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Crises like the COVID-19 pandemic may strike the world universally but they don’t affect us all equally.
While we see our own health systems become overburdened in Europe, we know that if the virus surges in countries already affected by overwhelming challenges such as conflict, displacement and poverty, millions may die.
The World Health Organisation (WHO) has already identified insufficient intensive care facilities in African countries as being the biggest challenge it faces if the virus spreads, and there is precedent to show this.
The 2014 Ebola epidemic that hit West Africa was not only a health crisis, it was a development crisis. A virulent outbreak was made all the more devastating by its occurrence in countries ravaged by years of war and poverty.
As we put our collective shoulders to the wheel in responding to the COVID-19 outbreak, we cannot neglect the urgency of supporting the most vulnerable nations right now. If this is to be our finest hour, it means ensuring that those who are furthest behind are not forgotten.
At the same time, there are valuable lessons from the Ebola outbreak of 2014 that should give us cause to be optimistic about the eventual impact of community mobilisation.
Although Ebola was not a respiratory condition and was far less transmissible than COVID-19, it was far more deadly, with an average fatality rate of around 50 per cent.
The more compelling parallels are in the responses to these outbreaks, in the shared necessity and urgency of community mobilisation and solidarity.
While the iconic image of the Ebola outbreak was of responders in full protective hazardous materials suits - and these individuals and teams played a heroic role in slowing the spread of the virus - the most important force in stopping Ebola was community mobilisation towards collective preventative action.
Both Sierra Leone and Liberia were recovering from brutal protracted civil wars that decimated their infrastructure in the 1990s, with only one doctor for every 33,000 people in Sierra Leone. In Liberia, there were even fewer. Added to this, the cultures in these West African countries are outward and tactile, with much of life lived out on the street.
The scale of the challenge in implementing behaviour change and social distancing in this context was immense. It involved ambitious partnerships between the Ministries of Health, UN agencies, international organisations like Concern, national NGOs, and most importantly, local health care workers and volunteers.
In times of crises, unusual partnerships are formed. During the Ebola crisis, Concern worked with Glasnevin Cemetery to develop a system for registering the details of those who were buried in Sierra Leone, so that their families could mourn them at a marked gravesite in the future. We collaborated with tech companies such as Microsoft, NetHope, and Facebook to expand connectivity infrastructure in the region.
This connectivity was vital because it allowed people to speak to their relatives who were quarantined, cut off from their loved ones at the most difficult and frightening time of their lives. We can certainly appreciate how essential these connections are right now.
And yet, the most important partnerships of all were between the frontline responders and the affected communities.
At the heart of the response were the community health care workers who travelled to the most remote regions, or through the densely populated urban slums to teach communities about hygiene and social distancing strategies that could curb the spread of the virus.
One of these workers that I met in Liberia was Denise, a young mother of one. Denise carried leaflets, a thermometer and knowledge - these were her weapons against the disease. She went door to door with clear messages: wash your hands; know the symptoms; and if someone is sick, call the hot line. When asked about the risks to herself, she simply said: “I know but this is my job. I cannot sit at home in fear, I have a job to do.”
Denise was an unsung hero in a dangerously tense and frightening time.
You could feel it throughout West Africa. Society had changed almost overnight. Immediately you had to adapt to continuously washing your hands, getting your temperature checked repeatedly, no shaking of hands, no embraces. Public places had become centres of fear.
During my visit I never witnessed human contact between two individuals, never saw anyone break the rules, until the last day when I was on the shuttle bus that takes you out to the airplane. A woman got on with her young children. As she stepped onto the bus she tripped, and without thinking, numerous hands went out to help her. Their response was automatic and in that second it was not themselves they were thinking of but the mother and her children.
Even in the depths of the worst fear, the human reaction to help someone remained. Compassion and humanity was not lost.
Behaviour change is not a cold thing. It doesn’t erode our empathy; on the contrary, if anything, it strengthens it. We may feel much more vulnerable and overwhelmed by the scale of this crisis but we can trust in each other to reach out and help.
At Concern, our main worry right now is for those who cannot distance themselves, and those who do not have enough water to wash their hands. Whether they are found in the crowded displacement camps of Northern Syria, or the tightly packed informal settlements of Nairobi, Kinshasa or Port au Prince. Those who are already most vulnerable may now be faced with the greatest challenge.
The COVID-19 crisis is deeply distressing but our response will forge a solidarity like no other. We must make sure that solidarity extends to those who need it most and that we leave no one behind.
Dominic MacSorley is the Chief Executive of Concern Worldwide.
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