COVID-19 response in fragile states: Trust, speed and scale

by 20th May 2020
A women carries a VSLA safe, Mali A women carries a VSLA safe, Mali CARE/Josh Estey

Just as in the UK, trust, speed and scale is needed to meaningfully limit the impact of COVID-19 in communities already living in poverty. Unlike the UK, countries like Chad, Mali and Niger already had 12.8 million people in need of humanitarian assistance due to conflict and climate change. With support from the UK Department for International Development (DFID), CARE will be able to reach thousands of people here, but we and our peer NGOs have the capacity to scale this work up significantly, and the experience to make a real impact. The window we have to reach those communities is closing quickly – the international community must accelerate its response before it’s too late.

Responding to the COVID-19 pandemic and its humanitarian impacts is different to most responses I’ve worked on. It’s different because we can all relate to it - we’re experiencing the crisis at home, as well as in every country CARE works in abroad. So we all have first-hand experience of the challenges that other countries face and the types of help people might need: soap and hand sanitiser to keep our hands clean; strengthened health systems that can test and trace, and keep victims alive; economic support, to help people who’ve lost their jobs to get through the crisis; and responsive services for GBV survivors as stress levels soar in lockdown.

But responding in a conflict-affected context like that of the Sahel, introduces new complexities to otherwise similar activities. Conflicts destroy infrastructure, displace people and sow distrust between groups and against governments. In northern Mali, for example, 93 per cent of healthcare facilities have been destroyed in fighting. At the start of the crisis the country had just three ventilators for a population of 19 million people. Almost 240,000 people are internally displaced. According to the Fragile States Index, state legitimacy and group grievances have significantly worsened over the last decade.

By 18th May, 874 COVID-19 cases were confirmed in Mali, with 52 deaths. In neighbouring Niger, the number of cases is slightly higher at 904, with 54 deaths. Efforts to contain the virus in the UK aim to keep the NHS from being overwhelmed. But here in communities where the health system already cannot meet day to day needs, we must focus on prevention. It’s essential to act early and fast to change behaviour and stop community transmission.

Trust as the foundation for the response

Lessons from Ebola outbreaks in West Africa and the DRC have shown us that a health-only response is not going to work. “Trust is the absolute foundation needed for any [Ebola] response,” according to British doctor Oliver Johnson who worked on the front line of the Ebola response in Sierra Leone. In contexts where power is dispersed and trust in state messengers is low, successfully changing behaviour can only be done effectively through strong community engagement.

In Mali, Niger and Chad, with support from DFID, CARE is working with local partners, religious leaders and established networks to make sure that local communities hear messages from trusted interlocutors. We have extensive links with peer-to-peer Village Savings and Loans Associations (VSLAs) that are able to reach hundreds of thousands of people. In West Africa, just in the last year 645,288 women and girls have joined savings groups, with over 200,000 of them directly trained by CARE. By using such networks, accurate messages on COVID-19 can be passed quickly between community members, and rumours can be tracked and rebutted.

Putting women at the forefront of the response also gives us the opportunity to challenge gender roles. In CARE’s West Africa rapid gender analysis, new evidence shows traditional decision-makers have started seeking guidance from women-led VSLA groups due to their active presence in mobilising communities in COVID-19 prevention and response. We will also be working through these groups to raise awareness of the heightened risks of gender-based violence and refer cases for specialist support.

Even if we are successful in getting messages across, however, it’s not a given that people will be able to act on those messages. In Mali’s Mopti region, for example, over half a million people are displaced and many live in overcrowded IDP camps with limited access to facilities for handwashing. CARE aims to install almost 1,300 handwashing points and improve access to clean water and household hygiene products so people can wash their hands and reduce disease transmission.

Anti-COVID-19 restrictions have affected livelihoods in the Sahel, but even as local restrictions lift, difficulties in travelling between countries and the global slowdown in demand will hit the world’s poorest hardest. This will compound the harsh lean season that regions in the Sahel are already facing. To help people get through the toughest times, under the DFID project CARE will reach almost 25,000 people with cash support and will work with 2,800 women to restart their livelihoods.

A sluggish international response leaves communities at risk

At the recent International Development Committee inquiry, IDC Chair Sarah Champion MP said: “It’s very clear there is a window where we can make [communities] resilient and prevent outbreaks of COVID-19… but that window is closing very, very quickly. So we need to be much swifter in our response in getting that money out to the front line.” Local NGOs and their international partners are the front line, and are able to act immediately through established relationships with local communities.

But funding for frontline organisations is coming through very slowly, as donors pass most of their assistance through multilateral agencies who will eventually sub-grant to NGOs – a process which often takes about three months. In contrast, DFID’s RRF took just 24 days from the call for proposals to contracting. The START Fund – which has supported quick turn-around COVID-19 prevention projects in almost 20 countries but has now exhausted its funding – can compress that timeline to 72 hours. This shows how much more quickly the international community could tackle this epidemic if donors focussed on funding organisations that can make the most immediate impact.

UK NGOs have the experience, links with local organisations and communities to be able to deliver programmes with the trust that is so needed in this COVID-19 response. We can work at speed if our donors do. We need the funding community to help us to deliver at the scale that this global pandemic demands.

Helen Thompson

I joined CARE International UK in 2017 and currently head up our Humanitarian team. Before CARE, I worked for DFID in Afghanistan and Palestine, as well as on the Middle East and North Africa more widely.

At CIUK I oversee programmes all over the world that respond to humanitarian need caused by natural disasters and conflicts. Some of our largest programmes support internally displaced people and vulnerable communities in Yemen and Syria.

At DFID I was an accredited governance advisor, and I’ve used this specialism to expand CARE’s work on grassroots peacebuilding and women’s leadership in conflict contexts.

One good thing I’ve read

Farewell Kabul: From Afghanistan to a more dangerous world by Christina Lamb – I read this shortly after I left Afghanistan following a 2.5 year posting in Kabul. I found that it resonated with my experience of the country and the conflict, however limited that was by security restrictions, and provides a valuable insight into the history and futility of the war.

Email: HThompson@Careinternational.org

Twitter: @HVThompson24