International Development Committee inquiry: The impact of Coronavirus on developing countries

Concern Worldwide (UK) submission

17th April 2020

About Concern Worldwide

Concern Worldwide is an international non-governmental humanitarian organisation dedicated to the elimination of extreme poverty. We deliver life-saving aid in emergencies as well as long term development support to communities. Each year, we work with 25 million people across 23 countries, in some of the hardest to reach and most fragile places.

Concern has extensive experience of Infection Prevention and Control (IPC) and community awareness campaigns, from our work during the Ebola outbreaks in West Africa and the Democratic Republic of Congo (DRC). Our work in community mobilisation, teaching and training of thousands of community healthcare workers and health system strengthening have proven to be essential in the prevention of deadly diseases like Cholera and Ebola.

We welcome the opportunity to provide written evidence to inform the International Development Select Committee’s inquiry into the impact of COVID-19 on developing countries around the world, and the UK’s response.

COVID-19 Response is a Global Humanitarian Challenge

1. Concern Worldwide views the coronavirus response as a global humanitarian challenge. Countries with healthy economies and well-resourced systems are struggling to stay ahead of the virus. In the 23 countries in which Concern works, health systems and safety net mechanisms are already under pressure.

2. Indeed, healthcare services in the world’s poorest communities are weak, overstretched and in some cases non-existent. These communities also suffer from increased rates of malnutrition and other illnesses, making them more vulnerable to COVID-19.

3. Just as in the UK, the COVID-19 pandemic is not only a health crisis. The restrictions and lockdown measures will have a profound effect on the poorest people’s livelihoods. Even before COVID-19, 3.4 billion people - almost half the world’s population - already struggled to meet their basic needs. COVID-19 response is likely to push those already struggling, especially women and children, further in to poverty.

The UK must prioritise reaching those people furthest behind, first

4. Based on Concern’s Ebola experience, we know that humanitarian responses must protect the most vulnerable including those without access to services, information and livelihood security. As the UK responds in developing countries we must ensure that women and girls can access appropriate on-going care, with referral pathways for survivors of violence maintained and safeguarded. Extensive sensitisation efforts and sharing facts on the virus saved countless lives.

5. It is critical that the UK government does not take a one-size-fits-all approach to the response in developing countries, especially in already vulnerable humanitarian contexts. The responses must be context relevant and context appropriate. For example, those within refugee camps or densely populated urban areas will find it incredibly difficult to practice social distancing as a response.

COVID-19 response is already exacerbating existing crises

6. We are seeing evidence that COVID-19 is exacerbating existing crises. East Africa and South Asia are still reeling from swarms of locusts that have devastated crops. Yet Coronavirus restrictions are now delaying the delivery of pesticides and equipment to control the locusts. It is now reported that a second wave of locusts is spreading on an even greater scale than the first.

7. The virus is of course also creating many difficulties for humanitarian organisations to operate. Travel restrictions on humanitarian staff and disruptions to supply chains and pipelines are making it harder than ever to ensure the distribution of essential supplies, such as food rations, to vulnerable populations.

Likely under-reporting of COVID-19 cases so far

8. Within the last week the number of COVID-19 cases globally has almost doubled to over 2.2 million. Yet we know that the actual number is likely to be far higher. Under-reporting is clearly a concern, especially in those developing countries with the weakest health systems where their ability to test and confirm cases will be severely limited. Equally, it will be extremely difficult to get an accurate picture in conflict affected states.

Impact on aid programmes

9. Experience from previous disease outbreaks, including Ebola, warn us that deaths from other illnesses and undernutrition, can increase during a pandemic. Therefore, it is imperative that existing humanitarian programmes can continue to operate as far as is possible so as not to compound the existing need – for instance in the treatment of children suffering from malnutrition.

10. Indeed, this is critical to ensure that the response does not compound existing need which could generate even further upheaval, conflict, displacement and the spread of other diseases in the coming months.

Concern Worldwide’s COVID-19 Response

11. We are adapting our programmes to ensure life-saving work can continue. Of course, the safety of our staff and the communities we work with is paramount. We are ensuring the supply of personal protective equipment and introducing physical distancing measures.  For example, we are training parents to screen their own children for signs of malnutrition, with health workers using dolls to demonstrate.

12. We are also giving parents longer supplies of therapeutic foods so that they do not have to visit health centres as frequently. Where we anticipate supply chain problems, we are pre-positioning stocks of essential supplies. In Bangladesh, we have ensured that refugees in Cox’s Bazar have one month’s supply of food.

13. At the same time, we are scaling up our COVID-19 specific response. Concern is working in refugee camps in countries such as Iraq, Syria and Bangladesh so that we can slow the spread of the virus. At the time of writing examples of our work includes:

• Distributing soap and detergent to 84,500 people living in camps in the north of Iraq;
• Building hand washing facilities at health centres in northern Syria and providing hygiene kits; and,
• Running awareness campaigns on hygiene promotion and infection control among Rohingya refugee communities in Bangladesh.

14. Again, learning from our experience tackling Ebola, we know that effective community engagement will be critical in our efforts. Creating dialogue with community leaders and traditional healers can build trust and lead to a higher take up of health messaging. We also know from past experience that gender based violence can increase during a pandemic. We therefore continue to mainstream gender across our programmes.

Impacts on INGOs ability to operate

15. NGOs have considerable experience and expertise which will be essential in responding to this crisis. However, UK-generated fundraising revenue will be affected by the restriction of face to face fundraising activities, the closure of charity shops and longer term economic impacts.

16. Urgent funding from the UK government is therefore more important than ever. To be well positioned to tackle COVID-19 in places like Haiti, Syria, and Ethiopia, we will need to hire and train more staff and supply them with the right tools and equipment, and for that we will need funding.

17. While the activation of the Rapid Response Fund (RRF) by DFID is certainly welcome, it must represent only the beginning of support, funding and partnership with INGOs. NGOs are often best able to reach those who need the support most. Equally, they have a role in being able to respond quickly – an imperative in tackling COVID-19 effectively and a known issue with the multilateral system. 

Recommendations

18. It is our view that rapid action is needed to be taken now to reduce the transmission of COVID-19 and support developing countries to prepare, respond and recover from any outbreak. Therefore, we recommend that:

a)      COVID-19 should be treated as a global humanitarian challenge, going beyond a solely health-specific response.

b)      In the face of this global humanitarian crisis, the UK must continue to provide humanitarian aid in places prone to conflict, political instability or climate change.

c)       The UK’s approach and programming must be context-specific with no one-size-fits-all approach. Some measures which can be applied in the UK, for example social distancing, will not work in complex settings such as camps, high-density urban settlements and situations of ongoing conflict.

d)      COVID-19 responses should be mindful of existing conflict dynamics and ensure that responses target people in greatest need, following the principle of impartiality.

e)      The learning from Ebola response should be demonstrably applied, including using international NGOs’ expertise as an essential resource in responding to this new crisis.

f)        Ongoing support to existing programmes for the most vulnerable people and communities should be maintained wherever possible.

g)       Resources for COVID-19 response should be new and additional, and prioritise the most vulnerable people and communities living in the most fragile contexts.

h)      Life-saving humanitarian activities such as the distribution of food and cash should be considered essential services and exempt from restriction or impediment by authorities.

i)        Governments and private sector - especially social media platforms and technology companies - must put profits and politics aside to ensure factual, clear and unambiguous COVID-19 information is shared.

j)        The UK should show real global leadership on international co-operation, investment and accountability. The UK should support a fully funded COVID-19 UN Global Humanitarian Response Plan, including full and proper inclusion of NGOs in all processes and efforts.

We look forward to engaging with the Committee’s inquiry as it develops.

Rachel Hickman

Concern Worldwide UK