Since the start of the outbreak in December 2019, the new coronavirus has spread to over 182 countries and territories. As of 21 March 2020, there have been over 266,000 confirmed cases of coronavirus disease 2019 (COVID-19), with over 11,100 deaths reported, including among children. UNICEF is revising its appeal to meet the increased needs of communities, and of health systems and structures – to both protect against the disease and address COVID-19’s collateral impacts.
Good handwashing and hygiene practices are essential to reduce transmission and exposure to the coronavirus. The pandemic is against a backdrop, though, of estimates of some 3 in 10 people worldwide, or 2.1 billion people, lacking access to safe, readily available water at home, and 6 in 10, or 4.5 billion, having no safely managed sanitation. The poorest and most vulnerable people are at a greater disadvantage in accessing safe water and sanitation.
As part of the measures implemented by governments to control the COVID-19 pandemic, some 124 governments have already closed schools, resulting in over 1.2 billion learners going without access to education or, generally for the first time, studying remotely. Where distance-learning mechanisms are attempted, they will not reach all children and youth – those without internet access or adult supervision will be disadvantaged. Children on the move are already disproportionately affected by learning disruptions, and they are at great risk of exclusion from online or other alternative learning options. As schools close, school lunches and other support services are no longer available for the poorest children. Even when schools reopen, children will be returning to only 53 per cent of schools having basic hygiene services (defined as having a handwashing facility with water and soap available). Nearly 900 million children worldwide lack basic hygiene services at their school, increasing their risk of exposure to diseases such as COVID-19.
In many countries, especially those with ongoing humanitarian crises, the COVID-19 outbreak is creating significant additional pressure on the already overburdened social service delivery systems, exacerbating the vulnerabilities of affected populations. The urban poor, migrant, internally displaced and refugee populations are especially at risk as they tend to live in overcrowded settings, making it incredibly difficult to practise social distancing. These settings often also lack continuous access to water and sanitation services. Populations on the move will be further exposed to the disease as basic essential and life-saving services are hindered due to control measures, movement restrictions, border closures and discriminatory access to testing and other health services.
While countries attempt to control and interrupt the virus transmission and ensure that people with COVID-19 receive appropriate treatment, health resources, including personnel and facilities, are being diverted to the response. The pandemic has forced health services to adapt, to protect the safe delivery of some services and discontinue others as the capacities to respond to COVID-19 become severely stretched. Some services such as institutional deliveries – including caesareans, essential newborn care, and treatment of severe diarrhoeal disease and pneumonia – cannot be interrupted. If others such as immunization are interrupted for more than a few weeks, there will be increased morbidity and mortality from other highly contagious diseases such as measles.
Safe health services require adequate water, sanitation and hygiene (WASH) services. Protective equipment at health facilities, to help with infection prevention and control (IPC), is also needed – to keep health workers from being exposed to the virus as well as preventing them from potentially infecting patients. The availability of personal protective equipment (PPE), including gowns, masks, goggles and gloves, is extremely limited due to the unprecedented demand, and the closure of factories producing the materials, leaving health workers at risk of exposure to the COVID-19 virus.
Returning to the effects of enforced measures to control the spread of the virus, there is a range of other collateral impacts that particularly affect children and women. Loss of household incomes for the poor and vulnerable (including migrant workers) affects the financial capacity of parents and caregivers to access the basic services that are essential to meeting children’s needs. Control measures that do not account for the gender-specific needs and vulnerabilities of girls and women may increase their protection risks and negative coping such as early marriage or child labour.
Persons with disabilities (particularly girls and women) may be at heightened risk due to inaccessible information about prevention and assistance, barriers to accessing health services, and difficulties accessing WASH services to ensure the use of prevention measures such as handwashing. Further, persons with disabilities may be disproportionately affected by social and economic impacts due to a reliance on service providers for daily tasks of living, a lack of access to remote/distance-learning options, and pre-existing isolation and marginalization.
At a macro level, the economic slowdown is likely to have serious implications for medium- to long-term fiscal capacities to maintain social sector spending (including social protection). Combined with economic repercussions, such as loss of livelihoods and access to services, catastrophic impacts are anticipated in all countries, especially for low- and middle-income countries and for the most vulnerable and marginalized people in society.