Freetown has over 1 million residents, many of whom live in about 68 crowded informal settlements. Residents of these settlements struggle daily to access basic services such as water, sanitation, and health-care services. We found that the government’s Covid-19 response measures (curfews, lockdowns, and travel restrictions) excluded informal residents from contributing to its design, and the implementation of these measures prevented these residents from accessing basic services. Like the urban planning processes in Freetown, the Covid-19 response planning was done with the limited inclusion of informal residents, and not considering how these response measures would affect their livelihood priorities. The economic conditions of already vulnerable people such as those living with disabilities, beggars, and women heads of households worsened as a result of these measures. While these challenges were dire, communities were resilient in reversing the spread of Covid-19 through tailor‑made messaging and by supporting the most vulnerable with food and basic needs. In this article we argue that the inclusion of the urban poor in decision-making and urban planning processes can improve service delivery and their ability to cope with health shocks.