COVID-19 | Rethinking how to respond to COVID-19 in places where humanitarian crises intersect by Rodrigo Mena

It is widely known that COVID-19 will disproportionately affect developing countries and impoverished peoples. Many of these countries are already affected by conflict and disasters including humanitarian crises, making the contexts even more fragile and complex and the threat of COVID-19 even more serious. Some approaches to fighting the coronavirus pandemic might not be feasible in these contexts where multiple crises intersect, argues Rodrigo Mena. The responses implemented in many countries are not sufficient to minimize impacts that include the potential loss of thousands of lives in vulnerable contexts; prevention and context-specific solutions that also address the root causes of humanitarian crises are needed now more than ever.

While many are waiting for the crisis to pass, we need to remember that hazards such as conflicts, earthquakes, or droughts do not take holidays during pandemic times. When they set in, governments will have to decide where to allocate the limited funds they have. Whereas many countries already have to make hard choices, hovering between strategies to prevent an economic recession and the prevention of the spread of the virus, countries with several pre-existing and ongoing crises, particularly those dependent on humanitarian aid, have even harder choices to make. When a disaster occurs together with COVID-19, will efforts be directed toward rebuilding the country or stopping the spread of the virus? And how will these countries deal with ongoing issues such as underdevelopment in general?

After four years researching disaster responses and humanitarian aid in conflict-affected places, I summarise here some considerations to take into account on why the general approach to COVID-19 might not be viable in many situations. Most recommendations can make things worse in traditional humanitarian crisis scenarios or places where the poorest and most vulnerable live. The places I studied faced disasters, conflict, and were generally underdeveloped, making them particularly vulnerable to any shock, including pandemics such as the COVID-19, and rendering governments incapable of responding effectively.

Refugee Camp, Bangladesh - COVID19

Refugee Camp in Bangladesh. Photo: Rod Mena

Additional issues are multiple. Here are a few:

  1. Lack of access to water. With about 780 million people in the world without access to clean water (780 million!) and in places facing conflict, ‘access to safe water is often compromised; infrastructure is damaged or goes into decline, pipelines are in disrepair, and water collection is dangerous’, as presented by UNICEF. The advice to wash your hands regularly or use disinfectant might certainly not be feasible for many. In fact, aid actors are already struggling to deliver water in many places and an extra demand for it can exacerbate or be the source of new conflicts.
  2. Lack of space. As many have indicated, COVID-19 will disproportionately affect the most vulnerable in the world, including those depending on humanitarian aid to survive. Social distancing might be impossible for the close to 30% of the world urban population living in slums, or for the close to 7 million living in refugee camps. And with more than 6% of the world’s employed population in the informal economy, the option to stay at home or quarantine looks unfeasible for many, let alone for those whose homes have been destroyed or left behind when they had to move because of disasters and conflict.
  3. Greater humanitarian need. In addition, less-developed countries and populations not being aided at the moment might also start needing support. For example, despite multiple difficulties in many refugee camps and crisis-affected areas, there is a system in place to support people in need, but people living out of those spaces might struggle as much or more with this pandemic. The humanitarian aid sector, thus, will face a greater number of people depending on external aid. How and whether the aid sector should assist people affected directly or indirectly by the coronavirus is still an open debate, not only in terms of the real capacities to do it beyond the funding, but also in terms of capacities to do it adequately and safely[1].
  4. Challenges to apply response strategies. A number of challenges can also impede the World Health Organization’s Test, Treat, Track strategy in places under high levels of conflict or facing humanitarian crises[2]:

Testing. If there is zero or reduced access to testing kits (and laboratories or medical personnel to run the tests), accurate figures on the number of deaths or infected people are obscured, making it difficult to plan how to provide relief.

Treating. When it comes to treating the most severely affected by COVID-19, the main procedure is connecting them to ventilators. A global shortage of ventilators is already apparent, and in least-developed countries, we need to add reduced access to reliable sources of electricity. In fact, close 20% of the world populations do not have access to electricity, and in low-income countries that can reach up to 60% —and yes, this includes hospitals that only have electricity via petrol or diesel generators.

Tracking. Then, when it comes to tracking the virus, we know that in places affected by conflict and disasters, many people are displaced or constantly on the move (there are 70.8 million displaced people worldwide, ranging from internally displaced persons to refugees and asylum seekers). Also, the demographics or databases of these places are not always reliable. This makes tracking very cumbersome or even impossible.

  1. Finally, the option to close borders or declare lockdowns might be detrimental in places affected by war or conflict, where many flee to safety or do not have access to goods and services to support their lives.

Vulnerability is created

These are far from all the concerns, but they are enough to show what is well known in disaster studies: that disasters are not natural but socially constructed, including the COVID-19 crisis, as a blog post from Ilan Kelman clearly shows. The pandemic that we have is much more the consequence of social and politically wrong decisions and lack of preparedness than the spreading rate or lethality of the virus. Particularly, a lack of preparedness or decision not to act based on the knowledge that we had (because multiple official reports indicated the probabilities of a pandemic like this and how to prevent it or mitigate its impacts), has greatly contributed to the severity of the crisis[3].

If we do not start thinking about how to prepare to COVID-19 in less-developed places with context-specific solutions, we will be repeating the story; we will keep choosing not to be prepared, which will keep on resulting in catastrophic impacts. If there is something that we have learnt from disasters in the past, it is that prevention is almost always better than responding. Not doing so, or expecting that measures as these reviewed above will work in the most vulnerable places, is to turn a blind eye and hope for the best.

[1] But now with a global economic recession and an aid system already with a 40% shortfall on the funds needed to assist everyone in need, as presented in the 2019 ‘Global Humanitarian Assistance Report’.
[2] And in many cases not even feasible in western countries like France or the United States.
[3] For instance, the ‘National Risk Profile 2016’ of the Netherlands indicated that ‘due to the possible destabilising impact, the main focus of the NRP [National Risk Profile] is on the risks of a large-scale outbreak of an infectious disease, such as a flu pandemic’. Similarly, in 2006, the United States developed the National Strategy for Pandemic Influenza based on the risk of this event to occur (with the following update in 2017). Also, astonishingly, a report on global preparedness for health emergencies dated September 2019, issued by the Global Preparedness Monitoring Board, co-convened by World Health Organization and the World Bank, that ‘explores and identifies the most urgent needs and actions required to accelerate preparedness for health emergencies, focusing in particular on biological risks manifesting as epidemics and pandemics’, concludes that a global pandemic ‘would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared’.

This article is part of a series about the coronavirus crisis. Read all articles of this series here.

R. Mena (2019)About the author:

Rodrigo (Rod) Mena is a socio-environmental researcher and AiO-PhD at the International Institute of Social Studies of the Erasmus University Rotterdam. His current research project focuses on disaster response and humanitarian aid governance in complex and high-intensity conflict-affected scenarios, with South Sudan, Afghanistan and Yemen as main cases. He has experience conducting fieldwork and researching in conflict and disaster zones from in Africa, Latin America, Europe, Oceania and Asia.

Image Credits: Rod Mena

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