Save the Children written evidence submission to the International Development Committee’s inquiry on COVID-19; the current situation and the immediate risks and threats

1. Introduction

1.1.   Save the Children was founded 100 years ago in London. It is now a global movement operating in 120 countries, fighting to ensure that all children survive, learn and are protected. In response to the coronavirus outbreak, which we believe to be the gravest humanitarian challenge in our organisation’s history, we have launched an emergency grants programme and educational support for families in poverty in the UK.

1.2.   Save the Children is currently working with over 500,000 community health workers in 44 countries. We plan to train and equip 100,000 more health workers in the coming months. Each of these people, as the UN Secretary-General reminds us, will be taking extraordinary risks to help others. In order to get them the support they need, we have launched the largest global appeal in our 100-year history.

2. What the UK Government can do to protect a generation of children around the world:

2.1.   COVID-19 knows no borders. It is a global threat and demands a global response. The health crisis caused by the virus has unleashed a social and economic crisis with profound implications for the world’s most deprived and marginalised children. One of the lessons learned from the Ebola outbreak is that the response to a pandemic cannot just be a health response.

2.2.   The UK Government is well placed to provide the leadership required to ensure that no child is left behind by the global Covid-19 response and should focus on six key areas: disease containment and mitigation, global financing, support for family finances, education, working with the NGO community and child protection

2.3. Disease containment and mitigation

2.3.1. It is vital that countries substantially reduce transmission of COVID-19 by effectively implementing a series of appropriate measures, at the right time, while protecting the most vulnerable groups.

2.3.2. These measures must reflect careful consideration of their impact on the survival of members of the most vulnerable population groups, including impact on poverty and access to food.

2.3.3. There is urgent need for a single, coordinated global plan of action to support national-level responses to slow the spread and mitigate against the worst impacts of COVID-19 across the world. Delayed action on prevention and containment could cost over 3 million lives in South Asia and sub-Saharan Africa alone.

2.3.4. We need to act quickly. There is a narrow window of 4 – 8 weeks to put in place preparedness and mitigation measures before the pandemic overwhelms countries’ health systems. The UK Government should:

2.3.4.1.              Support health and nutrition services for all, free at the point of use for the duration of the crisis. This should include financial and technical support to the public health sector in low- and middle-income countries to enable the requisition of private health services to create a unified approach, free at the point of use, to achieve equity in access and outcomes. Fear of direct and indirect costs at health facilities, including user fees, prevents people from seeking care and make it harder to test, track and contain the virus. Free health care  would therefore be an effective method to ensure public health and stem the spread of the disease undetected.

2.3.4.2.              The UK must contribute urgently to the mobilisation of $8 billion of donor funds for a coherent and coordinated global plan, led by the WHO and delivered through Governments and other partners who are best placed to quickly mobilise in each country. This plan must focus on building strong and resilient health and nutrition systems, engage civil society, and support government-led country strategies. It should prioritise marginalised and vulnerable populations, reaching down to the primary care and community level.

2.3.4.3.              Investment in community-based strategies to improve outreach and education, dissemination of public health messages, contact tracing, surveillance, prioritise water, sanitation and hygiene (WASH), address stigmatisation, social distancing and preparedness as well as setting up community-based testing centres and a supply of tests. This must include training support to community health workers and other key frontline health and care workforce – of which over 70% are women.

2.3.4.4.              National stakeholders including civil society organisations should be meaningfully involved in response, prevention, mitigation and defeat of COVID-19, in line with WHO core principles of human rights and health that call for accountability, equality, non-discrimination and participation.

2.3.4.5.              The UK Government must ensure that critical essential services can continue in order to protect the lives of the most vulnerable but also to ensure strong public health response to the COVID-19 pandemic and reduce the burden on the health system. Critical services preventing maternal, new-born and child deaths must not be neglected, including infant and young child feeding, immunisation, sexual and reproductive and maternal health services. To ensure sustainable change it is vital that the UK still makes a substantial investment this year in Nutrition for Growth and Gavi, the Global Vaccine Alliance.

2.3.4.6.              The global COVID-19 pandemic poses a major risk within countries of secondary outbreaks from other vaccine-preventable diseases. Vaccines save lives, protect the well-being of families, safeguard incomes and promote economic growth. Gavi is one of the best investments in global health and critical component to ensuring global health security. 

2.4.   Global Financing

2.4.1. We welcome the UK and G20 decision to agree a suspension of debt service payments from official bilateral creditors. This is a decision which will release resources for the response to Cov-19 and the associated economic fall-out. The World bank, IMF and G20 governments have played an important leadership role.

2.4.2. The debt service suspension must be applied to all scheduled payments, principal and interest, for all creditor institutions, with no exceptions. If national laws and procedures are a barrier to implementation that barrier should be removed. We urge Paris Club and non-Paris Club creditors to report on the amounts suspended.

2.4.3. The Spring Meetings provide an opportunity to build on the foundations now in place. In particular, there is an urgent need to clarify the terms on which commercial creditors will participate in the initiative. We would urge governments to encourage full participation by commercial creditors, where necessary by using their regulatory authority or passing appropriate legislation.

2.4.4. We commend the UK and G20 for taking decisive early action on suspension, while recognising that many countries will require debt reduction in due course.

2.4.5. Ensure that the UK Aid response prioritises support for the most vulnerable countries and children, with a focus on strengthening public health, education and social protection systems.

2.5.   Support for family finances

2.5.1. Loss of jobs, income and livelihoods, combined with the threat of global recession threatens the safety, wellbeing and nutrition of millions of children. Many of the poorest countries have not invested sufficiently in building inclusive social protection systems, and now lack the foundations needed to provide direct support to families. The UK Government should:

2.5.1.1.              Invest in scaling up national social protection schemes and systems where available to deliver a rapid response, alongside providing complementary humanitarian cash, voucher and in-kind assistance as appropriate. The UK must ensure that all responses delivering direct support are inclusive and fulfil the rights of the most vulnerable, including women and girls, people with disabilities and marginalised groups.

2.5.1.2.              Prioritise nutrition, ensuring that children and other nutritionally vulnerable groups have support to enable them to access appropriate, safe and nutritious food. The period from conception to a child’s 2nd birthday is critical to avoiding life-long negative impacts. 

2.6.   Education and learning

2.6.1. 1.5 billion children and students across 188 countries are currently out of school because of the crisis. We know from the Ebola crisis that this is likely to lead to increased child labour, child and early marriage and teenage pregnancy, especially for the most deprived and marginalised, preventing a return to school. We also know that once out of school, there is a risk that children will not return. The UK can provide leadership to mitigate the impact of school closures and uphold the right of every child to a safe, quality, inclusive education. The UK Government should:

2.6.2. We welcome the UK’s additional £5m for Education Cannot Wait, which with partners like Save the Children, is adapting education programmes in 26 countries already affected by conflict and displacement to ensure the most marginalised children can access distance learning. The UK can continue to lead the way by calling on other bilateral donors to include and increase funding for education in their global response.

2.6.3. Ensuring distance learning prioritises the containment of COVID-19 and the safety of children and caregivers through inclusive measures to raise awareness of good practice in Water, Sanitation and Hygiene (WASH) and social and behavioural change activities, as well as prioritising children’s mental health and psychosocial wellbeing.

2.6.4. Provide additional funding for mid-term needs including: supporting governments, authorities and partners to sustain teacher salaries or incentives, so that schools have the staff they need to re-open after the pandemic. Safe school re-opening programmes, with a focus on WASH provision, and activities to reintegrate adolescent girls and other groups at risk of not returning to school.  

2.7.   Working with the NGO community to deliver

2.7.1. To deliver on these priorities as the crisis takes hold in South Asia and Africa, DFID should prioritise financing INGO programmes, their partners, and community networks.

2.7.2. INGOs are a crucial mechanism available to DFID to support direct delivery and in partnership with national and local NGOs though existing networks. This includes inclusive awareness-raising about COVID-19 at community level, grassroots health services, initiatives for out-of-school children, social protection mechanisms, and support for people who are vulnerable as a result of lockdowns.

2.7.3. This could include initiatives such as working with INGOs to develop appropriate national and global interventions, opening a challenge fund to finance specific INGO proposals and match-funding INGO appeals. In order to enable an effective response, DFID must apply maximum flexibility in current and new funding and advocate this principle with other donors (including the UN).

3. Crisis-specific updates and recommendations:

3.1.   COVID-19 and conflict

3.1.1. In our COVID-19 response, Save the Children maintains a key focus on protecting children trapped in conflict. Our latest Stop the War on Children[1] report estimates there to be around 149 million children currently living in high-intensity conflict zones. The world’s ability to protect these children from COVID-19 is severely hampered by the warfare around them.

3.1.2. Conflict destroys national capacity to deal with crisis and sets back development. Explosive weapons with wide area effects, have decimated health care systems and critical civilian infrastructure in populated areas such as Aleppo and Mosul, and only half the heath facilities in Yemen are fully functional. The lack of equipment and infrastructure to respond to COVID-19 is starkly visible in the Middle East. More than 15 million children and their families in Yemen, Syria and Gaza are set to face COVID-19 with fewer than 1,700 ventilators and beds.

3.1.3. Children’s lives everywhere are greatly impacted. They may have loved ones who are sick, or unable to work, and may be missing out on school. Many will be confused and frightened about the sudden changes they are seeing in their lives. The most deprived and marginalised children and their families are the most vulnerable in any community. They may have a disability, be financially insecure, or have poor access to healthcare, support and protection.

3.1.4. This is a global pandemic and the virus has hit people from all countries and communities. However, for children living in fragile places like conflict zones, refugee camps, and overcrowded communities, where people are already struggling to survive, COVID-19 will have a particularly devastating impact. As during any time of crisis, women and girls are likely to be disproportionately affected. In an age when we are all connected in so many ways, our response to a global pandemic is only as strong as our protection for the most vulnerable.

3.2.   Children’s safety and protection

3.2.1. Crises exacerbate existing inequalities and most affect the most deprived and marginalised. The biggest loss of life may in the short term come from an erosion of humanitarian programming. It is therefore critical to ensure sustained funding for ongoing humanitarian action and continuing access for aid workers. The UK should:

3.2.2. Support the UN Secretary General’s call for a global ceasefire, using its position on the UN Security Council to ensure that the Council adopts a strong and unequivocal Resolution on this issue. 

3.2.3. Press governments and international agencies to classify the social services workforce and humanitarians as essential workers, ensuring they are well-resourced and allowing them to continue to go about delivering essential services irrespective of movement restrictions. The UK should press parties to conflict to ensure a neutral and impartial humanitarian space and uphold humanitarian access. 

3.2.4. Ensure that all interventions work to mitigate against confinement, school closures and disrupted care arrangements.

3.2.5. Ensure the protection of all children from violence, including increasing risks of gender-based violence, such as sexual violence, child marriage, intimate partner violence and domestic violence, as well as sexual abuse, neglect and exploitation. The UK should also prioritise targeted interventions and include safeguarding, child protection, mental health and psychosocial support, as well as sexual and reproductive health response measures, for child survivors.

3.2.6. Advocate for national governments and authorities to ensure training of first responders, health, education, gender-based violence, mental health and psychosocial support, and child protection service staff on COVID-19 related child protection risks, and how to safely report protection concerns.

4. Yemen

4.1.   Yemen and COVID-19:

4.1.1. Yemen is the world’s worst humanitarian catastrophe. On 10 April 2020, the UN Humanitarian Coordinator confirmed that a patient from Hadramout governorate tested positive for COVID-19. The seriousness of this cannot be overstated.

4.1.2. The international community must operate on the assumption that COVID-19 will spread rapidly through the one of the world’s poorest and most conflict affected countries.

4.1.3. In the entire country of 28 million people: Half of the country’s medical system has been destroyed or is only partially functioning. There are only approximately 5,000 COVID-19 tests available. There are 700 ICU beds, but only 60 of these for children, and 500 ventilators.

4.1.4. It is essential that all parties to conflict immediately adopt a ceasefire so that Yemenis and the international community can respond to this pandemic. There cannot be a proper response in an active conflict zone.

"At night before I sleep, I think of my best friend. I wish I could just close my eyes and not remember but I can’t. I just sit and cry myself to sleep... I wake up in the morning in the same state. The last voice I heard before the explosion was my best friend’s. She was laughing with us. She died in the explosion.” Hala, a 13-year-old girl, Yemen[2]

4.1.5. The humanitarian situation remains dire. Extreme shortages of food, safe water, sanitation and healthcare, as well as deadly massive outbreaks of cholera and diphtheria, have taken a heavy toll on civilian lives. In an environment where more than half of all health facilities are closed or partially functioning, inadequate access to safe water and sanitation, as well as adequate quality and quantity of foods is creating a perfect storm of conditions that will exacerbate the impacts of the virus.

4.1.6. We are already seeing increased reporting of incidents of gender-based violence with the restrictions on movement. Protection risks for children will also increase with school closures.

4.1.7. The response must be holistic and multi-sectorial – cannot be narrowed only to a health response. There are serious concerns for the impact COVID-19 and response measures will have for communities in vulnerable situations including poorer communities, those in IDP camps, with little water and sanitation facilities, and those whose daily livelihoods are critical to survive.

4.1.8. Borders have been closed and authorities in both the north and south have banned flights in and out of Yemen. Land border crossings are seeing quarantine centres established and checkpoints / border closures have been seen across north/south lines. These restrictions bring added challenges to providing life-saving humanitarian aid.

4.1.9. There is also fear of a politicisation of responses that leads to the obstruction of delivering humanitarian assistance and disruption of commercial supply chains.

4.2.   The UK Government should:

4.2.1. Continue to push all parties to the conflict to secure an immediate cessation of hostilities, a country wide ceasefire for all parties, and a long-term, sustainable political solution. This is a man-made conflict; it is simply a matter of political will to help turn the tide and unlock the next stage of potential peace negotiations for Yemen. An end to the conflict will be critical for tackling COVID-19 and meeting immediate needs. What is needed now is serious and determined leadership from the UK Government – prioritising peace and bringing international pressure to bear on parties to the conflict.

4.2.2. Support all measures to scale up activities to prevent, mitigate and contain this deadly virus, such as scaling up of inclusive public awareness raising campaigns, water, sanitation and hygiene activities and health services, as well as community engagement. Support the scaling up of preventative, mitigation and containment measures in Internal Displacement (IDP) camps and settlements which are particularly at risk.

4.2.3. Ensure that essential non-Covid-19 responses continue. Maintain humanitarian funding for critical life-saving humanitarian programming, such as food distributions, cash assistance, health, and water, sanitation and hygiene awareness. This includes ensuring all children and families are protected, have access to basic services including community-based child protection, such as psychosocial support. There is a very real risk with the focus on Covid19 – as we are already seeing – that wider needs, including nutrition, are forgotten about, as the response sits within ‘health’. The reality of the needs however, are that now is the time to be scaling up community level treatment, including acute malnutrition alongside treatment of the other typical diseases.

4.2.4. Lead a concerted and coordinated effort by donors to find solutions to humanitarian access and the continuation of humanitarian programmes that does not compromise humanitarian principles. Donors must avoid politicising humanitarian access and funding to Yemen. At this time of global pandemic, any suspension of life-saving aid, or withdrawal of support to healthcare programmes will leave an already vulnerable population at heightened risk.

4.2.5. Urge authorities in Yemen to ensure the removal of bureaucratic and administrative barriers and streamlining of processes for programming permissions and access relating to the COVID-19 and wider humanitarian responses.

4.2.6. Advocate with authorities in the north and the south to ensure that measures to contain Covid-19 provide special arrangements to ensure life-saving humanitarian activities can continue subject to appropriate public health and safety arrangements being put in to place. 

4.3.   Save the Children response:

4.3.1. Save the Children is working hard to keep its programs safe for children and working on the basis of two potential scenarios – I) a gradual increase in cases with individual clusters growing and ii) a large scale outbreak with a rapid increase in infections and mortality rates, particularly in high density population centers such as Aden, Hadramout, Sana’a and Marib. Either scenario is likely to put the health system under considerable strain and will require large scale support from external aid actors.  

4.3.2. Save the Children supports over 170 health facilities across the country with primary health care – hubs of first response for many who come seeking care. Education and inclusive awareness campaigns will be critical for preventing and slowing the spread of the virus.

5. Rohingya

5.1.   Rohingya and COVID-19:

5.1.1. COVID-19 is the most pressing concern for refugee children and their communities in Cox’s Bazar. The first cases of COVID-19 have now been confirmed in Bangladesh, and in Cox’s Bazar town. While not yet confirmed in the camps, the threat of COVID-19 is an imminent one and will expose and exacerbate existing challenges for refugees in Cox’s Bazar.

5.1.2. Critically, the current provision of health services – for Rohingya and host communities – in both Cox’s Bazar district more widely and the camps, is totally insufficient. There are only 64 isolation beds across all 34 camps available for a population of over 900,000 people, with an additional 47 beds identified in Teknaf and Ukiya around the camps. While work is underway to increase existing capacity and add new facilities across the district by approximately 1,500 beds, it is unclear how this will be achieved in a timely fashion, and even with those additional beds, it is unlikely provision will be adequate.

5.1.3. The latest modelling from Johns Hopkins University estimates that some 550,000 people in the Kutapalong camp could become infected within three months, with nearly 19,000 people hospitalised.[3] This number draws on data from experience in other outbreaks in non-humanitarian contexts. Given the conditions in the camps, the lack of mobile data, an absence of equipment and healthcare, and restrictions on the ability of humanitarian actors to respond, the potential impact could well exceed these projections.

5.1.4. The response is currently limited in a few key areas. First, there is a significant shortage in the availability of Personal Protective Equipment – not just for medical staff, but for all frontline workers. This not only puts volunteers and staff at risk, but also risks increased transmission within the camps.

5.1.5. Second, following concerns about security in the camps, the Government of Bangladesh have restricted access to the internet since September 2019. In addition, there is currently no way for Rohingya to legally acquire sim cards. This has implications for the ability of humanitarian organisations to respond in a safe, efficient manner – particularly as the number of staff allowed into the camps reduces. Further, it greatly affects the ability of Rohingya communities to access important public health information, to conduct contact tracing, and to access acute health support and life-saving assistance. Effective channels for communication will be critical to the response.

5.1.6. Third, although essential from a containment and prevention perspective, the impact of social distancing measures can negatively affect children’s access to protection services and education. Children in the camps are exposed to a host of risks – including violence, exploitation and abuse. It is vitally important that any response to COVID-19 does not exacerbate existing vulnerabilities or create new child protection concerns.

5.2.   The UK Government should:

5.2.1. Continue to work with diplomatic and humanitarian partners in Bangladesh to ensure that local and international NGOs, as well as UN agencies, are able to effectively provide assistance to refugees.

5.2.2. Make every effort through bilateral and multilateral engagement to ensure that the Government of Bangladesh is enabling high quality humanitarian response – ensuring that Rohingya children’s rights are protected and upheld.

5.2.3. Urgently work with the Government of Bangladesh to enable a high-quality response to COVID-19 – including the provision of mobile internet and telecommunications to refugee communities.

5.3.   Save the Children response:

5.3.1. Save the Children has nearly 1,364 staff and volunteers supporting our programmes in child protection, access to education, health and nutrition, water, sanitation and hygiene services, as well as distribution of shelter and food items. We work in almost all the Rohingya refugee camps in Cox’s Bazar.