The COVID-19 pandemic has shone a spotlight on pre-existing intersecting and compounding inequalities and injustices. Data shows that Muslims in the UK are more likely to die from COVID-191. However, when social deprivation and ethnicity are controlled for, this excess risk diminishes1. This is consistent with structural discrimination and racism being key drivers of health disparities from COVID-19 among Muslims in the UK. A syndemics approach2 is a useful lens to illustrate the “biosocial complex” that enables the dual pandemics of Islamophobia andCOVID-19 to interact, converge and amplify health inequities.


Islamophobia is often seen through the lens of discrimination or race-based oppression (racism) as expressions of racism move away from biological differentiation to more socially acceptable cultural racism within postcolonial and Orientalist narratives. Islamophobia is, however, more than this; it is a complex intersectional form of discrimination and oppression that operates along and between axes of religion, race, culture, gender, class and citizenship within structures of power and privilege. It produces differential inequities and exclusion, interacts at multiple levels, and multiple axes of oppression are simultaneously embodied by Muslims who are racialized by society. Both the Runneymede Trust3 and the APPG4 define Islamophobia as an expression of racism.


Although the origins of Islamophobia can be traced back to the Crusades, it has increased in global prominence with a series of “moral panics around British Muslims” 3. These includes the Satanic Verses affair and Gulf War in the 1980s and 90s and anti-Muslim sentiments have become acutely accentuated after 9/11 with discourses on the “War on Terror”, “home-grown” terrorism and ISIS ‘jihadis’3. This has led some to portray Islam as an ideological and cultural pathogen in need of quarantine and elimination. In the UK, these global norms are “globalised” to reproduce health and social inequities.


In the context of COVID-19, and drawing on Singer’s work on syndemics2, Islamophobia and COVID-19 interact synergistically at the population level and contribute to excess burden of illness in the Muslim community. At the biological level, the convergence of the pathophysiological processes of SARS-CoV-2 and embodiment of Islamophobia produces excess morbidity and mortality.


It is well known that almost half of Muslim households in the UK live in poverty5, an indicator of structural discrimination against Muslims. Social deprivation is one of the strongest risk factor associated with poorer outcomes from COVID-196. Austerity policies therefore disproportionately impact Muslim families and the pandemic has further increased financial hardship especially for Muslim-majority Pakistani and Bangladeshi families where individuals are more likely to be working in shut down sectors and in insecure employment7. Inequities and exclusion produce socially patterned and trauma-embodied diseases associated with high allostatic loads (“weathering”)such as diabetes, ischaemic heart disease and obesity8as well as increased inflammatory markers9. These cardio-metabolic and chronic inflammatory disorders are higher in Muslim- majority ethnic groups10 and are known to be strong predictors of serious illness and mortality and may be associated with the cytokine storm observed in severe COVID-199,11. Additionally, living in urban areas with high neighbour density12, poor quality and insecure housing and household overcrowding with multi-generational occupancy5,13 found among Muslim communities increase exposure, reduce opportunities for self-isolation, and facilitate the onward transmission of COVID-19.


The hostile environment further institutionalises Islamophobia and worsens COVID-19 outcomes through policies on immigration and security. Just under 50% of Muslims are born outside the UK10 and are therefore disproportionately impacted by immigration policies which create a barrier to accessing healthcare due to surcharges or fear of deportation14. This can lead to a delay in accessing care, with Muslim patients more likely to present sicker and with more advanced disease. Security policies such as Prevent similarly create a climate of suspicion and surveillance15and discrimination by healthcare professionals has also been reported by Muslim patients 16. This may account for lower uptake of preventative health programmes by Muslims essential to optimise health17.


The media is a particularly important institutional force that entrenches Islamophobia through shaping public perception. During the pandemic, divisive media narratives that blame and scapegoat Muslims for transmitting infection were widespread18. This is in addition to fake news and conspiracy theories on social media which have been linked with increased levels of Islamophobia during the pandemic19. Stereotypes and stigma through the creation of a socially devalued identity of Muslims through public policy and the media not only create a barrier to accessing healthcare but create mistrust in mainstream services and information and are a public health risk for all. They encourage alternative systems of healthcare and information, reduce compliance with public health measures, and threaten community cohesion which is essential to successfully manage a pandemic.


Muslims are also more likely to face discrimination and exclusion in the labour market and workplace. They are more likely to work in key worker roles, in insecure employment and in the gig economy20. This has increased exposure risk to COVID-19 and in the absence of adequate statutory sick pay creates a financial penalty and deterrent to self-isolate when sick thus increasing individual, household and community risk.


The NHS is a microcosm of social norms and values where Islamophobia is internalised and inequities reproduced. Over 95% of doctors who died from COVID-19 were from an ethnic minority background21 and the first four doctors to die were Muslim22. Muslim doctors have reported difficulty with accessing PPE23which increases exposure risk. This is against a backdrop of well-known discrimination against Muslims in the NHS24, a Triple Penalty affecting Muslim doctors where doctors feel vulnerable, excluded, judged, stigmatised, bullied and discriminated25, a dress codes policy which discriminates against Muslim doctors, and the Prevent policy which creates a culture of fear and suspicion of Muslim colleagues27.  A recent survey by the Huffington Post and the British Islamic Medical Association showed that over 80% of medics in the NHS have experienced Islamophobia with detrimental impacts on their wellbeing and careers28. A large survey conducted by ITV, of which over 50% of respondents were Muslim, highlighted that during the COVID-19 pandemic, ethnic minority doctors have felt less likely to raise concerns and are more likely to be discriminated and bullied into taking higher risk roles, contributing to stress, burnout, excess illness and deaths29. This is consistent with institutional Islamophobia in the NHS which must be addressed.


Muslims have a long history of contributing to British society. Initial migration of Muslims began when workers from the British Empire, which covered 50% of the world’s Muslim population at its peak30, were recruited from the Indian subcontinent to work for the British East India Company 31. The inequities currently experienced by Muslims in the UK are an embodiment of necropolitics, a system of social and political power that determines who lives and who dies 32, and which replicates the colonial legacy of oppression and exclusion. In order to eliminate health inequities among Muslims from COVID-19 and beyond, it is imperative that a multi-level multi-sectoral and interdisciplinary approach is adopted which addresses the “causes of the causes”33 in a holistic and integrated way.


Action must begin with the government adopting a definition of Islamophobia, committing to addressing its urgent and long term impact, and collecting data on religion, a legally protected characteristic34, across public health programmes and NHS services to monitor health inequities. Action must include reforming laws and policies on immigration, security, austerity, social mobility and social security, improve media regulation and accountability, provide affordable housing and secure employment, and address discrimination in educational, employment, housing and criminal justice systems against Muslims. Within the NHS, a zero-tolerance policy against Islamophobia must be implemented along with a culture of inclusion and compassion, and psychological safe routes for raising concerns. Improved faith literacy and faith networks which support and empower Muslim healthcare professionals and culturally sensitive opportunities for networking and mentoring should be made available.


The hallmark of a civilised society is the protection of its most vulnerable groups and supporting individuals to realise their capabilities35 and achieve self-actualisation36 and holistic wellbeing. It is this combined rights-based, social determinants and wellbeing approach centred on core values of justice, equity and compassion that can address the syndemic of COVID-19 and Islamophobia to ensure optimal health, peace, safety and security for all.


  1. Office for National Statistics. Coronavirus (COVID-19) related deaths by religious group, England and Wales: 2 March to 15 May 2020, retrieved from
  2. Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. The Lancet. 2017 Mar 4;389(10072):941-50.
  3. Elahi F, Khan O. Islamophobia: Still a challenge for us all, A 20th-anniversary Report. Runnymede: Intelligence for a Multi-ethnic Britain. 2017.
  4. All Party Parliamentary Group, Islamophobia defined, 2017. Retrieved from
  5. Ali S. British Muslims in Numbers: A Demographic socioeconomic and health profile of Muslims in Britain drawing on the 2011 census. MCB; 2015.
  6. Caul, S., 2020. Deaths involving COVID-19 by local area and socioeconomic deprivation – Office for National Statistics. Office for National Statistics.
  7. Platt L, Warwick R. Are some ethnic groups more vulnerable to COVID-19 than others. Institute for Fiscal Studies, Nuffield Foundation. May 2020 May.
  8. Geronimus, A.T., Hicken, M., Keene, D. and Bound, J., 2006. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American journal of public health96(5), pp.826-833.
  9. Vepa A, Bae JP, Ahmed F, Pareek M, Khunti K. COVID-19 and ethnicity: a novel pathophysiological role for inflammation. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020 Sep 1;14(5):1043-51.
  10. Hanif, R.W. and Susarla, R., 2018. Diabetes and cardiovascular risk in UK South Asians: an overview. The British Journal of Cardiology25(2), pp.S8-S13.
  11. Yadav UN, Rayamajhee B, Mistry SK, Parsekar SS, Mishra SK. A syndemic perspective on the management of non-communicable diseases amid the COVID-19 pandemic in low-and middle-income countries. Frontiers in Public Health. 2020 Sep 25;8:508.
  12. Office for National Statistics, 2011 Census. 2011. Retrieved from
  13. Perry J & El-Hasan AA., A guide to engaging Muslim communities, Matrix Housing Partnership, 2008. Retrieved from
  14. MedAct, Patients Not Passport: Migrants access to healthcare during the Coronavirus crisis, June 2020, retrieved from
  15. MedAct, False positives: the Prevent counter-extremism policy in healthcare. July 2020, retrieved
  16. Laird LD, Amer MM, Barnett ED, Barnes LL. Muslim patients and health disparities in the UK and the US. Archives of disease in childhood. 2007 Oct 1;92(10):922-6.
  17. Chang KC, Soljak M, Lee JT, Woringer M, Johnston D, Khunti K, Majeed A, Millett C. Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study. Preventive medicine. 2015 Sep 1;78:1-8.
  18. Centre for Muslim Media Monitoring, Report on COVID-19: the impact on British Muslim communities, retrieved from
  19. Chang KC, Soljak M, Lee JT, Woringer M, Johnston D, Khunti K, Majeed A, Millett C. Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study. Preventive medicine. 2015 Sep 1;78:1-8.
  20. Awan I, Khan-Williams R. Research Briefing Report 2020: Coronavirus, fear and how Islamophobia spreads on social media. 2020. Retrieved from
  21. British Medical Association, COVID-19: the risk to BAME doctors, Updated 2020 Nov 13. Retrieved fro,
  22. Khan A. Muslim minority doctors first to die on frontline of UK pandemic. Al Jazeera News. April 2020. Retrieved from
  23. Hamed A, Latif A, Haris M, Patel S, Patel M, Mustafa SAR, Khan O, Shoaib A, Waqar S, The impact of keeping a religious beard in the COVID-19 pandemic: an online cross-sectional  survey  study  exploring  experiences  of  male  medicalhealthcare professionals, November 2020, retrieved from
  24. West M, Dawson J, Kaur M. Making the Difference. Diversity and inclusion in the NHS. King’s Fund, London. 2015 Dec.
  25. Muslim Doctors Association. The triple penalty: Muslim doctors in the NHS. 2018. Retreived from
  26. Malik A, Qureshi H, Abdul-Razakq H, Yaqoob Z, Javaid FZ, Esmail F, Wiley E, Latif A. ‘I decided not to go into surgery due to dress code’: a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre. BMJ open. 2019 Mar 1;9(3):e019954.
  27. Younis T, Jadhav S. Keeping our mouths shut: the fear and racialized self-censorship of British healthcare professionals in PREVENT training. Culture, medicine, and psychiatry. 2019 Sep 15;43(3):404-24.
  28. Day A. “Uncovering the reality of Islamophobia in the NHS shocked me in a way I wasn’t expecting”. Huffington Post. September 2020. Retrieved from
  29. ITV News. “Discrimination on frontline of coronavirus outbreak may be factor in disproportionate BAME deaths in NHS staff. May 2020. Retrieved from
  30. Robinson F. The British empire and the Muslim world. The Oxford History of the British Empire. 1999;4:398-420.
  31. Ansari H. ” The infidel within”: Muslims in Britain since 1800. Oxford University Press; 2018 Aug 1.
  32. Mbembe A. Necropolitics, in Foucault in an Age of Terror. 2008 (pp. 152-182). Palgrave Macmillan, London.
  33. Marmot M. Inclusion health: addressing the causes of the causes. The Lancet. Jan 2018 20;391(10117):186-8.
  34. Equality Act2010. Retrieved from
  35. Sen A. Capability and well-being. The quality of life. 1993 Mar 11;30:270-93.
  36. Maslow AH. A Dynamic Theory of Human Motivation. 1958