The COVID-19 pandemic was a crisis unlike any other the humanitarian system had faced before, in scale, nature and global spread. It challenged humanitarians to respond to the direct health impacts of the virus, and to the secondary effects of restrictions – all while donors struggled domestically with the disease and its economic repercussions. The pandemic prompted UN appeals for a record number of countries in 2020, including several high-income countries, and it further blurred the lines between emergency aid and social safety nets.

If, as the previous edition of the SOHS suggested, the 2014–2016 Ebola Outbreak was the benchmark for an ‘atypical’ crisis that confounded standard public health and humanitarian responses, the COVID-19 pandemic exceeded this in a way that few in the system predicted. While the ‘cacophony’ of ‘never again’37 lessons from Ebola were well synthesised by 2016, collective reflections on the system’s response to the COVID-19 pandemic are still emerging.38 These lessons are likely to be mixed as the progress of the virus and the policy responses to it played out so differently across the world – and as one leader put it, 'we need to think about ‘COVID-19 responses in the plural, because there hasn’t been a global response'.

We need to think about ‘COVID-19 responses in the plural, because there hasn’t been a global response.

Rapid response and flexibility

Despite post-Ebola warnings that the next pandemic was ‘a matter of when, not if,’39 COVID-19 caught the world unprepared. In many Western countries, governments failed to apply the principles of early detection and robust response at the onset of the pandemic, partly because the virus was new and partly because divided political and public health opinion led to a ‘wait-and-see’ approach. The result was high rates of transmission, which then prompted stringent lockdowns.  

The humanitarian community braced itself for catastrophic levels of transmission in overcrowded and sanitation-poor crisis settings across the world, but in many contexts this did not appear to materialise.40 Experts put this this down to factors including younger populations and unreliable reporting of caseloads: the effects of COVID‑19 on crisis-affected populations remain largely anecdotal, as many of these situations were already data-poor and became more so as data collection by government and international actors halted.41  

In the places where it was already operational, the humanitarian system’s model of tight coordination and quick appeals mobilisation – often criticised for their top-down rigidity – worked in its favour. Inter‑Agency Standing Committee (IASC) guidance and protocols were swiftly produced and actioned, and large-scale logistics operations launched. The first-ever agreement was signed between the IASC and the COVAX facility to secure vaccines for vulnerable and marginalised communities in humanitarian contexts. As one global leader put it, guidance was ‘properly internalised by the humanitarian eco-system and the result of that has been that the damage that COVID-19 could have caused has been greatly reduced … The humanitarian eco-system has set rather a good example’. 

Evaluations suggest that it was easier to implement COVID-19 programming in contexts which had previously been affected by disasters, due to existing emergency response protocols.42 In interviews, donor representatives suggested that there was a missed opportunity for the WHO-led response to involve and learn more from this. The post-Ebola intentions for WHO and the UN Office for the Coordination of Humanitarian Affairs (UN OCHA) to work more closely together in major health crises were not deployed and two separate appeals processes were launched, instead of a unified call for support. 

Donors responded to immediate humanitarian needs with additional funds and a new degree of flexibility. Although new funding was initially directed to large UN agencies and not rapidly disbursed to partners, NGO representatives told us that collective calls for adaptable funding were largely met with a ‘strong willingness to pivot existing funding’ and a ‘common sense’ approach to the best use of committed funds. This has been held up as evidence that flexible financing can work, but there was scepticism that it has translated into a lasting disruption of business as usual.  

Access and presence

While the system was responsive, the politics and practicalities of humanitarian access were a stumbling block. Where access constraints were already high, the health response was prevented from reaching vulnerable communities. In Syria, for example, government-imposed impediments and aid diversion saw medical supplies blocked from areas outside state control. According to one source, a combination of UN reluctance to upset Damascus and obstructions to the cold chain prevented WHO from applying for the ‘humanitarian buffer’ – GAVI’s 5% reserve of COVID‑19 vaccines meant for people in conflict zones or humanitarian settings who cannot be reached by government vaccination campaigns.43 Elsewhere, there was evidence that COVID-19 restrictions were being used as a pretext to stymie wider aid efforts: in Yemen, interviewees for this study reported multiple incidents of agencies being forced to close programmes unpopular with the authorities in the name of redirecting resources to the COVID-19 response.  

As international travel was restricted and many agencies withdrew international staff at the start of the pandemic, the system was system was compelled to look more to local capacity. One INGO leader noted the sacrifices made by national staff, observing that the pandemic had prompted ‘the realisation that it’s really the national staff that are running things and should be running things’. A study conducted over the course of 2020 revealed an attitudinal shift from asking ‘if’ to asking ‘how’ to localise; but it also showed that, overall, there was little evidence of a transformational shift in power towards local actors as a result of the pandemic.44 The focus was on increasing remote management and decision-making, more than on local leadership. Relationships between international and national staff were also sometimes strained – evaluations found that shifting functions and increased workloads during the pandemic may have led to a rise in miscommunication.  

As international staff withdrew and national staff reduced their interactions with communities, the limits of remote programming began to show. The digital divide, where some communities or individuals lacked internet and mobile communication access, affected the assessment and coverage of needs. Lockdown measures brought with them a surge in protection cases, including violence against women and girls, which absent aid workers could not effectively monitor or address. Given what we’d learned from the Ebola Outbreak, protection should have been a central and essential element of the pandemic response, but evaluation evidence found this lesson went unheeded.45 Although remote education programmes proved fairly successful, school closures exposed children to harm and left them out of the sight and reach of support programmes.46 Cut off from sustained interaction with communities, agencies lost community trust and acceptance, especially as misinformation proliferated. 

Social safety nets

COVID‑19 restrictions generated immediate and lasting economic shocks that had a far worse effect on many vulnerable people than the disease itself. One humanitarian leader noted that it was a ‘mistake’ to think of the pandemic as a medical problem, as it was in the Global North: ‘It became a socioeconomic meltdown in the south … it devastated the socioeconomic lifeline of vulnerable people, and we didn’t really realise that until later.’ In Venezuela, the lockdown coincided with hyperinflation, which had already rendered a third of the population food insecure by the start of 2020, causing a major rise in malnutrition in the course of the year.47  

The shockwaves of the pandemic increased the humanitarian caseload48 as fragile development gains were reversed, and people tipped from economic precarity into humanitarian need. With limited financial resilience and means of recovery, the incomes of the world’s poorest were the worst hit.49 Social protection systems were extremely variable in their ability to meet widening and deepening needs – for example, the system in Pakistan held up well,50 while Uganda struggled.51 In many countries, humanitarian agencies linked their cash programming to national social protection schemes to better reach the most vulnerable, forging new connections and generating new lessons about shock-responsive programming (see Chapter 12). But this gave rise to concerns about whether sustained national safety nets and basic services would be able to support these people in the longer term. Even factoring in debt relief,52 developing countries faced an economic ‘long COVID’ that, without proactive development investments, may contribute to greater vulnerability to shocks and a new and chronic humanitarian caseload. 

Bangladesh case study: COVID-19 in Cox's Bazar

COVID-19 in Cox's Bazar 

Author: Local researcher Bangladesh. Name withheld to protect the author’s identity. 

Almost a million Rohingya refugees have been living in the dense tangle of 34 camps in Bangladesh’s Cox’s Bazar since 2017. An average of 40,000 people pack each square kilometre,53 living with temporary shelters and infrastructure due to the host government’s policy of encampment and its refusal to grant longer-term status to refugees. In these conditions, public health experts predicted that COVID-19 could spread quickly and with catastrophic consequences. In March 2020, models predicted that up to 1 in 200 Rohingya refugees in the camps could die from COVID-19 unless appropriate measures were taken.54 

Initial response 

In the first instance, the Bangladeshi authorities acted quickly. On 25 March 2021, the Refugee Relief and Repatriation Commissioner ordered the shutdown of all 34 Rohingya camps, limiting humanitarian access and restricting services to emergency food, health assistance and medicine. Gatherings were banned, and schools and women-friendly spaces closed.55 Only essential workers were allowed access to the camps and had to travel in authorised vehicles that were inspected at check-posts for paperwork, social distancing and mask usage. 

The public health response was slower to mobilise. In the first six months of the pandemic, there was little hospital capacity, no specific testing centre for refugees56 and limited provision of personal protective equipment (PPE) for health workers.57 But within the camps the anticipated health crisis did not materialise. By the end of 2021, according to WHO, 3,250 COVID-19 cases and 34 deaths had been reported. As one humanitarian worker put it, ‘none of us know exactly how and why COVID-19 went through the camp quite as quick as it did and with very few fatalities’. 

Despite inconclusive evidence as to why infection rates remained low,58 there is a sense that the humanitarian system performed well in the face of direct threats to health. One health coordinator in Cox’s Bazar noted that specialised facilities were set up with capacity for a large number of patients: ‘I think that the humanitarian system did rise to the challenge to some extent of the COVID-19 response.’ 

Immediate and longer-term humanitarian consequences 

The system has been less able to mitigate or address the impacts of shutdowns and the shift to pandemic response and away from other assistance and protection needs. In the words of one INGO aid worker, ‘Once COVID‑19 hit, all of our gains were reversed and worse’. One UN representative explained how refugees’ fears of contracting the virus in healthcare facilities, combined with the strain on essential services, resulted in an increase in preventable non-COVID-19 deaths. Later in the response, healthcare facilities found themselves in high demand: as other services were closed down, people came to them with different concerns, including protection issues, which resulted in ‘some overcrowding, some dissatisfaction with health services’.  

The impacts of the disruption went much wider. At the start of the pandemic, INGO and UN staff presence in humanitarian settings diminished, as aid workers chose not to return to duty stations, self-evacuated, were evacuated by their organisations, or got stuck outside Bangladesh when international borders closed. Several agencies found themselves operating with their heads of office in other countries. Strict isolation and quarantine protocols were implemented for NGO and UN staff and in-person activities were cancelled, including assessments, awareness sessions and community consultations. Many organisations saw their facilities shut down or appropriated for use as isolation centres. Funding was reallocated to COVID‑19 prevention and response; proposals had to be rewritten and programmes stalled. One UN agency explained how a long-awaited shelter programme was placed on indefinite hold. Government officials ordered the postponement or closure of activities deemed non-essential, including protection. Income-generating and cash-based activities were restricted.59  

With the reduced humanitarian presence in the camps, security and protection threats increased significantly, with refugees reporting kidnappings, murders, extortion, rape, drug dealing and routine violence by criminal gangs. One focus group participant told our researchers that ‘safety and security conditions in Bangladesh are worse than in Myanmar’. An aid worker summed up the prevalent sense of fear: ‘We also know that armed groups run rampant. Gender-based violence is a huge issue. The camp, the humanitarians leave at three o’clock, and then it sort of becomes, from what people have told me, very scary and dark. And I think that the safeguarding and protection is a huge, huge gap in the response’.

Safeguarding and protection is a huge, huge gap in the response.

Providing protection services remotely was a difficult task that became even more challenging when further shutdowns were imposed. In a May 2021 meeting of UN agencies, the Office of The Refugee Relief and Repatriation and the Bangladeshi authorities, it was decided that protection (in addition to education) was a non-critical activity despite the rise in protection threats, including gender-based violence. ‘Last year, we could provide both remote and in-person support,’ said one gender-based violence specialist, ‘but this year, it was just fully restricted. We could not provide any kind of in-person case management support to the survivors, so it’s telephone only.’ As the global evaluation of refugee rights during the COVID‑19 pandemic confirmed, this deprioritisation of protection had severe consequences for affected people.60 As one focus group participant explained, ‘domestic violence has become more common, and since NGOs activities have decreased during COVID‑19, gender-based violence cases can be seen immensely’. 

While government shutdowns are widely felt to have helped contain the spread of the virus in the camps, many humanitarians are concerned that they have been used to further restrict humanitarian space, with immediate and longer-term impacts on education, security and protection, and on refugees’ faith in the humanitarian system. ‘The Rohingya don’t have any reason to trust anyone,’ said one expert. ‘I’ve seen them lose trust in the international justice process, in the Bangladesh government, and humanitarian actors, and in each other.’ That trust was further fractured by the absence of humanitarian workers during the pandemic, and according to many aid workers, it will be difficult to win back. 

37

 IRC, The Ebola Lessons Reader (New York: International Rescue Committee, 2016). https://www.alnap.org/help-library/the-ebola-lessons-reader

38

 Taylor et al., Rights of Refugees. https://www.alnap.org/help-library/joint-evaluation-of-the-protection-of-the-rights-of-refugees-during-the-covid-19

39

Jeremy Konyndyk, ‘Struggling with Scale: Ebola’s lessons for the next pandemic’, Centre for Global Development, 2019. https://www.alnap.org/help-library/struggling-with-scale-ebola%E2%80%99s-lessons-for-the-next-pandemic-0

40

Several studies found that the officially reported rates of COVID-19 transmission, critical illness and death were much higher in high-income than low-income countries. One study found that COVID-19 was three times as prevalent in high income countries than other countries (Karlinsky and Kobak, ‘The World Mortality Dataset’) www.alnap.org/help-library/the-world-mortality-dataset-tracking-excess-mortality-across-countries-during-the-covid . However, as Chapter 1 explains, subsequent excess mortality analysis by WHO showed the toll on lower-middle-income countries to be much greater (WHO, ‘Global excess deaths). https://www.alnap.org/help-library/global-excess-deaths-associated-with-covid-19-january-2020-december-2021

41

Many countries – including Venezuela, Mali, South Sudan and Yemen, Myanmar, Afghanistan and Mozambique – had missing data or low positive test rates, an indicator that the pandemic may not be under control in the country.

42

ALNAP (forthcoming).

43

Natasha Hall, Rescuing Aid in Syria (Washington DC: Center for Strategic and International Studies, 2022), 13. www.alnap.org/help-library/rescuing-aid-in-syria

44

 Véronique Barbelet, John Bryant and Alexandra Spencer, Local Humanitarian Action during COVID-19: Findings from a Diary Study (London: HPG/ODI, 2021). www.alnap.org/help-library/local-humanitarian-action-during-covid-19-findings-from-a-diary-study

45

 ALNAP forthcoming.

46

 ALNAP forthcoming.

47

WFP, ‘Venezuela Food Security Assessment’ (Rome: WFP, 2019). https://www.alnap.org/help-library/venezuela-food-security-assessment

48

 The number of countries with UN coordinated appeals rose from 36 to 55 in 2020 and the number of people estimated to be in need rose by from 224.9 million to 243.8 million.

49

Sánchez-Páramo et al., ‘COVID-19 leaves a legacy’. https://www.alnap.org/help-library/covid-19-leaves-a-legacy-of-rising-poverty-and-widening-inequality

50

 Sania Nishtar, ‘Tackling Poverty amidst COVID-19: How Pakistan’s Emergency Cash Programme Averted an Economic Catastrophe’, Policy in Focus 19, no. 1 (Special Issue, 2021), 37. https://www.alnap.org/help-library/tackling-poverty-amidst-covid-19-how-pakistan%E2%80%99s-emergency-cash-programme-averted-an

51

Valentina Barca, ‘Social Protection and COVID-19: The Emerging Story of What Worked Where... and What It All Means for Future Crises’ (Blog), FP2P, 29 September 2021. https://www.alnap.org/help-library/social-protection-and-covid-19-%E2%80%93-the-emerging-story-of-what-worked-where%E2%80%A6-and-what-it

52

For example, the G20 launched the Debt Service Suspension Initiative (DSSI) to provide short-term liquidity support for low-income countries; World Bank, ‘Low-Income Country Debt Rises to Record $860 Billion in 2020’ (Press Release) World Bank, 2021. https://www.alnap.org/help-library/low-income-country-debt-rises-to-record-860-billion-in-2020

53

Mohammad Mainul Islam and MD Yeasir Yunus, ‘Rohingya refugees at high risk of COVID-19 in Bangladesh’, Lancet Global Health 8, no. 8 (August 2020): e993–94. https://www.alnap.org/help-library/rohingya-refugees-at-high-risk-of-covid-19-in-bangladesh

54

 Shaun Truelove et al., ‘The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study’, PLOS Medicine 17, no. 6 (16 June 2020): e1003144. https://www.alnap.org/help-library/the-potential-impact-of-covid-19-in-refugee-camps-in-bangladesh-and-beyond-a-modeling

55

Human Rights Watch, ‘Bangladesh: COVID-19 aid limits imperil Rohingya’, Human Rights Watch, 28 April 2020. https://www.alnap.org/help-library/bangladesh-covid-19-aid-limits-imperil-rohingya

56

Rajon Banik et al., ‘COVID-19 pandemic and Rohingya Refugees in Bangladesh: What are the major concerns?’, Global Public Health 15, no. 10 (2 October 2020): 1578–81. https://www.alnap.org/help-library/covid-19-pandemic-and-rohingya-refugees-in-bangladesh-what-are-the-major-concerns

57

MSF, ‘Five Challenges in Bangladesh amid Coronavirus COVID-19’, Médecins Sans Frontières, 2020. https://www.alnap.org/help-library/five-challenges-in-bangladesh-amid-coronavirus-covid-19

58

Some observers attributed this to differing immune responses, others to the effectiveness of domestic public health measures.

59

 Mohammed Masudur Rahman, Sarah Baird and Jennifer Seager, ‘COVID-19’s Impact on Rohingya and Bangladeshi Adolescents in Cox’s Bazar’ (Blog), UNHCR, 21 December 2020. https://www.alnap.org/help-library/covid-19%E2%80%99s-impact-on-rohingya-and-bangladeshi-adolescents-in-cox%E2%80%99s-bazar

60

Taylor et al., Rights of Refugees. https://www.alnap.org/help-library/joint-evaluation-of-the-protection-of-the-rights-of-refugees-during-the-covid-19