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‘Crisis in a Crisis’ in Humanitarian Response Locations

Yemen, the world’s largest humanitarian crisis, is hit by once-in-a generation floods that have leave over 5 [ ... ]

During its Monday media briefing, the WHO Director General outlined four types of COVID-19 outbreaks occurring globally, including countries that [1] responded rapidly and avoided large outbreaks, [2] brought large outbreaks under control, [3] overcame their first peak and are struggling with new peaks, and [4] are currently in the intense transmission phase. The last category presents the biggest immediate risk and includes ten countries that account for almost 80% of new infections, with half of these in the U.S. and Brazil alone. The rate of new infections in the U.S. does not appear to be slowing despite an increase in testing, with total cases expected to surpass 4 million this week. With over 2 million confirmed cases, the outbreak in Brazil continues to be a major concern, particularly in light of irregularities in official government figures. This led to a stand-off last month between Brazilian President Bolsonaro– who has been criticized for downplaying the pandemic despite testing positive for the virus last week – and the Supreme Court, which prompted one Justice to demand the government immediately “re-establish the daily dissemination of epidemiological data on the COVID-19 pandemic.”
The Red Cross Red Crescent has warned that South Asia is quickly becoming the next epicentre of the pandemic, with rapidly rising cases across India, Pakistan, Bangladesh and Afghanistan. With the second highest number of daily new cases and over 1.1 million confirmed infections, the outbreak in India is rapidly escalating. This includes the Delhi metropolitan area that is home to 25 million people and accounts for almost half of all cases in the country. The latest projection from MIT, still under peer review, warns that India could have the largest number of cases in the next six months, with modelling scenarios estimating up to 287,000 cases per day in the absence of stronger public health measures.
Across Africa, the number of COVID-19 infections surpassed 750,000 this week, as the over 15,000 mortalities over the past five months have now exceeded the total number of lives lost to the West African Ebola outbreak between 2014 and 2016. At least 22 African countries have seen the number of Coronavirus cases double in the last month, with at least 35 countries experiencing community transmission. With the largest number of cases on the continent, South Africa recently re-imposed a ban on the sale of alcohol to reduce avoidable injuries and the burden on hospitals, while tightening curfews and mask requirements. Fragile health systems in many countries on the continent are increasingly overwhelmed, according to the WHO Director for Africa, who called on governments and the international community to scale up public health measures such as testing, contact tracing and case isolation. There is particular fear of outbreaks among vulnerable populations such as humanitarian response locations, marginalized communities as well as elderly populations, who are on average ten times more at risk of death, although they only account for 20% of COVID-19 infections in Africa.
Countries that previously succeeded in containing the virus are meanwhile reporting resurgence in cases, such as Hong Kong where a third wave of outbreaks prompted renewed lockdowns and physical distancing measures. A paper in the BMJ shows how COVID-19 related mortalities in Mexico have also tripled since the country began to relax lockdowns in early June despite warnings by experts and local health officials questioning official figures by the government. The cost of a subsequent lockdown in OECD countries alone has been estimated at US$1.1 trillion in additional output losses this year, which would increase five-fold if an outbreak were to occur in early 2021.

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh

The strongest cyclone ever recorded in the Bay of Bangal (with maximum sustained winds up to 265km/h) is expected to hit India and Bangladesh on Wednesday. Millions of people are being forced to evacuate north-east India, while only 12,000 shelters have been prepared in Bangladesh to house the nearly five million people in the expected path of Cyclone Amphan. The impact is likely to be hardest on those living in low-lying flood prone coastal areas, as the Needs Assessment Working Group of Bangladesh estimates that up to 14.2 million people in coastal districts are likely to be affected, displacing 1.4 million people and damaging up to 600,000 houses.

Vulnerable communities affected by COVID-19 outbreaks and lockdown will also likely be impacted, including the approximately 1.2 million Rohingya refugees that live in over-crowded camps in Cox’s Bazar in Bangladesh. In collaboration with humanitarian partners, including UNICEF and UNHCR, the IOM is constructing a COVID-19 treatment centre in Cox’s Bazar along with cyclone preparedness effort (alerting the community, reinforcing critical infrastructure and prepositioning emergency items before the cyclone makes landfall).

COVID needs in Humanitarian Emergency Settings

The UN High Commissioner for Refugees made an appeal for US$745 million for preparedness and response to outbreaks of COVID-19 among the more than 71 million refugees and forcibly displaced people that remain acutely vulnerable. While no major outbreaks have been reported in large refugee and IDP settlements, UNHCR is rapidly scaling up efforts in 134 refugee-hosting countries that are reporting local transmission. There is also widespread evidence of deep economic impacts on refugees, as 70% of refugees surveyed admitted to skipping meals, and this is most acute among refugee women.

Médecins Sans Frontières has outlined five key priorities for the international community in order to protect migrants and vulnerable populations in humanitarian response locations. These include:

Ensuring COVID-19 is not used as an excuse to enforce restrictive migration control policies and evade international obligations towards refugees, asylum seekers and migrants;
Governments must not use COVID-19 emergency measures to target refugees, asylum seekers and migrants, and measures should be proportionate and limited in duration, respect human dignity, and based on scientific evidence and not applied arbitrarily;
Lockdowns and mass quarantining cannot be cut-and-pasted or discriminatorily applied;
Direct humanitarian evacuation corridors for displaced people at risk (including people above 60 years and those with respiratory conditions, diabetes, or other health complications); and
Safeguarding access to healthcare for all (ensuring border closures do not prevent the mobility of people, essential supplies and aid workers, particularly in humanitarian response locations).

EU is Creating Humanitarian Air Bridges to enable the COVID-19 Response

The European Commission has allocated 10 million Euro to support a humanitarian air bridge amid travel shutdowns. In the absence of commercial air travel, the air bridge will allow humanitarian staff and supplies to be delivered across 30 routes deemed important for the COVID-19 response, with the first flight launched last week from France to the Central African Republic with 60 humanitarian workers and 13 metric tons of humanitarian cargo.

Build Back Better After COVID-19

The International Recovery Platform developed a toolkit of existing guidelines and tools to support countries and communities when they are ready to recover from the COVID-19 pandemic crisis. It supports recovering communities to “build back better” towards more resilient health systems, economies, and more just societies. The Compendium of Tools and Guidelines are organized according to four categories: Health Sector Recovery; Private Sector and Livelihood Recovery; Inclusive Recovery; and Disaster Recovery Governance. The IRP is a joint initiative of UN, international finance institutions, national and local governments, and NGOs engaged in disaster recovery and sustainable development.

A paper commissioned by the Swedish International Development Cooperation Agency provides analysis and guidance on to inform the design, implementation and adaptation of conflict sensitive humanitarian and development responses to COVID-19.

Lancet Papers Decry the lack of Ethical global leadership on health inequities around COVID-19

A paper in the Lancet calls for greater ethical global leadership on health inequities during the COVID-19 pandemic. The authors reference widespread reports of the disproportionate impact of the pandemic on vulnerable communities around the world, while pointing to “unconscionable stockpiling by wealthy countries” and even attempts to extract profits from the crisis through economic speculation.

Another paper in the same issue highlights how social inequalities in health profoundly, and unevenly, impacting COVID-19 morbidity and mortality. Among the social determinants of health, the authors identify emerging findings on the correlation of the pandemic with poverty (including homelessness), physical environment, and race or ethnicity. The paper also notes how physical distancing measures are significantly more difficult for vulnerable and marginalized populations, while school closures have increased food insecurity for children living in poverty, exacerbating physical and mental health. The authors urge policymakers to emphasize the mitigation of social determinants, including improving housing and reducing overcrowding as well as improving access to health services and income support. The paper also calls on social determinants of health to be an essential part of pandemic research priorities, public health goals, and policy implementation.

Preventing a COVID-19 Related Global Food Crisis

The Food and Agriculture Organization made an appeal for US$350 million to scale up efforts to address hunger and livelihood-boosting efforts in contexts vulnerable to food crisis. As part of the broader UN Global Humanitarian COVID-19 Plan, the appeal will include supporting farmers’ access to fields, seeds and other inputs to plant or buy feed for their animals in order to avoid the cascading impacts of missing planting seasons such as drops in output. The FAO also advocates proactive efforts for stronger emergency livelihoods interventions to avoid famines.
The WEF also reports how the pandemic has amplified the risk of worldwide food-price spikes, urging greater coordination across governments to avert disruptions to food supply chains, including through food protectionism. While lockdowns have led to a collapse in demand for discretionary goods and services, the opposite is true of food as panic buying and food hoarding has proliferated. On the supply side, global grain stockpiles could be quickly depleted as the virus disrupts production and distribution, compounded by the worst locust outbreak in 70 years that have left countries in East Africa acutely vulnerable. In Kenya, for example, the price of staple foods has risen by 60% since last year.
ICRISAT published a new report that outlines four key strategies to protect the lives and livelihoods of farming communities in Eastern and Southern Africa. These include:
1. Diversification of farming systems for improved resilience and profitability (including technologies suitable for sustainable intensification);
2. Enhancing access to seed at scale of grain legumes and dryland cereals (through community seed banks that also supports grain aggregation);
3. Building capacity of partners to promote technologies in a participatory manner (including governments, community organizations, local leaders and women); and
4. Gender integration and empowerment to engage actively in agribusinesses (including livelihood-strengthening activities like climate-smart agriculture)

CommunityFirst COVID-19 Roadmap

This week, SeeChange Initiative and Ilisaqsivik Society, in partnership with the Association of Médicos Sin Fronteras in Latin America, and the Dahdaleh Institute, launched the CommunityFirst COVID-19 Roadmap, a planning tool to empower communities in developing local strategies to organize, prepare and respond to COVID-19. The Roadmap is available in English, Spanish and Inuktitut, and also includes an Emergency Readiness Checklist. Last month, the Executive Director of SeeChange and a Steering Committee member of the CommunityFirst Roadmap published an article in the Lancet on local efforts among Inuit communities to address COVID-19 and TB. The role of community-based responses to the pandemic was also highlighted in STAT.

Webinar Resources

COVID-19 in Humanitarian Setting: Magnifying Gender Inequalities? (JHU)
- Wednesday, May 20, 2020 (8-9am EST)
Digital Solutions to Covid-19 and Urban Challenges in Sub-Saharan Africa (CSIS)
- Thursday, May 21, 2020 (9-10am EST)
Humanitarian Operations During Covid-19: A Conversation with UNHCR (CSIS)
- Monday, June 8, 2020 (9:30-10:15am EST)

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Social Distancing Works

An article in Health Affairs examines the role of social distancing measures in reducing the growth rate of the pandemic in the U.S. The authors conclude that jurisdictions with no physical distancing policies had 35 times more cases of COVID-19, and that the rate of new infections dropped the longer a physical distancing policy was in place.

COVID-19 can cause severe illness in children

A cross-sectional study in JAMA Pediatrics confirms earlier reports that COVID-19 can cause severe illness in children (CFR of 4.2), but considerably less than in adults. Similar to adult COVID-19 patients, severe cases in children are strongly associated with pre-existing comorbidities (including developmental delays, genetic anomalies, and immune suppression). A separate retrospective review in the Journal of Pediatrics, authors examined associations between underlying epidemiologic and clinical conditions with rates of hospitalization, finding positive correlations with neurological disorders (19%), cardiac conditions (9%), hematologic conditions (9%) and oncologic conditions (5%).

COVID-19 may increase frequency of Children’s Kawasaki Syndrome

Emergent reports from around the world suggest an association between a Kawaski-like syndrome and COVID infection in children. An observational cohort study in the Lancet hypothesizes that COVID-19 may be responsible for the 30-fold increase in the incidence of hyper-inflammatory syndrome Kawasaki-like disease among older children in Italy.

RCTs pending on the benefits and safety of convalescent plasma for people with COVID-19

A Cochrane Rapid Review shows that only 32 patients in seven case-series studies have been studied systematically, and there is at this time limited evidence on the benefits and safety of convalescent plasma for people with COVID-19. The review noted that 47 studies are currently underway, and 22 of these are Randomized Control Trials. Cochrane will update this clinical review on a monthly basis as trial results emerge. It notes that its review and conclusions are likely be different from its current assessment of “limited evidence.”

80% of secondary transmissions may have been caused by a small fraction of infectious individuals

A pre-print publication on Wellcome Open Research examines outbreak size outside China, and highlights the high variability across countries in the overdispersion of COVID-19 transmission. Findings suggest that 80% of secondary transmissions may have been caused by a small fraction of infectious individuals, and that the effective reproduction number could be drastically reduced by preventing relatively rare superspreading events.

Voluntary collective isolation and contact-tracing for vulnerable Indigenous Communities

The Lancet published a paper this week on a case study and potential protocols for indigenous populations in the Bolivian Amazon. The interdisciplinary study proposes a multiphase COVID-19 prevention and containment plan focused on voluntary collective isolation and contact-tracing that could be exported and adapted to local circumstances elsewhere to prevent widespread mortality in indigenous communities.

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An alarming new report by the ILO estimates that nearly half of the global workforce, more than 1.6 billion people, could lose their livelihoods due to COVID-19 related reductions in global trade and increased lockdown control measures. The report projects that lost income could total US$3.4 trillion this year, as the equivalent of 200 million full-time jobs have or will disappear since the start of the pandemic. The staggering figures include many informal workers that may lack worker benefits or social protection, and push upwards of 500 million people into poverty. The UN High Commissioner for Human Rights issued a Guidance for countries to adopt strategies that protection homeless people, as the Special Rapporteur on Extreme Poverty and Human Rights raised the likelihood that extreme poverty will increase for the first time in 20 years that is threatening 40 to 60 million people globally.

With incomes virtually stopping overnight in some countries, the UN Global Network Against Food Crisis warns that as many as 265 million people around the world may suffer from food insecurity and possible starvation. This includes the half a billion smallholder farmers that produce almost 80% of food consumed in Asia and Sub-Saharan Africa. Some countries have turned to cash payments to support the poor, including Pakistan where the government announced US$900 million in emergency funds for over 80 million people. Many countries such as Bangladesh are confronted by increasing public protests due to lockdowns. In Malawi, the High Court set aside plans for a COVID-19 lockdown pending a review within seven days, as protestors against the lockdown carried placards declaring that it would be better to contract the virus than die of hunger because they are unable to work. The WHO has also expressed concern of community spread in West Africa, as multiple countries have issued targeted lockdowns and curfews in major cities in addition to restrictions on inter-urban travel, stopping short of nationwide lockdowns.

With a looming recession and ballooning debt obligations in many developing countries, the IMF urged donor countries to support economic stimulus packages to address the immediate and long-term hunger impact. UN OCHA also states that about 700 million people (10% of the world’s population) are most vulnerable and concentrated in about 30 to 40 countries which already receive humanitarian assistance and will see a big drop in incomes as the virus spreads and governments impose restrictive measures and lock downs. They estimate that US$90 billion would be needed to provide income support, protect against starvation, and support a systematic health response for the world’s most vulnerable people. This represents 1% of the approximately US$8 trillion stimulus packages that the IMF states G20 countries have put in place to safeguard their own economies. The World Bank’s Pandemic Emergency Financing Facility will meanwhile provide a modest $200 million in pandemic bonds to 64 low- and middle-income countries to finance COVID-19 related medical and personal protective equipment, medicines and support for frontline health workers.

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Yemen, the world’s largest humanitarian crisis, is hit by once-in-a generation floods that have leave over 5 million children facing the threat of cholera and acute diarrhea. More than 110,000 cases of suspected cholera have been recorded across 90% of regions in Yemen since January. More than a million displaced Yemenis and refugees are currently in need of urgent critical aid, as another report by the Lebanon Protection Consortium examines the impact of regional lockdowns on Syrian refugees in Informal Tented Settlements residents in Lebanon.

The UNHCR warns that a looming humanitarian crisis is unfolding in South Sudan. Years of conflict, recent natural disasters like floods and locust swarm, as well as the looming threat from COVID-19 leave 1.7 million displaced people in crowded sites with poor sanitary conditions and limited or no access to health facilities are struggling to meet basic needs. Aid organizations have described the “impossible” challenge of COVID-19 response in humanitarian response locations. In refugee camps such as Cox Bazaar, Bangladesh, there are particular difficulties in enforcing social distancing and hand washing practices, as UNICEF attempts to scale up delivery of health and hygiene supplies to Latin American and Caribbean countries.

A COVID-19 Humanitarian Plan for Afghanistan is seeking US$108 million to reach a third of the country, as more than 7 million children are expected to face food shortages due to the current pandemic. This is in addition to the $733 million that the UN and humanitarian partners are seeking as part of the Humanitarian Response Plan for Afghanistan to provide water, sanitation and hygiene kits and tailored hygiene promotion activities. A report by the U.S. Special Inspector General for Afghanistan Reconstruction yesterday raised alarm that COVID-19 could alsoderail peace talks, as the country is likely to confront a ‘health disaster‘ through the end of the year.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), about 700 million people (10% of the world’s population) across 30-40 countries remain acutely vulnerable to the impact of COVID-19. An estimated US$90 billion is needed to provide income support, protect against starvation, and support a systematic health response for the world’s most vulnerable people. This represents about 1% of the approximately US$8 trillion stimulus packages that G20 countries have put in place to safeguard their own economies.

In partnership with the London School of Hygiene and Tropical Medicine (LSHTM) and the Geneva Centre for Education and Research in Humanitarian Action, OCHA yesterday released a Rapid Learning Review that outlines 14 actions, insights and ideas for humanitarian actors to consider in their COVID-19 responses synthesizing the best available knowledge and guidance. A coalition of academic institutions also released a set of 14 Principles in Protecting Migrants, Refugees and other Displaced Populations signed by over 800 international experts, as the WHO this week issued an Interim Guidance on Preparedness, prevention and control of COVID-19 for refugees and migrants in non-camp settings.

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Earlier today, China increased the number of COVID-related deaths in Wuhan by 50%, raising the country’s toll by 1,300 to 4,632. While the government claims this reflects updated hospital counts as well as those who died at home, the revision in the reported figures partially validates accusations of under-reporting, including by intelligence agencies. The broader challenge is that most models of the pandemic are based on prior figures from China and may need to be revised to reflect these significant adjustments.

In China, a cluster of cases linked to the Nigerian community in Guangzhou has also sparked alleged discrimination towards Africans by locals and virus prevention officials.

Asian-Pacific countries are beginning to experience second waves of infections, including Singapore which is reporting the highest case rate in the region (500 cases per million people). Despite these spikes, the “suppress and lift” strategy of aggressive testing, isolation, and contact tracing by countries such as Singapore and Hong Kong remains a model response and has helped prevent exponential spread.

In Iran, the number of reported cases and deaths approach 80,000 and 5,000, respectively. Fearing a protracted economic crisis, some “low-risk” businesses were allowed to open, prompting concerns of a second wave of infections. The government has asked for economic support and sanction relief from the IMF, which the U.S. has thus far blocked despite international pressure to sideline geopolitical tensions to allow countries to respond to the pandemic.

With 13,835 confirmed cases, India has become the third Asian country to surpass the 10,000 mark. Like in Pakistan (7,025) and Bangladesh (1,838), the true outbreak size is expected to be significantly higher in India due to varying testing and counting strategies. In India, the government has extended the nation-wide lockdown until May 3, while food shortages and a mass exodus from major urban areas has raised concern about local transmission in rural parts of the country. There are positive reports that some states like Kerala have managed to bend the curve by adopting “aggressive testing, contact tracing, and cooked meals.”

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During its Monday media briefing, the WHO Director General outlined four types of COVID-19 outbreaks occurring globally, including countries that [1] responded rapidly and avoided large outbreaks, [2] brought large outbreaks under control, [3] overcame their first peak and are struggling with new peaks, and [4] are currently in the intense transmission phase. The last category presents the biggest immediate risk and includes ten countries that account for almost 80% of new infections, with half of these in the U.S. and Brazil alone. The rate of new infections in the U.S. does not appear to be slowing despite an increase in testing, with total cases expected to surpass 4 million this week. With over 2 million confirmed cases, the outbreak in Brazil continues to be a major concern, particularly in light of irregularities in official government figures. This led to a stand-off last month between Brazilian President Bolsonaro– who has been criticized for downplaying the pandemic despite testing positive for the virus last week – and the Supreme Court, which prompted one Justice to demand the government immediately “re-establish the daily dissemination of epidemiological data on the COVID-19 pandemic.”
The Red Cross Red Crescent has warned that South Asia is quickly becoming the next epicentre of the pandemic, with rapidly rising cases across India, Pakistan, Bangladesh and Afghanistan. With the second highest number of daily new cases and over 1.1 million confirmed infections, the outbreak in India is rapidly escalating. This includes the Delhi metropolitan area that is home to 25 million people and accounts for almost half of all cases in the country. The latest projection from MIT, still under peer review, warns that India could have the largest number of cases in the next six months, with modelling scenarios estimating up to 287,000 cases per day in the absence of stronger public health measures.
Across Africa, the number of COVID-19 infections surpassed 750,000 this week, as the over 15,000 mortalities over the past five months have now exceeded the total number of lives lost to the West African Ebola outbreak between 2014 and 2016. At least 22 African countries have seen the number of Coronavirus cases double in the last month, with at least 35 countries experiencing community transmission. With the largest number of cases on the continent, South Africa recently re-imposed a ban on the sale of alcohol to reduce avoidable injuries and the burden on hospitals, while tightening curfews and mask requirements. Fragile health systems in many countries on the continent are increasingly overwhelmed, according to the WHO Director for Africa, who called on governments and the international community to scale up public health measures such as testing, contact tracing and case isolation. There is particular fear of outbreaks among vulnerable populations such as humanitarian response locations, marginalized communities as well as elderly populations, who are on average ten times more at risk of death, although they only account for 20% of COVID-19 infections in Africa.
Countries that previously succeeded in containing the virus are meanwhile reporting resurgence in cases, such as Hong Kong where a third wave of outbreaks prompted renewed lockdowns and physical distancing measures. A paper in the BMJ shows how COVID-19 related mortalities in Mexico have also tripled since the country began to relax lockdowns in early June despite warnings by experts and local health officials questioning official figures by the government. The cost of a subsequent lockdown in OECD countries alone has been estimated at US$1.1 trillion in additional output losses this year, which would increase five-fold if an outbreak were to occur in early 2021.

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