Action Against Hunger submission to UK International Development Committee inquiry on

the impact of Covid 19 on developing countries

1. Introduction: Action Against Hunger is an international humanitarian and development NGO, operating in 50 countries across West and East Africa, the Middle East and Latin America. This submission addresses the immediate impact of Covid 19 on our humanitarian operations and capacity to operate, and the wider impacts the virus threatens to have on global nutrition, food security and health systems.

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

2. Even before the impacts of Covid 19 are fully felt, we have already observed a sharp rise in global food insecurity -  now affecting 135million people[1]. This is why the UN WFP has said the world faces a ‘biblical famine’ in 2020. In addition to conflict and climate change induced hunger, Covid 19 threatens to cause a new spike in food insecurity and to overwhelm struggling health systems in some of the poorest and most fragile states. Yet, good nutrition plays an essential role in recovery from Covid 19 because it is vital for a healthy immune system and wider resilience.

3. In many countries, the effects of Covid 19 on fragile food systems can already be felt, due to strains on supply chains and the retail sector, restrictions on trade and movement that have led to reduced import and price hikes. Further, high rates of infection and continued social distancing practices will impact agricultural input and yields, leading to more severe food insecurity and malnutrition outcomes in the [2]long term. It comes at a time when desert locusts which have destroyed crops across East Africa, threaten to return in the region and to spread to West Africa and the Middle East[3]. Nevertheless the food security pillar of the Global Humanitarian Response Fund is only 5% funded.

4. Action Against Hunger is particularly concerned about the deteriorating situation in the West African Sahel. There are now 1.1 million displaced people in Burkina Faso, Mali and western Niger, a figure that has increased by 290% in one year. 4 million people are estimated to be currently in food crisis in the Central Sahel, nearly 4-fold higher than the average of the last 5 years. Between June and August (the lean season), the number of food insecure is projected to increase to 5.5 million. Because of the impact of Covid19, these numbers could reach 19 million in Mali, Niger and Burkina Faso (with 13,8 million additional people in food crisis). Roughly 3,600 schools and 240 health centers have had to close due to violence.  Counter-insurgency operations in the Sahel have already had a devastating impact on livelihoods—specifically on freedom of movement, access to markets, and the use of certain types of necessary agricultural inputs, putting communities in the region in a vulnerable position to cope with Covid 19.

5. In Yemen, five years of brutal war has left 80% of the population in need of humanitarian assistance; two-thirds of the country lacks adequate access to clean water and sanitation; millions are living on the brink of starvation; close to 20 million people lack access to adequate healthcare; and other diseases such as cholera and dengue are already rife. All of these factors create a dangerously conducive environment for the spread of the virus. The war also continues to displace thousands of civilians. The recent military escalation in Marib and Al Jawf has displaced over 40,000 people in the first few months of the year alone, and could displace thousands more in the coming weeks.

6. The threat of Covid-19 adds another layer to an already difficult and complex operating environment for aid organisations, in particular we, and all humanitarian actors, face:

       Movement constraints and travel restrictions

       Forced delays and halts to activity

       Possible increased security risks including from rivalry between conflict parties to control COVID response resources and willingness to seek to take advantage of the COVID situation in order for authorities to increase frontline activity

       The possibility of civil unrest if supply of food & other essentials should be jeopardized.

7. We are therefore adopting contingency measures including enhanced hibernation capacity; additional Standard Operating Procedures; adapting activities to reduce vector risk and close monitoring of the COVID and security situations.

8. In Somalia we have already observed a sharp decline in economic activity that is worsening purchasing power. Prices of key essential items, including medical supplies, are rising, impacting both livelihoods and our own operating costs. The movement of people is constrained. We anticipate worsening inequality given there were already high rates of youth unemployment and now labour demand is falling. We also anticipate a deterioration of the humanitarian situation in Somalia due to

       Lack of access to basic services by already vulnerable populations such as IDPs

       The collapse of the already weak health systems where essential frontline staff lack PPE

       Reduced demand for services by the community due to fear of infection

       Lack of access to resources on international markets due to a ban on international flights and lockdown measures

       Staff delayed in accessing communities due to movement restrictions and unable to hold mass gatherings.

9. In Nigeria there is a very high risk of Covid 19 spreading like wildfire given the shelter, WASH and health situation of IDPs camps in the North East. In this context, social distancing and adequate hygiene are not possible. We face major challenges as we try to ensure continued access to humanitarian assistance for refugees and IDPS, due to:

       Increasing restrictions on movement and community gatherings

       Some NGO staff are scared due to their limited access to PPE

       The prices of essential commodities have increased

       Key international staff are either not able to come to the country or have left the country

       The health infrastructure is too weak to manage the virus once it starts spreading

       There are signs of increased insecurity/hostility in the North East

       There is a risk of criminality increasing given the impact on livelihoods combined with market prices.

10. The conflict risks that humanitarian actors face in all these countries are a reason why the UK should promote at every opportunity the UN Secretary General’s global appeal for a ceasefire to improve humanitarian access at this critical time, endorsed by 107 UN Member States.

11. Meanwhile Covid 19 challenges the delivery of many nutrition programmes globally so action is needed to ensure programmes can continue.  A severely undernourished child is nine times more likely to die from common infections than their better nourished peers[4]. Nevertheless, nutrition programs around the world have paused operations due to COVID-19 containment strategies. Lower-middle income countries often depend on Community Health Workers’ (CHW) ability to deliver life-saving interventions directly, but social distancing means that visits to health clinics and support by CHWs are not being recommended. Health systems overwhelmed by COVID-19 cases will not be able to respond to malnutrition-related illness. We must enable parents to treat malnourished children while in self-isolation and ensure breastfeeding mothers know what to do if they fall ill with the virus. One common approach that is being promoted globally is working with CHWs and volunteers with appropriate PPE to conduct home visits and conduct small groups sessions to continue delivering essential routine services.

12. We must also be able to ensure the distribution of essential supplies, such as food and supplements. Life-saving activities must be classified as essential and exempt from restrictions by authorities. The UK should use its diplomatic relationships in some contexts to advocate for exemptions to access and movement restrictions for humanitarian and health personnel and essential supplies.

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

13. As described above, the global COVID-19 is both a health and food security crisis. To enable a better and effective response to needs and adapt to fast changing operational contexts, the UK should provide sufficient, rapidly dispersible and flexible funding to support conflict-sensitive, multi-year, integrated responses to conflict and hunger and COVID-19. This investment can’t come at the expense of ongoing humanitarian responses.

14. We welcome DFID’s leadership on the global Covid-19 response. The activation of the Rapid Response Facility (RRF) component of DFID’s response is timely. However only £20m has been allocated to fund the  response across 15 countries. Given the challenges outlined above, this is not sufficient to meet the high level of needs that UK NGOs are facing. Early action saves lives and we know that UN agencies cannot respond quickly enough, given it often takes 90 days for UN agencies to disburse emergency funds to partners. Action Against Hunger and other NGOs can respond in 48 hours and can scale up rapidly, and we have the important community reach (see below) and networks of local partners.

15. We have submitted several proposals to the RRF but have low expectations of success given the large volume of proposals submitted from the sector for a relatively small funding allocation. We and several other NGOs collectively propose that:

       DFID to increase the amount of funding allocated to the RRF to an amount commensurate to the delivery capacity and reach of UK INGOs. Taking into account previous RRF activations for single-country responses of approximately £5m for a shorter time-period, we believe that a 15 country call for 6-month projects merits a £100 million investment from DFID.

       If CHASE is not in a position to increase the funding level immediately, that CHASE seeks to secure a second allocation urgently before proposals are outdated, and that this is used to fund strong proposals from the first round of bidding, with no requirement that NGOs should develop new proposals;

       . Where proposals to the RRF are strong but cannot be funded due to limited resources at DFID HQ, that the CHASE team works with DFID country offices to identify adequate resources at country level that can fund these responses while ensuring existing humanitarian programmes may continue;

       DFID to provide confirmation of the amount and the timeframe in which funding will become available to NGOs to support in-country responses via DFID country offices;

       DFID to undertake a participatory review of the RRF activation and allocation process, including all pre-qualified partners.

16. Besides additional funding needs, some examples of our experiences where we have ongoing DFID funded programmes are:
17. In Yemen, we are part of a DFID funded consortium which until recently received funding for health service provision, but this funding was redirected to cash programming before the Covid 19 outbreak which has left us closing down DFID supported health facilities. The healthcare system in Yemen relies now on international support to function and we would have liked to see an urgent pro-active response from donors, including DFID, to engage with existing partners to rebuild lost health service capacity.
18. In Somalia, there is a lack of coordination between donors in their response to the pandemic. For improved impact and coordination we would also like to see donors, including DFID, prioritizing support to government lead initiatives and national level response plans. INGOs are also struggling with a lack of flexibility about delivering ongoing interventions, this is made more challenging by slow decision making processes with fund managers.
19. In Nigeria, we welcome seeing additional funding from DFID directed to Covid 19 response, however there are ongoing challenges with the need to build more flexibility into current grants, to adapt to the new context. Coordination at different levels of government - federal, state, local government area - in Nigeria is improving and support from donors including DFID to improve that coordination is important.

20. In all humanitarian contexts, INGOs are challenged by continued high demand from donors for analysis, scenario plans, costed plans and other outputs which stretches the already limited capacities of the organisations. We would therefore propose that DFID should apply “force majeure” as an overriding principle of response to the COVID-19 pandemic to explain temporary suspension and delays in programming. As such, DFID should authorise no cost extension requests for projects and the department should respond rapidly and flexibly to requests to change programme design. With ongoing projects, DFID should ensure we can continue to pay project staff and cover additional costs, including travel. Reporting requirements must be minimised both for new and ongoing projects to reflect the increased burden on country staff posed by the pandemic. DFID could also review the application of crisis modifiers to development and resilience programmes in fragile contexts[5].

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

21. A key lesson from Ebola is the need to act swiftly ahead of an outbreak, and take a response to reduce the spread of disease that has the buy in of local communities. The Ebola response in Sierra Leone, Liberia and Guinea demonstrated that community engagement is critical in responding to epidemics [6] [7].  It is vital to ensure that vulnerable populations (women, children, elderly, refugees, etc.) participate in response design. In many fragile states, however, it is more costly to deliver a response that considers the specific needs of vulnerable communities. DFID therefore needs to be willing to invest in the coordination mechanisms, staff, structures, research and processes to implement this approach.

22. Regarding community based responses, in the West African Sahel, social distancing measures may be impossible because of overcrowding and poor sanitation[8] due to many people living in crowded households or urban slums or IDP camps. Such measures will also make it hard to meet essential needs amongst people who rely on daily and frequent interaction for income generating activities, access to water, energy sources or food. IDPs, refugees and vulnerable host communities in this region may also be at greater mortality risk, not least because of higher levels of comorbidities such as under nutrition, malaria and HIV. However, there are existing strengths in the region that should be built on to cope with the impact of the virus. Communities, used to facing disasters, have already established coping strategies. There is a strong informal network of leaders at community level (community leaders, religious leaders, businessmen and businesswomen, traditional healers, youth groups, etc.) that could be used to deliver messages on hygiene and other protection measures to be taken, on limitation of movements, etc. Donors and governments should learn from Ebola to implement a rapid response with strong, inclusive and transparent coordination mechanisms.

23. Similarly, in Somalia, we would call for taking lessons from Ebola and intervening through existing systems, partnership and community structures as this greatly improves aid efficiency. Successful community level initiatives target reducing fears and changing dangerous health behaviours in a way that is sensitive to local cultural and lifestyle factors and available health services.

24. We would therefore call on the UK to use its role as a major donor to the Global HRP to ensure that community based responses and NGO requirements are incorporated into country HRPs.

25. Regarding health services, despite the lessons learned from the Ebola outbreak to strengthen primary care services, health systems have remained weak across Sub Saharan Africa where only half of health facilities have basic water services, one out of five has sanitation services, and there are less than 0.5 doctors per 1000 people. Seasonal epidemics put health services under additional stress: in a few months the rainy season will bring increases in cholera and malaria across Sub-Saharan Africa.

26. This is why mortality from other causes is likely to rise during the pandemic. In Sierra Leone the Ebola virus pandemic, led to a decline in access to maternity services and a rise in maternal mortality to the reallocation of health service resources[9]. Elsewhere, studies of the Ebola outbreak in West Africa suggest that about as many people died because they could not get treatment for malaria, HIV and tuberculosis as from the Ebola virus itself. This is why a recent report has estimated that the secondary impacts of Covid 19 threaten more children's lives than the disease itself, and 30 million children’s lives could be at risk from causes such as malnutrition and malaria[10].

27.             COVID-19 similarly threatens to divert medical resources from other lethal diseases and undernutrition. It is therefore important not to lose sight of the fact that nearly half of all deaths of children under five each year are attributable to undernutrition[11]. Experience with malaria and Ebola indicate people infected with Covid-19 will be more vulnerable to undernutrition. Undernutrition is, in turn, a risk factor for other diseases and death. Nevertheless access to nutrition services is already declining which poses a deadly risk emerging from Covid 19.

28. In light of this DFID should publish the Ending Preventable Maternal and Young Child Deaths Action Plan, rather than put it on hold due to the pandemic, and put this at the heart of DFID’s five year strategy. DFID should further maintain investments in nutrition programming alongside investment from national governments. Continuity of investments in global health and development, such as basic nutrition and health services, vaccines, food security, and WASH programs, are more important than ever. These programs contribute to improved recovery from disease and resilience to economic shocks.

29. Nutrition must remain a top priority in DFID’s approach to health systems strengthening in order to protect progress in maternal and child mortality reductions. COVID-19 response and recovery initiatives should integrate nutrition through a multi-sectoral approach with special focus on infant and child nutrition, food security, WASH, and social protection. Specific priorities should include: breastfeeding promotion; the prevention of wasting, for example by pre-positioning therapeutic foods and other nutrients and ensuring proper delivery through health and social protection systems, particularly primary health care; enhanced hygiene behavior change campaigns; and ensuring access to nutritious food.

The impact of the outbreak, and consequential mitigation measures, on fund-raising by UK-based development charities/NGOs

30. The pandemic is negatively affecting NGO operations on multiple fronts. This unprecedented global health crisis is causing increased levels of need amongst vulnerable populations we work with; it is increasing the costs for essential supplies; restricting movement and access to vulnerable people; and in addition, we face a sharp decline in income due to the impacts on our supporters. In Action Against Hunger’s case, we have many supporters in the restaurant and hospitality sector who are unable to operate now, which means we must plan for a sharp drop in unrestricted income this year, which is essential for meeting our core operating costs.

31. Our mitigation measures so far have involved furloughing around 25% of UK staff, cutting expenditure across the organisation and working to diversify income sources. Nevertheless the impacts will be significant which is why INGOs have called for DFID to consider measures to support INGOs to meet core operating costs, just as the DCMS has done for domestic charities. This could include increasing flexibility within existing grants; a stabilisation loan or granting mechanism that would sustain core capacity in the short term; forgiveable loans; and an increase in the NPAC rate.

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