Tag Archives: COVID-19

“We are all fragile, but we are not all equally fragile”: Humanitarian operations amidst the COVID-19 pandemic

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Illustration: Prachatai via Flickr

As the COVID-19 pandemic is spreading across the globe, its impact touches all corners of society. What happens when the pandemic reaches areas that were already dealing with various sorts of humanitarian challenges, and in what ways are humanitarian operations being impacted both directly and indirectly? In a time where the news are being flooded with information related to the pandemic and much of national authorities’ time and resources are being spent at mapping domestic repercussions, this post is an attempt to highlight some of the potential impacts COVID-19 can have or is already having on humanitarian operations around the world.

Responding to the pandemic and related repercussions has become a key priority for humanitarian actors, and humanitarian information hubs are now posting regular updates related to the pandemic response. The United Nations has launched a Global Humanitarian Response Plan for COVID-19, and SPHERE and its partners have developed a manual with guidance on how to apply humanitarian standards to the COVID-19 response. Reliefweb has established a page devoted to the COVID-19 pandemic, including an interactive map showcasing the pandemic in locations with a humanitarian response, appeals and response plans, manuals and guidelines, maps and infographics, reports by humanitarian actors and more. The Humanitarian Data Exchange (HDX) provides global COVID-19 epidemiological data.

While all areas of humanitarian operations may be critically affected by the pandemic and related mitigation efforts, four thematic areas have emerged in humanitarian circles as the most discussed so far: 1) Health infrastructure and health information; 2) Exacerbation of existing vulnerabilities; 3) Refugees and other migrants; and 4) Access and delivery of humanitarian aid.

Health infrastructure and health information

As the disease has brought some of the world’s most advanced and well resources health systems to their knees, many humanitarian practitioners have expressed concern for what will occur when the virus reaches countries with less developed health infrastructure. UN Secretary General Antonio Guterres has warned that developed countries must assist those less developed, or potentially “face the nightmare of the disease spreading like wildfire in the global South with millions of deaths and the prospect of the disease re-emerging where it was previously suppressed”. Coordinated global action is also the key message of the recently published UN report Shared responsibility, global solidarity: responding to the socio-economic impacts of COVID-19.

These concerns are not unfounded. For instance, the Central African Republic, a country with a population of almost five million people, only has three ventilators for the whole country. In Venezuela, now with 165 confirmed COVID-19 cases, hospitals were lacking basic resources and health personnel had been fleeing the country already before the arrival of the virus. Moreover, if a large number of people all fall ill at the same time, the efforts to take care of patients contracting the virus is likely to divert resources away from other lifesaving work, such as other health programmes. Senior Policy Fellow at the Center for Global Development Jeremy Konydyk gave a stark reminder that during the Ebola outbreak in West Africa, other diseases caused more deaths than what Ebola did.

Konydyk is not the only one to make comparisons to the Ebola outbreak. On a slightly more optimistic note, it has been pointed out that developing countries with recent experience in fighting epidemics such as Ebola are to some extent better prepared for handling COVID-19. For instance, existing Ebola screening systems have rapidly been converted to screen for coronavirus disease at airports and border crossings. Given many African countries’ recent experience with fighting epidemics, overall young populations and less frequent travel, Gunnar Bjune argues that a targeted response towards the most vulnerable populations would be more efficient and appropriate for the region.

Another important lesson from the Ebola epidemic is the importance of accurate and trusted public health communication to reduce misinformation and distrust amongst the public, as pointed out by Christopher Wilson and Maria Gabrielsen Jumbert in their 2018 article on communication technology in humanitarian and pandemic response. Providing accurate information and building trust in health officials will be a key issue also for combating COVID-19.

Exacerbation of existing vulnerabilities

As with all emergencies, the repercussions tend to be distributed unequally in society and exacerbate existing vulnerabilities. The COVID-19 pandemic and the measures taken to mitigate the spread of the disease are likely to follow the same pattern. Those without existing safety nets will be hit the hardest. In the words of Senior Editor at the New Humanitarian Ben Parker during a recent webinar: “we are all fragile, but we are not all equally fragile”. 

The world economy, which was already weak before the pandemic, is falling into recession. Reduced fiscal revenues will negatively impact welfare programmes, leaving the most vulnerable without access to essential services. While a plummeting global economy and international travel restrictions have severe impacts in their own rights, they may also create difficulties in obtaining imported goods like food and medical equipment. Trade-dependent countries will be particularly vulnerable. In a recently published report, the World Food Programme predicts that global food insecurity is likely to increase.

Vulnerabilities on the basis of gender are also likely to be exacerbated, in particular due to the mitigation strategies employed to fight the pandemic. As Margot Skarpeteig, Policy Director at the Norwegian Agency for Development Cooperation (NORAD), writes for Bistandsaktuelt, men are more likely to contract the disease, but the repercussions will hit women and girls the hardest. Based on lessons learned from the Ebola outbreak, Skarpeteig points out that lockdowns could lead to an increase in domestic violence, that closure of schools could result in an increase number of rapes and child marriages, and that rerouting of resources could lead to worse maternal care, all of which mainly impact women and girls. Several of these concerns are echoed in the COVID-19 Global Humanitarian Response Plan.

Other vulnerable groups who are likely to be severely affected include the urban poor, refugees and other migrants, and groups generally marginalized in terms of access to economic welfare and health services.

Refugees and other migrants

As the pandemic is also turning into a mobility crisis, refugees and other migrants are facing mutually reinforcing vulnerabilities, as they are often housed in crowded areas with limited health and sanitation facilities and now also experiencing enhanced immobility.

Many governments have imposed lockdowns and closed their borders to stop the virus from spreading. This has devastating impacts on many migrant workers, in particular those relying on daily wages, many of which do not have a social network to rely on. UN High Commissioner for Human Rights Michelle Bachelet and UN High Commissioner for Refugees Filippo Grandi call for refugees and other migrants – regardless of their formal status – to be an integral part of national systems and plans for tackling the virus, as many of them do not have access to basic health services.

Further, several frameworks put in place for refugees are now temporarily being removed. On 17 March, IOM and the UNHCR announced a temporary suspension of resettlement travel for refugees. In Uganda, authorities have put up a temporarily bar on arrivals of refugees and asylum seekers. Syrian refugees in the two main refugee camps in Jordan have been on lockdown since 21 March. In Greece, there have been major concerns for and calls for evacuation of camps with very limited health and sanitation facilities, and in early April the refugee camp in Ritsona was quarantined as 20 refugees tested positive for COVID-19.

Kristin Bergtora Sanvik and Adèle Garnier have called attention to how the pandemic is reshaping refugee and migration governance through ‘legal distancing’. Countries hastily adopt restrictive regulation on migration and asylum processes on the one hand, while simultaneously slowing down due process mechanisms. The results are further exclusion and marginalization of already vulnerable groups.

Delivery of humanitarian aid: Access and localisation

While humanitarian organizations are working hard to maintain their existing operations, most humanitarian work is affected by the pandemic and mitigation efforts in some shape or form. Through travel restrictions, imposed regulations, and withdrawal of staff, the pandemic is affecting the delivery of humanitarian aid in multiple countries, and the impacts are cascading as the disease reaches new corners of the world.

Amongst the effects on aid operations covered by The New Humanitarian over the past week are: aid access is blocked for ’unsanitary’ quarantine spots in Burundi; transport bans in Burkina Faso create access challenges for humanitarians; non-essential aid workers are being evacuated from the Democratic Republic of Congo creating limits on staff; border closures in Afghanistan threaten supply chains; and flight bans hamper aid delivery in Yemen. Imposed restrictions on gatherings and travel are hampering both delivery of humanitarian assistance and general access to vulnerable populations. On 25 March, the Norwegian Refugee Council (NRC) reported that they were unable to reach 300,000 people in the Middle East alone.

As large international organizations are struggling to reach people in need, the pandemic might turn out to have an unexpected effect on localisation. The so-called ‘localisation agenda’, and outcome of the World Humanitarian Summit 2016, vowed to increase funding to national and local partners, and involve them in decision-making and assistance in humanitarian response. Since 2016, the humanitarian system has been criticised for failing to support localisation (see for instance Sandvik and Dijkzeul’s blog post from 2019). The conditions caused by the pandemic, however, might change how international and local staff coordinate and operate. Similar to how many enterprises are being forced to speed up digitalization to keep in touch from various home offices, the restrictions on travel and limits on international staff might force international humanitarian actors to increasingly rely on local partners in delivery, coordination and management of humanitarian assistance, as well as enhancing communication structures between the local responders and international assistance providers.

Uncertain outcomes and long-term consequences

While the four themes mentioned here seem to be the most frequently discussed in humanitarian circles so far, the range of repercussions caused by the pandemic and mitigation efforts has yet to be seen.

It is highly likely that other issues may emerge as the situation develops, and the long-term consequences remain unknown. Technological measures applied to keep the pandemic at bay are amongst the issues that might cause severe and unintended long-term consequences (such as tracking mobile devises, drone surveillance, collecting biometric data etc.). Humanitarian data governance is not a new issue (see for instance Katja Lindskov Jacobsen and Larissa Fast’s 2019 article for Disasters), as it often deals with sensitive data from vulnerable populations. During previous health crisis people with diseases have faced discrimination and stigma, such as people living with HIV and Ebola survivors. Keeping in mind also future consequences, it is therefore of vital importance that ethics and privacy is considered, and that actors employ responsible data governance and management.

The lack of testing capacities in many countries and overworked international and local staff may also result in the exact impact of the pandemic being hard to state specifically at any point. Yet, there is no doubt that the impacts will be large and long-felt for humanitarian operations and the people already in need of humanitarian assistance.

Governing global health emergencies: the role of criminalization

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This text first appeared on the International Health Policies blog and is re-posted here. Kristin Bergtora Sandvik (S.J.D Harvard Law School 2008) is a professor of legal sociology at the Faculty of Law, University of Oslo, Research Professor in Humanitarian Studies at PRIO, and former Director of NCHS. Her work focuses on refugee governance, technology, innovation and criminalization in emergencies. Her most recent publications deal with humanitarian wearables and digital dead body management in aid. The research undertaken for this blog post was supported by the project Humanitarianism, Borders and the Governance of Mobility.

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. A novel coronavirus, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in 2019. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19). Photo: CDC/ Alissa Eckert, MS

The point of departure for this blog is the apparent frequency of criminalization strategies in early government responses to the Corona virus. While much attention has been given to the securitization of global health responses – also in the case of Corona – less systematic focus has been given to the partial criminalization of infectious diseases as a strategy of global health governance.

As the scope of the Corona outbreak is broadening, the number of countries deploying criminalization measures is also rapidly increasing. China has introduced harsh regulations to deal with the Corona virus, including ‘medical-related crimes’ involving harassment and violence against medical personnel, refusal to submit to quarantine and obstructing dead body management. Singapore and Hong Kong have criminalized the breach of travel restrictions and misleading authorities or spreading false rumours.   Taiwan plans sentencing the violation of quarantines. Iran will flog or jail people who spread false rumours. A Russian prankster is facing jail-time for Corona ‘hooliganism’. In the US, prospective quarantine violators from the infamous cruise ship Diamond Princess were facing fines or jail time. Beyond governments’ need to be seen doing something in the face of public panic across the Global East and the Global North, how should we think about this propensity to reach for penal measures?

How we explain disease and whom we blame are highly symptomatic of who we are and how we organize our relations with others, in particular the practices and life forms of marginalized elements of society. This will also likely be the legacy of Corona. Moreover, current global health responses to infectious diseases remain bound up with both colonial-era and historical command-and control trajectories of response and needs to be understood in context.

In this blog, I map out three categories of criminalization.  My assumption is that the Corona response will likely involve all three in some form or other. I take the broad conceptualizations of criminalization in circulation in legal, policy and media discourse as the starting point: this includes criminal law sanctions  and administrative and disciplinary sanctions as well as popular perceptions of the uses of penal power and social ‘criminalization-talk’.  The idea is that criminalization can be understood as a strategic tool with multiple constitutive uses in the global health field.  

In the following, I outline three different things that criminalization ‘does’ in the global health field, which may serve as a resource for thinking about how criminalization will shape approaches to the Corona virus.

First, I am interested in the direct and indirect criminalization of health care delivery through the criminalization of individuals infected with or suspected of being infected with specific infectious diseases. The problem with this approach is that it risks aggravating humanitarian suffering because it is either premised on criminalizing the practices and attributes of groups that are already in a marginal position, or that with infection, patients immediately become  socially or economically ‘marginalized’ which allows for criminal interventions. This category of criminalization covers transmission, exposure, interaction with ‘vulnerable groups’ (such as children), failure to disclose or simply physical movement. It relies significantly on the mobilization of othering and of metaphors of fear.  The global health response may also be undermined through the de facto criminalization of individuals by way of the use of compulsory health powers such as surveillance, contact tracing, compulsory examination and treatment, regulation of public meeting places, quarantines and forced isolation of individuals.

These regimes might be so repressive as to have severe humanitarian impact on the populations concerned. Human suffering here does not emanate from the inability to offer health care but from the human rights violations arising from how fear and stigma fuel criminalization of ‘vulnerable/deviant/threat groups (such as drug users, those with precarious migration status, sex workers and the LGBTI population) and how criminalization in turn produces further deviance and marginalization.  A characteristic of early phases of epidemics is that certain groups are singled out as risky and characterized as dangerous, allowing for repressive public health interventions.

At the same time, fear of harassment, arrest and detention may deter people from using health services.  A ‘deviant’ social status combined with health status may lead to discrimination and ill-treatment by health care providers. Criminalization is linked to high levels of harassment and violence, reported by lesbian, gay, transgender people and sex workers around the world (see here and here). Notably, in the context of HIV/AIDS, criminalization, and quarantine and individual responsibility for disclosure have been considered as key tools to halt or limit transmission, despite innovations in treatment that radically transform the nature and lethality of HIV/AIDS. Globally, prosecutions for non‐disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. At least 68 countries have laws that specifically criminalize HIV non‐disclosure, exposure, or transmission. Thirty‐three countries are known to have applied other criminal law provisions in similar cases.

For the fast-moving but relatively low-mortality Corona-virus, these lessons indicate that a marginalized social status can contribute to exacerbating transmission and constitute a barrier to adequate health care, potentially increasing mortality.

Secondly, criminalization and repressive public health measures and discriminatory barriers are also a complicating factor during emergencies caused by other factors. As seen in the context of Ebola, general violence as well as violence against health care workers undermines efforts to end outbreaks. Humanitarian emergencies confront public health systems with often overwhelming challenges. In the midst of this, criminalization of individuals who are infected or perceived as risky or dangerous further compromises the ability to address preexisting epidemics and hamper transmission, thus exacerbating the impact of the overall impact of the crisis. 

Third, in situations when the disease itself is the emergency, criminalization and the attendant practice of quarantines directly hampers efforts. Historically, quarantines have been used for a wide range of diseases including venereal disease, tuberculosis, scarlet fever, leprosy and cholera. Quarantines are co-constructed through the longstanding tradition of framing infectious disease through criminalization, whereby stigma, medicalization and incarceration have worked together to produce colonial bodies construed as racial and sexual threats to national security (see here and here). Quarantine was a widely employed tool against Ebola in Sierra Leone and Liberia.  As noted  by commentators, according to the logic underlying quarantines ‘subjects marked as abnormal, diseased, criminal, or illicit should be isolated for their own betterment and for the collective good’. While resistance becomes a proof of deviance and of the necessity of segregation, in the case of Ebola, quarantines may compel fearful communities to hide  suspected cases. In the contemporary context, with an international human rights framework on health suggesting that rights-based approaches to disease prevention and mitigation should be foregrounded,  problematic tradeoffs between criminalization-oriented public health measures and fundamental rights and liberties are likely to proliferate, as illustrated by the US government’s budding ‘war on Corona’.

This blog has provided an initial map of how criminalization may shape the Corona response. In sum, when criminalization is pegged directly onto suffering human bodies, criminalization hinders global health interventions in three ways. Criminalization might be so repressive that it has severe health-related impacts on the populations concerned. Criminalization also undermines and exacerbates challenges already faced by the public health infrastructure during an emergency. Finally, the repercussions of criminalization are most impactful in situations when the disease itself is the humanitarian crisis and where criminalization directly hampers efforts to contain and mitigate epidemics.