Lessons learned from the COVID-19 response : the case of the Disasters Emergency Committee

The Disasters Emergency Committee[1] (DEC) launched a COVID-19 appeal on 14 July 2020. By the end of August, the campaign had raised more than 22.5 million Pounds sterling (25.5 million Euros). Half of this sum was donated by the general public, while the other half was from the British government, based on the ‘UK Aid Match’ mechanism[2].

Contrary to the appeals by DEC in response to ongoing emergencies where needs are already known, this appeal adopted a proactive approach, based on the idea that responding as early as possible with preventive measures was the most effective way of tackling the pandemic. Selecting countries on the basis of the expected impact of COVID-19 was difficult as decisions were made on the basis of assumptions and incomplete information.

The funds raised by the COVID-19 appeal were allocated to the 14 members of the DEC who were already active in the 7 countries selected: in Asia (Afghanistan and Bangladesh for the Rohingya refugee crisis), in the Middle East (Yemen and Syria), and in Africa (the Democratic Republic of Congo, Somalia and South Sudan), all countries where there is a critical situation made worse by the COVID-19 crisis.

The DEC, which is strongly committed to high levels of transparency, continuous learning and responsibility, selected Groupe URD to carry out a real-time review. The review had three objectives: 1. Understanding the impacts of the pandemic on operational contexts; 2. Analysing the adjustments that had already been made and those that still needed to be implemented to meet needs and operational challenges; 3. Promoting learning and the continuous improvement of humanitarian practices and the ongoing response. The review, which began in October 2020, was carried out by mixed teams of national and international consultants who collected and analysed data and facilitated a series of national workshops.

Impacts of COVID-19 on humanitarian contexts

After several months of uncertainty, it became clear that the main impact of the pandemic was in developed countries, and particularly affected specific population groups: the elderly and people with comorbidity. The graph below shows very clearly that the majority of deaths were registered in the Americas and in Europe.

It should nevertheless be pointed out that, in many countries, the figures are not accurate and therefore the virus is having a silent impact. This is particularly the case in Afghanistan, Syria and Yemen, where humanitarian workers and community representatives have noted a significant increase in deaths not reflected in the official figures. A study carried out in Aden (Yemen) which used a geospatial technique to analyse cemeteries showed, for example, that there was an increase of 230% in the number of burials compared to previous years[3].

In sub-Saharan Africa, the situation seems to be different. For the moment, counterfactual studies have not shown a significant rise in the number of deaths for reasons that remain to be clarified. Demographics, the young age of the population and better preparation to manage an epidemic are possible explanations for the low rates of mortality linked to COVID-19.

However, the impact of COVID-19, over and above the number of dead, is considerable. The measures implemented to slow down the propagation of the virus have effectively held up the delivery of essential services and activities, thus increasing pre-existing vulnerabilities. The closure of health and family planning centres has had, and continues to have, a significant impact, for example on vaccination programmes, early pregnancies, and maternal and child health in general. Prevention measures, social isolation, economic difficulties and the fears that these create for the future, have had a profound impact on mental health. This has been observed and reported in numerous countries and should be a priority for aid actors and states. What is more, certain more vulnerable groups of people are affected disproportionately, notably in terms of protection. School closures, lockdown measures, overcrowding, the lack of activities and the lack of economic prospects have led to a general increase in the amount of violence against women and children. The health crisis has also reduced access to protection services for displaced persons and refugees.

The repercussions of the crisis on household economies and food security are even more worrying. There has been a significant deterioration in levels of food security in numerous countries (at the end of 2020: 36% of the population in Afghanistan was affected by acute food insecurity, while the percentage was respectively 25% in DRC, and 40% in Yemen). The measures taken to stop the pandemic, including the temporary closure of borders, the disruption of trade, the closure of countless private establishments (shops, factories, schools, etc.), the increase in unemployment and the reduction of cash transfers from diasporas have had significant economic and social consequences.

Key learning points based on the criteria of the Core Humanitarian Standard (CHS)

The key learning points from the real-time review are presented on the basis of the 9 commitments of the Core Humanitarian Standard (CHS), to which the DEC members have signed up. For the purposes of this article, a certain number of general lessons that are useful to the aid sector as a whole have been selected and are presented below.

Commitment 1 : Humanitarian response is appropriate and relevant. In the context of the pandemic, the relevance of responses can be questioned at any moment based on how the pandemic evolves and the impact of preventive measures. The ‘no regrets’ approach, (which, in the face of uncertainty, consists of making decisions on the basis of the worst case scenario) and the decision to prioritise health-related programmes were justified during the initial months and remain necessary in numerous contexts. However, the type of programmes that are implemented deserve to be reviewed in the light of the information that is now available about the different impacts of the epidemic.

As the pandemic has profoundly destabilised the majority of health systems, it will continue to be necessary to support them in order to care for patients affected by COVID-19 or other illnesses. It is crucial to prevent a large scale epidemic from taking hold in refugee camps such as in Cox’s Bazar in Bangladesh or in IDP camps in Afghanistan and Syria, where population density is extremely high and health conditions are deplorable. Hygiene messages, which are valid for a number of contamination risks, and the supply of basic equipment, continue to be relevant. However, given the economic impacts of the pandemic – which are more severe for certain population groups, such as women, children and the elderly – and the consequences in terms of protection and food security, aid programmes need to adapt and go beyond the initial health-based response.

In terms of education, schools were closed for an extended period in numerous regions, which has had a significant impact on children. It is therefore essential to support education systems in order to guarantee access to education despite the pandemic. Innovative teaching methods to prevent and reduce the number of pupils dropping out of school, and to avoid subsequent negative secondary effects, have been developed and deserve to be explored further. There is also an urgent need for gender-based violence protection programmes, as well as mental health and cash transfer programmes for the most vulnerable people.

Commitment 3: Humanitarian response strengthens local capacities and avoids negative effects. In all the countries concerned by this appeal, the DEC members already had significant experience of working with local partners. This proved to be extremely useful as the crisis underlined, once and for all, the added value of partnerships between international and local actors.

Aid localisation is a process that needs to be pursued and accelerated. Local partners should be supported and their central role in crisis response should be fully recognised. They should consequently have access to more financial resources. Local partners should take part fully in planning and decision-making – not simply implementation – because, as this crisis has shown, they have a number of strategic comparative advantages, such as in their interactions with local communities. This is all the more important when there is restricted movement and there is a greater need for local personnel. At the same time, this must not be done in a way that weakens the central role of local authorities in managing the pandemic.

Commitment 4 : Humanitarian response is based on communication, participation and feedback. It is now widely recognised that a community-based approach is essential to managing major health crises like epidemics. This makes two-way communication possible, with the dissemination of prevention messages on the one hand, and a system for monitoring and referring cases of contamination on the other. Because of constraints to access and the holding of public meetings, new communication channels have been used. There has been a significant increase in the use of radio and social networks due to the importance of pursuing prevention efforts and disseminating public health messages. However, in order to optimise community engagement and ensure that there is confidence in health policies, it is essential to understand how risks are perceived and to combat rumours. Social scientists and communication specialists therefore need to be mobilised. This is a lesson that continues to be relevant and that will allow future vaccination campaigns to be prepared better.

Engagement 8 : Staff are supported to do their job effectively and are treated fairly and equitably. Due to health risks and lockdown measures, new methods have emerged in terms of remote working and team management. These are likely to continue, implying less international travel, the recognition and promotion of local human resources and capacities, and the use of relevant information technology. Due diligence and staff protection have been two key elements of the response at all levels, whether for staff in the field, at headquarters or for implementing partners. Now we must look at how due diligence in relation to health risks can be further institutionalised and integrated into programme management in a cross-cutting manner. What is more, longer term monitoring of the psychosocial and socio-economic impact of this crisis on staff will be crucial once the pandemic is over given the number of people who have been affected by the virus (the death of friends or relations) and the prevention measures that have been implemented, such as lockdown.

Conclusion 

The way that the health crisis is going to evolve remains very uncertain. For the response to remain relevant, it is essential to adapt programmes by continuing to analyse needs as they evolve. The emergence and spread of variants of the virus could lead to an ongoing and worsening pandemic situation, particularly in African countries previously less affected by the crisis. It is therefore of capital importance to remain vigilant and to monitor WHO indicators, as well as other monitoring systems in the field, such as the number of patients in health centres, the detection of traces of the virus in waste water, cemetery activity, etc. What is more, the seriousness of the global economic crisis could have a significant impact on aid sector funding and could lead to reductions in humanitarian funding, which, in the current situation, could have tragic consequences for the most vulnerable people in numerous countries, and on a number of levels (the health economy, food security, etc.). Combined with other factors, including conflicts, these consequences could lead to the collapse of certain countries like Yemen or Syria. In this context, helping local staff and partners to reinforce their response capacities, and helping to increase their share of direct funding in order to broaden their scope of action, are essential for the future.

[1] The DEC is a collective made up of 14 British humanitarian organisations: Action Against Hunger, Action Aid, Age International, British Red Cross, CAFOD, CARE, Christian Aid, Concern Worldwide, Islamic Relief, Oxfam, Plan International, Save The Children, Tearfund and World Vision. When a large-scale disaster affects countries that do not have the capacity to respond to the humanitarian needs that are created, the DEC raises funds in order to provide assistance rapidly and effectively.

[2] Commitment of the British government to provide £1 of public aid for every £1 donated to a UK Aid Match charity appeal by an individual living in the United Kingdom, up to £10 million.

[3] Excess mortality during the COVID-19 pandemic in Aden governorate, Yemen: a geospatial and statistical analysis, Koum-Besson et al., London School of Hygiene and Tropical Medicine, London, United Kingdom.