Communities across Africa urgently need additional medical professionals, technical assistance, and financial support as COVID-19 continues to spread in places with high rates of malnutrition and fragile health systems. However, nongovernmental organizations have withdrawn out of concern for the safety of their staff members, creating a life-threatening gap in support when and where it is needed most.
Many aid and development agencies are limiting staff travel to "mission-critical" to curb the spread of the novel coronavirus. For now, the changes aren't impacting lifesaving operations — but experts worry that could change.
The continent already faces the most severe shortage of health workers of any region in the world. A growing pandemic here could push already fragile health systems past the breaking point. While it is hard to generalize about this richly diverse region, there is one common thread in the contexts in which my teams at Action Against Hunger work: People are vulnerable. Even in the best of times, limited supplies and human resources mean we are only able to help the neediest people among the neediest among the neediest.
An East African coalition of humanitarian NGOs recently surveyed our members — including a few United Nations representatives — to learn more about how they are responding to the current situation. The results are not scientific, but they are telling.
In the face of COVID-19, 94.4% have postponed or canceled surge deployments of personnel due to concerns around lockdowns and well-being, according to findings revealed to a closed inter-humanitarian working group. Moreover, 66.7% have withdrawn staff from countries they serve — most frequently from South Sudan, Somalia, and others topping the U.N.’s list about concerns of a potential “hunger pandemic.”
Diminishing support on the ground underscores the need for more NGOs to build their staff from within and hire qualified workers who come from the communities they serve. This represents a shift in traditional approaches to development, and it can take time to build local capacity. Yet my experience in leading East African operations from a regional headquarters in Kenya suggests that the shift is not only possible, but it allows for knowledge-sharing and scale to better address local contexts.
Yet even for local teams, coronavirus-related lockdowns present a problem. Not all governments classify humanitarians as essential workers. Perhaps as a result, 77.8% of NGOs we surveyed are delaying their programs. Food security work is the area most impacted — a recipe for disaster for people living hand-to-mouth.
Alarmingly, more than half of our survey respondents already report humanitarian commodity pipeline challenges. While our survey is not conclusive, it echoes U.N. predictions that food insecurity in East Africa could double in the next three months.
Malnutrition and the coronavirus could prove a deadly combination. COVID-19 attacks the lungs; serious cases often lead to pneumonia. For undernourished children, the risk of mortality from pneumonia increases fifteenfold. Both COVID-19 and malnutrition are urgent health issues.
Before the pandemic, the people we serve were suffering from preventable illnesses. For the millions of children who do not live to see their fifth birthday, malnutrition is an underlying cause nearly half of the time. Other respiratory and communicable diseases have symptoms that appear quite similar to COVID-19, making diagnosis even more difficult. Out of understandable fear, some health clinics are now referring people with asthma and other issues to COVID-19 centers, increasing the risk of spread.
Particularly in Somalia and other places struggling with conflict and other stressors, few humanitarian agencies have medical expertise. The global community must channel support to those that do so they can scale up. Yet donors have told us that the best they can do is hold the line on previously planned contributions. This will not be enough to save lives in the face of COVID-19 and address the wave of hunger that the pandemic is bringing.
Some communities are trying to change that. In Uganda, a grassroots effort has raised millions of dollars, despite the economic strain that people there are experiencing. In East Africa, people need support to shoulder the burden of the pandemic along with the many other challenges they face. In the past 12 months, East Africa struggled with prolonged drought, then intense flooding and biblical swarms of locusts, which are currently threatening food supplies once again as the next wave hatches — in many places, just in time for what should be a plentiful harvest. Now, we're dealing with the pandemic.
The U.N. recently issued a $6.71 billion appeal to prevent COVID-19’s spread. While I applaud the effort, I am deeply concerned that it is not enough. The U.N. itself may agree: Its top humanitarian official, Mark Lowcock, projects that $90 billion or more is needed to deal with this pandemic.
So far, the international community has committed $1.4 billion, a fraction of Lowcock’s projection. The U.N.’s COVID-19 Global Humanitarian Response Plan is an important step, yet it is not enough. More funds are needed — now — to deal with COVID-19 and the related rise in hunger.
Prevention is much cheaper than treatment. It costs roughly $140 to educate a health worker and $15 for hygiene kits, while caring for a coronavirus patient costs $8,000 or more. We can deliver water for crops and hygiene to a whole community for $40,000. When hunger displaces an entire community, it costs much more, in both economic and human terms.
The humanitarian sector must expand its capacity to address this crisis. Together, we should:
Push donors to ensure that personal protective equipment is available to all front-line health staff. Otherwise, we cannot guarantee the safety of those workers or protect the communities we serve.
Expand cash-transfer programs. Families around the world have lost their livelihoods — in Kampala, Uganda, about half of the refugees recently surveyed by the World Food Programme reported that their household income had dropped by more than 75%. Remittances from relatives abroad, too, have declined. Cash transfers are one of the fastest, most flexible ways to provide emergency relief.
Improve coordination among humanitarian organizations — both local and international — and with governments. This is more important than ever to avoid duplication of efforts, to identify opportunities for collaboration and skill sharing, and to address gaps in programming.
Support and build up local health workforces. In Somalia, Action Against Hunger is providing training for and paying the salaries of Ministry of Health staffers. There are simply not enough doctors, nurses, and health workers to meet the population’s needs. We must encourage and empower a larger and stronger local health workforce.
Focus on community-based interventions. The pandemic has made people fear health centers — meaning fewer parents are taking their children for lifesaving nutrition and health care in time. When health workers and volunteers provide household visits and small group educational sessions in the community, we can reach those in need sooner and closer to home.
My team is working with the World Health Organization to assess preparedness and gaps across the region. Even before we have any answers, I can tell you that nobody is ready. Across East Africa, it seems there is always an emergency ahead. In places with fragile systems, where governments have the least capacity, humanitarian organizations are recalling their staffers at a time when we most need to scale up to avert an unthinkable human catastrophe.