London, United Kingdom – Leilani Medel was 23 when she left her hometown near the northern city of Santiago in the Philippines for the United Kingdom.
The only girl of three siblings, she was the first in her family of farmers to receive higher education. She enrolled in nursing school, knowing it would open up opportunities to work abroad.
The Philippines is the world’s largest supplier of nurses, producing more graduates every year than it is able to employ.
Its government actively encourages migration and its economy benefits from high remittances.
Approximately 18,500 Filipino nationals work in the UK’s National Health Service (NHS), the third-largest group after Britons and Indians.
Among migrant communities in the NHS – about 18 percent out of 1.2 to 1.5 million staff, coronavirus is taking a heavy toll on the Filipino community.
Out of more than 100 healthcare workers who have died after contracting the virus in the UK, at least 25 have been from the Philippines, according to Kanlungan, an umbrella organisation for Filipino community support groups across the country. That includes health and social care workers, and hospital staff.
When Leilani began showing COVID-19 symptoms in late March, she kept it from her family.
“She didn’t want us to worry,” said her younger brother Noel Osoteo, speaking to Al Jazeera by phone from the Philippines. “Especially my father. She was my father’s girl, his favourite.”
Marissa Medenilla, Leilani’s aunt, spoke to her on March 26. By then, Leilani, her husband and their 14-year-old daughter Angeline had all fallen ill.
“She told me her breathing was painful. I said I know because I experienced that as well,” said Marissa, a care worker in Bristol.
A few days later, on April 1, Leilani was admitted to intensive care.
She died on April 11.
Angeline was assigned to a foster family while her father, who was recently extubated, recovers.
Leilani was one when her aunt Marissa moved to the UK to work in care.
They met again as adults when Leilani migrated in 2002.
After a year, Leilani returned to the Philippines for her wedding, but came back to the UK without her husband to work in a care home.
It took the couple at least two years before they could live together in the UK, where they settled in Bridgend, Wales.
“She would send an allowance to the family every month,” said Noel, her younger brother. “I don’t think her husband knew.”
Leilani would visit Marissa in Bristol whenever she had a couple of days off. Even that, at times, was difficult.
“We are workaholics,” said Marissa. “She always worked, nights most of the time, so that she could look after her [daughter] during the day.”
Marissa believes that working hard and a lack of protective equipment could be why Filipino nurses appear particularly vulnerable.
“I ordered some masks for myself, so I [would] always bring mine,” said Marissa, an agency care worker. “At the beginning, we weren’t allowed to wear masks. [Management] said it would frighten the people we look after.”
The standard personal protective equipment (PPE) for care workers is now a surgical mask and plastic gown, but amid a global shortage, care homes tend to be left behind.
Marissa fell ill in late February and recovered.
A study published in late April by the Health and Social Care journal confirmed concerns raised in recent weeks that ethnic minorities working for the NHS are disproportionately affected.
The study, which surveyed 106 cases reported in the media up until April 22, found that 63 percent of those who died were of black and minority ethnic (BAME) background, and that more than half were migrants. Thirty-six percent of these were from the Philippines.
Minorities are over-represented in some sectors of the NHS, comprising 45 percent of medical staff.
The survey also revealed that no deaths have been reported among staff considered at high risk of exposure – anaesthetists and intensive care doctors and nurses.
The authors argued this could be due to these categories being more “rigorous about use of PPE and the associated practices known to reduce risk”.
Amid a shortage of protective equipment, hospitals are rationing available PPE according to government guidance.
In an April survey of 14,000 of its members, the Royal College of Nursing found that of half felt pressured into working without the recommended PPE or reusing single-use items.
The majority of Filipino workers who have died have been medical ward nurses, healthcare assistants, hospital porters and carers – who tend to be lower-paid.
The Philippine embassy confirmed to Al Jazeera that 56 Filipinos had died after contracting COVID-19 by the end of April, including citizens, dual citizens and Filipinos by ethnicity.
Three were undocumented.
The community as a whole counts nearly 200,000 people in the UK.
Civil society groups fear undocumented migrants, who may have arrived legally and lost their status, are particularly at risk.
“We are in touch with about 200 undocumented Filipinos,” said Susan Cueva of Kanlungan.
“Many lost their jobs, have no recourse to public funds, no government support. We have seen people who were kicked out of their accommodation [because they could no longer pay rent],” she said.
Some families have opened their homes to people who have been evicted, while others volunteer to deliver food to the ill.
“We try to give them information about the possibility of support in case any of them get ill,” said Cueva.
NHS charging regulations, which restrict access to healthcare for undocumented migrants, do not apply to COVID-19 treatment and testing.
But campaigners say this does not work in practice.
“At the end of the day if they are undocumented they are afraid to be in touch with the authorities,” said Cueva.
“Most Filipinos living in the UK are in low-paid jobs. They often live in overcrowded accommodation [because] they have to send money back home. We know there’s a mix in accommodation of undocumented and NHS workers who go in and out of the house, and that concerns us.”