at Dadhaleh Institute

Compounding crises undermine ethical, equitable COVID-19 response

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh The strongest cyclone ever recorded in [ ... ]

The World Food Programme has identified 25 ‘hotspots’ where acute hunger is reached devastating levels. Most of the countries stretch between West and East Africa, while vulnerable populations in Latin American and Middle Eastern countries, where the pandemic has exacerbated income losses, disrupted supply chains that contributed to surging food prices. The WFP and FAO previously estimated that food security could increase by 81% this year to almost 270 million people. Every 1% rise in acute hunger also contributes to a 2% increase in refugee outflows, which further threaten vulnerable populations as well as regional stability. The UN released an updated COVID-19 Global Humanitarian Response Plan last week, with the $4.9 billion WFP response accounting for nearly half of the sum, and an additional $500 million special provision for the 25 hotspots most at risk of famine.
A new study in PLoS Medicine shows that combining severe and moderate acute malnutrition treatments into a simplified protocol could be as effective as traditional treatment while saving $123 per child. The ‘Combined Protocol for Acute Malnutrition Study’ was conducted by LSHTM, the International Rescue Committee and Action Against Hunger, and found that the combined protocol was 76.3% effective at promoting nutritional recovery, which is slightly better than the 73.5% for standard treatment. With 50 million children currently not receiving malnutrition treatment, the efficacy and cost savings could translate into program expansions, with three million child deaths a year are linked to malnutrition.

The UN released an updated COVID-19 Global Humanitarian Response Plan, doubling its appeal to $10.3 billion, more than 80% of which would support responses in 63 low-income countries. Another $1.8 billion would be directed for ‘global requirements’, transport of aid workers and supplies accounting for $1 billion, with a further $300 million allocated directly for NGOs and $500 million for 25 ‘hotspots’ most at risk of famine. The UN Emergency Response Coordinatorwent on to warn that the pandemic and the associated global recession are about to wreak havoc in fragile states, while describe the response by wealthier countries as “grossly inadequate and dangerously short-sighted.”
The timely and directed appeal comes as G20 Finance Ministers and heads of central banks are set to meet virtually this coming Saturday. An estimated $11 trillion in stimulus packages have been appropriated by G20 countries as part of an unprecedented economic response, representing 10% of global GDP. To protect the most vulnerable 10% of the world across 32 low-income countries would meanwhile cost less than $90 billion, which is less than 1% of domestic stimulus packages by wealthier countries. The UN Emergency Response Coordinator contrasted the solidarity and international coordination in the aftermath of the 2008 Global Financial Crisis, particularly highlighting the need to reinforce and reassert the role of the IMF and World Bank in supporting lower income countries.

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During the Sustainable Development Goals progress review meeting over the weekend, the UN Secretary General issued one of his strongest rebukes of the international community for systemic inequities that the COVID-19 pandemic has exposed. In a significant departure from his traditional diplomatic tone, the Mandela Day speech by the UN head noted the many “myths, delusions, and falsehoods” around international progress on equality. Among the examples he listed was the “lie that free markets can deliver healthcare for all. The fiction that unpaid care work is not work, the delusion that we live in a post-racist world, the myth that we are all in the same boat.” He went on to call for a “New Social Contract” with commitment of renewed and inclusive multilateralism, while urging for fundamental reforms to the UN Security Council, the IMF, and the World Bank.
Humanitarian response locations remain a particular cause for concern, including in sub-Saharan Africa which is home to over 26% of the world’s refugees. Ongoing conflicts and persistent attacks have led to the closure of hundreds of health facilities, including in Mali and Burkina Faso where 1.5 million people are left without adequate health care. During its Monday media briefing, the WHO cited a recent study by Oxford University highlights the risk of conflict on outbreaks, identifying 63 fragile countries currently facing unrest and conflict in the background of the COVID-19 pandemic, while additional 13 countries are projected to experience new conflicts over the next two years. The study further estimates that the average cost to host and neighbouring countries for a civil war is about $60 billion, while 100 million could be pushed into extreme poverty and 130 million face starvation.

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As countries eagerly hope to end the lockdowns that have decimated national economies, one idea that has gained traction is the issuance of immunity passports to those that have either tested negative or recovered from COVID-19. In Nature, however, an article this week outlines four practical challenges and six ethical objections to immunity passports:
1. Unclear whether recovered patients develop immunity to future exposure to virus.
2. Serological testing for antibodies remains unreliable (low specificity and specificity).
3. No country has sufficient serological testing capacity (minimum of two per person).
4. Only a small fraction of the population would be certified (e.g. less than 0.5% of the U.S. population based on current number of confirmed cases).
5. Systems to monitor immunity will erode privacy and increase the risk of forgery.
6. Marginalized communities will be disproportionately impacted, including profiling and potential harms to racial, sexual, religious or other minority groups.
7. Unfair access due to testing shortages and systemic inequities.
8. Create further inequity between immuno-privileged and vulnerable communities.
9. Could open the possibility for discrimination on the basis of other health information (e.g. mental health status, genetic tests) by employers, insurers, or law enforcement.
10. Can lead to perverse incentives, e.g. if social and economic liberties are only granted to people who recover from COVID-19.

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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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A new report by the World Bank projects the sharpest historic decline in global remittances could push 40-60 million people into extreme poverty
- The UNHCR warns of the impact of reduced remittances on migrants and vulnerable communities, issuing a new guidance on Cash and Voucher Assistance programs
A UNDP report warns of the alarming increase of gender-based violence due to COVID-19
- COVID-19 Pandemic Could Have Long-Term Consequences On Women’s Health Care Access Globally, Health Workers (UNFPA)
- Care and Connection in Crisis: Feminist Strategy to Confront COVID-19 (Madre)
- Commentary: We need a feminist response to the pandemic (Devex)
Like Zambia, more African countries seek emergency funding from the IMF
A ban on large funerals in South Africa has forced people to give up many traditions, but they have also rediscovered old ones, including “secret burials” (BBC)
By prioritizing Early detection, contact tracing and 28 day quarantines, Kerala’a COVID-19 fatality rate (0.53%) is the lowest in India, and has limited the spread of the virus without inflicting any of the human suffering seen in other parts of the country (Commentary: The Kerala Model (Shashi Tharoor)
In a new commentary, Tony Blair and Agnes Kalibata highlight four global actions to increase food security during the pandemic. These including: (1) Increasing funding for food-relief and social-protection measures; (2) Investing in local agricultural production; (3) Supporting regional and local logistics hubs to limit disruptions to food and agricultural produce supply chains; and (4) Incentivizing funding of agro-processing and Agtech companies.
- DIGHR Fellow Rhonda Ferguson also argues that displacement of local food systems threaten 265 million people with famine, and that transformation in trade is urgently needed (Conversation)
- HIV and Food Insecurity: A Syndemic Amid COVID-19 (AIDS and Behaviour)
- Small-scale farmers can help build resilient food systems in post-COVID world (IFAD)

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A new WHO study projects that up to 190,000 people in Africa could die and an additional 29-44 million could get infected by the Coronavirus in the first year if containment measures fail.
Harvard Professor Joseph Nye – one of the world’s leading scholars on global governance- examines the “abysmal failure of leadership” from the U.S. and China, urging that more global solidarity and recognition of mutual interest is essential to address the pandemic
In collaboration with DIGHR, the Ilisaqsivik Society, and Médecins Sans Frontières (Latin), SeeChange Initiative is launching a Community Roadmap planning tool today to support communities organize, prepare and respond to COVID-19. See:
- CommunityFirst COVID-19 Emergency Readiness Checklist
- What the Covid-19 pandemic is teaching us about community (STAT)
In a commentary, Nobel Peace Prize laureate, Kailash Satyarthi, highlights the compassionate work of community and civil-society groups working with vulnerable populations, urging G20 to increase international aid and coordination through UN agencies like WHO, UNICEF and UNOCHA.
A study in Lancet Global Health projects an additional 0.25-1.2 million children under 5 could die indirectly in the next six months as a result of the pandemic though disruption of health systems and decreased access to food. This would be the first increase in global child mortality since World War II. The researchers from Johns Hopkins also estimate that indirect maternal deaths could rise from 8% to 38%.
An analysis by the New York Times reveals spikes in fatalities across Latin America (including Brazil, Ecuador and Peru) that exceed the worst pandemic trajectories in Europe and the U.S. The Brazilian president, when asked about the death toll, replied “So what? What do you want me to do?”.
Amazon indigenous leaders warn of the potentially devastating effects of COVID-19 (New Humanitarian), where “no specific attention has been given to indigenous communities”.In Brazil, the potential effects highlight the lack of government support with food and health services. The former health minister of Ecuador, meanwhile, warns that “everyone is at risk” if marginalized communities are not able to afford basic health services, while officials in Mexico suggest that thousands of deaths are not being reported, obscuring the true toll of the COVID-19 epidemic.
China, South Korea and Japan are experiencing a resurgence in COVID cases, as the WHO and public health experts warn against lifting containment measures too early (CNBC)
- Authorities in Wuhan plan to test all 11 million residents over the next ten days after discovering new infections for the first time since its lockdown was lifted, prioritizing vulnerable groups and high-density areas (BBC)
Exceptionally heavy seasonal rains across East Africa since late April have resulted in widespread floods that caused a heavy loss of life and property, compounding the risks to human health and food security from the COVID-19 pandemic and the most serious desert locust invasion in decades. (WMO)
COVID19 epitomises why a “One Health” approach – which recognises the fundamental interconnectedness of humans, animals, and their shared environment- is key to ensuring the healthy and sustainable future of the planet. coChairs of the Lancet One Health Commission are calling for a COVID-19 One Health Research Coalition (Lancet)

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An article in The Lancet (Has COVID-19 subverted global health?) emphasize the importance of context and equity as key principles of global health. In light of limited financial aid from wealthier countries, the authors urge developing countries to adopt policies that reflect their local context that focus on what is possible, acceptable, just, and sustainable.

What accounts was South Korea’s COVID Secret? Fast Testing, High-Tech Tracing, Zero-Tolerance Isolation (Atlantic)

Lockdown Is a Blunt Tool, We Have a Sharper One: Contact Tracing (NYT)

WHO issues a Technical Guidance on Contact Tracing for COVID-19 in Africa (WHO)

The U.S. can expect a series of ‘mini-epidemics’, as the flattening curve is misleading, as the CIDRP outlines three potential futures: recurring small outbreaks, monster wave, persistent crisis (NYT)

Where the latest models think we are headed and why they disagree (FiveThirtyEight)

Reopening some states can heighten risk of or recurring second waves in others (STAT)

Simulation: Ending restrictions earlier is associated with higher projected cases and deaths, but also quicker economic recovery according to a RAND Corporation online tool

In the New England Journal of Medicine, the authors provide two lessons in the Italian response to the pandemic, highlighting the important of testing of health care workers, and how “urgent and decisive” lockdown of the region earlier could have contain the epidemic (Adaptations and Lessons in the Province of Bergamio)

National Geographic reviews the lessons learned from national responses to the COVID-19 pandemic, including the spread of social mitigation, the effectiveness of travel restrictions, testing and the impact of speed of response on outbreak trajectory (How to measure your nation’s response to coronavirus).

It took the U.S. only seven days to exceed projected COVID-19 deaths for August (Newsweek)

A new paper in the Journal of Risk Research (Resilience in the face of uncertainty) describe how political interference undermined the ability of the U.K. National Health Service with COVID-19 preparedness and response. Similar to the Bank of England, the authors argue that national emergency preparedness requires greater independence.

While the full impact of the pandemic on food security remains unknown, Dr. Rhonda Ferguson (DIGHR Research Fellow) argues that the displacement of localized food systems require transformation in trade to protect the estimated 265 million people threatened by famine (Coronavirus: Another chance to transform the global food trade)

COVID-19 and Globalization (One Health)

Could COVID-19 mark a ‘turning point’ in the climate crisis? (WEF)

Effective transmission across the globe: the role of climate in COVID-19 mitigation strategies (Lancet Planetary Health)

Iran’s locust threats grow amid coronavirus pandemic, sanctions (New Humanitarian)

As the number of cases in Iran top 100,000, the spokesperson for the Health Ministry expressed concern in the “rising trend” over the least three days (Daily Star Lebanon)

Public Health Emergency of International Concern (PHEIC) Declaration for COVID-19 extended (WHO)

Why we can’t compare country responses to COVID-19: death rates, data and geography (WEF)

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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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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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April 9 marks the 100th day since the WHO was notified of the first case of “pneumonia of unknown cause” in Wuhan, China.

As of April 12 at 10am EST, the total worldwide deaths from COVID-19 has surpassed 110,000, as confirmed cases approach 1.8 million. The actual number of dead and infected worldwide are believed to be much higher, but testing shortages, different counting practices and concealment by some governments limit detection and reporting.

The U.S. is the current global epicentre with over 530,000 confirmed cases and over 20,000 deaths, while the five worst affected countries (U.S., Spain, Italy, Germany, France) account for over 60% of all cases and almost 80% of deaths globally.

Community transmission is spreading, and the rapid increase of cases across low- and middle-income countries has become a critical global issue, as over 20 developing countries are reporting more than 1,000 cases. The number of African cases increased approximately by 40% over the past week, with all 55 countries reporting cases and 8 African countries seeing exponential rise. South Africa’s border controls and lockdown over the past two weeks have significantly reduced the number of new cases.

The economic fallout from the global pandemic could push 500 million people into poverty (8% of global population), according to a UN University report. This would be the first time that poverty has increased globally in over thirty years. The World Bank and IMF have scaled up and accelerated efforts to provide emergency funding to countries, while the UN Office for the Coordination for Humanitarian Affairs (OCHA) issued a US$2 billion appeal for a Coordinated Global Humanitarian Response Plan, which as of April 8, is only 20% funded.

As governments confront the dual challenge of containing the viral pandemic and economic crisis, public health experts warn countries that premature re-opening could lead to a second wave of outbreaks, echoed as well by modelling projections in a recent Lancet paper. Oxfam has urged world leaders to contribute to the $2.5 trillion economic rescue plan set out by the UN to “keep poor countries and poor communities afloat.” Mounting job losses and disruptions to global supply chains are also expected to result in chronic food shortages, as countries are urged to keep trade open and to protect farmers.

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The number of confirmed cases and reported deaths have consistently increased by 10-20% per day over the past week, surpassing 7,300 and 250, respectively, across 23 locations with humanitarian responses. This does not include countries like Iran where UN humanitarian agencies do not operate, and where the number of reported cases is 71,686, including 4,474 COVID-related deaths.

The COVID-19 Global Humanitarian Response Plan by OCHA will be implemented by UN agencies, with international NGOs and consortiums playing a direct role in the response, but remains about 20% funded as of 8 April.

The FAO published a framework for Addressing the Impacts of COVID-19 in Food Crises, including an appeal for US$110 million to maintain the provision of critical assistance where there are already high levels of need. The WFP estimates that 100-120 million people across 80 countries will require urgent support and food supplies.

The UN High Commissioner for Human Rights issued renewed guidance on protection of human rights, calling for urgent and coordinated action by countries to prevent “wider inequalities and extensive suffering.” This is in light of reports by the IOM of increased restrictions at points of entry, limiting mobility and delivery of essential goods. Humanitarian organizations, including the ICRC and MSF have urged countries to protect vulnerable populations, including IDPs and asylum seekers.

The combination of economic and social stresses, along with restrictive control measures, have led to a dramatic increase in the numbers of women and girls facing domestic abuse, as the UN Secretary General called for urgent measures to address the “horrifying global surge in domestic violence.”

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The World Food Programme has identified 25 ‘hotspots’ where acute hunger is reached devastating levels. Most of the countries stretch between West and East Africa, while vulnerable populations in Latin American and Middle Eastern countries, where the pandemic has exacerbated income losses, disrupted supply chains that contributed to surging food prices. The WFP and FAO previously estimated that food security could increase by 81% this year to almost 270 million people. Every 1% rise in acute hunger also contributes to a 2% increase in refugee outflows, which further threaten vulnerable populations as well as regional stability. The UN released an updated COVID-19 Global Humanitarian Response Plan last week, with the $4.9 billion WFP response accounting for nearly half of the sum, and an additional $500 million special provision for the 25 hotspots most at risk of famine.
A new study in PLoS Medicine shows that combining severe and moderate acute malnutrition treatments into a simplified protocol could be as effective as traditional treatment while saving $123 per child. The ‘Combined Protocol for Acute Malnutrition Study’ was conducted by LSHTM, the International Rescue Committee and Action Against Hunger, and found that the combined protocol was 76.3% effective at promoting nutritional recovery, which is slightly better than the 73.5% for standard treatment. With 50 million children currently not receiving malnutrition treatment, the efficacy and cost savings could translate into program expansions, with three million child deaths a year are linked to malnutrition.

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