DRC: Ebola outbreak
Equateur province in DRC has been affected by an outbreak of the Ebola virus disease (EVD). The outbreak is believed to have begun in early April and was officially declared on 8 May. Since 3 May, 39 suspected cases have been reported, two of which have been laboratory confirmed. The full scale of the outbreak is still being determined as poor infrastructure and the remote location constrain response to the outbreak.
DRC: Ebola outbreak in Nord Kivu
On 1 August, a new Ebola Virus outbreak was declared in Mabalako health zone, Beni territory, Nord Kivu, when four samples collected from patients suffering from an ‘unknown disease’ tested positive for the virus. So far, 33 cases including 20 deaths (CFR: 60.6%) have been reported, though the latest official press release states 26 cases and 20 deaths as of 28 July. The declaration of this outbreak followed detection of a significant cluster of suspected viral haemorrhagic fever in July in Nord Kivu. Investigations found that sporadic deaths in May in the affected communities may have been related. A strike affecting the health sector in Nord Kivu is one factor why the detection and response to the virus has been impeded.
Ebola en Afrique de l'Ouest. Guinée : réticence face à la réponse humanitaire contre Ebola
Au 19 avril, 3 151 cas confirmés d'Ebola avaient été signalés en Guinée, et 2 358 personnes avaient succombé à la maladie (OMS, 20/04/2015). Une certaine réticence visà-vis la réponse humanitaire contre Ebola a été constatée. Des incidents violents ont éclaté dans certaines régions, ce qui a entravé l'acheminement de l'aide et l'accès du personnel humanitaire aux communautés. Des agents humanitaires ont parfois été contraints d'interrompre leurs activités à cause de problèmes d'insécurité. Des cas de réticence ont également été recensés au Libéria et en Sierra Leone, mais c'est en Guinée que l'opposition était la plus forte et la plus virulente.
Un ensemble complexe de facteurs sous-jacents a été identifié. Un certain nombre de facteurs, qui existaient déjà avant la flambée de l'épidémie, ont été aggravés. D'autres facteurs sont apparus en raison de la nature de l'épidémie et suite aux interventions mises en œuvre. Le présent rapport vise à analyser le niveau de réticence de la population à l'égard de la réponse humanitaire contre Ebola en Guinée en dressant un bilan de la situation actuelle et future en fonction de l'évolution de l'épidémie, et en étudiant les facteurs sous-jacents et aggravants.
Ebola in West Africa. Guinea: Resistance to the Ebola Response
As of 19 April, the Ebola outbreak has infected 3,151 people in Guinea, 2,358 have died (WHO, 20/04/2015). The epidemic has been characterised by incidents of resistance to the response. In several areas these incidents have been violent and this has impacted humanitarian access to certain communities. At times humanitarian actors have had to temporarily suspend their activities because of insecurity. Liberia and Sierra Leone have also reported resistance, but it has been much more frequent and violent in Guinea.
There is a complex network of underlying causes. Some were factors dating from before the outbreak, which have been exacerbated during the epidemic. Others are factors at play specifically because of the nature of the outbreak and the response. This report aims to analyse the resistance to the Ebola response in Guinea, by outlining the current situation and the evolution over the course of the outbreak, and exploring underlying and aggravating factors.
Uganda: Anticipation of the Ebola Virus Disease
As of 18 August, 91 cases of Ebola and 50 deaths (CFR 54.9%) have been reported in Ituri and Nord Kivu provinces of DRC. Conflict and insecurity in both areas are aggravating the crisis and increasing the risk the disease will spread further. Conflict is hampering humanitarian access of health workers to the local population, as well as driving displacement across the border to Uganda. Around 99,400 refugees from DRC have arrived in Uganda since January 2018, and the number of new refugees in Uganda from the two Ebola-affected provinces rose in July to 250 a day from 170 a day. The Ebola outbreak itself is also a cause for cross-border migration, as people try to leave the affected areas.
Ebola in West Africa: Impact on Health Systems
The reported cumulative number of Ebola cases across Guinea, Liberia and Sierra Leone is 23,694, including 9,589 deaths as of 22 February, making it the largest EVD outbreak ever recorded. Incidence has been stabilising in all three countries since January 2015, and the response is moving towards early recovery.
The large number of Ebola virus disease (EVD) cases has overwhelmed the weak and under-resourced health systems in the three most affected countries. Scarce resources have been diverted to the Ebola response, and health facilities have been temporarily closed or reduced operations.
The lack of monitoring and surveillance for diseases other than Ebola has led to big gaps in information. Little information is available on other health problems, including potential disease outbreaks, access to treatment for HIV/AIDS or tuberculosis, the burden of malaria, and access to maternal health services, immunisations and medication.
Fear of contracting EVD and mistrust of the health system has made people reluctant to seek treatment from health facilities, further impacting the health sector and increasing the risk of mortality and morbidity from otherwise treatable diseases.
Liberia: Re-emergence of Ebola
On 20 November, a new Ebola virus disease case was confirmed in Monrovia, capital of Liberia. The latest case, depending on sources either a 10-year or 15-year-old boy, who lives in the eastern Paynesville district of the city, was admitted to a treatment centre in the outskirts of Monrovia on 19 November. Two direct family members tested positive as well on 20 November. As of 20 November, at least four other people, of whom two relatives, had been admitted to the Ebola treatment centre (ETC). At least 153 contacts have been identified and are being monitored. Food and water were delivered on 21 November to high risk contacts.
The boy was at school, the Living in Christ International Ministry School, and appears to have shown symptoms before being admitted to hospital, according to health officials. At least seven healthcare workers may have treated him without the protective equipment essential for Ebola cases (New York Times, 21/11/2015). According to media sources, the child’s family and school will be put into quarantine.
These are the first new Ebola cases in Liberia, since the country was declared free from the disease a second time on 3 September 2015.
Ebola in West Africa: Protection and Security
UN and national officials are warning of the serious threat Ebola is posing to the safety of the countries. In a statement to the UN Security Council on 9 September, the Liberia’s Defence Minister warned its national existence was "seriously threatened" by the Ebola virus.
The Governments’ poor management of the epidemic has generated deep frustration among the three countries’ societies, and the security situation, particularly in Liberia, is gradually deteriorating. The Ebola crisis has exposed citizens’ lack of trust in their governments and exacerbated social tensions, increasing the possibility of profound unrest in these fragile countries. The lack of a prompt, robust, and efficient response from the international community contributes to the mistrust.
Children and women have been deeply affected by the EVD outbreak. Children related to people with EVD have been abandoned. Children are extremely vulnerable and in critical situations in the three most-affected countries due to the loss of a parent.
Ebola in West Africa: Impact on health
As of 21 September, the estimated cumulative number of confirmed Ebola virus disease (EVD) cases reported by WHO in the three most affected countries (Guinea, Liberia, and Sierra Leone) is 6,242, including 2,909 deaths. The ‘hidden caseload’, however, is unprecedentedly large, and these figures are believed to include only a fraction of all cases in this rapidly spreading epidemic.
According to a WHO projection, the aggregate caseload of EVD could exceed 20,000 by early November. Other agencies project the possibility of more than ten times as many cases, use different assumptions such as transmission to other countries, and evolution of the virus towards easier transmission between people.
The humanitarian community is already overwhelmed with the management of the epidemic and is greatly challenged in facing all the implications of this unprecedented and complex regional crisis. The current outbreak in West Africa is by far the largest ever recorded, and already numbers more cases than all past Ebola epidemics combined. 26 million people are estimated to live in the three most-affected countries. The epidemic started in Guinea in December 2013 but was only identified in March, and spread to Liberia, Sierra Leone, Senegal and Nigeria.
Ebola in West Africa Potential Impact on Food Security
Around 22 million people are estimated to live in the three countries most affected by the Ebola epidemic, Guinea, Liberia, and Sierra Leone. As of 3-4 November, the estimated cumulative number of confirmed Ebola virus disease (EVD) cases reported by WHO in the three most affected countries is 13,241 including 4,950 deaths. However, the numbers of registered cases and deaths seem to underestimate the real magnitude of the outbreak.
If not addressed in the coming weeks, the consequences of the outbreak will lead to long-lasting impacts on farmers' food livelihoods and household economies, resulting in a major food security crisis by March 2015. The most affected areas within each country are also the most agriculturally productive. Reduced food trade and rising prices, as well as expected reductions in domestic harvests, are all undermining a fragile food security situation.
Control measures implemented to contain the outbreak, such as border closures, quarantine, movement restrictions, curfews, have curtailed the movement and availability of food, goods, and services in the region, leading to panic buying, food shortages and increased basic food and commodity prices. Higher food prices and the loss of purchasing power mean an increasing number of vulnerable households are resorting to negative coping strategies in order to access food.
Food insecurity and lack of access to markets have been increasing community tensions. Lack of food in quarantined areas has led to violence.
A multidimensional and multi-sector approach is required to contain the outbreak and stabilise affected areas while safeguarding against a long-term food security crisis.
Ebola: Sierra Leone Multi-sector Needs Assessment Report
The number of new Ebola infections in Sierra Leone is declining, despite the outbreak continuing to claim lives. New cases have dropped to around 9-12 per week, according to recent WHO figures. There were over 500 cases per week at the height of the crisis around late November 2014.
The impact on the lives of the thousands of people directly affected by the disease has been devastating. It has caused substantial suffering to many others, leaving the population very vulnerable.
No recent assessment has evaluated and compared the status of populations in areas with high, medium and low exposure to Ebola. In this report, we refer to low, medium or high exposure areas based on the proportion of Ebola cases up to January 2015, compared to the 2014 population projections for those areas. Low Ebola exposure areas are districts in which the proportion of EVD cases compared to the population is between 0.01% and 0.10%. Medium Ebola exposure districts are defined as districts in which the proportion ranges from 0.11% to 0.20%. High exposure districts are districts in which the proportion of EVD cases is between 0.21% and 0.52%.
The Ebola Needs Analysis Project (ENAP) assessment was designed as a probability sample survey, conducted with 188 KIs from 59 chiefdoms and wards. The aim was to analyse the impact of the Ebola crisis from a multi-sectoral perspective.
Ebola in West Africa: Mapping of Assessments and Identification of Gaps - Sierra Leone and Liberia
A multitude of needs assessments have been conducted to capture impacts of the Ebola outbreak on affected communities, since March 2014. This paper reviews all of the assessments on Liberia and Sierra Leone made available to the Ebola Needs Analysis Project (ENAP), between December 2014 and 20 March 2015. Several assessments have been conducted at a regional level. This report focuses only on those conducted on a national level or lower, to allow for disaggregation of results. The review aims to inform the humanitarian response and future assessments, by identifying what information exists and where information gaps remain.
WASH in Guinea, Liberia, and Sierra Leone: The Impact of Ebola
There have been 26,339 cumulative Ebola cases as of 4 May 2015, with 10,895 deaths. However, the outbreak shows signs of subsiding. At the end of April, Guinea reported under 30 cases a week, Sierra Leone under 20, and Liberia declared the outbreak over on 9 May 2015. The crisis has highlighted the weaknesses of existing infrastructure and institutions, which have not been able to respond to the additional strain. Many, like the health system, have been weakened further.
The Ebola outbreak appears to have had a limited short-term impact on the WASH sector. Delivery of WASH services in Sierra Leone and Liberia were, for example, far more affected by civil war during the 1990s and 2000s. Despite WASH being addressed by the Ebola response , it necessarily remained secondary to the health sector. Assessments have been planned to scrutinise the impact of Ebola as a whole, at least in Liberia, but there are almost none completed to date. This, coupled with the limitations of available information, has led to a sporadic and an incomplete picture of the exact impact of Ebola on the WASH sector in all three countries.
Yet its impact must not be ignored. Pervasive unhygienic conditions and use of unsafe water have been identified as a key underlying factor in thousands of deaths prior and during the Ebola outbreak. In the medium to long-term, lack of development in the WASH sector is a constant burden to the three countries’ recovery and development. Addressing WASH development offers the opportunity to greatly increase the quality of life. In Liberia it has been estimated that improvements to the water supply could reduce diarrhoea morbidity by 21%, while improved sanitation facilities could reduce diarrhoea morbidity by 37.5%.
This document summarises the baseline data on WASH available for each country. It then provides an overview and analysis of the known and probable impacts of the Ebola outbreak on the WASH sector at both the community and facility level. Relevant aggravating factors not linked to Ebola are described, and WASH-related areas that present a possible risk to the people of Liberia, Sierra Leone, and Guinea are highlighted. Information gaps and lessons learned are outlined at the end.
Ebola Outbreak in West Africa: Lessons Learned from Assessments in Sierra Leone and Liberia
In the complex environment of an epidemic, capacity to identify humanitarian needs is essential to inform and guide operations. Such capacity was challenged in the three countries most affected by the Ebola crisis, due mainly to problems of access and fear of the disease.
This report gathers lessons identified from assessments of the humanitarian situation in West Africa during the later stages of the Ebola crisis, between November 2014 and April 2015. It is based on conversations with individuals from different organisations who conducted assessments, as well as on ACAPS experiences of assessments conducted in Sierra Leone and Liberia during the Ebola Needs Analysis Project (ENAP).
The document provides a starting-point for organisations planning an assessment in this Ebola outbreak or in similar future situations. More general lessons, which have been covered in other publications, are repeated here because experience has indicated they need reinforcing. When considering these lessons, it is important to keep in mind that Liberia and Sierra Leone are developing countries whose public health systems were already weak pre-crisis.
Ebola Outbreak in West Africa: Challenges to the Reintegration of Affected Groups into Communities
Reintegrating those most affected by Ebola back into their communities is central to a country’s post-Ebola recovery. The reintegration process helps those affected to cope with the impact of the outbreak and to regain a sense of normality. It is also an essential part of increasing community preparedness and building resilience to possible future emergencies such as a new epidemic or a natural disaster.
Out of approximately 28,500 suspected, probable and confirmed cases, nearly 11,300 people have died since December 2013. With such a significant caseload, everyone living in Sierra Leone, Guinea and Liberia was affected by the Ebola outbreak in some way. Ebola survivors and their households, grieving families, orphans, quarantined people and frontline workers are among the most affected groups. This report outlines the key challenges these groups face as they reintegrate into their communities, and explores the main challenges for the response in supporting them through the process.
Ebola Outbreak, Sierra Leone: Communication: Challenges and good practices
After the Ebola outbreak was declared in Sierra Leone, in June 2014, early messages about the high mortality rate of Ebola were met with fear and denial by many communities (BBC, 14/06/2015). At the peak of the outbreak, the government’s order to place more than one million people under quarantine further damaged trust between affected communities and responders (ACAPS, 10/2015) As the outbreak spread, it was important to find appropriate ways to tell people how to minimise the risk of catching the disease and what to do if it affected them and their families. The way messages were developed and disseminated evolved with the epidemic. In Sierra Leone cases spread silently until May 2014, then uncontrollably until November 2014, before slowly getting down to zero in November 2015. Now that the country has been declared Ebola free, communication remains a key aspect of community mobilisation efforts to address remaining Ebola-related issues, such as survivor stigma and complacency towards prevention measures. This is the second of two reports that ACAPS is producing with the aim of identifying lessons learned and good practice in community-led communication processes. This report focuses on Sierra Leone and the first covers Liberia. The grey boxes indicate content that relates to communication in emergencies in general and is common to both reports.
Ebola en Afrique de l'Ouest: Impact sur les systèmes de santé
Le nombre cumulé de cas d'Ebola signalés en Guinée, au Libéria et en Sierra Leone est de 23 694. Au 22 février, 9 589 personnes avaient succombé à la maladie. Il s'agit donc de la plus grande flambée d'Ebola de l'histoire. Depuis janvier 2015, le taux d'incidence de la maladie s'est stabilisé dans les trois pays et les opérations devraient progressivement céder la place aux activités de relèvement.
Le grand nombre de cas d’Ebola a ébranlé les systèmes de santé fragilisés et défaillants des trois pays les plus touchés. Les ressources (humaines et financières) limitées ont été redirigées vers les programmes de lutte contre Ebola et les établissements de santé ont soit fermé leurs portes pour une durée indéterminée, soit réduit leurs activités.
La défaillance des systèmes de suivi et de surveillance des maladies autres qu'Ebola ont entraîné d'importantes lacunes en matière d'information. Peu de données sont disponibles en ce qui concerne les autres problèmes de santé, y compris les flambées potentielles de maladies, l'accès au traitement contre le VIH/sida ou la tuberculose, l'incidence du paludisme et l'accès aux services de santé maternelle, aux campagnes d'immunisation et aux médicaments.
De nombreuses personnes hésitent à se faire soigner dans les établissements de santé de peur d'être contaminées et en raison d'une certaine méfiance à l'égard du système de santé, ce qui entraîne d'autres répercussions sur le secteur de la santé et risque d'augmenter les taux de mortalité et de morbidité liées à des maladies pourtant guérissables.
Liberia. Multi-Sector Assessment: Ebola Needs Analysis Project
At the beginning of April 2015, ACAPS conducted a phone based, multi-sectoral assessment of KIs in all 15 counties of Liberia. The objective of the assessment was to identify the main problems faced by communities, and how their needs differ from the pre-Ebola situation. The assessment intends to inform the ongoing discussions on early recovery and strategic decision making on sustainable development.
Ebola Outbreak in West Africa 22 Months on: Key Issues for Recovery and Preparedness
Since the Ebola epidemic started it has killed at least 11,295 people, out of at least 28,295 reported confirmed, probable, and suspected cases. It began in Guinea in December 2013 and rapidly spread to neighbouring Sierra Leone and Liberia.
All three countries were highly vulnerable to external shocks before the crisis, and still are today, due to a combination of low socioeconomic indicators, high risks of natural hazards, and a history of poor governance and political violence. Chronic poverty and weaknesses in public services greatly contributed to the rapid spread of the Ebola epidemic, its scale and severity. The epidemic not only caused severe health issues, including high levels of psychological trauma among communities, it also further weakened health systems, and impacted food security and livelihoods.
As of 5 October 2015, the transmission of the virus has been confined to several small areas in Guinea and Sierra Leone; reported incidence has remained below 10 cases per week since the end of July this year. While surveillance and treatment efforts to stop the transmission and re-emergence of Ebola continue, the response is moving away from its emergency phase towards longer-term recovery and building a more resilient health system.
Beyond a Public Health Emergency: Potential Secondary Humanitarian Impacts of a Large-scale Ebola Outbreak
This report documents the secondary humanitarian problems and impacts of largescale Ebola outbreak on the different humanitarian sectors, to provide a non-exhaustive plan to help future responders. A large scale Ebola outbreak, in this document, refers to an epidemic with an unprecedented scale, geographical spread and duration.
At the beginning of the crisis, the international community perceived the outbreak as a purely public health emergency. The response was oriented towards the containment of the epidemic and treatment of the sick patients. The initial focus was on providing beds for patients and mobilising health practitioners. The livelihoods, education or protection needs of the affected communities, indirectly caused by the outbreak, were left unaddressed.
The secondary humanitarian problems and impacts of the epidemic were extensive, and threatened the lives and livelihoods of more than 22 million people in the three most affected countries, Guinea, Sierra Leone and Liberia. The disruption of public and private services created an “emergency within the emergency”. Humanitarian actors failed to activate their surge capacity, or set up emergency funding and coordination structures, as a result of this perception of the crisis. It took time for the humanitarian community to recognise the complexity of the crisis and respond to the secondary impacts on other sectors. One major lesson learned during this epidemic has been the need to broaden the scope of the humanitarian response during a large-scale Ebola outbreak.
Ebola Outbreak, Liberia: Communication: Challenges and good practices
After the Ebola outbreak was declared in Liberia in March 2014, early portrayal of Ebola as an incurable killer disease was met with intense mistrust, resistance and fear by many communities and early responders (The Guardian, 09/2014). As the outbreak spread, it was important to find appropriate ways to inform people how they could minimise the risk of catching the disease and what to do if it affected them and their families.
The way messages were developed and disseminated evolved with the epidemic. In Liberia the number of cases spread uncontrollably until September 2014, finally getting to zero in May 2015, before re-emerging twice on a very small scale. Communication remains a key aspect of community mobilisation efforts to address remaining Ebolarelated issues, such as survivor stigma and complacency towards prevention measures. This is the first of two reports that ACAPS is producing with the aim of identifying lessons learned and good practice in community-led communication processes. This report focuses on Liberia and the second covers Sierra Leone. The grey boxes indicate content that relates to communication in emergencies in general and is common to both reports. The report covers the changing behaviours of the affected population, the most effective channels for reaching communities, the most trusted actors for information delivery and the adaptation of messaging to the needs of affected populations. These insights suggest ways to better address communication needs in future outbreaks.
Ebola Outbreak in West Africa: Impact on Health Service Utilisation in Sierra Leone
Overall, visits to primary health facilities decreased by a third in June–December 2014 compared to the same period in 2013. Most districts show an initial drop at the onset of the Ebola outbreak in June, and a further decline as the epidemic reached its peak in November–December.
The decline in health service utilisation is not uniform across key health services. Malaria and diarrhoea services are the most affected. In December 2014 suspected malaria cases decreased by half compared to December 2013, and only 20% were receiving treatment. In the same period, treatment of diarrhoea decreased by about 60%.
By December 2014 only half of all pregnant women were receiving antenatal care and delivering in primary health facilities.
In September 2014 half of children under 12 months did not receive the recommended vaccinations, compared to about 70% coverage before the outbreak. Vaccination rates have remained low until the end of the year.
Key health service utilisation has been most affected in Kenema, Port Loko, and Kailahun districts.
Ebola Outbreak in West Africa 23 Months on: Sierra Leone University Students’ Views on the Crisis
As the response moves towards recovery and long-term development planning, the perceptions of the younger generation on the crisis highlight their priorities for the future. Like the focus group discussion, the report covers three main themes: the main impacts of Ebola on student life (negative and positive), current concerns, and recommendations for recovery and development plans.
Latina America and Caribbean: Zika Virus Epidemic
The Zika virus epidemic in Latin America and the Caribbean is most affecting Brazil, with over one million cases estimated. Colombia reports over 18,000 confirmed and 2,000 suspected cases and anticipates over 650,000. El Salvador reports over 6,000 suspected cases. Venezuela reports over 4,500 confirmed cases, however unofficial estimates are thought to be as high as 400,000.
An alert to the first confirmed case of Zika virus in Brazil was issued in May 2015 by the Pan American Health Organization (PAHO). As of 1 February, Zika has been confirmed in 23 countries in South and Central America and the Caribbean. The spread of the disease is likely to continue as the vector species, the Aedes mosquito, is widely distributed in the region.
On 1 February 2016 the World Health Organization (WHO) declared Zika a public health emergency, following a significant increase in the number of reported cases since the start of the year. The last time WHO declared a global health emergency was during the Ebola outbreak. The current Zika outbreak is unlikely to present a crisis of the same scale; the declaration has been issued to fast-track aid and further research, particularly due to a potential link with neurological disorders and congenital birth defects.
Sierra Leone: COVID-19 outbreak
Sierra Leone reported its first two confirmed case of COVID-19 on 30 March and 02 April. Sierra Leone was one of the last West African countries having no confirmed cases although it was one of the only countries in Africa having COVID-19 testing prior to the global outbreak. Three new testing sites have recently been set up and can undertake up to 40 tests a day with capacity to install a 130 bed isolation unit; China has also donated additional tests, respirators, and PPE. It is unclear if this capacity is concentrated in Freetown or is across the country.
The country is likely to face challenges if the virus is not contained and there is a large outbreak, especially in its capital and biggest city, Freetown. In 2015 the greater Freetown area was the country’s Ebola epicentre, seeing high caseloads and a lack of coping capacity. Current plans are informed by lessons learned, although the infrastructural and economic conditions of much of the city’s inhabitants are challenging and may hamper COVID-19 prevention efforts.
Written by Lars Peter Nissen, ACAPS Director
The world’s first Humanitarian Summit is only a few days away and we are all finalising statements and commitments. There are very divergent opinions on what can be achieved in Istanbul, and a few key actors have chosen to stay away, but most of us are going, oscillating between careful optimism and predictable pessimism.
The discussion on how to improve needs assessments has been high on the humanitarian policy agenda for the past 5-6 years, and some progress has been made. The issue has also been a key element in discussions leading up to the summit. Needs assessment was one of ten issues addressed in the so-called “Grand Bargain”, where donors, agencies and some NGO representatives together have aimed to tackle some of the most difficult issues facing the sector. The grand bargain has been quite an exclusive discussion, with only the heaviest players in the room, and the discussion on needs assessment has been characterised by stark disagreement. It has therefore been fascinating to follow the proceedings from ringside.
On the surface, it can be hard to find the root of the disagreement, among the many different opinions and confusion with respect to language, etc. ACAPS position can be found in this short document, where we outline our vision for the “assessment ecosystem”.
At the core of the discussion lies a fundamental disagreement over whether assessment and analysis are best done through a centralised or a distributed process. Compare the first commitment from the Grand Bargain, with the recommendation from a recent report from the International Development Committee (IDC) of the UK’s House of Commons.
“Aid organisations and donors commit to: Provide a single, comprehensive, cross-sectoral, methodologically sound and impartial overall assessment of needs for each crisis to inform strategic decisions on how to respond and fund thereby reducing the number of assessments and appeals produced by individual organisations.” Grand Bargain
“The global humanitarian system displays a worrying lack of separation of powers between those assessing needs and those appealing for funds. DFID should propose the establishment of an independent body to be responsible for conducting needs assessments in crises. DFID should work with like-minded donors in the build up to and at the Summit to ensure this fundamental problem is addressed.” UK House of Commons International Development Committee
These two visions are not compatible. The Grand Bargain emphasises that we need to pull everybody closer together to be more effective and reduce the number of assessments. The IDC makes the opposite point, and argues that forcing everybody to work off the same assessment creates problem in with lack of checks and balances.
Having worked with the subject matter for the past six years my opinion is very clear: it is naïve and arrogant to pretend that the humanitarian sector is the only sector in the world that will not benefit from stronger checks and balances. I have seen numerous examples of assessments distorted by groupthink (how well did we assess Ebola?) and more or less sinister agency bias. These have made us make the wrong decisions and have moved us away from a needs-based assessment. As a sector with scarce resources we cannot afford this.
Most important, this is not a technical problem, but a political problem. As such, it can only be addressed by constructing a system where a biased assessment is confronted with an alternative narrative, not by coming up with a new assessment methodology.
The Grand Bargain does have good and constructive elements. However, with respect to assessments, it is depressing to see that negotiations among the most important and powerful leaders in the humanitarian sector have yielded a result, which will not move us forward, and will most probably will move us backward.
Paradoxically, the Grand Bargain’s take on assessment is itself the best argument in favour of second opinions in the humanitarian sector, second opinions that will hold us to account and get the right solutions on the table.
On 11 March 2020, WHO declared the COVID-19 outbreak as a pandemic, after the number of cases surpassed 100,000 outside China and rapidly spread throughout the globe.
By then, “Of the 118,000 cases reported globally in 114 countries, more than 90 percent of cases are in just four countries, and two of those – China and the Republic of Korea - have significantly declining epidemics. 81 countries have not reported any cases, and 57 countries have reported 10 cases or less”, WHO Director-General, Tedros Adhanom, stated.
The situation has quickly evolved, more cases have been identified in the rest of the world (about 160 countries) than in China as of 18 March.
The role of ACAPS
The COVID-19 pandemic is infecting and causing illness in a rapidly expanding proportion of countries and populations. Previous epidemics have shown that collateral impacts on people, livelihoods and overall wellbeing go beyond the infection itself.
The disease specific impact and response will be well monitored by public health authorities, WHO and other specialist organizations, but the secondary effects, which will be multi-sectoral, are often unrecognized and thus unmitigated.
ACAPS will focus predominantly on the immediate, short and medium-term secondary effects of the COVID-19 pandemic. Our view will to produce global analysis, providing a broad overview of the situation overall, as well as context specific analysis, with a narrower focus on regions, countries and crisis hot spots.
We see a critical role for monitoring these effects and making a holistic view of the situation available.
We see a critical role for monitoring these effects and making a holistic view of the situation available.
Looking beyond the mortality and morbidity caused directly by COVID -19 in the short term, the key areas we envision our analysis to include a focus on:
- Impact on essential health services
- Impact on access and availability of regular goods and services
- Humanitarian operations
- Social cohesion and protection
In line with ACAPS’ established methodology, three different approaches will be employed:
- Global comparable datasets will be produced through expert judgement and secondary data review (SDR). This will involve continual scanning of a broad range sources
- Deep dives into specific contexts, crises and themes will be developed using Contextual a mixed methods approach (including field level primary data collection where appropriate)
- Forward-looking scenarios and risk reports will provide perspectives on global and crisis-level risks and possible futures. These products will be based on ACAPS scenario building approach.
All tools and methodology will be specifically adapted to the COVID-19 pandemic.
We are inherently collaborative in nature, our data comes from a broad range of sources and partners to contribute to the most holistic and inclusive picture of impact and needs, and we look for partnerships to augment our capacity and to bring new information and voices into the analytical process and products.
We welcome reactions to this work, let us know what you think and please get in touch with us if you are interested in collaborating or have information you would like us to include via firstname.lastname@example.org
This project is in collaboration with
And in close coordination with WHO and OCHA.
Rohingya response: Health behaviours & COVID-19
The 855,000 Rohingya Refugees currently residing in 34 makeshift camps in Cox’s Bazar, Bangladesh are highly vulnerable to COVID-19. Lessons learned from previous epidemic responses, such as the response to Ebola across affected African countries, highlight the critical role perceptions have on health seeking behaviour, trust in humanitarian responders and the willingness of affected communities to comply with public health measures.
Among the Rohingya refugees in Bangladesh, distrust and lack of confidence in the medical system of the response is widespread. The implications of this on the effectiveness of any COVID-19 response cannot be overstated or ignored. The perception that the Rohingya have of the health system in the camps is their reality and is highly informed by their culture, history, and their understanding of sickness and health. Therefore, if the perceptions and opinions of Rohingya on healthcare are not taken properly into account and if community awareness and engagement are not prioritized as a key pillar of the COVID-19 response, lessons indicate that the capacity of response actors to control the outbreak will be severely hindered.
The purpose of this thematic report on health behaviours is to support humanitarian responders in understanding the current perceptions of healthcare, the impact of these perceptions on health seeking behaviour and the direct implications these perceptions and behaviours have on the ability to respond to, and control, a COVID-19 outbreak in the Rohingya refugee camps.