Humanitarian crises monitoring: Impact of Coronavirus

Submission of Written Evidence by Save the Children to the International Development Committee

1. Introduction

1.1.   Save the Children was founded in 1919 in London. It is now a global movement working in 120 countries to ensure that all children survive, learn and are protected. We believe the COVID-19 outbreak to be the gravest humanitarian challenge in our organisation’s history and are working alongside partners and governments around the world to respond to its direct and indirect affects.

1.2.   The COVID-19 pandemic will have a profound and long-lasting impact on children’s life-chances, causing the greatest harm to the poorest and most marginalised children who are most likely to be reliant on weak health systems, have their ability to learn affected, live in areas with ineffective governance and be hit hardest by lock-down measures due to reliance on the informal economy, While the UK Government has taken a leadership role in the global response, it must do more to ensure funds can reach community level quickly, working more closely with NGOs, and using their influence to ensure that all states approach this crisis as one of child rights and child protection as well as addressing its health and economic impact. Building back better will require a clear plan to set out the UK’s contribution in regaining progress towards the Sustainable Development Goals, and should be accompanied by a new UK aid strategy also aimed at this target.

2. Long-term implications

2.1.   The pandemic will exacerbate existing inequalities between and within countries. Save the Children has estimated that the crisis could push between 40 and 60 million people into extreme poverty in Sub-Saharan Africa alone, between 22 million and 30 million of whom are likely to be children.[1]  Within countries, the impacts will be disproportionately felt by the most marginalised and deprived groups in society, including families in the informal economy, internally displaced people and refugees, children living in congregant living conditions such as slums, and people with disabilities. In Peru, for example, where approximately 70% of the population is in the informal economy with precarious incomes, large numbers of people have already been pushed into poverty.[2]

2.2.   The OECD has projected that lockdowns directly affect sectors amounting to up to 1/3 of the GDP of major economies, with a loss of 2% of annual GDP growth for every month of containment.[3] The slow economic recovery of major economies around the world is projected to have a negative impact on financial flows, from foreign direct investment and trade to ODA, which will have direct impact on developing countries and the services that can provide for children.

2.3.   Health

2.3.1. There are various long-term implications on health as a result of COVID-19 and the measures put in place to respond to it. Poverty caused by not being able to work means that many people cannot afford to pay for care, or to travel to health facilities. Financial barriers to accessing care have been increased by the impact on livelihoods caused by the response to the pandemic. As we've seen in other outbreaks, one long-term impact is mistrust in the system, stigma associated with facilities and health workers which means people don't seek care and fall ill as a result. The long-term funding impact on routine services is a concern, as funding has been diverted to tackling the pandemic. Research by Johns Hopkins University estimates increases in maternal mortality ranging from 8% to 39% depending on the severity and duration of disruptions to routine health care.[4] There is a risk that even when a COVID-19 vaccine is available, access will be restricted for the poorest countries due to competition for supply with richer countries. This highlights the critical importance of an approach to tackling the pandemic that is rooted in equity.

2.3.2. Data from the United States suggest that children make up less than 1.7% of diagnosed COVID-19 cases, but the secondary effects of the crisis on children are severe.[5] There is evidence for increasing child mortality either due to weakened or disrupted health services or reduced use of routine services. Research by Johns Hopkins University modelled various reductions of coverage of life-saving interventions and for different time periods for 118 low- and middle-income countries.[6] Reductions in coverage of around 15% for 6 months would result in 253,500 additional child deaths (an increase of 10%), while reductions of around 45% for 6 months would result in 1,157,000 additional child deaths (a 45% increase).

2.3.3. The World Health organisation models that loss of access to treatment for malaria could increase malaria deaths by 50% (with scenarios ranging from 7% to 99%), within which children would be disproportionally affected.[7] As a direct consequence of COVID-19, immunisation campaigns – such as those for measles targeting 78 million children in at least 23 largely high-burden countries or those focussed on polio – have been suspended. Data from March across most of India’s health facilities show significant drops in child immunisations relative to the same time last year, ranging from 16% for PCV and BCG to 69% for MMR. [8] This suggests negative long-term effects on children who are losing out on life-saving vaccines, in line with similar observations during the Ebola outbreak.

2.3.4. Despite a lack of recent data on the effects of covid-19-related quarantine on children’s mental health, there are fears that quarantined children “might be more susceptible to mental health problems because of their higher risk of infection, and the grief and fear caused by parental loss or separation.”[9] Previous research on the effect of health-related disasters on children’s psychological wellbeing finds that 30% of isolated or quarantined children met criteria for PTSD, a percentage four times higher than in non-quarantined peers.[10]

2.4.   Nutrition and Food Security

2.4.1. Short and long-term food security is a serious concern. The World Food Programme (WFP) has issued a warning that unless swift action is taken the number of people suffering from acute food insecurity could double, jumping from 135 to 265 million.[11]  The situation is particularly dire for children as school closures mean that 368.5 million children globally who rely on school meals might have lost access to a reliable source of food. [12]

2.4.2. In the short-term, an inability to access nutritious foods or critical nutrition services such as infant and young child feeding and nutrition counselling, will lead to more children suffering from wasting and if the period correlates with key windows of opportunity (such as the first 1,000 days) will lead to increased stunting. Early estimates suggest that the number of children under age five who are stunted may increase by 5%, or 7 million children, but should economic contractions be larger than anticipated this figure would likely increase.[13] The longer and deeper the crisis, the likelihood of more sustained negative impact on nutritional status.

2.4.3. Economic and social disruption both at the macro level (such as food system disruption and economic recession) and at the micro level (such as more families living in poverty or on reduced income) will mean a protracted nutrition and food security crisis which could undo progress to date and hold back millions of children from reaching their potential. The latter is already a significant concern in several countries, including Afghanistan where more than seven million children are at risk of hunger as food prices soar due to the lockdown imposed in the country.[14]

2.5.   Protection

2.5.1. There are severe protection concerns brought about by the virus’s economic impact and by measures introduced to pandemic. Death and incapacitation of caregivers, loss of livelihoods and subsequent impoverishment risks driving children to more extreme forms of survival, including early marriage, sexual exploitation and recruitment and use by armed forces and armed groups.

2.5.2. There is a significant risk of increased rates of child marriage and adolescent pregnancy and subsequent maternal mortality and ongoing exposure to gender-based violence. Increased child marriage will likely also lead to a reduction in the number of girls returning to education following school closures, which will have a detrimental longer-tem impact on women’s economic empowerment. In a village in Sierra Leone heavily affected by the West African Ebola outbreak, school enrolment rates for adolescent girls dropped by as much as one third.[15]

2.5.3. In addition to being a grave rights abuse, the lifelong health impacts of exposure to gender-based violence on women and girls are wide-ranging and include death, disability, higher risk of sexually transmitted infections, unintended pregnancy and miscarriage, premature and low-birth weight babies, depression and suicide. Children witnessing violence in the home may also face long-term effects associated with being orphaned, higher risk of mortality and morbidity, and higher risk of perpetrating or experiencing violence later in life.[16] These health impacts have huge economic impacts – 2016 estimates put the annual cost of violence against women at USD $12 trillion.[17] This is by no means an issue restricted to developing countries – countries with increased reports of domestic abuse during COVID to-date include Argentina, Canada, Cyprus, France, Germany, Spain, Singapore and the United Kingdom.[18] Reports in Kosovo have increased by 17% country-wide and by100% in one area.[19]

2.6.   Conflict

2.6.1. The impact of Covid-19 on child rights and child protection will be significant across contexts but particularly exacerbated for the 149 million children living in high-intensity conflict zones.[20] Containment measures will be harder to enforce in locations where governments lack legitimacy with parts of the population, while restrictions on delivery of external humanitarian assistance to these populations will weaken already fragile health systems that will be quickly overwhelmed by the scale of need. In these settings, any short-term shocks are likely to have long term effects on children’s health outcomes.

2.6.2. In many humanitarian contexts, children are detained for real or perceived association with armed groups, putting them at high risk of transmission, as they are unlikely to be able to take preventive measures. Securitised containment measures may increase the numbers of children detained either individually or with their families. As justice systems slow down and stall, children in detention are likely to remain for prolonged periods of time without due process.

2.6.3. The economic and social consequences of the pandemic threaten to aggravate social division in the medium and long-term, amplifying and generating conflict. Border closures may prevent parts of the population from exercising their right to seek asylum. Travel restrictions are impacting on conflict prevention and resolution measures, peace processes and peace-keeping initiatives, undermining the achievement of child rights and derailing efforts to protect children, for example to repatriate children of foreign fighters in Syria with caregivers to their countries of nationality.

2.6.4. The closure of schools as a result of COVID-19 crates the risk of use by armed groups, particularly because of military mobilisation as part of the pandemic response. The resulting damage to school infrastructure may prevent schools from safely reopening and increase the amount of time children are out of school.

2.6.5. In the longer term, there is a risk of a reduction in humanitarian funding for 2021 and onwards, with likely recession leading to shrinking ODA budgets, within which there is likely to be reduced prioritisation of activities not directly related to the pandemic

2.7.   Education

2.7.1. Currently an estimated 1.2 billion learners – approximately 72% of the total student population - are out of education because of school closures in response to the Covid-19 pandemic.[21] Whilst hard to predict, school closures could last anywhere between 2-12 months.[22] 258 million children were out of school worldwide,[23] and last July, UNESCO published dire projections suggesting on the world’s current trajectory, there will be almost no progress on reducing the number of children who are out of school by 2030. Indeed - the report demonstrates that none of the ten targets that form Sustainable Development Goal 4 will be met by 2030.[24] This pandemic risks putting any progress that has been made into reverse.

2.7.2. While some countries are better prepared for providing learning continuity for children during school closures than others, it is likely that the poorest girls and boys in all contexts will struggle to continue with their learning. Remote learning will likely deepen education inequalities and learning gaps because of the digital divide and different loss of learning by socio-economic group. Worldwide, 50% of students out of the classroom do not have access to a computer, and 40% lack Internet access at home; with those figures as high as 90% and 82% respectively in Sub-Saharan Africa.

2.7.3. Prior to COVID-19, there was already a global teacher shortage – the world needs 69 million new teachers to reach the 2030 SDG targets on education[25]. The current crisis could further exacerbate this shortage as teachers fall sick and could be forced to leave the profession if their salaries are not guaranteed.[26]

2.7.4. Many national education systems already face considerable challenges as a result of conflict and displacement, environmental emergencies and a lack of funding. COVID-19 further compounds these challenges, with countries under huge pressure in responding to the pandemic, risking education budgets risk being reduced.

3. DFID’s Response to the Pandemic

3.1.   While the Government has rightly focused its efforts on responding to the pandemic on domestic priorities, we welcome the leadership that it has shown in the global response. The UK has been the second largest donor to the Global Humanitarian Response Plan, and committed to double its existing £2.2bn loan to the IMF Poverty Reduction and Growth Trust, alongside announcing funding for research into a COVID-19 vaccine, lobbying to achieve agreement from the G20 on the suspension of debt payments by the poorest countries, and co-hosting the European Commission-led pledging conference. While the UK’s response has had flaws, in many cases this country has taken bigger and earlier steps than other donors, and has been influential in shaping how others have responded.

3.2.   Funding

3.2.1. DFID like other donors has been over-reliant on UN agencies. We fully support a coordinated response, and welcome the Government’s funding to UN agencies, however this is yet to translate into disbursement to frontline agencies in-country, who are much better able to operate at community level.

3.2.2. The UK Government has allocated more than £130M through UN agencies. Some organisations, like UNICEF, have indicated their plan for disbursement by region or theme, but for most this remains unclear and only UNICEF and UNHCR have started regular consultations with NGO partners. DFID should work with UN partners to agree more rapid mechanisms for NGOs to access UN funding so that preparedness and mitigation work in communities can get underway, and ensure transparency in the way the UN is going to disburse the funds to NGOs.

3.2.3. NGOs must be a core part of DFID’s response to the crisis, both through multilateral agencies but also directly. NGOs have existing local networks and strong community ties that can be utilized for key responses, particularly in appropriate information awareness and education campaigns. While the Department argues that the UN gives scale that NGOs do not, with fewer relationships to manage, they could very easily be working with consortia of NGOs (as they are in Yemen and Somalia) in more contexts, reducing the relationship management requirements and increasing the scale. NGOs are well placed to support Governments and can work with existing structures to be the bridge between health and nutrition services and communities, for instance working in health facility and community settings, scaling up Integrated Community Case Management, integrating nutrition services, conducting extensive health and WASH promotion and working in a variety of contexts and levels of fragility and instability. NGOs’ reach enables us to support many deprived and marginalised communities that others can’t, particularly refugee and internally displaced children and those affected by conflict.

3.2.4. DFID’s £50 million partnership with Unilever and the £20 million Rapid Response Fund are welcome steps, but fall short of what is needed to mobilise preparedness and response plans quickly and DFID should look to work directly with NGO consortia and individual NGOs in a greater proportion of its response. In terms of dialogue with civil society, we are pleased that the department has instigated structured consultation with UK-based NGOs.

3.3.   Global Financing

3.3.1. We welcome the UK and G20 decision to agree a suspension of debt service payments from official bilateral creditors. This is a decision that will release resources for the response to COVID-9 and the associated economic fall-out. The World Bank, IMF and G20 governments have played an important leadership role. The debt service suspension must be applied to all scheduled payments, principal and interest, for all creditor institutions, with no exceptions. There is an urgent need to clarify the terms on which commercial creditors will participate in the initiative. We urge governments to encourage full participation by commercial creditors, where necessary by using their regulatory authority or passing appropriate legislation. 

4. Lessons learnt and lessons to learn

4.1.   One of the major lessons of the 2014-15 Ebola outbreak in West Africa was the speed at which the international community needs to react. It is evident that resources have been mobilised more rapidly in this case, and that to some extent the crisis is being approached as wider than a health issue, spanning nutrition and food security, education, protection and income support, which was largely missing during the response to the Ebola outbreak. During the Ebola crisis, people were not able to, or chose not to, seek healthcare for unrelated issues and there was an increase in the burden placed on frontline health workers, including community health workers who are often unpaid, and not trained or protected appropriately. This led to an increase in maternal mortality as well as childhood illnesses – it is vital that this lesson is learnt and efforts are made to ensure routine essential health services are able to continue. Additionally the Ebola crisis saw a breakdown of trust between communities and medical professionals, NGOs and other institutions. Community engagement, understanding of community practices, and developing strategies based on community guidance must be at the forefront of the COVID-19 response, and information must be child friendly and culturally appropriate.

4.2.   Persistent issues remain in terms of humanitarian funding, where the localisation agenda and efforts to quickly disperse funds to partners on the ground show little sign of improvement. While DFID’s support for the START fund, a multi-donor, multi-CSO humanitarian funding pot for rapid response in emergencies, is encouraging, more work is required to introduce this sort of flexibility at greater scale.

4.3.   In terms of developing country debt, there are important lessons to learn from the financial crisis of 2008. In 2010, Parliament passed the UK Developing Countries (Debt Relief) Act. This prevented any creditor suing a country outside the terms of debt relief brokered by the UK at the G8 summit in 2005. The same principle could be used to protect countries from legal action in relation to the Covid-19 debt crisis. The Government should include protections for the 77 countries included in the G20 agreement on suspending debt payments from being sued by private creditors in the UK in the forthcoming draft Insolvency Bill so that any country suspending debt payments in line with the G20 request cannot be sued in UK courts.

5. DFID’s contribution to ‘building back better’

5.1.   Building back better must be rooted in the Sustainable Development Goals, which provide a blueprint for progress. In order for us to ensure that the 2020s does not become a “lost decade”, reversing hard-earned gains in sustainable development, there is an urgent need to improve collaboration at global, regional and national level and to invest in capacity to deliver on the SDGs.

5.2.   The UK played a key role in the negotiations around the post-2015 framework and securing and defining the pledge to Leave No One Behind. As a major donor, the UK should lead the way in raising the ambition around the SDGs and follow through on the commitments it made in its Voluntary National Review last year. This should include the establishment of a multi-stakeholder engagement mechanism that is able to fulfil its mandate to monitor and deliver on the SDGs across Government and with all partners.

5.3.   The Government should also produce a new UK aid strategy that sets out the part aid will play in the UK’s contribution to meeting the Sustainable Development Goals and assisting in sustainable and equitable rebuilding efforts in the poorest countries following the pandemic.

5.4.   A commitment to building back better in the aftermath of the pandemic must be built on a commitment to universal health coverage (UHC), but cannot stop there. It has never been clearer that health is a global challenge that requires a global response, rather than an issue of individual national policy.

5.5.   The UK can play a critical leadership role in pushing for genuine global commitment to UHC, and healthcare provision that is free at the point of use for everyone, investing most in the most marginalised and deprived. It is in the interest of everyone that all countries have strong health systems that are able to prepare for and respond to crises while maintaining essential services, and DFID’s approach to health should make this a priority.

5.6.   With malnutrition playing a part in half of all preventable child deaths, achieving the Government’s commitment to end preventable child deaths will rely not solely on its laudable commitment to Gavi or a commitment to UHC, but also on progress towards ending malnutrition. DFID’s current nutrition funding obligations come to an end in December.

5.7.   To avoid this cliff-edge, the UK Government must pledge £800million per year to nutrition between 2021 and 2025, irrespective of the decision to postpone the Nutrition for Growth Summit to next year. Recommitting to effective central nutrition-specific programmes, and deepening the breadth and impact of nutrition’s integration across the department would mean more children being reached with vital nutrition services, a greater return on investments outside of their nutrition specific work, and ultimately more lives saved and stronger economies.

For further information, please contact:

Alastair Russell, Senior Public Affairs Adviser

0203 763 1270, a.russell@savethechildren.org.uk