Humanitarian crises monitoring: impact of coronavirus (interim findings) Contents

---

2Coronavirus—risks and threats

23.Covid-19 has affected nearly every country in the world, irrespective of income, economic power and geo-political weight. In terms of development, by almost any measure, and in virtually all sectors, progress has stagnated or been driven backwards by the pandemic or crushed by the weight of steps taken to stop the coronavirus spreading.

24.The former DFID Secretary of State, Rt Hon Anne-Marie Trevelyan MP, told us that the Covid-19 pandemic threatened to undo the last 30 years of progress by the international development community and this was echoed throughout our evidence and, more recently, by the Secretary-General of the UN.15

What is coronavirus / Covid-19?

25.Covid-19, is an infectious disease caused by a new coronavirus identified in 2019. The virus is one member of a family of coronaviruses which circulate in some animal species and, clearly, can transfer to humans. Covid-19 shares some characteristics with the 2003 SARS disease in China, and with the 2012 MERS disease in the Middle East. However, Covid-19 has spread faster and with more deadly results than either SARS or MERS. After just a month, Covid had overtaken both MERS (866 lives in just under 8 years) and SARS (744 lives in nearly 2 years) in terms of virulence.16 As of 10 November, 10 months after the first fatality, the W.H.O. was reporting a total of 50,459,886 confirmed cases of Covid-19 and, within that figure, 1,257,523 reported deaths.17 As discussed later, the figure for Covid cases is likely to be substantially under-reported (thankfully, the—already horrific—recorded death toll is not as likely to be subject to under-estimation in the same way).18

26.The coronavirus appears to be principally transmitted through small respiratory droplets (generated by coughing and sneezing but also by singing, cheering, laughing and normal breathing). These exhalations are passed on directly or by touch or by contact with surfaces contaminated by such droplets. In addition to the obvious challenges of absences of vaccines and a definitive treatment, the key complicating factors in tackling the Covid-19 pandemic seem to be:

• lack of clear ‘signal’ symptoms (people can be infected—and be infecting others—without feeling ill or displaying any outward evidence),
• no clear post-recovery immunity (it is not clear whether and, if so, for how long a recovered Covid-19 victim might be resistant to another bout),
• not enough testing (R&D is continuing but so far in many countries, the pandemic has outstripped capacity and appetite for mass testing with current equipment), and
• a relatively high proportion of mild cases (despite being very infectious, most people do not seem to suffer debilitating or life-threatening symptoms).

27.Without vaccines, effective therapies, and simple, speedy and reliable tests, the primary response to the coronavirus has been to prevent transmission by reducing contact between people. There is a spectrum between ‘shielding’, where the vulnerable people are isolated, to ‘lockdown’ when everyone is isolated in their residential groupings. But fundamentally, the solution is based on reducing contact and interactions between: family and friends; customers and vendors etc.; healthcare staff and patients; social services and vulnerable people; carers and dependents; members of audiences, congregations and sports crowds; and on and on. This involves cutting off the human contact most of us take for granted to maintain our: mental and physical health and well-being; and our livelihoods, societal, political and economic welfare too. This creates the fundamental coronavirus dilemma.

Impacts

28.Our evidence identified a range of specific risks, threats and vulnerabilities in developing countries arising from the coronavirus pandemic. Broadly, these fell into four categories:

• direct impacts from the spread of coronavirus infections and the incidence of cases of Covid-19
• indirect or ‘secondary’ impacts arising from measures taken by national or local authorities to prevent the spread of infections
• secondary impacts due to decisions and behaviours on the part of communities, families or individuals seeking to avoid infection, and
• constraints on the freedom and capacity of humanitarian actors to provide assistance and relief.

Direct impacts

29.Unsurprisingly, our evidence submitted earlier in the year, was deeply concerned about the direct impact of coronavirus and Covid-19 on lower and middle income countries. Serious suffering and fatalities were predicted to be markedly exacerbated where there were existing diseases and other co-morbidities and poor nutrition, as well as already weaker, damaged–sometimes devastated–health systems and facilities. No country suffering from the pandemic on any sort of scale has escaped having its health system severely tested, no matter how high the national income. However, in some developing countries healthcare systems were ready to fail. One example, referenced throughout our evidence (and discussed later), is Yemen.

30.There were particular concerns about conflict zones and refugee camps that are so often the result of conflict. Bob Kitchen, Director of Emergency Preparedness and Response, International Rescue Committee (IRC), told us:

I am very worried about places that Governments do not have access to, so places that are controlled by non-state armed actors. Large portions of north-east Nigeria, large portions of Somalia and some portions of Sudan, et cetera, are very concerning, because we have zero visibility or standard surveillance systems …

The other place that I am very worried about … is refugee camps, where the first confirmed case in Cox’s Bazar within the Rohingya community has sent a ripple of … incredibly serious concern through our organisation yesterday, with such a large population of vulnerable refugees living in such a constrained environment with very little space. Social distancing in a refugee camp is essentially not possible.19

31.Robert Mardini, Director-General, International Committee of the Red Cross, explained:

We try to target our resources where we think we have the most added value. This means places of detention, central prisons and informal places where people are deprived of their liberty, because these are hotspots and high-risk areas for infectious diseases and COVID-19.

We also focus on leveraging our dialogue with non-state armed groups, crossing the front line and trying to influence armed groups in order to spread the right messages. …20

32.The public healthcare systems of developing countries have seemed ill-prepared for this pandemic. BOND told us that, generally, the health systems in many developing countries were “fragile, poorly resourced and lack capacity to respond to the effects of COVID-19.”21 Global Justice Now drew comparisons between available resources, saying “For example, while the UK has 28 doctors per 10,000 people, even relatively rich developing countries have a small fraction of that with 9 doctors per 10,000 people in South Africa, 8 in India.”22 Several witnesses were concerned that developing countries would not have the capacity to undertake widespread testing or treatment of Covid-19 cases, despite the “great strides” made in the last few decades in developing national and international public health institutions such as the Africa Centres for Disease Control (Africa CDC).23

33.In addition, preventative measures, common in wealthier countries, would inevitably be more challenging, for instance, in crowded accommodation settings, with limited access to clean water, such as camps for refugees and internally-displaced persons or informal shanty-towns. Here, livelihood, and day-to-day living, relied on contact; isolation with online life management was not likely to be easily, or widely, supportable.

34.However, the direct impacts of Covid-19 are not easy to calibrate in a precise way and comparisons between countries, regions and continents are bedevilled by complications as considered in the next section. The W.H.O. confirmed figures for Covid cases in its regions and selected developing countries are set out below.

Cumulative coronavirus cases in W.H.O. regions

Cumulative coronavirus cases in selected developing countries24

Country	12 May	10 November
	Cases	Cases	Deaths
Pakistan	34,336	344,839	6,977
Bangladesh	16,660	421,921	6,092
Nigeria	4,787	64,184	1,160
Democratic Republic of Congo	1,102	11,607	316
Occupied Palestinian Territories	375	70,841	593
South Sudan	194	2,960	59
Myanmar	180	61,975	1,437
Uganda	126	14,574	133
Yemen	65	2,070	602
Syria	47	6,284	321

35.We discuss the quality and availability of Covid-19 data in the next Chapter.

Secondary impacts

36.At the heart of any response to the coronavirus pandemic in any country is the question of when does the cure become worse than the disease? When do the impacts of the measures taken to control and eliminate the pandemic become worse than those of the pandemic itself; and whether, and how, this coronavirus dilemma can be measured, expressed and resolved?

37.Concerns about the indirect, collateral or secondary impacts of the pandemic were a constant refrain in the evidence submitted to the inquiry. Back in April, the former DFID Secretary of State, Rt Hon Anne-Marie Trevelyan MP, told the Committee:

My personal profoundest concern is that the secondary impacts [of the coronavirus pandemic] will be felt for years to come and the poorest will be most disproportionately affected.25

38.Marian Schilperoord, Senior Operations Manager, UN High Commission for Refugees (UNHCR), echoed this, saying:

In UNCHR, we are actually referring to a triple crisis. One is the health crisis … Secondly, for UNHCR, the protection risks arising from this crisis are also important. … UNHCR feels that border closures and access to territory do not automatically go hand in hand with the pandemic. There are the increased rates of sexual and gender-based violence that were already referred to … The third emergency that we are really seeing is the loss of livelihoods. … Children are also out of school. We are seeing an accumulation of very negative impacts.26

39.Robert Mardini, ICRC, also supported this view and said: “the secondary and the socio-economic consequences are as deadly as the primary consequences. … those countries where the economic situation is dire and/or contact is affected by war are the most vulnerable. … The livelihood support programmes are extremely important, as important as anything we can do to prevent [the pandemic] and to support hospitals and health centres.”27

40.The key secondary impacts of concern raised in evidence included:

• reduced attention, resources and patient attendance in relation to non-Covid health conditions and initiatives (especially immunisation programmes)
• damage to the economy, industry and business closure, reduced trade, leading to loss of income and livelihoods, leading to reduced food security
• reduced economic performance, globally, will reduce all national income, including remittances,28 humanitarian relief, official development assistance and other forms of aid
• illness and financial anxiety may increase levels of domestic violence; loss of income, isolation from support and services, may increase sexual exploitation and abuse of women and children, including child marriage, leading to a reduction in engagement with formal education
• reduced community cohesion and respect for human rights, international law, and rights of migrants due to formal and informal measures and behaviours, aimed at controlling the pandemic29

Non-Covid health conditions and initiatives

41.Most campaigners against non-Covid diseases were concerned that in the drive to tackle coronavirus, staff, drugs and facilities were being diverted to the Covid-19 response.30 Such reductions may allow the resurgence of diseases which were being steadily brought under control, such as malaria, polio, TB and HIV/AIDS as well as a range of non-communicable diseases and neglected tropical diseases.31 Former DFID witnesses were also worried by Covid’s secondary impacts, especially in relation to inoculation programmes. DFID wrote that it was: “ … drawing on lessons learned from such previous experiences with global health emergencies to help … pre-empt and mitigate the secondary impacts of COVID-19 on other priorities, such as the provision of essential health services including for other infectious diseases and sexual and reproductive health and rights.” The Department noted that during the 2015–16 Ebola outbreak, preventable deaths from malaria increased by around 50% in Liberia, Sierra Leone and in Guinea. DFID highlighted that the number of additional deaths from malaria—around 10,620—was comparable to the total number of deaths from Ebola during that outbreak: around 11,325.32

42.When the last DFID Secretary of State returned to the topic of Covid impacts in oral evidence with us in July, she reported that, since April:

… the secondary health impacts are starting to be seen. As we have seen in western countries, people are not going to their healthcare providers for things like child vaccinations or maternity support, as well as other more day-to-day primary care activity. … and that is where a great deal of my anxiety lies: that we will have as many preventable deaths through that gap in continuous medical support as we will from that sharp impact of Covid.33

43.In particular, Daniel Graymore, formerly DFID’s Head of Global Funds (and UK representative at the global vaccine alliance, Gavi), said that Covid was clearly a huge threat and challenge in the countries in which Gavi had been operating with such success. He said a significant number of vaccination campaigns and introductions had already been impacted, disrupted and delayed by the pandemic and this was going to have a huge impact into the future. In addition, there was quite a lot of evidence and data on the damaging impact of a loss of confidence in the vaccination process which would require rebuilding.34 Professor Charlotte Watts, the former DFID’s Chief Scientific Adviser, told us:

… we are very concerned about the secondary impacts, and those are multiple. There are things like the impact on immunisation levels, but there are also other risks. For example, if people perceive that hospitals are a place of risk, that they might catch Covid there, it could impact on whether women go to health facilities to deliver babies or to access antenatal services. Therefore, the breadth of impacts from Covid are multiple and potentially, in some settings, bigger than Covid itself.35

44.The UN has warned that “COVID-related disruptions could cause a spike in illness and deaths from other communicable diseases”. Despite the gains made in recent years in many areas, recent service disruptions could cause “hundreds of thousands of additional deaths from AIDS, malaria, tuberculosis and neglected tropical diseases.” The RBM Partnership to End Malaria wrote that: “While COVID-19 is the shock pushing 40–60 million people back into poverty, malaria will be the force preventing them from climbing back out again.”36

45.We recommend that, as part of a renewed consistent approach to promoting global health, the FCDO should continue to fund existing programmes aimed at the eradication of previously identified diseases. The Government should use its integrated voice to lobby development allies and partners to stop any transfer of resources from existing programmes, and the Global Fund, to Covid initiatives.

Economic damage, loss of livelihood, global recession

46.Lockdowns risk severely damaging both formal and informal economies, especially the operation of physical marketplaces (crucial to the latter). Unemployment, loss of income, and resulting food insecurity, will disproportionately affect vulnerable groups. Mercy Corps, argues that the threat to livelihoods may surpass the direct threat of Covid-19. In addition, remittances—often vital to coping in crises—may also dry up, given the global nature of the problem.37

47.The ILO has predicted a loss of up to 25 million jobs worldwide. The informal economy, including young people and women, will be hardest hit economically. In Africa for example, 90% of employed women are in informal employment compared to 83% of employed men.

48.In the context of Gavi, specifically, Amanda Glassman, Centre for Global Development, pointed out the potential for countries previously transitioning from low to middle income, or expected to do so, falling back into recipient status.38 The Foreign Secretary, Rt Hon Dominic Raab MP, wrote to us in July 2020, disclosing a 20 per cent. cut in the aid budget for 2020 in anticipation of reduced GNI. He said:

So that we can react to the potential shrinkage in our economy, and therefore a decrease in the value of the 0.7% commitment (which is based on the UK’s GNI), we have identified a £2.9bn package of reductions in the Government’s planned ODA spend so we can proceed prudently for the remainder of 2020. This package includes underspends, delaying activity and stopping some spend. All ODA spending Departments will now work with our respective supply chains to realise these reductions.39

Other donors may act likewise.

Domestic violence and sexual exploitation and abuse of women and children

49.Lockdown, family illness and loss of income could all impose disproportionate stress and risks on women, girls and children in terms of violence, abuse and exploitation, including sexual exploitation, with the simultaneous isolation from access to mitigating services. Children might find themselves isolated with an abusive relative. Women traditionally would undertake the lion’s share of any nursing duties but also seem to suffer an increase in domestic abuse (something prevalent in locked down settings from the UK40 to Cox’s Bazar).41

50.Farah Kabir, Action Aid’s Country Director for Bangladesh, told us that: “On the social side, women and girls are at high risk because men are also under lockdown. They’re confined in that space. There is acceptance of domestic violence and their right to do that. Child marriage is increasing, and this is leading to trafficking.” She added that this was the case also across Bangladesh and was not a ‘camp’, or ‘Rohingya’, problem:

… just in the month of April, domestic violence has gone up. There has been rape. There have been gender-based homicides. This comes from one month of tele-surveys. In one of the surveys conducted in the slum areas, a number of women told us that this is the first time they have experienced domestic violence, because of the pandemic.42

51.Other evidence pointed to risks that loss of income or livelihood could lead to the sexual exploitation of women or children to mitigate that loss.43

52.Successive UK governments have always stated that safeguarding and action against gender-based violence, including sexual violence, were high priorities for action. We have previously welcomed this stance and recommend that the new Department continues to make it a priority to maintain and strengthen the international alliance around initiatives in this area. We also recommend that the new Department maintains the UK’s international leadership on this agenda, preserves existing levels of funding and seeks to identify what further interventions may counteract the effect that Covid has had in increasing levels of domestic violence and sexual exploitation and abuse of women and children.

Erosion of respect for rights

53.UNHCR described the coronavirus pandemic as a protection and humanitarian rights crisis for the forcibly displaced. The UN organisation said the risks included:

• the entrenchment of repressive emergency laws and policies
• non-adherence to democratic principles and human rights, such as abusive treatment of asylum-seekers and refugees, with deportations and forced returns
• quarantine (of migrants) leading to restriction of movement, detentions and restricted access to, or total suspension of, due procedures44

54.The International Committee of the Red Cross wrote that, in conflict zones, it was vital that key provisions of international humanitarian law were respected in order to respond adequately during these unprecedented times–access by humanitarian personnel and movement of medical and relief supplies and access to water must all be protected.45

55.We recommend that the Government continues to project clearly onto the international stage, the importance it places on the UK’s place within the rules-based international infrastructure and the crucial foundations of human rights and the rule of law as fundamental British values.