World Vision UK Written Submission to the IDC on the Impact of Coronavirus on Developing Countries

1.       We welcome the opportunity to provide evidence to the International Development Select Committee. World Vision is the world's largest international children's charity. We are a Christian multi-mandated organisation implementing relief, development and advocacy activities for children, their families and communities to overcome poverty and injustice. We work in 100 countries to help improve the lives of millions of people worldwide.

2.       World Vision has serious concerns about the immediate and long-term impact COVID-19 will have on children and their communities, especially those most vulnerable living in the most fragile contexts. In contexts where health and protection systems are already weakened, there is even less capacity to respond and cope. Without drastic preventive measures, the virus will continue to spread in these countries with catastrophic impacts.

The direct and indirect impacts of the outbreak on developing countries, and specific risks and threats.

3.       World Vision has a long history of working in humanitarian health crises, as well as long-term rebuilding. Based on our experience we recommend that DFID adopts policies and funds COVID-19 response plans that holistically and in a conflict sensitive manner address the secondary impacts of the pandemic on children and families. These should particularly pay respect to child protection, gender-based violence, education, water and sanitation, social cohesion, food security, and livelihoods. It is important to address the immediate needs of children and embed measures to rebuild societies after the shock has passed – by investing in strengthened health and protection systems to build resilience going forward

Immediate Concerns

Child protection

4.       One billion children each year are already exposed to violence. Previous epidemics like Ebola indicate that COVID-19 will result in additional wide-ranging child protection risks. Loss of income, food insecurity and closure of schools and day care centres, accompanied with movement restrictions, put pressure on parents who have to provide for their family’s immediate needs.  This may increase family stress and conflict, leading to increased physical violence in the home, including against children, as increased pressure can significantly increase mental and psychosocial issues among parents. Exposure to sexual violence may also increase as families are forced to stay confined to homes and children are unable to avoid abusive relatives.

5.       Crises often lead to increased trafficking and sexual exploitation of girls and boys. In situations where movement of people is limited, predators may move their activities online. The increase of digital interactions may mean children are increasingly targeted by predators online. We have already seen an increase in demands for child pornography in India, exposing children to greater risk of trafficking, sexual violence and exploitation, both digitally and offline.

6.       Public health measures such as quarantine or isolation can unintentionally separate children from their family/caregivers leading to other child protection risks. Based on previous epidemics, the number of orphans and children left without carers will increase as parents and grandparents are lost to the virus. This can lead to greater vulnerabilities and psychosocial distress for children.

7.       The serious and long-term economic impacts of COVID-19 put children at increased risk of modern slavery, including the worst forms of child labour. As the inability to meet basic needs increases, there is a heightened risk that families will turn to negative coping mechanisms. Millions of children may be driven into child marriage, hazardous labour, trafficking and the exchange of sex for assistance or to supplement family income.

8.       Despite the risks of violence increasing, the capacity of mechanisms for reporting and support will be limited. Current epidemic response measures are putting a significant strain on existing health, education, and social protection systems. This, combined with movement restrictions and the closure of public services, may negatively impact the ability of informal and formal child protection mechanisms to respond to existing and increased caseloads. Protection systems in many developing and fragile contexts are already insufficient to prevent and respond to child protection concerns; these will be further weakened. This will make it more difficult to identify children at risk and for children experiencing violence to have their cases reported, receive referrals, and get adequate support.

Gendered vulnerabilities

9.       Countries most affected by COVID-19 have reported increased gender-based violence (GBV) incidents. Forced coexistence in narrow living spaces together with economic and health shocks, place extra stress on households leading to increased domestic violence. Life-saving care and support for GBV survivors (i.e. clinical management of rape and mental health and psychosocial support) may be disrupted or significantly affected. Health service providers may be overburdened and preoccupied handling COVID-19 cases. GBV caseworkers may be unable to meet and assist survivors and will need to adopt new modalities to follow-up cases. Confinement may restrict the work of GBV caseworkers, with serious consequences for those who rely on this support.

10.   COVID-19 will heighten gendered social norms which have a daily impact on girls and women. In many countries women and girls do more care work than men and boys. This is exacerbated in a health crisis as women and girls bear responsibility for caring for ill family members and the elderly, increasing their risk of contracting COVID-19 and the stresses on them. Girls and women face increased risks of GBV (including child marriage) and despite increases in girls’ access to education, they are less likely to return to school after isolation.

Humanitarian contexts

11.   Prior to COVID-19, 149.5 million people globally, including 76.5 million children, needed humanitarian assistance. 95.5 million needed health assistance and 100 million people needed basic water, sanitation and hygiene services. In Somalia only 26% of households report access to both water and soap.[1] The country has hit less than 40% of its target of two health facilities per 10,000 people and has only 19% of its target skill health workforce.1 OCHA estimates about 3.1 million Somali will need health services in 2020 even without the pandemic. The capacity and capability to provide healthcare to those that contract COVID-19 in these places will be extremely limited and could collapse.

12.   Living conditions in humanitarian settings make preventative measures such as handwashing, social distancing and self-isolation challenging. An outbreak of COVID-19 in these areas is expected to be fast-spreading, with a comparatively high mortality rate. Additionally, mortality rates of other illnesses are likely to increase, as already over-stretched health services risk collapse. For example, in North-West Syria there are over 3 million IDPs and host communities surviving in a shrinking space. In Idlib 1 million are displaced. Many live in informal tented settlements and crowed collective shelters. There is limited access to water, sanitation and hygiene provision. Fighting has devastated health facilities and significantly reduced access to health workers, medicines and personal protective equipment. Preventative measures will be challenging, if not impossible to implement here.

13.   Any movement restrictions, particularly those that apply to humanitarian workers, will have an immediate impact on those in humanitarian settings, including the 11.7 million people in Syria requiring vital humanitarian assistance. The humanitarian community will do all it can to utilise digital solutions, but access issues to affected population will negatively impact the level and quality of support we can provide.

14.   To mitigate the risks to those in humanitarian contexts the UK should: protect ongoing investments in humanitarian and development assistance for the most vulnerable; adapt programmes to be COVID-19 sensitive in existing humanitarian response contexts; prioritise a conflict sensitive approach, including regular context analysis; ensure and, where possible, maximise humanitarian access, including creation of exceptions for humanitarian workers’ and supply chain movements; and find alternatives to humanitarian programme suspensions where COVID-19 prevention policies are required.

Long-term Considerations

Secondary health impacts

15.   Although adults seem to bear the brunt of the disease, as with the Ebola outbreak, secondary health impacts could put up to 30 million children’s lives and futures at risk.[2] In order to mitigate this DFID should continue to invest in health system strengthening and prepare to respond to potential secondary health issues.

1. Over 26 million children are at greater risk of being exposed to potentially fatal infectious diseases due to a 30% reduction in Diphtheria-tetanus-pertussis (DTP3) immunisation coverage.
2. More than 5 million additional children could suffer from malnutrition, including severe wasting, an increase of almost 40% from current numbers.
3. 100,000 additional children could die from malaria – an increase of 50%.

Education

16.   192 countries are implementing nation-wide school and university closures, disrupting the education of more than 1.57 billion learners or 91.4% of the world’s student population.[3] This is an increased disruption for refugee children and those who do not have the facilities to study remotely. As this crisis continues to worsen and expand children are likely to miss a significant portion of their already-disrupted education.

17.   DFID should continue to fund education programmes to ensure children do miss too much education. Where possible COVID-19 considerations should be integrated into existing education programming to enable children, particularly those in refugee contexts, to continue their education.

Conflict sensitivity and social cohesion

18.   The spread of the virus and corresponding restrictions in many countries has the potential to exacerbate pre-existing tensions and inequalities (for example around conflict, food insecurity or fragile economic systems). It may also create new tensions such as growing resentment, xenophobia, fear and frustration. Therefore, context monitoring must be ongoing as the social fabric of societies is increasingly strained, particularly in fragile contexts. There must be a conflict-sensitive approach to COVID-19 so that activities do not exacerbate or create new tensions. Moreover, existing efforts to build peace and social cohesion must be maintained, and where possible scaled up.

Economic impacts

19.   Movement and business restrictions will increase the vulnerability of informal or low wage workers, particularly refugees. This will reduce or stop their ability to earn an income to meet basic needs, having a knock-on impact on the children and adults they support. This will further reduce poor households’ ability to absorb the health expenditure created by COVID-19 (e.g. consultation, diagnostic tests and/ or medicines and related transport).

20.   DFID should look at learning around recovery lending, to help small business recover from emergencies (drawing on learning from Typhoon Haiyan, the last El Nino response in 2016 and DFID funding at the end of the Ebola response in Sierra Leone to help recapitalise microfinance institutions).

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

21.   World Vision is pleased to see DFID leading the international fight against COVID-19. However, of the recent £200 million announced, only £20 million is available to NGOs, which will be released via the Rapid Response Fund (RRF) and localised funding calls. NGOs and wider civil society have a crucial role to play given their strong, trusted and longstanding relationship with local community and local authorities. DFID should consider how it can work more directly with civil society for increased impact and larger reach. Based on learning from previous epidemics direct funding to NGOs with local capacity for community level engagement on prevention and behaviour change action maximises impact. We recognise DFID’s strong contribution to UN and IMF mechanisms as well as vaccine development. However, these mechanisms are slow to reach community-based actors directly.

22.   The most critical requirement for a response is speed and therefore we encourage DFID to also consider how existing funding processes can be more flexible and adaptable to rapidly changing contexts on the ground, including by directing more funds through NGOs and local actors. This is not to say that vital safeguarding, aid diversion, donor and beneficiary accountability measures should be loosened, but they should be streamlined.

23.   In addition, as the prevalence rates in developing countries increases so does the need to ensure co-ordination between governments, WHO, UN, private sector and civil society is strengthened. This includes the need to globally co-ordinate critical supplies (that will mitigate the spread of COVID-19 as well as treat it) to ensure they reach those most in need. As concerns around supply shortages grow, increasing the possibility of price inflation, a global response to boosting supply capacity is needed, to ensure the poorest countries and those most in need are not left behind.

Lessons identified and learned/applied from previous experience with infectious diseases and the implications for DFID’s policy on a global heath strategy.

24.   Community engagement and understanding the local context was key in turning the tide against the Ebola outbreak, and therefore must be integrated from the beginning of the COVID-19 response. Understanding local cultures and adapting response programmes accordingly is crucial to prevention and control. World Vision’s work with faith leaders, community health workers and traditional leaders yielded fruits in restoring trust and confidence in healthcare. World Vision is using the same method to spread information about COVID-19 in communities’ local languages so it can be quickly disseminated, and DFID should consider a similar approach.

25.   Working with faith leaders can also increase understanding of local contexts, practices and beliefs to help actors understand positive and negative behaviours in a health epidemic. Ongoing context analysis and conflict sensitivity must be embedded in all responses to COVID-19. With the situation in any location changing daily, regular review and scenario planning must be central to the UK government’s and implementing partners’ activities, especially in conflict and fragile contexts. This requires sufficient time and budget allocations within proposals.

26.   The Ebola crisis also highlighted the need for continuing investment in systems to ensure funds are not diverted and crucial sectors are not forgotten as governments and actors try to deal with the health crisis and its impacts. COVID-19 requires an urgent response to stop/slow the spread of the disease, thus support to health systems to effectively respond and support those made vulnerable by it is vital.  The response must be take into account gendered impacts, the needs of the most vulnerable, and the integrated benefit of embedding protective interventions across health, education and other sectors. Therefore, donors should urgently commit emergency funding for health and child protection system strengthening, provide technical resources for support, and ensure equitable distribution of supply chains. They should also finance child-friendly and inclusive risk communication/community engagement and provide any necessary online MHPSS training.

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