COVID-19 is having a profound impact on the humanitarian sector worldwide, given the severe restrictions in delivering aid across borders and face-to-face amid a pandemic.
These challenges are compounded by the reality that vulnerable people and communities globally and locally have been disproportionately affected by COVID-19. Racialized minorities, people with disabilities, victims of violence and injustice, and people with lower or no incomes are being hit hardest in terms of their physical and mental health, and economic well-being.
“Not since World War II have we seen a crisis with the global impact COVID-19 is having. But because Humanity & Inclusion (HI) is used to working on the front lines in crises, such as the Ebola outbreak in West Africa and the earthquake in Haiti, the organization quickly adapted how we delivered our services to beneficiaries. When we had to stop face-to-face rehabilitation, we leveraged technology and used platforms like What’s App to provide rehabilitation services to families through remote support and maintain continuity of care. It also helps that 90% of HI’s staff are local. We didn’t have the huge problems getting staff across borders and we really understand the needs of people in their communities,” says Shivji, who worked with HI across Asia, the Middle East, Africa and the Caribbean after joining in 2005, and served as UK CEO and Global Lead for Strategic Partnerships from 2012 to 2020.
HI was founded in 1982 by two French doctors who set up rehab centres in refugee camps in Thailand, Cambodia, Burma, and Laos, where amputees who were victims of landmines learned how to make simple, adjustable prosthetic limbs. In 2019, the organization launched a project in northern Uganda using the latest 3D scanning technology and 3D printers to create made-to-measure splints for refugees. “Last March, we adapted our program of using 3D printing to manufacture prosthetics and orthotics for rehabilitation and partnered with Uganda’s Ministry of Health to produce protective face visors for frontline health workers to help address the shortage in personal protective equipment,” explains Shivji, “Some of the best innovations come out of crises.”
At Comic Relief, Shivji is leading the organization’s social change strategy and global philanthropic funding. “For some time, Comic Relief has been focusing on inequalities, and COVID rapidly led us to sharpen our focus on this work,” she says. One key initiative in response to COVID has been a new Comic Relief fund that aims to support diverse communities disproportionately impacted by COVID-19 in the UK, including communities experiencing racial inequalities.
“We are also looking into the future and funding organizations that want to make lasting change in the world. This includes organizations that are forging new ways of working in the wake of COVID-19, and in particular, organizations led by, working with, and for those who are hardest hit and systematically excluded in society,” says Shivji.
Deploying international humanitarian expertise domestically
Christine Hwang, MDCM’92, has performed humanitarian work on Red Cross missions around the world from Haiti to Nepal to Cameroon over the past two decades. But since the earliest days of the pandemic, Hwang has been deployed on missions to help and support Canadians imperiled by COVID-19 on cruise ships and in long-term care homes, federal penitentiaries and Indigenous communities. “I’m a disaster responder at heart and I go wherever I’m needed most,” says Hwang.
Last February she travelled to Japan as senior medical officer with a Canadian Red Cross team of aid workers asked by the Government of Canada to provide assistance and support to Canadian Consular Affairs, who were providing support to more than 70 Canadian passengers who had either tested positive for COVID-19, or had to quarantine there, after travelling aboard the Diamond Princess cruise liner off the coast of Japan.
“We had some Canadians who were very sick. They couldn’t understand the Japanese language and weren’t familiar with medical practices in Japan. We were brought in to provide psychological and social support, and to be a liaison with medical expertise in dealing with healthcare professionals,” says Hwang, who answered patients’ medical questions and explained the benefits and risks associated with proposed COVID treatments and procedures.
For example, Hwang helped patients and their families to make informed decisions about undergoing crucial medical procedures. “I was able to help patients and their families make difficult decisions about medical procedures to treat COVID. In some cases, these procedures were important for the patient’s recovery and they made choices that had a positive impact on their care and health,” says Hwang, who retired as medical director of Toronto Public Health clinics in 2019 “to follow my passion to do more of these kinds of missions.”
Hwang’s next assignment involved leading implementation of an epidemic prevention and control zoning system at federal penitentiaries in the Prairies. “The Red Cross has now implemented the system in over 200 long-term care and federal correctional facilities across Canada,” says Hwang, who established the Christine Hwang Leadership Award in 2017 to recognize each year a second-year Ă山ǿĽé medical student who fosters a positive environment through leadership, initiative, and community involvement.
In October, the Cree Board of Health and Social Services of James Bay (CBHSSJB) called in the Red Cross to help 12 vulnerable Elders, whose residence was uninhabitable as the result of a fire and who had been temporarily relocated to a wing in the Chisasibi hospital in Chisasibi, Que. “The Red Cross deployed and set up equipment from our emergency field hospital in the municipality’s Banquet Hall in order to offer the Elders a more comfortable home where they can live a more normal life as community members,” says Hwang, who was re-deployed to assist with rapid infection prevention and control assessments in long-term care homes in British Columbia’s Lower Mainland in late January.
Hwang believes it has been enlightening for federal and provincial governments to see firsthand how valuable the broad international experience and expertise of humanitarian organizations, such as the Canadian Red Cross, can be in helping people and communities impacted by crises and disasters in their own country. “The Canadian government has worked in partnership with the Red Cross so much this past year, tapping into our technical expertise in providing humanitarian services and aid during the pandemic. We have international expertise that we applied domestically, and I hope that governments will turn to humanitarian organizations more in the future,” she says.
Humanitarian organizations adapt to do double duty
Another big impact of the pandemic on humanitarian organizations and their work has been to shift or divert focus, attention, and resources away from many other urgent global problems. “COVID has overwhelmed everything else. Global humanitarian issues that are not COVID—involving displaced people or maternal child health, for example—have tremendous difficulty getting attention at all,” says Dr. Timothy Evans, inaugural Director and Associate Dean of Ă山ǿĽé’s new School of Population and Global Health, and Executive Director of Canada’s COVID-19 Immunity Task Force.
In the face of these challenges, humanitarian organizations have shown ingenuity, adaptability, and resourcefulness in trying to safely continue providing services to their own clients under infection control constraints while also offering their experience and expertise in dealing with humanitarian crises and disasters by setting up community-based surveillance and emergency field hospitals, for instance, in response to COVID-19.
“Humanitarians organizations have had to deal with COVID, as well as everything else they’re doing. This involves mainstreaming infection, prevention and control protocols throughout their operations and also, where appropriate and possible, changing to a virtual mode of interface with their clients using mobile technologies,” says Evans.
Because humanitarian organizations need to develop and maintain good relationships and communication networks with the communities they serve, they are well-suited to implementing and maintaining confidence in infection control interventions in communities. “Humanitarian organizations also understand the need to mobilize quickly, assess health risks and deliver interventions with speed. COVID emergency operationĚýcentres and facilities have been much stronger with the help and support of humanitarian organizations as a result of their experience dealing with previous crises, such as the Ebola and MERS outbreaks. These organizations have strong institutional memories and a tremendous amount of innate resourcefulness, which is helping now,” he says.
The pandemic has also been a catalyst for change in where humanitarian organizations deliver their services:
“With COVID, the need for intervention can be anywhere in the world. Some of the countries hardest hit at the beginning were the richest countries. The services humanitarian organizations provide are usually needed most in countries with fewer resources. But in rich countries, overwhelmed governments have urgently needed support from humanitarian organizations, especially in addressing the disproportionate impact of COVID among lower socioeconomic groups and racialized minorities. These are cases where NGOs and humanitarian organizations are more suited to lead because they have a better understanding of these communities and have an ability to move more quickly than the over-taxed public health infrastructure,” says Evans.
Co-creating sustainable emergency response capacity in communities
Rachel Kiddell-Monroe, LLM’13 (Bioethics), believes COVID-19 has shown that the top-down approach inspired by the colonial roots of humanitarianism is no longer sustainable or acceptable. Humanitarian workers need to deeply listen and be guided by the priorities and needs identified by the local population and community rather than preconceived priorities assessed by humanitarian agencies.
“We need to listen to the people living in the crisis. At SeeChange, we partnered with an Inuit-led community organization called Ilisaqsivik to co-create a sustainable response to COVID-19. The Community First solution and methodology has now been used by oppressed communities—those constantly forgotten or sidelined by governments and agencies in crisis situations—to organize, prepare and respond to COVID-19. Indigenous communities in Honduras then adapted this methodology to prepare and respond to the impacts of hurricane Eta and hurricane Iota. We’re seeing that this innovation created by and for oppressed communities is both a decolonized and sustainable way for communities to maintain an emergency health response capacity,” says Kiddell-Monroe, Executive Director of the SeeChange Initiative, MĂ©decins Sans Frontières (MSF) International Board director and Professor of Practice at Ă山ǿĽé’s Institute for the Study of International Development (ISID).
Dealing with “knock-on” health effects of COVID globally
For nurse, epidemiologist and bioethicist Dr. John Pringle, the increasing reliance of governments on humanitarian organizations to intervene and provide critical emergency support during the pandemic also points to a steady weakening and erosion of public health systems globally.
This trend was glaringly evident when Pringle served on a mission with MSF in 2015 to assist with the West Africa Ebola crisis, where he helped set up a new Ebola treatment centre and mass administration of antimalarial medications. “The Ebola crisis in West Africa highlighted the weaknesses and major gaps in global public health systems. When there are major crises these gaps really stand out. It’s appalling to me that a humanitarian organization, such as MSF, had to be called in to respond to that sort of crisis when we live in a world with such a concentration of wealth, and disparities in wealth and health. People are left to suffer and to die, and they have to rely on emergency health care delivered by privately funded humanitarian organizations as a last resort,” says Pringle, who recently left his role as an assistant professor at Ă山ǿĽé’s Ingram School of Nursing in the Faculty of Medicine and Health Sciences to do humanitarian action work and research as a humanitarian affairs policy advisor for MSF in the many countries where its medical teams are tackling disasters, conflicts and epidemics.
Humanitarian organizations are also stepping in to fill critical gaps in dealing with the “knock-on” or ripple effects of COVID on services for other health problems, as MSF did in the Ebola crisis. “From a humanitarian perspective, when there are public health crises and disease outbreaks there are knock-on effects that impede the access to essential health services in other areas such as maternal-child health care, management of chronic illness and other public health problems. These can cause tremendous suffering and death not by the outbreak directly but the indirect effects. Because the healthcare system had collapsed during the Ebola outbreak, people were also dying of malaria. MSF launched one of the largest mass drug administrations of antimalarials to prevent and treat malaria, and we saved a lot of lives,” says Pringle, who also served on earlier MSF missions in northern Nigeria and Eritrea.
A global pandemic has meant the demand and need for humanitarian services continues to grow. MSF has opened new projects in countries like France, the United States and Canada, in addition to over 70 countries where it was already working. Like many other humanitarian organizations, MSF is providing medical humanitarian aid to respond to COVID and its knock-on effects, especially among marginalized populations that have reduced access to health care and treatment.
“One of the positive innovations we’re seeing is increased collaborations between international organizations, like MSF, with local community organizations to see what their needs are and how they can be supported in working with people who are in precarious situations, such as migrants, the homeless and other vulnerable populations. As a researcher in humanitarian ethics, it’s important for me to be directly involved in humanitarian action during and after the pandemic,” says Pringle, who is embarking on his next frontline mission this March.
Global investment in humanitarian and public health sectors
During COVID-19 humanitarian organizations have stepped up globally and domestically within their host nations and in local communities. They are applying their invaluable expertise and experience in dealing with crises and disease outbreaks to support and assist governments and public health systems in implementing emergency infection prevention and control programs. These efforts have been especially important in addressing the disproportionate impact of COVID-19 on racialized minorities and other vulnerable populations including older adults in long-term care facilities, as well as the pandemic’s ripple effects in exacerbating many health problems other than COVID.
Humanitarian organizations have had to adapt and innovate to continue delivering services and aid to the populations they serve in the face of COVID restrictions and a dominant focus on the pandemic. A positive and promising trend arising out of the pandemic is the increased collaboration between humanitarian agencies and public health systems. This highlights the urgent and continuing need for a global commitment to strengthen and increase investment in both the humanitarian and public health sectors.
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