “the Impacts of Covid-19 on Indigenous Women and Gender-Diverse People in Canada.” Their study illuminates the glaring correlation between state responsibility for the ever-expanding violation of Indigenous people’s “absolute right to physical and mental integrity” and a clear upsurge in domestic violence in conjunction with the conditions of Covid-19. The survey concludes that “actions from government at all levels are needed to address the issue of systemic violence against Indigenous women and gender-diverse people.”
The NWAC’s ongoing work continues to hold the Canadian government accountable for its promise – i.e., its commitment to a national action plan fulfilling the “Calls for Justice” issued by the National Inquiry on Missing and Murdered Indigenous Women (MMIWG.) The NWAC further situates its stance on the current health emergency in the context of established relationships with Indigenous peoples globally, engaging in common advocacy around the intersectionality of Human, Indigenous, and Women’s rights frameworks, to “ensure a gendered response… and that women and girls are put at the centre of recovery efforts.”
Even as it ostensibly acknowledges gender violence’s systemic roots, the Canadian government’s response to it under Covid-19 conditions has tended to reflect a partial and superficial understanding of the phenomenon. Referencing its “engagement strategy” and national action plan, it vaguely reported in 2020 that the “challenges of family violence and mental health during isolation, or the needs of LGBTQ and Two-Spirit individuals or those with disabilities requires particular attention during the pandemic.”
Finally, in mid-2021, the federal government announced a “$724.1 million investment to expand culturally relevant supports for Indigenous Peoples facing gender-based violence and support new emergency shelters and transitional (second-stage) housing across the country, including in the North and in urban centres.” It typically “acknowledged” the need for a “broader effort to end the national tragedy of missing and murdered Indigenous women, girls and 2SLGBTQQIA+ people, so that they are safe and free from violence, no matter where they live, work or travel,” without specifying how such an effort might be concretely organized.
Indigenous women’s organizations highlight how culturally relevant supports are nested in women’s particular responsibilities to care for people and maintain a healthy relationship with water (which is in turn a domain of pregnancy and birth.) This pattern cannot be divorced from the many water crises afflicting Indigenous communities, also ignored for years by the federal government, and the ways these crises complicate women’s positionalities in relation to the pandemic.
The National Aboriginal Council of Midwives (NACM) has developed extensive insights into how Covid-19 not only worked to compromise pregnancy and birth but also helped undermine the care midwives provide “beyond the clinic,” including for Elders and others who are immune-compromised, often found to be “living in overcrowded homes, struggling with mental illness, substance use and trauma.” Their work has increased awareness “of the inequitable burden of Covid-19 on marginalized populations” including ampliﬁcation of “already inequitable access to safe sexual and reproductive care … [and] how racism contributes to ill health and lack of access to healthcare.”
The death of Joyce Echaquan, an Atikamekw a mother of seven, in September 2020 in a Quebec hospital following abusive comments from staff that she recorded on her phone, exposed this racism during the pandemic. Yet, the immediate government response was to dismiss such cruelty as a reflection of exceptional attitudes on the part of some individuals – as an isolated event, not the upshot of centuries of colonialism. (Her death was preceded by a long string of highly publicized deaths and incidents of racism experienced by Indigenous peoples interacting with healthcare staff.) In their early 2021 report, What we heard: Indigenous Peoples and Covid-19, Angela Mashford-Pringle and colleagues noted four Indigenous people “killed when police have been involved (e.g., wellness checks, routine traffic stops, etc.)” Institutionalized racism along with the failure of all levels of government to keep promises and uphold the rights of Indigenous peoples has fostered deep mistrust.
The colonialism demonstrated over more than two years of Covid-19 illustrates how vital it is for Indigenous people to lead, and for those controlling non-Indigenous resources to support them. For example, NACM emphasizes the colonial and inequitable system under which midwives have long operated and their crucial role as advocates for reproductive justice and as carriers of deep ancestral knowledge, key to advancing spiritual and mental well-being amid the pandemic.
Organizations speciﬁcally serving Indigenous LGBTQ+ people also offer considerable insights into effective holistic prevention and care that builds on historic experience with HIV and on anti-stigma/anti-discrimination activism. For example, 2-Spirited People of the 1st Nations, an organization based in Toronto, ﬁrst posted community-speciﬁc information about Covid-19 to Facebook on 9 March 2020. They persisted with programs aimed at supplying healthy food and at reducing harms from drug addiction after their offices closed. They and many other urban Indigenous community organizations rapidly adapted programming to social media and YouTube to include new online health services — emotional, mental, spiritual, and physical, often woven together – as well as links to such supportive networks as the Two Spirit Journal’s (2020) series, “In Our Own Voices: Two-Spirit People Responding to Covid-19.”
Online prayer services, drum socials, craft classes, and other forms of engagement combatted pandemic-induced alienation and loneliness. Staff at the Native Women’s Resource Centre (NWRC) in Toronto shifted to the phone and online quickly to ensure that the women and children they served did not experience discontinuities in service. Access to healers and other service producers was facilitated by online groups. NWRC also kept the welfare of its staff in mind, supplying medicines and teas to employees as they worked from their homes. Sacred fires were lit. Those unable to attend them were invited to light a candle at home. Through such inventive stratagems, a sense of connection to the community was kept alive. Although such projects may not have reached the most vulnerable, rendered inaccessible through isolation, housing insecurity, and sometimes mental illness, they highlighted the protective value of Indigenous leadership and culture in crafting both short- and long-term responses to the Covid-19 pandemic.
The extensive shortcomings associated with existing policies and practices which have accelerated Covid-19 morbidity and mortality for urban-based Indigenous people must be contextualized by gendered intersectionality and in historical and ongoing settler colonialism. The state’s responsibilities extend not only to addressing biomedically deﬁned health needs in a global health crisis, but to overall community well-being through concrete actions against racist and misogynistic structures that sustain and escalate racial and gender-based violence, cultural disenfranchisement, and the dispossession of Indigenous peoples from the life-giving nourishment of their relationships to their lands.
The investment in shelters and attention to culture-based services is obviously needed. But real transformation requires deeper actions which include affirmation of the diversity, leadership, and self-determination of Indigenous peoples in urban areas, and recognition of the intersectionality of racism, gendered discrimination, and coloniality, which sustain the oppression of Indigenous peoples. Urban Indigenous community leaders need to be supported in their emphasis on delivering cultural and spiritual services, while militating against any discontinuity of cultural services. The wellness of service care providers must be prioritized. Women’s roles as caretakers, and notably the positionality of midwives, provide insights into intimate forms of both suffering and coping, and the culture-based pathways to community health, highlighted in urban communities.
Covid-19 is more lethal for Indigenous people under the conditions of colonialism, and colonization is more lethal under the circumstances of Covid-19. Cycles of pandemics across the centuries underscore the devastation of immediate and enduring colonial consequences. Pandemic times enable slippage backward from the tentative steps forward governments have taken in the era of the TRC and the MMIWG inquiry. A slowly evolving colonialism has led to the sufferings of Indigenous people. Their strengths-based community resources and their defence of their rights to self-determination promise to resolve them.
 As told to Charles Hill-Tout, in Ralph Maud, ed., The Salish People: The Local Contribution of Charles Hill-Tout, vol. 2 (Vancouver: Torchbooks), 22.
 As described by Brian E. Titley, A Narrow Vision: Duncan Campbell Scott and the Administration of Indian Affairs in Canada. (Vancouver: UBC Press, 1992), 84. See also Lena Faust and Courtney Hefernan, “Residential school deaths from tuberculosis weren’t unavoidable – they were caused by deliberate neglect,” Globe and Mail, 12 July 2021. Link to source.
 Billie Allan and Janet Smylie, First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada (Toronto: Wellesley Institute, 2015), 8. Link to PDF download.
 Maureen Lux, Medicine that Walks: Disease, Medicine, and the Canadian Plains Native People, 1880-1940 (Toronto: University of Toronto Press, 2001), preface. See also Jeffrey Ostler, “Disease Has Never Been Just Disease for Native Americans,” The Atlantic, 29 April 2020, Link to source; and David Childs, “Learning from History: Pandemics are Nothing New in Native Communities,” Democracy & Me, 8 April 2020 Link to source.
 Similarly, Mica Jorgensen unmasks the workings of calamitous discourse in relation to climate crisis in “Catastrophic Rhetoric: False Enchantments and ‘Unprecedented’ Disasters in British Columbia’s Punishing 2021,” Syndemic Magazine, 4 February, 2022. Link to source.
 An extended analysis of what is presented here can be found in Heather A. Howard-Bobiwash, Jennie R. Joe, and Susan Lobo, “Concrete Lessons: Policies and Practices Affecting the Impact of COVID-19 for Urban Indigenous Communities in the United States and Canada,” Frontiers in Medical Sociology, 23 April 2021. Link to source. See also United Nations Department of Economic and Social Affairs, “Covid-19 and Indigenous Peoples,” 18 March 2022, Link to source, and United Nations, “International expert group meeting on the theme “Indigenous peoples and pandemics” 21 April 2, 2022 (accessed 18 March 2022), Link to source.
 Heather Howard and Susan Lobo, “Indigenous peoples’ rural to urban migration,” in Immanuel Ness, ed., Encyclopedia of Global Human Migration (New York: Wiley-Blackwell, 2013), 1–13; Heather Howard and Craig Proulx, eds. Aboriginal Peoples in Canadian Cities: Transformations and Continuities (Waterloo, ON: Wilfrid Laurier University Press, 2011); and Heather Dorries, Robert Henry, David Hugill, Tyler McCreary, and Julie Tomiak, eds., Settler City Limits: Indigenous Resurgence and Colonial Violence in the Urban Prairie West (Winnipeg: University of Manitoba Press, 2019).
 Yves Belanger, “The United Nations declaration on the rights of indigenous peoples and urban aboriginal self-determination in Canada: a preliminary assessment,” Aboriginal Political Studies 1, 1 (2011), 132–161. Link to source.
 José Francisco Cali Tzay for the UN General Assembly, Report of the Special Rapporteur on the rights of indigenous peoples, A/75/185, 20 July 2020. Link to source; Government of Canada, “Government of Canada Response to SR Questionnaire–Covid-19.” 7 July 2020, Link to source.
 National Association of Friendship Centres, Submission to the Special Rapporteur on Indigenous Rights: Canada’s Response to COVID-19 and Urban Indigenous Communities – Perspectives from the Friendship Centre Movement (Ottawa: National Association of Friendship Centres, 2020), 5, 7.
 National Association of Friendship Centres, Submission to the Special Rapporteur on Indigenous Rights: Canada’s Response to COVID-19 and Urban Indigenous Communities – Perspectives from the Friendship Centre Movement (Ottawa: National Association of Friendship Centres, 2020), 7.
 Native Women’s Association of Canada, The Impacts of COVID-19 on Indigenous Women and Gender-Diverse People in Canada (Ottawa: Native Women’s Association of Canada, 2020), 1.
 National Inquiry into Missing and Murdered Indigenous Women and Girls, Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls (Ottawa: National Inquiry into Missing and Murdered Indigenous Women and Girls, 2019); Native Women’s Association of Canada, “MMIWG & Violence Prevention,” Link to source.
 Government of Canada, Federal Pathway to Address Missing and Murdered Indigenous Women, Girls and 2SLGBTQQIA+ People (Ottawa: Queen’s Printer, 2021), 7.
 Shirley Thompson, Marleny Bonnycastle and Stewart Hill, “COVID-19, first nations and poor housing: ‘wash hands frequently’ and ‘self-isolate’ akin to ‘let them eat cake’ in first nations with overcrowded homes lacking piped water,” Canadian Centre for Policy Alternatives, Winnipeg (May 2020). Link to PDF download (Accessed 2 June, 2020).
 Angela Mashford-Pringle, Christine Skura, Sterling Stutz, and Thilaxcy Yohathasan, What we heard: Indigenous Peoples and COVID-19 (Ottawa: Government of Canada, 2021), 20.
 Ibid., 12.