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Amnesty

International UK                                                       

 

 

 

 

 

 

Humanitarian crises monitoring:

The impact of coronavirus

 

Submission to the

International Development Committee

 

April 2020

 

 

 

 

 

 

 

 

 

 

 

 

Amnesty International United Kingdom Section

The Human Rights Action Centre, 17-25 New Inn Yard, London EC2A 3EA

Tel: 020 7033 1500  advocacyteam@amnesty.org.uk www.amnesty.org.uk

Written evidence from Amnesty International UK (ERM0013)

 

  1. Amnesty International UK (AIUK) is a national section of a global movement of over seven million people who campaign for every person to enjoy all rights enshrined in the Universal Declaration of Human Rights and other international human rights standards. We represent more than 670,000 supporters in the United Kingdom. We are independent of any government, political ideology, economic interest or religion.
  2. AIUK welcomes this opportunity to contribute to the work of the International Development Committee through its inquiry into Humanitarian crises monitoring: The impact of coronavirus. This submission focuses on the potentially devastating impact of COVID-19 on displaced older people and displaced people with disabilities, and on the urgent need for the UK government, especially the Department for International Development (DFID), to lead in ensuring that the humanitarian response to COVID-19 is human rights compliant and leaves no one behind. Relevant Amnesty International material includes “Bangladesh: COVID-19 response flaws put older Rohingya refugees in imminent danger,” 6 April 2020; Excluded: Living with disabilities in Yemen’s armed conflict, 3 December 2019; and “Fleeing My Whole Life”: Older People’s Experience of Conflict and Displacement in Myanmar, 18 June 2019.

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. Older people and people with disabilities are regularly left behind in humanitarian contexts, with insufficient attention paid to their rights and specific needs. All too often, humanitarian assistance is designed and implemented in a way that does not respect their rights to health, housing, water, sanitation, food, information, participation, and non-discrimination. COVID-19 threatens to exacerbate these existing problems in how governments, donors, UN agencies, and non-governmental organizations respond to humanitarian crises around the world.
  2. Older people are among the groups most at risk of COVID-19. In the UK, Europe, the US, and China, most of those who have died of COVID-19 have been over age 60, with death rates increasing with age, and highest for those age 80 and older. At the same time, the vast majority of older people infected by COVID-19 survive. Older people should be at the centre of the humanitarian response to COVID-19, given their elevated risks. Their access to health care resources and services including ventilators should be based on principles of equality and non-discrimination.
  3. People with certain health conditions, including cardiovascular disease, hypertension, diabetes, and chronic respiratory illness, are also at increased risk of COVID-19. In humanitarian contexts, many people living with such conditions have long struggled to access adequate health care, including essential medicines, as Amnesty International and other organisations have documented. COVID-19 mortality rates in the UK, Europe, the US, and China are therefore likely to underestimate the risk in humanitarian contexts, given the pervasive lack of treatment for major co-morbidities.
  4. People with certain types of impairments—including sensory impairments, cognitive impairments, and physical impairments limiting mobility—are routinely neglected in humanitarian contexts, including in their basic access to information.
  5. In Bangladesh, where Amnesty International has undertaken significant research on older refugees, there are around 860,000 Rohingya women, men, and children who were forced to flee Myanmar. This includes more than 31,500 women and men age 60 or older. The Kutupalong-Balukhali Extension in Bangladesh is one of the world’s largest refugee camps, and faces extremely high risks of COVID-19 spreading rapidly due to overcrowding and to poor sanitation and housing conditions.
  6. In March 2020, a team from the Johns Hopkins Center for Humanitarian Health modelled the impact of COVID-19 on the Bangladesh refugee camps. They said a “large-scale outbreak is highly likely after a single introduction of the virus into the camp,” with hospitalization needs vastly outpacing existing capacity even in the low-transmission scenarios modelled. They reported “only one facility with few mechanical ventilators in the camps and one facility with less than 10 ICU beds and no ventilators.” The Hopkins team said the camps’ young demographics, with more than 50 percent of the population under 18, might mitigate the overall death toll. However, given how the virus spreads, older people and people with certain health conditions face enormous and imminent risks.
  7. Among the 31,500 older Rohingya refugees in Bangladesh, many live alone or are primary caregivers for children. As documented in detail in our June 2019 report, humanitarian response is too often rooted in an assumption that information and assistance will filter to older people through their families, which fails to respect older people’s rights, ignores reality, and causes harm.
  8. At the end of March 2020, Amnesty International undertook interviews on the COVID-19 response with 15 older refugees in Bangladesh. Among the older Rohingya women and men interviewed, very few had received accurate information about COVID-19’s symptoms and about appropriate preventative measures, much less relevant assistance—such as soap, alcohol-based hand rubs, and other material. Many had only heard rumours about a deadly virus. As a result, fear is rampant.
  9. Hotiza, a Rohingya woman around 85 years old, who has been a refugee in Bangladesh since 2017, told us: “I’m very afraid, because if the virus arrives to the camp, no one will be alive, as here many people are living in a very small place… I have no money, that’s the big challenge… I face difficulties with my stomach, I feel headaches, I cough, but [the camp clinics] just give me some tablets… What can I do? I’m just praying, there’s nothing else I can do.”
  10. Since September 2019, Bangladesh has restricted access to telecommunications and the internet in the refugee camps, which severely limits the Rohingya refugee population’s access to information about COVID-19. By comparison, Amnesty International has done some initial interviews with older refugees in Jordan and Lebanon, and awareness of COVID-19 symptoms and preventative measures appears very high. Most older refugees in those places had, either directly or indirectly through children living nearby, received information from humanitarian organizations via WhatsApp and SMS messages and accessed further information through the internet.
  11. Abdu Salam, 70, has a physical disability that makes it difficult for him to walk, especially amid the Bangladesh refugee camps’ hilly terrain. He said he lacks access to health care and support for pain and other significant health problems. About COVID-19, he told us, “I didn’t hear any new things, just people are saying, ‘A disease is coming, pray.’ I don’t know the name of the disease. Here, no one did any meeting on the disease… No NGO people have told me about the disease... Just other people who live here are saying pray more and more, one disease is coming… People are saying there’s no medicine for that disease, so what more should I do?”
  12. The Bangladesh authorities and humanitarian partners, with support from the BBC, have designed some creative ways to disseminate information about COVID-19, including through attaching megaphones to tuk-tuks and blasting messages in the camps in the Rohingya language. But while most older people Amnesty International interviewed knew such messaging was happening, they often were not able to hear the messages in detail or at all. It is essential that messaging about COVID-19 is accessible to everyone, both in format and language.
  13. Sayeda, a Rohingya woman in her 80s, has lived in the refugee camps since 2017. She is not receiving food assistance because she was unable to walk to where registration occurred; she has to rely on her adult son’s distribution. About COVID-19, she said: “I don’t know anything about that virus, just people are saying something about a virus on the megaphone, but I don’t hear well, that’s why I don’t know anything… I’m always thinking, what are they saying on the microphone… No one told me to do anything, just my son told me to pray so I just pray always.”
  14. Most of the older refugees interviewed had heard information about COVID-19 preventative measures only from religious leaders or neighbours. Most described hearing it was important to wash their hands after going to the bathroom and before meals; and to not allow children to play in dirty areas. These are woefully insufficient for COVID-19. Worse, none had yet received sanitation materials—such as more soap or alcohol-based hand rubs—in response to the pandemic and many already struggled to obtain sufficient water. When combined with the overcrowding in the camps and the tightly-packed shelters made of bamboo and tarpaulin, there is an enormous risk of rapid spread with grossly inadequate preventative measures in place.
  15. Bor Islami, a 71-year-old Rohingya refugee, told us: “No one has come to make us aware of how to be protected from the virus, what we must do. When we went to pray at the mosque, our religious leaders told us not to live in a dirty place and not to eat dirty food… I just heard the virus’s name. No one has explained it to me, so I don’t even know how the virus works. After hearing about the coronavirus, we’re very afraid, so now we’re following our religious teachings strongly and asking for help from God.”
  16. In its modelling of the Bangladesh camps, the team from the Johns Hopkins Centre for Humanitarian Health said most of its “findings are applicable to other refugee and IDP camp-like situations” and expressed concern the “COVID-19 pandemic… could be used as an excuse to take retribution against refugees, as well as other vulnerable groups such as IDPs and undocumented migrants.” The Hopkins team concluded that such actions would undermine the rights of refugees, internally displaced persons (IDPs), and migrants and also “jeopardize the effectiveness of containment and mitigation measures, as pandemics require planning and responses that do not discriminate by nationality and protect the health of the global population.”
  17. In December 2019, Amnesty International published a report on the impact of the conflict in Yemen on people with disabilities. A conservative estimate puts the number of people with disabilities in Yemen at 4.5 million, although given the ongoing conflict, the actual figure is likely higher. Our research, which took place in the southern governorates of Aden, Lahj and Abyan, shows that people with disabilities— whether living in displacement or the wider community—face barriers in equally accessing quality health services, putting them at further risk in the event of a COVID-19 outbreak. Among the challenges are the distance to health care services as well as the costs of accessing those services, which are primarily concentrated in urban centres. Mobile health clinics have conducted semi-regular visits to some displacement sites, but there was inadequate follow-up by medical staff.
  18. Amnesty International also documented inadequate living conditions in IDP camps in southern Yemen. People with disabilities and their families described inaccessible latrines and washing facilities. In all the sites Amnesty International visited in June 2019, there were no dedicated latrines for people with disabilities or private facilities for those who cannot move around, and researchers observed the absence of handles, ropes, or chairs that would enable people with no or limited mobility to use latrines, which were inaccessible for wheelchairs. Such issues are at the heart of fulfilling people with disabilities’ right to sanitation. If unaddressed, they also pose serious risks to COVID-19 preparedness and response. Heavy rains and flooding in recent weeks in southern Yemen have exacerbated the conditions of displaced communities, and although Amnesty International was informed in March 2020 of COVID-19-related awareness campaigns by local authorities and humanitarian organizations (and the distribution of buckets and bleach in at least one displacement camp), it was not immediately clear to what extent this assistance was widely accessible to people with disabilities. Amnesty was informed of shortages in important items like soap.
  19. In addition to the direct threat from COVID-19, displaced older people and people with disabilities are also disproportionately at risk of being harmed by protective measures, including in their access to food and health care. Changes to food distribution to effect social distancing could, for example, cause longer waits or having to travel to different distribution sites; absent proactive planning and a response targeted to individual needs, such changes could undermine access to food for some older people and people with disabilities. Likewise, people with limited mobility at times have difficulty accessing camp clinics and, even when they can, find many clinics lack essential medications for non-communicable diseases like high blood pressure and chronic respiratory illness—co-morbidities for COVID-19. As a result, such people rely disproportionately on purchasing life-saving medications in markets. Any decision to close markets for social distancing needs to include measures that ensure people can maintain access to essential medications.
  20. In the response to COVID-19, governments, the UN, and humanitarian organizations must not repeat the long-existing exclusion of older people and people with disabilities. The UN Global Humanitarian Response Plan to COVID-19, presented on 25 March, was a missed opportunity, as it did not include older people as a separate “most affected and at-risk population group,” unlike children and women and girls. Rather, “old age” was at the end of a list of “conditions” framed as “people suffering from…”. In his remarks introducing the Humanitarian Response Plan, UN Secretary-General Antonio Guterres rightfully stated that “[o]lder persons, persons with chronic illness and persons with disabilities face particular, disproportionate risks, and require an all-out effort to save their lives and protect their future.” This should be reflected in a revision of the Humanitarian Response Plan.

 

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

  1. The UK has been a global leader in funding humanitarian assistance and working to make such assistance more inclusive. It supported, together with USAID, the development in 2018 of the Humanitarian inclusion standards for older people and people with disabilities. Amnesty International believes there are at least eight critical steps the UK should take right now, to help respond to the risks COVID-19 poses to older people and people with disabilities in humanitarian crises.
  2. First, the UK should work with its partners in the UN, and particularly with Secretary-General Guterres and Assistant Secretary-General Lowcock, to ensure that the Humanitarian Response Plan is revised to specifically include older people as a “most affected and at-risk population group”. This would help give due recognition to the grave risks COVID-19 poses to older people in humanitarian situations and help tailor the humanitarian response worldwide to these risks.
  3. Second, the UK government should, together with partner governments, demand that displaced people around the world have access to information, for example through telecommunications and the internet. The UK should call on host governments to immediately end restrictions that undermine such access.
  4. Third, the UK government, particularly through DFID, should ensure humanitarian organizations and other implementing partners have policies to include older people and people with disabilities in the design, provision, and monitoring of aid delivery. For example, to ensure accountability for equitable treatment, the UK should require that its implementing partners disaggregate their reports on aid delivery by age, including older ages, as well as by gender and disability. For assistance to health providers, the UK should require they have clear policies against and monitor for discrimination on the basis of age or disability, among other grounds.
  5. Fourth, the UK government should strongly consider providing additional funding for the humanitarian response to COVID-19, especially for contexts where there are elevated risks due to overcrowding or to the limited capacity of local health services. We welcome April announcements of £200 million in funding for the UN, the Red Cross and NGOs to tackle the virus in developing countries, and of £21 million for Bangladesh, including at least £10 million for the refugee response. We urge the UK government to go further to help bridge key gaps in resources for humanitarian response.
  6. Fifth, key areas that existing or additional funding should support include: (a) ensuring information about the symptoms of COVID-19, preventative measures, and accessing relevant services is available to older people and people with disabilities in accessible formats, in a language they understand, with targeted outreach to those living alone; (b) ensuring older people and people with disabilities have equal access to face masks, soap and water, alcohol-based hand rubs, and other material essential to their protection in camp settings; and (c) ensuring that, as governments impose social distancing and other restrictive measures, such as the closing of local markets, displaced older people and people with disabilities continue to have full and equal access to food assistance as well as to essential medications and other health care, including for non-communicable diseases and for assistive devices. 
  7. Sixth, the UK government should work to ensure that, in the context of COVID-19, host governments facing humanitarian crises provide displaced people equal access to national systems for health care and for social protection.
  8. Seventh, the UK government should work with the UN and with host governments responding to humanitarian crises to ensure that preventive containment and confinement measures do not exclude older people and people with disabilities from decision-making processes related to response and mitigation efforts. Separation on preventive health grounds of older people or other people considered particularly at-risk of COVID-19, including some people with disabilities, should be voluntary.

 

  1. Eighth, and finally, the current COVID-19 response should serve as a wake-up call to the longstanding exclusion of older people and people with disabilities living in situations of humanitarian crises. Going forward, the UK government should work closely with other donors, with UN agencies, and with humanitarian organizations to demand and monitor compliance with the Humanitarian inclusion standards for older people and people with disabilities. Older people and people with disabilities should systematically participate in the planning, design, and delivery of humanitarian assistance and, like all individuals, have their rights respected.