The Double Emergency: When COVID-19 impacts a humanitarian crisis

Season 2, episode 5

The Double Emergency: When COVID-19 impacts a humanitarian crisis

Nearly a quarter of the world’s children live in conflict or disaster-stricken countries. COVID-19 has been an added blow to their already uncertain futures. Travel with us to Yemen to learn about the double burden that COVID-19 has placed on the world’s worst humanitarian crisis. Then to the Pacific Islands, to find out what happens when a cyclone strikes during the pandemic.

Producer: Priyadarshini Mitra

Sound Mix: Chandra Bulucon

Episode Transcript: 

[00:00:05.02] The sounds you just heard bring hope-- the sound of chartered planes delivering supplies that can save lives. Despite pandemic related restrictions, these planes have still managed to transport UNICEF-supported provisions of personal protective equipment for frontline health workers, medical supplies, vaccines, and nutrition items to 109 countries as they respond to COVID-19. For the hundreds of millions of children living in some of the world's most fragile places, COVID-19 has been an added blow to their already uncertain futures.

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[00:00:50.97] Since the arrival of the coronavirus, there is hardly anyone in the streets. There are days when we don't eat anything, and we often have to go to bed hungry.

[00:01:02.97] 13-year-old Isaac lives on the street in Kinshasa in the Democratic Republic of the Congo. His life was difficult even before the pandemic, and life after could be even tougher. Nearly a quarter of the world's children live in conflict or disaster-stricken countries. So even before the coronavirus upended lives around the world, they were already struggling with basics, like food, water, limited access to essential services, like education and health care. For them, COVID-19 was a double emergency. On today's episode, we travel to some of these double emergencies to find out how the direct impact of the deadly coronavirus disease is compounded in places with pre-existing vulnerabilities. I'm David Morley-- president and CEO of UNICEF Canada and the host of the For Every Child podcast.

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[00:02:15.63] Though the situation in Canada continues to improve, it, along with the US and countries in Europe face shortages of ventilators, intensive care units, and protective equipment. The first wave of COVID-19 placed a tremendous strain on health care systems in many developed countries, killing hundreds of thousands of people in just a few months. As of today, in developing nations, like Brazil and India, the virus is wreaking havoc, but a country like Yemen was already the world's worst humanitarian crisis well before the pandemic.

[00:02:55.08] Since conflict in Yemen escalated into a brutal Civil War in March, 2015, the country has become a living hell for children, with nearly every child in Yemen in need of humanitarian assistance. The health system has been on the brink of collapse with many families finding it difficult to access the health care they need just to survive. There's severe food insecurity and hunger. There's an economic crisis, and vulnerable communities are grappling with outbreaks of dengue, acute diarrhea, and cholera. Now, add COVID-19 to that. I'm joined by UNICEF representative in Yemen, Sarah [INAUDIBLE]. Sarah, in a recent report on Yemen, you said that countless childhoods have been lost in this five-year war, and that we may lose many more as COVID-19 spreads. Why are the lives of children in such danger in Yemen?

[00:04:02.11] So right now, we have over 12 million children in need of aid, and I was saying sometimes to the team that when I say that number, it seems like you keep repeating the same number over and over, and people aren't listening, or people get tired of listening. But there are literally each of your children in the millions. They're children with faces and names. They're children with dreams and aspirations. They're children who want to have the same opportunities like every other child. And these over 12 million children, about 1.7 million of them, have been forced to flee their homes, so they're living in camps.

[00:04:44.80] Prior to their movement, their displacement, they had very little access to services, and with their movement and their displacement and their rapid movement because of the bombardment, because of the airstrikes, because of the conflict, these children don't have a place to call home. I was speaking to one of them not too long ago, and she was telling me, we fled Hodeidah, and we're in Sana'a, but it looks like we have to flee here as well. And she said, we're fleeing, but we don't know where we're fleeing to. And that's powerful in terms of not even knowing where your family is going to be running the next day. It's powerful for us as adults who need to understand what children are facing, but it's sad, and it's horrific for the children who are in that situation.

[00:05:30.57] When the conflict started at the beginning of the crisis, there was first the food crisis, where almost 60 million people were in need of food. That food crisis never went away. And then we had the cholera catastrophe-- that's what I call it-- where cholera hit the country, a country that remains endemic. So the food crisis started. Never went away. The cholera catastrophe never went away, and then we have the COVID-19 scare. And five years on, the conflict has been there. It seems there's no peace in sight, and meanwhile, these children they're depending on us, and these children don't have any space or platform upon which they can stand and advocate for their own rights or speak for themselves.

[00:06:10.94] And we might say, well, that's for children in many developing countries around the world, but I can see that the child in Yemen is in the worst place to be a child in the world right now, and that was prior to COVID. And so right now, the children in Yemen are in the worst situation we have in the world-- the largest humanitarian crisis. And children are facing bombing. They're facing blasts. They're facing bombardment, and if you're a child in Yemen, you don't want to wake up the next morning. And talk about wanting to remain under your covers-- some of them don't have covers, and some of them don't have beds, and that's what children are facing right now in Yemen.

[00:06:49.61] That's heartbreaking to hear. A lot of people must be wondering, how did we get here? Can you give us a little more detail about what these past five years of conflict has meant for children in Yemen?

[00:07:03.47] Over these five years that spans the conflict including this crisis and compound, complex issues that children have been facing, we first look at the issue of health-- lack of appropriate facilities, staff, and equipment in health. What we've been trying to do is look at preserving the health system from collapse because even up until now, no salaries are paid for civil servants, so health workers are not doing anything. In 2019, we can say that we started to give some small allowances, but still 10.2 million children don't have access to basic health care because of bombardment-- because of active front lines.

[00:07:41.78] So we have tens of thousands of children dying from preventable diseases every single year. Over the past five years, we've seen diphtheria and measles resurge in ways that are just inexplicable. Inexplicable from the standpoint of the fact that it didn't have to happen. If there hadn't been no conflict, and we haven't had this collapse of the health system, the near collapse of the health system, children wouldn't be in this situation. When we look at children under five, we have about 2 million children under five who are malnourished. In addition to that, almost 50% of the children are stunted, which means they are chronically malnourished, and they have damage to the cognitive development.

[00:08:23.37] So you're talking about half of Yemen's children under five, who will not reach their fullest development potential. You also have 1.2 million pregnant or breastfeeding mothers, who are acutely malnourished. So malnutrition spans across the adults, the children, and is linked to the absence of food. We have this emergency cash transfer program that reaches about 9 million people. Evidence that we have shows that the food is-- the money is used for food. If it's not used for food, then it's used for medicine. If it's not used for medicine, then repayment of debt, which has been linked to their listing on this emergency cash transfer beneficiary list, so they get a loan because they are beneficiaries of this emergency cash transfer.

[00:09:03.74] So when you look at the issue of malnutrition, and it's linked to directly the absence of food-- the food scarcity and the inability for families to put food on the table for children to eat. And then with COVID, we now have a reduction by almost 31% in terms of access to services for screening for malnutrition. So when you're looking at the 2015 to now, when we're looking at the five-year period we started out, Yemen was already a poor country. Yemen was already 158 rank in human development index. Now, it's 177. So it's dropping. It's spiraling downward so fast. It's plummeting so fast, and children are seriously at risk of death.

[00:09:41.56] We're warning now that even with the fact that children used to depend on food at school, school meals, to be able to help to boost their nutritional status, well, prior to COVID, we had 2 million children out of school. Now, with COVID, we have 7.8 million children out of school who don't have access to that one meal a day that they depended on. For many of them, that meal at school was their meal. Now, they don't have that, so they're not learning. And in addition to that, many of them don't have food to eat and let alone talk about nutritious food, if they can find it.

[00:10:16.63] So when you look at the Johns Hopkins University recent publication, they fear that almost 7,000 children under the age of five will die in the next six months just from preventable diseases, like diarrhea, malnutrition, and respiratory tract infections, and that further is compounded by COVID-19. That's not factoring in COVID-19. And that would then present a 28%-- almost 30%-- increase in child death. And for us as UNICEF, that's unforgivable if we don't do something about that. In terms of water, sanitation, and hygiene, right now, almost 10 million children do not have access to safe water, sanitation, or hygiene.

[00:10:55.96] In response to COVID, the primary message is wash your hands with soap. Wash your hands with soap. Don't touch your face, until you wash your hands. Wash your hands with soap. That's the message around the world-- wash, wash, wash. Well, in Yemen, that's a far off dream to wash your hands with soap because children don't have access to water and soap. 3/4 of households-- 75% of the households in Yemen cannot afford soap, and they have to make a choice between soap and a pack of noodles or something for the child to eat. They will choose the food.

[00:11:31.19] And if they don't have the water, what's the incentive for the soup anyway? That's the reality of a child in Yemen right now-- no water, no soap. So we're talking about a collapsing health system that we're trying to preserve. We're talking about wash and water systems that we're trying to preserve, and we're talking about access to it. The reality is that about 75% of the households in Yemen right now can hear all the messages in the world. They can listen to Facebook, and go to Google, and hear the community messages we're giving at the household level and so forth. It means nothing if they don't have the water and soap.

[00:12:10.06] And there's a lot we're doing about that, but there's more we need to do. And for the children, we are there to serve. It's really difficult to look them in the faces. And I had the opportunity to see some of them recently feeling that I was far removed from them with COVID, with the lockdown. We're able to connect many children by Zoom. And listening to them was heartbreaking. Many of them spoke about water. Many spoke about education. Many spoke about diseases, and several of them spoke about child labor and the fact that they confronted with so many challenges that they have to earn the keep for the family.

[00:12:49.73] So when you put all of that together, what does it spell? Disaster. It spells disaster. And all of these conditions in Yemen are ripe for a COVID wildfire-- complete COVID wildfire is what I called it. So beyond the bombs, the bullets, and the bombardment, children have no reason, no reason to hope. Poverty, poverty, poverty-- poverty pulls children out of school. Poverty pushes them into the conflict. Poverty pushes them into negative coping mechanisms. Poverty pushes them across the brink. And right now, we have more than 80% of Yemenis living below the poverty line-- huge, huge threat for abuse, trafficking, arrest, imprisonment.

[00:13:33.33] We have children who are facing sexual abuse. We have boys and girls. Cases have been reported of sexual abuse of children. We have a situation, where services that are required to address those needs are not readily accepted due to many factors in country. And primarily, we're fighting and struggling every day to make sure that these children can have access to those services, but it's just a vicious cycle. And until the war stops, it seems like that everything we do sometimes seems like it's just not enough, and it's not enough. Because every day, children are being born. Every single day, you have new children coming into the world, so every single day we have new needs.

[00:14:23.40] I can completely identify with that feeling of wanting to do more. Can you tell us a bit more about what role UNICEF has been playing in Yemen? We have a lot of programs in place, but particularly, I would like to speak to a few things that we're doing that I think are critically important and for you to be aware of. As it relates to the immediate situation of COVID, there are four things that I will call the four lines of effort right now, and it's the four S's. It's suppressing. It supplies. It's saving lives from COVID-19, and it's saving lives from other health or other health conditions.

[00:15:01.59] So in terms of suppressing, that's where we're focusing on what we call the risk communication and community engagement. We have over 20,000 foot soldiers across the country who are carrying out those messages. And hand-in-hand with that, wherever we can, wherever we have the resources, we're providing water and soap. And where we can, we're doing community shielding for high risk populations because as you know, the strategy for COVID-19 is those who have symptoms and those who are already seen as the most high risk, and the ones who are already seeming to be COVID positive are the ones who are tested, so testing is unavailable to everybody.

[00:15:38.39] We're also supporting supplies, masks, gowns, shields, gloves-- whatever we can provide in terms of PPE. The pieces of PPE that are required for health workers. PPE that's required for our own staff and frontline workers. We only have-- last I checked, we have less than 10% of the needs of supplies met, and that's looking holistically across the operation. That's not only UNICEF across the operation. We've brought in some special flights. We've brought in trucks across the border from Oman into the South of Yemen. We've had special flights into Sana'a and Aden. And with all that we're doing, chartering these flights and making sure we bring in supplies, it's not enough. And as I said, we're not the only ones bringing them in.

[00:16:22.00] In terms of saving lives from COVID, WHO leads on that, but we're also supporting that very heavily in terms of bringing in test kits to support the WHO effort. We're also supporting some of the hospitals, some of the staffing, and we're also training health workers, making sure that health workers understand how to protect themselves and how to prevent COVID. Then lastly, the last line of effort is the non-COVID health response, and that's where UNICEF plays a critical role in trying to preserve and carve that out-- making sure that we don't have COVID being managed in every single health facility because the system can't cope. The system can't manage it.

[00:16:58.74] And so really working hand-in-hand with WHO to make sure where we have a responsibility at the health facility level, we're maintaining over 4,000 health facilities across the country-- over 4,000. And although we've seen a drop in service access due to many factors, including the conflict-- but also because of fear as well. So although we've seen that drop, what we're doing is encouraging health workers to remain in the health facilities, encouraging families to continue going to the health facilities because you don't want because of your fear of COVID that you die from a disease that can be easily managed.

[00:17:33.80] The reality on the ground is that people are dying in numbers and being buried in numbers due to COVID. That's where UNICEF steps in because we're always the voice of the voiceless. People are dying of COVID. People are dying of COVID in the North, and we have to be the voice to talk about it because children are also dying because their parents are dying, and they can't meet the needs of the children every day. Those children are now confronted with a new reality. Child-headed households is something we're going to have to confront in weeks to come.

[00:18:00.54] So this continues to be compounded. In the South, we do have a situation where there is a declaration of cases. But even at that, we stand over 900 cases right now. We know that's nothing compared to what's actually in these communities had we the best testing capabilities in Yemen. Outside of COVID, there was an emergency before, and that's what we say-- COVID is an emergency within an emergency and an emergency within other emergencies.

[00:18:27.63] I mean, Yemen is just emergency plethora, and outside of COVID, we have to maintain. We have to continue making sure that children don't get cholera. They don't die from acute watery diarrhea or cholera. We have to make sure they don't die from dengue. We have to make sure that they get vaccinated for preventable diseases and find creative ways to do that in the midst of COVID.

[00:18:50.42] We have to make sure that even if children can't go to school right now, we have to find creative ways to deal with the Yemen context and make sure that we have some sort of plan in place to be able to help children learn something from a distance. That's actively happening right now. We continue to pay teachers incentives for teachers, knowing that if we don't keep those teachers, we haven't stopped the teachers incentives program. Because if we didn't pay those teachers, they won't be available for the next teaching time when school opens.

[00:19:19.28] So then been trying to maintain the systems as it were and making sure we prevent all of the systems from collapsing during this emergency period. It's extremely difficult. It's not easy dealing with multiple authorities, but we have fantastic partners on the ground. We have fantastic staff on the ground, who are trying to make sure that the five years of these children's lives doesn't mean the whole story. It's just going to be a chapter, and we have the opportunity to do that-- to make the five years of conflict only a chapter and not the full story of their lives. And then when they turn the page after the five years, the chapter also changes and the scene changes. The narrative changes. The plot changes. It all changes for them because we are that voice for them that have to make that change-- that have to help to make that change in their lives.

[00:20:07.21] That's such a beautiful way to put it, Sarah. These five years are just a chapter, not the entire story for the children in Yemen. Thank you, Sarah, for that message of hope. There's a young voice in Yemen who shares your optimism. Let's listen in.

[00:20:28.95] Hey, world. My name is Arija [INAUDIBLE]. This is my home, Sana'a, Yemen. It has suffered nearly five years of war-- almost a quarter of my life. The world is in a bad shape. Not only here where water is scarce but everywhere. Disasters are happening. The environment is damaged by waste and greed. People suffer. Disaster strikes. In Yemen, we know the good days don't last forever, but we now rely on solar powers-- water systems, health centers, and soon, schools run entirely by the sun. We don't rely on fuel. The sun provides us with the energy we need. Although the crisis here continues, we are rebuilding with an eye to a future, my future.

[00:21:12.96] Arija's future relies greatly on the generosity of donors, so it's important for each one of us not to forget the children of Yemen. You can go to unicef.ca/helpyemen to find out more. From a long-term humanitarian crisis like Yemen, let's move our focus to a very different kind of crisis-- a natural disaster. By their very nature, cyclones, hurricanes, and such sudden crises are unpredictable. They can strike any time and leave a slew of devastation in their path. And now, imagine one during COVID-19.

[00:21:55.80] With closed borders, restricted movement, and physical distancing rules, how does one take shelter, get protective equipment into the country, and get essential services back up and running? This is exactly what happened recently in the Pacific Islands as the category five cyclone, Harold, wreaked havoc in Vanuatu, Solomon Islands, Fiji, and Tonga. UNICEF Pacific representative, Sheldon Yett, joins us from Fiji. Sheldon, can you tell us a bit more about the impact the cyclone had?

[00:22:33.66] Yeah, I mean, this is a category five cyclone, which is the biggest cyclone you can have. Absolutely massive. So we had winds of 200 kilometers per hour, and winds of 200 kilometers per hour mean one thing if they hit a Western city, like Toronto or Montreal. Something else when they hit a village in the middle of the Pacific, where houses are often made with very flimsy architecture made out of corrugated iron, straw, and mud, so absolutely devastating. You look at pictures of it, and you just-- it's a great wasteland of devastated buildings of destruction. It's just astounding talking to people who've gone through it there. It's like having a freight train bearing down on you, hearing this noise, and hearing the horrible sound of buildings collapsing and the muffled cries of others-- a horrible, horrible sound.

[00:23:33.84] Yeah, I can't imagine. I remember it wasn't a cyclone, but I remember after the earthquake in Haiti that that's what people talked about. As night descended, they couldn't help. They wanted to be able to help, but they couldn't help, and all you could do was hear people. And then I guess, you've been having to deal with COVID-19 as well, and that must have given you a whole bunch of different challenges as well. Well, of course, COVID is a challenge no matter where you are. We've seen countries all around the world struggling to get this under control, and here in the Pacific, it's even a bigger threat because of the co-morbidity that all the other issues that make people sicker, that make people more at risk to having the-- experiencing the worst impact of this disease.

[00:24:29.04] The Pacific has very high rates of heart disease, very high rates of diabetes, very high rates of all the other issues that put people at risk. So it's a particular danger here. I think the other issue is that the quality of health care here is extremely limited. There are only a handful of doctors, a handful of nurses. Some countries have just one or two ICU area hospitals, where you can get the kind of dedicated support that is necessary. So it's tremendous risk here, and they have a category five cyclone on top of it. Makes it even worse.

[00:25:10.24] So what did it mean? Have you been able to do the social distancing and things that we're doing here in Canada? I mean, that-- did that have an impact on the way UNICEF was able to respond?

[00:25:27.63] The issue of social distancing is a critical one, so what do you do when a cyclone is bearing down on you? Normally, of course, you go into government shelters, and government shelters weren't designed with COVID in mind. No one had ever heard of COVID. So we talk to our friends in the Ministry of Health. We talk to the government, and government gave very clear instructions here. The first threat to people was the cyclone itself. You go get shelter. And secondly, you have to worry about social distancing. But first, save your life. Make sure you're not hit by the flying glass, the collapsing buildings.

[00:26:04.81] But then how do you get support? How do you get supplies to people? It's absolutely impossible. Of course, governments here, like governments elsewhere, are limiting movement. People don't want individuals to go from affected community A to community B that isn't affected yet. So there are tremendous restrictions on where people could go and on people coming in from other countries. As UNICEF, we want to provide support immediately. We want to get our best technicians, our best child protection officers, our water and sanitation officers, our education officers on the ground in the communities most affected. And we couldn't do this now. We couldn't do it because flights were canceled. Movement was restricted, so that made it even more difficult. And it made it more difficult because we couldn't move the supplies we wanted to move.

[00:26:57.15] So was there ways we could try to overcome it? I guess if in the best of times with these far flung islands, how do we get supplies out to the different countries that are all around there?

[00:27:13.02] Yeah, David, you've asked a very good question. I mean, I think it's important that listeners understand just how vast an area we're dealing with here. My office covers 15% of the surface of the Earth-- thousands and thousands of miles of open ocean. It's huge. And islands of pinpricks scattered out there-- very, very difficult to get supplies, to get people there when you need to get them there, and very expensive to do so. This made it even more difficult to do that. So a number of things that we've had to do-- one, we've had to make sure that communities had pre-positioned supplies.

[00:27:53.07] So we had-- I mean, we knew in advance that, of course, we're likely to see more cyclones. The Pacific is, I think, the part of the world that's most affected by natural disasters. You have-- when it comes to percentage of GDP, we've got 8 out of the 20 countries in the Pacific are most affected by disasters, so it has a huge, huge impact. So we knew we had to do this in advance. It's something we're used to dealing with. We had pre-positioned supplies. We've worked with local communities. We've worked with local NGOs to-- so they know what to do, and this made this even more important, given the circumstances.

[00:28:40.55] With so much of the economies at risk of devastation and how else-- I guess, pre-positioning supplies is one way that we're preparing for the next cyclone because I guess, we know there's going to be other cyclones. Are there other measures that we try to take to help these countries be ready for the next disaster?

[00:29:07.69] Yeah. Let me talk a little bit about pre-positioning supplies, though, because in some respects, if that's all we had to do. Well, we'd be done with it. We'd be fine. We could all pack our bags and go home, but that's not the case in a COVID environment. Because people are hearing reports and seeing things, sometimes correct and sometimes not correct in social media about the risk of supplies coming in from countries like China, countries like the United States, countries like Australia. All countries that have had a large number of cases. So governments are also worried about accepting supplies that are coming from highly affected countries. So we can bring supplies in, but we couldn't get them to the people who need them most.

[00:29:54.13] What we found is supplies ended up staying in capital cities because governments were worried about being criticized from their populations of bringing COVID-affected supplies that are going to make the population even worse off. So we had them sitting in the airport, then we had crews fully-dressed in PPE unloading the airplanes, and hosing down all the supplies, and waiting sometimes three days, four days a week, two weeks to get them out there. So what we did is that we worked with-- we chose best knowledge, and we tried to translate the protocols.

[00:30:35.83] And as you know, scientific protocols can be like reading a letter from your lawyer-- a little bit difficult to understand. You need to translate it into things that are actionable. So working with our ministry counterparts to make sure they could digest it, make sure they could pass it on to others. And that helped. It helped us get the supplies out faster, but I think we were a little naive to be very frank. We thought the science will speak for itself, but it doesn't. We hadn't fully taken account for the human emotion and how long it took to trickle down and to convince people that these items were safe.

[00:31:15.46] So we worked to show them that science made sure they understood what it actually meant, and then worked with communities to make sure they understood this as well. Once people were used and once people saw that they weren't getting sick from the plastic buckets, from the plastic tarpaulins, that helped, and it sped things on further. So that's really important. But we were interviewing children affected by TC Harold, and the testimony of a girl named Melanie really struck me. Melanie was 11 years old, and her family was directly affected by the cyclone.

[00:31:58.30] And her sister, who was four years old, hurt her arm, and poor Melanie couldn't help her sister. And listening to this girl talk about how she felt when her sister broke her arm, and she couldn't provide assistance-- she couldn't get her sister to the health clinic, and she didn't know what to do. And she worried that it could get infected. She worried that it could get worse. She heard her sister crying in pain and saw the arm swelling up each day. I just felt for this child.

[00:32:34.81] There is no hospital for her to go to. No way for her to get the help, and she knew that if you didn't get help for her sister, could get a lot worse. Thankfully, her sister was able to get help, and in the end, it's fine. But you know that pain that she felt as a child caring for a sibling is something that really affects you when you hear about that. It's one thing to see pictures. Something else to talk to a child who's been through that.

[00:33:04.81] Absolutely, Sheldon. It's something totally different, and a big thank you for being on our podcast but also just for all the work and the leadership that you do.

[00:33:18.94] And Thank you, David, and Thank you too UNICEF Canada for all the support you provide for children in the Pacific and children everywhere. Your listeners are key in providing the response and helping children meet their needs and the rights of children. Thank you very much.

[00:33:34.70] With that, we come to the end of our podcast. As we've heard from our guests, in the shadow of COVID-19, the futures of millions of children are being torn apart. Children in countries already suffering from conflict or disaster face potentially a deadlier foe. One can exact a devastating toll. But UNICEF is on the ground helping children tide through. For more than 70 years, UNICEF has been on the front lines of response protecting children against diseases.

[00:34:11.25] Our experience with infectious diseases, like the recent success in tackling the outbreak in conflict ridden Eastern Democratic Republic of the Congo, are valuable lessons. Lessons that help us in our current efforts against the COVID-19 pandemic. Children may be less susceptible to the coronavirus disease than adults, but the pandemic has upset their lives in unimaginable ways. We have to build back better for them. Millions of children's futures depend on the action we take today. We have no time to waste. You can visit us at unicef.ca to find out more about how you can play a part. Thank you for listening.

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