International Development Committee inquiry: Humanitarian crises monitoring – the impact of Covid-19 on developing countries evidence submission from the Institute of Development Studies


About the Institute of Development Studies

The Institute of Development Studies (IDS) is a global research and learning organisation for equitable and sustainable change. IDS is ranked best international development policy think tank (2019 Global Go To Think Tank Index) and first in the world for development studies by the QS University Rankings, with the University of Sussex.


This submission draws on evidence from several IDS researchers with expertise in the social dimensions of global health, pandemic preparedness and response, including:


Professor Melissa Leach, Director, Institute of Development Studies, member of WHO Social Science Expert Group and British Academy COVID-19 Steering Group, lead researcher for the Pandemic Preparedness Project (PPP) in Africa funded by the Wellcome Trust, and a lead researcher for the Social Science in Humanitarian Action Platform (SSHAP), a partnership between IDS, LSHTM, UNICEF and Anthrologica. 


Dr Hayley MacGregor and Dr Annie Wilkinson who conduct research as part of the Pandemic Preparedness Project (MacGregor as co-lead), the ARISE Hub: Accountability and Responsiveness in Informal Urban Settlements for Equity in Health and Well-being, funded by the Global Challenges Research Fund and SSHAP.


Dr Mariz Tadros, Director of the IDS-led Coalition for Religious Equality and Inclusive Development (CREID), funded by DFID.


For further information relating to this evidence submission please contact: Sophie Robinson, External Affairs Officer, or +44 (0)1273 915763.



Pandemics are a social phenomenon – they are shaped by the contexts in which they arise and unfold, not just the disease itself.  For measures against Covid-19 to be effective, such as ‘lockdowns’, physical distancing, handwashing, mass communication, trust, and changes to cultural and religious practices,  depends on how well they are attuned to their social contexts, on how individual people and their communities respond and on the societies in which they live. Responses that recognise this are critical.


Evidence from social science is vital to help find the most effective responses to Covid-19 that will work in different country, regional and cultural- specific contexts. Social science may not get the headlines in the way vaccines do, but without it medical interventions alone will not be enough. Therefore, scientific collaboration is crucial - collaboration that is international and cross-discipline - including social science and medical science and a broad coalition of private and public sector actors.  Social science is especially needed to help test the assumptions and nuance models when tackling pandemics, as we learnt during the Ebola outbreak in West Africa.


Communities must be put at the heart of response measures – this was the main lesson from Ebola that must not be forgotten. The extent of this will vary depending on each individual context but a ‘top-down’ approach alone will not work, particularly where there is any lack of trust in government or local authority officials. 



The WHO-mandated preparedness and response model, which is being applied to varying degrees in Northern countries, will struggle in resource-poor settings and in places with very different citizen-state relations. We are already seeing alarming examples (e.g. in Uganda) where local government and military agencies are using ‘lockdown’ mandates to abuse authority and enact violence against people going about their livelihoods in marketplaces. A different approach suited to context and building on ‘preparedness and response from below’ is key.


  1. The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats (particularly relating to countries with existing humanitarian crises and/or substantial populations of refugees or internally displaced persons)


1.1 Covid-19 in Africa – Sierra Leone, Uganda and South Africa

Covid-19 is testing the resilience of even the best equipped health systems. In Africa, Covid-19 is entering countries such as Sierra Leone and Uganda where there are competing disease priorities and outbreaks and a poverty of resources. In countries like Uganda and Sierra Leone there are few laboratories and they face acute equipment, infrastructure and human resource gaps. 


1.1.1 Sierra Leone had its first case of Covid-19 confirmed on 1 April. If it spreads throughout the country, the over-stretched primary and secondary care systems will be unable to cope. Humanitarian assistance in response to Ebola has done little to bolster fragile health systems in the longer term.  In Sierra Leone, treatment and community care centres built across the country to tackle Ebola were only temporary and most have been destroyed.


1.1.2 Research on the Ugandan/Democratic Republic of Congo (DRC) border and in Sierra Leone shows a lack of Covid-19 awareness; many people view it as distant, and it is spoken of as “a disease of the radio”. Hand washing and avoiding handshaking are more familiar to people from Ebola-containment measures, but people are unclear about the reasons for strict movement restrictions.


1.1.3 In Uganda Government health workers and village health teams are not taking hold of the narrative on this disease and people are forced to work out for themselves the facts from the rumours and decide the best course of action; whether to follow government directives or whether there is a greater risk of other difficulties such as starvation and other daily struggles. In fact, on 6th April 2020 the Uganda’s Virus Research Institute confirmed that for proportionate samples drawn from an urban and another from rural settings, only urban samples are being tested for Covid-19.


1.1.4 Reports from research partners in the field that show women living on the Uganda/DRC border are especially frightened and suffering from beatings. For example, on market day the district military and police authorities, supported by the local chairperson, chased market attendees away to avoid congestion, and potential spread of Covid-19. Those who were defiant were beaten in order to disperse the overcrowding populations in the market. This is a community still recovering from and facing the threat of Ebola and other diseases, which is on top of poverty, gender inequalities and other daily struggles. These villages are constantly having to respond to repeated disease problems.


1.1.5 In South Africa there are concerns relating to the high population of people living with HIV and therefore a large population living with a compromised immune system, who are particularly vulnerable to Covid-19. There are also concerns to consider regarding any disruption to the supply of the antiretroviral medication that is essential for those with HIV to take – either through supply-chain disruption caused by Covid-19 or people not attending their health clinics as usual to collect their medication.  This could result in secondary deaths.


1.2 Covid-19 in slums and informal settlements

Many developing countries have large areas of informal urban settlements or slums and we must consider how Covid-19 could impact people living in densely populated and unsanitary environments, and what could mitigate the worst of these impacts. This is challenging as the health and social needs of these populations are often invisible.


1.2.1 The informal or illegal status of many deprived settlements often undermines both the collection of data and the implementation of policies to improve health. Data is not usually disaggregated by slum and non-slum, or it is simply not collected, especially for health. Fortunately, community-based groups like Slum Dwellers International have collected their own data to fill these gaps and response planners, including DFID, should engage with these groups to understand the realities and challenges of disease control in these settings.


1.2.2 Despite some important population dynamics, slums are not ‘vectors’ of disease, as they are sometimes derogatively cast. Informal settlements and their residents are part and parcel of the city system, often subsidising and contributing to life elsewhere in the city. This makes control efforts built on containment and reductions in movement difficult to implement, especially if they impinge on people’s already threadbare livelihoods. We should beware of slum-wide quarantines, as were attempted ineffectively during Ebola and resulted in riots in Liberia, for example.


1.2.3 When IDS interviewed residents of informal settlements in Freetown, Sierra Leone, about their wellbeing and experiences of the health system, we were struck by the ubiquity of ill health and of unknown and unexplained diseases. In general, as in many places throughout the world, people rely on informal health providers as a first port of call, especially for fevers and coughs. It will be important to consider this reliance on informal providers and to make sure that these providers are included in pandemic response plans. Such providers could be key to early detection of cases.


1.2.4 An insight from our research is the relative isolation of older people, especially childless women or widows. These people did not have the social networks that are so crucial for surviving in Sierra Leone. This has major implications for Covid-19 and suggests that there may be significant pockets of highly vulnerable people – the old and those with co-morbidities – living in informal settlements, without support and unable to access care.


1.2.3 Community engagement will be key to effective epidemic control, be it delivering trusted messages, carrying out surveillance, or attempting to limit movement. An effective leader could be a chief or councillor, but they could also be a business person, traditional healer, a member of a youth group, or even a gang leader. The implications for Covid-19 are that those planning interventions need to take this complexity into account. They will need to find a way to work with overlapping, and at times competing, institutions.


1.2.4 Residents face repeated disasters – cholera, fires, flooding and mudslides – and a plethora of community-based groups exist to respond to these events locally. Any outside interventions need to work though these groups.


1.3 Covid-19 and non-majority faiths and minority ethnic groups

Around the world, people from non-majority faiths and minority ethnic groups already experience discrimination, marginalisation and outright targeting and violence. Covid-19 and the efforts to contain it have exacerbated these pre-existing and entrenched inequalities.


1.3.1 In Pakistan, 80-90 per cent of sanitation workers are Christian, as few other jobs are available to them. The government is not providing them with the protective equipment needed to do their work. Women work barefoot. Sanitation workers do not use gloves to empty sewers or manholes. These workers cannot afford to stay home to protect their health, unlike hospital doctors in Punjab, for example, who refused to go to work because of the lack of masks amid the coronavirus outbreak. Another religious minority, the Hazara Shias, in the Balochistan area of Pakistan – already victims of attacks and terrorist incidents over the last twenty years – are being scapegoated for (allegedly) spreading the disease both through official quarantine policies and via memes shared on social media and in WhatsApp groups.


1.3.2 In Iraq, displaced communities such as the Yazidis, are hugely vulnerable to both the disease itself and access to treatment. Thousands of Yazidis continue to live in displaced camps, where there are large numbers of people suffering from varied sources of vulnerability. Maintenance of social distancing in camps is extremely hard and conditions extremely harsh.


1.3.3 Globally there are also security dimensions of engaging with the coronavirus to consider. Groups such as ISIS are calling their followers to intentionally spread Covid-19 among enemies.


  1. The UK’s response, bilaterally and with the international community, to the spread of coronavirus to developing countries


2.1 Covid-19 is highlighting existing inequities in broad terms – social and economic inequalities, as well as health - and the poorest and most vulnerable will be hardest hit.  Government responses, including the UK Government’s response in cooperation with multilaterals, such as the UN, the World Bank and the G20, must be carefully designed and address longer-term issues of social protection, loss of livelihoods, housing and education and strengthening health systems. 


2.2 Research needed to ensure an effective UK response to the spread of coronavirus in developing countries

The UK government has a critical role to play both in the immediate term in bringing an end to the outbreak, in the short to medium term in addressing social, economic and political impacts, and longer term in building societies and economies post-outbreak. This will require a cross government response, informed by research, evidence and policy analysis drawn from collaborations across disciplines, sectors and communities. DFID’s record of development research puts it in a good place to lead this response.


2.2.1 In the immediate response DFID should invest in rapid response research to identify immediate and emerging issues and synthesise and share research through a networked approach.  Collating and disseminating research in a timely manner that also reaches non-academic audiences, for example to support practitioners and humanitarian responders, will be important.


2.2.3 In the short/medium term research is needed that supports recovery, understands and addresses the wider social, economic and political impacts of both the disease and the response. For example, social protection schemes, impacts on tax revenue and collection and loss of livelihoods. There is also much work to do to understand the impact Covid-19 is having on women, placing gender as a central issue, specifically around issues like the care economy, and also to understand and find answers to potential increases in gender-based violence that will be a real challenge in many societies.


2.2.4 The situation of women and men experiencing intersecting inequalities along the lines of religious affiliation, class and/or gender needs to be taken into account in vulnerability studies undertaken as part of health assessments. Redressing exclusion from access to health care will need to be sensitive not only to the right kind of entry points for outreach but also that efforts are done in a sensitive manner that does not trigger a backlash against religious minorities in vulnerable positions.


2.2.5 In the longer-term DFID should invest in research with a view to transforming systems for the future; in short to go even beyond “building back better”. This should involve bringing bigger picture learning towards long-term transformations in development more broadly and beyond the current Covid-19 crisis.


2.2.6 Research to learn from Covid-19 must engage with politics and power to understand what drives transformations and understand the implications for research if actual change is to take place. It is also important for future sustainable development for research to identify how Covid-19 has exposed systemic cracks and failures, but also potential solidarities and opportunities for recovery – and in so doing, identify new approaches that can help lead to a more resilient, equitable and sustainable world in the face of future global challenges and potential crises.


2.2.7 Taking an inclusive approach to addressing coronavirus in developing countries will be essential to tacking the spread and long-term impact of the disease. Programmes like the Coalition for Religious Inequalities and Inclusive Development (CREID), funded by DFID are essential for highlighting the impact of Covid-19 on religious minorities as a priority as well as providing practical support to help ensure that policies and programmes are sensitive and responsive to inequalities on the grounds of religion or belief. With fake news spreading almost as fast the virus itself, efforts to continue monitoring and addressing hate speech against religious minorities will also be vital. 


2.2.8 It is important that DFID also considers research which looks at understanding vulnerabilities and hidden marginalities which are leading to the exclusion of communities, particularly at the intersection of poverty and religious marginality. This is addressing increased circulation of hate speech which is vilifying those on the margins (on account of particular identities they are considered dirty, sources of pollution and therefore carriers of the contagion by default).


  1. Lessons identified and learned/applied from previous experience with infectious diseases (for example, Ebola); the implications for DFID’s policy on a global heath strategy


3.1 Lessons from Ebola - focusing on community engagement  

Communities must be put at the heart of response measures – this was the main lesson from Ebola that must not be forgotten.  The extent of this will vary depending on each individual context but a ‘top-down’ approach alone will not work, particularly where there is any lack of trust in government or local authority officials. 


3.1.1 Community action and collective solidarities are key to such preparedness and response from below. For example, during Ebola local movement restrictions enacted by trusted local authorities, including informal groups such as youth groups were much more effective, and we know that community engagement, listening to and responding to community concerns was vital in effective quarantines, enhanced hygiene measures and for adapting burial behaviours – as was building trust and having transparent and clear communication.


3.1.2 For some contexts it will also be important to explore how less conventional actors and embedded networks like churches/mosques/religious associations may be able to reach out and access marginalised communities in ways that others can’t, addressing the immediate and urgent material as well as immaterial needs of communities. 


3.2 Lessons from Ebola – social science needed alongside mathematical modelling

During the Ebola epidemic in West Africa in 2014, modelling assumptions proved to be inaccurate. One CDC model predicted up to 1.4 million cases, which thankfully did not occur, in part because the model had not factored in people’s social responses and the large-scale behaviour change and community-driven actions which emerged. The models focused on clinical isolation capacity resulting in huge efforts to build beds and hospitals as a key pillar of the response. However, in many locations the curve of the epidemic came down before such beds were built, and by the time they were ready, they remained empty.


3.2.1 The learning from this means that used alongside mathematical modelling, social science can nuance the models, and improve their parameters, as well as providing evidence of the gaps between the assumptions and the social realities on the ground. It can explain why things might not pan out as expected and uncover unintended consequences of interventions.


3.2.2 Some lessons can be learned from further back, for example, food supply systems are already limited with food scarcity ever-present, particularly in informal urban settlements in resource poor countries. Rice shortages and price rises caused urban rioting in Sierra Leone during the 1919 influenza pandemic.


3.3 Lessons from Ebola – understanding inequalities and social dynamics

3.3.1 Covid-19 is revealing, reinforcing, and catalysing new social and cultural relations; laying bare inequalities and anxieties, discrimination and division; but also galvanising solidarities and collective action. These reactions will drive changes in the epidemic curve, and how the pandemic unfolds. Anthropologists at IDS who worked on the West African Ebola epidemic cannot emphasise enough that we ignore these social dynamics at our peril. If we do, they will undermine the assumptions on which current plans are being based and cause vital opportunities for mitigating the impact of Covid-19 in developing countries to be missed.