A/HRC/45/44/Add.1 medicines in State medical centres and private pharmacies. The communities are not being served by the relevant health authorities and even the limited health sub-centres have closed. A number of complaints have been made, but the responses necessary for this population have not yet been received. 63. According to Government data, more than 60 per cent of the Afro-Ecuadorian population are part of the marginal urban sectors of cities such as Quito and Guayaquil, with 39.82 per cent working in services, 18.3 per cent in formal or informal trade and 11.83 per cent as construction workers. By its nature, their work generates little income, not enough for their subsistence, and without any guarantee of security. They are at risk of being thrown out of their homes while searching for a new job in the same fields. They are unable to save and to meet the needs of their families. They cannot provide for themselves for any significant period, not even for a few months. 64. Subsequent to the Working Group’s visit, reports of a high number of deaths of Afro-Ecuadorians in Guayaquil and other cities during the COVID-19 pandemic highlighted the structural inequities and the lack of access to health care historically faced by people of African descent in Ecuador. Structural racial discrimination may further exacerbate inequality in access to health care and treatment, leading to racial disparities in health outcomes and increased mortality and morbidity for people of African descent. 65. With regard to access to adequate housing, according to the data provided by the Government during the visit, it is estimated that 56 per cent of the Afro-Ecuadorian households have a housing deficit. According to the national survey on employment, unemployment and underemployment, conducted by the National Statistics and Census Institute, as of December 2018 a total of 85,513 households were inhabiting unsuitable dwellings, in terms of either the characteristics of the dwelling or its lack of attributes in structure, space and availability of public services. The Working Group was informed that to address this situation, efforts had been made through the development of the “Casa para Todos” (Homes for All) project, as part of the Government’s National Development Plan 2017–2021, to support sectors of the population that are in situations of extreme and moderate poverty in gaining access to a home of their own. Positive results from the project and new development plan for Afro-Ecuadorians are yet to be seen. C. Multiple forms of discrimination 66. The Working Group learned that people of African descent in Ecuador often faced inequalities and multiple forms of discrimination. In particular, the Working Group is concerned about the high levels of gender-based violence suffered by women of African descent and the lack of specific programmes to address the problem. According to the national survey on family relations and gender-based violence against women, conducted by the National Statistics and Census Institute, 60.6 per cent of women in Ecuador have experienced some type of violence. Indigenous and Afro-Ecuadorians have the highest cases of violence, at 67.8 per cent and 66.7 per cent respectively. Afro-Ecuadorian women also face disproportionately high rates of maternal mortality, particularly in the rural areas of the northern border region, owing to lack of access to health care. The Working Group also heard about intersectional discrimination and violence faced by the lesbian, gay, bisexual, transgender and intersex community on the basis of race and sexual identity. V. Conclusions and recommendations A. Conclusions 67. The Working Group welcomes the commitment demonstrated by Ecuador in its recognition of the collective rights of Afro-Ecuadorians, the progressive Constitution, its laws, and the many policies and plans, including affirmative action, to specifically address the human rights situation of people of African descent and systemic racial discrimination. 13