The COVID-19 pandemic has altered the socio-economic and health dimensions of many societies across the world. For those in urban informal settlements, direct and indirect negative impacts of the pandemic and the resulting government policies have had devastating consequences on their livelihood. As the virus continues to spread rapidly, the more popular measures such as curfews, lockdown, and working from home have overlooked the fate of slum dwellers, who are left to choose between life and livelihood. This article examines the unique challenges people in informal settlements are facing during the pandemic. It focuses on the city of Nairobi, which has several informal settlements where more than 4 million people reside. The authors note that a combination of systematic marginalization, poor policies, and inadequate planning has left millions of people in Nairobi vulnerable to the direct and indirect impacts of the COVID-19 pandemic. The article concludes that as the virus continues to spread rapidly and the emerging socio-economic challenges undermine government’s capacity to respond to the crisis, support from other stakeholders such as social workers may have a positive impact.