COVID-19: "An Explosive Situation in Terms of the Number and Volume of Humanitarian Needs" - The ICRC in New Delhi

Months into the COVID-19 pandemic, the world continues to grapple with several unknowns. The ICRC, one of the largest humanitarian organisations with presence in more than 80 countries, has continued its support and assistance to the affected communities in the face of unforeseen difficulties. It is working together with governments, authorities and the international community worldwide to help fortify the global response to this unprecedented crisis. In this interview to the ICRC New Delhi blog, Esperanza Martinez, Head of Health, ICRC Geneva, talks about the organization’s current priorities, operational challenges and the way forward.

How has the ICRC adapted its support to healthcare institutions operating under tremendous pressure across the world?

The adaptations in the ICRC started very early on. The institution began to prepare when the first cases came out of China and started to spread throughout the different regions. In the healthcare domain, the interventions are aligned with what the ICRC is doing in general – which is, first of all, maintaining essential services, second, adapting and proposing responses specific to COVID-19 and the third one focusing on the duty of care.

Despite the fact that we are already months into this global pandemic, looking after health care personnel continues to be important – both from the ICRC’s duty-of-care perspective and to prevent that our staff members become carriers of the disease to very fragile contexts with weak health systems. In relation to the maintenance of essential services, we are continuing running primary healthcare centres and hospitals across the five regions. To address COVID-19 more specifically, we have focused on strengthening our work in places of detention, the provision of personal protective equipment and training and capacity building on infection prevention and control. Looking after frontline responders by providing mental health and psychosocial support has been quite important as well. It is a large palette of services that has been maintained throughout this pandemic.

What has shifted though is the geographical focus. At the beginning, our ramp-up of services happened in Asia, followed by the Middle East and Africa. Now our main focus is the Americas.

What are the specific challenges faced by the ICRC staff in their response to the healthcare needs arising as a result of COVID-19?

The challenges for ICRC’s health personnel are a reflection of global challenges occurring during this pandemic. First, the provision of personal protective equipment has been really difficult across the different regions. The main reason at first was the lack of production in some key countries and afterwards, transport and exportation/importation restrictions. It has taken us months to be fully prepared in some contexts. And in some cases, we have adapted through local purchasing.

A second challenge that is becoming more and more prominent is the lockdown. The same way that populations are locked down, we do have teams which are unable to move, to go to the field. Many of them have switched to remote management of projects, which is working very well, but it means that they cannot travel. And many are in very difficult locations. The hardship and permanence of lockdown really takes a toll. We are looking at central level in the ICRC at how we can optimize the rotation of personnel, how can we ensure that those staff members working in healthcare, and also in water and sanitation, protection, economic security and management, are able to rotate and go back to their families or go home for a while.

In terms of duty of care, these two elements have required our focus and attention.

The ICRC President recently underscored the attacks on health workers responding to COVID-19 in more than 13 countries. What are the reasons behind these attacks and how can this issue be addressed?

Early into the pandemic, several states and the UN called for a global ceasefire but that did not meet with an agreement. As a result, many communities are dealing with this major crisis while still under attack. In many countries, the fighting has escalated and sadly, the healthcare sector has not been spared. There are instances where healthcare workers are prevented from going back home after working because they are seen as carriers of the disease. There are issues with their personal security as well as, in some cases, the excessive use of force to dispel protests aimed at requesting better personal protection equipment. There is a wide range of aggressions against healthcare workers and against patients as well. There are groups of people who have been discriminated against in this pandemic.

The ICRC is committed to help reduce attacks on healthcare facilities and healthcare workers. It is a very worrying trend and is not reducing. On the contrary, it is escalating. So, we are doing two things: raising awareness at the global level and working with local governments and authorities to try to enhance the safety and security of health personnel.

The toll on people’s mental health has also emerged as a worrying factor. What is the ICRC doing in this regard?

You have on one hand the impact on communities, the fact that people are in lock down very often in dysfunctional situations. As a result, we have seen reports on the increase in domestic violence and sexual violence during the pandemic. The locking down has restricted people, who are already at risk, from moving out or seeking help, and this places a huge toll on mental health. On the other hand, frontline healthcare workers are witnessing a large number of deaths – sometimes of close colleagues – and are often threatened by communities or by authorities. They are under stress not only from their work as healthcare personnel and first responders, but also because they, or their families, might also be affected by the virus.

The ICRC – through the mental health and psychosocial support program – is working on different fronts. We are doing training and capacity building of healthcare workers and frontline responders. In many countries, the ICRC has supported governments and ministries of health with hotlines. As a lot of people call to find advice and to clarify doubts in relation to COVID-19, this is a good opportunity to provide messages about self-care and on how to deal with the situation. Another aspect is public communication through what we call “info-as-aid”. In this, proper messaging is broadcasted in many countries through radio, social media or television to indicate that the situation is a difficult one but that there are measures that people can take to look after themselves and others.

A major study was recently released talking about the worsening of mental health and psychiatric conditions in this crisis. The same way that many people have been unable to go to hospitals to get treatment for non-emergency conditions, in many countries mental health conditions are not considered an emergency. Therefore, people who relied on therapy and medication are not getting it and their condition has really worsened. We are also working with ministries of health on raising awareness on the need to maintain these services. In summary, we have been tackling the mental health and psychosocial support aspects of this pandemic through many different entry points.

How do you see the pandemic unfolding in the coming months and the long-term humanitarian needs due to this?

This is a health crisis – but not only. It is now also a socio-economic crisis. The situation is worrisome as many people have lost their jobs as a result of strict public health measures implemented to prevent the spread of the virus. Many people are destitute already. The economic impact of the crisis is going to continue to be felt for many years to come.
The ICRC is looking at it as a compounded crisis and when mixed with armed conflict, this makes for a very explosive situation in terms of the number and volume of humanitarian needs. Looking forward, even if a vaccine is developed tomorrow or before the end of the year, the humanitarian consequences of this pandemic are also going to be present for many years.

And even though we are months into this pandemic, there are still a number of unknowns out there. We are still discovering how this virus is transmitted, we are still discovering new clinical presentations and why certain groups of people are more susceptible to dying than others, Africa is presenting a different pattern of clinical expressions, the mortality is behaving differently from one country to the other.

From a humanitarian perspective, we need to be prepared to continue responding. We need to be prepared to continue supporting our staff and the people that make it possible to deliver humanitarian aid today. For the ICRC, our staff members are the most valuable assets we have. We need to continue preserving both – our ability to operate, but also our own workforce. This is not a crisis that is going to be over soon. And even if it is over on the health front, we will still have the socio-economic impact to deal with in the years to come.

Lastly, your message to the health community and to people in general who are looking for hope in these challenging times.

Healthcare workers, doctors, nurses – anyone working in the health sector is a real hero in this pandemic. There have been so many instances in which they have put together a response leaving aside personal needs and family needs. A big thank you to them and a message of encouragement to keep going: we are not out of the crisis yet and we don’t know when we will come out of it. Most importantly, look after yourselves. Wear personal protective equipment and follow all required procedures. A healthcare worker who is alive and well can provide services to others. A healthcare worker who is sick or falls to this virus is not only going to be missed by his or her family but is also not going to help in the response. It is like the message in airplanes: you have to put your own oxygen mask first and then help others. In this crisis, it’s no different.

One of the things we are seeing with great worry is a sense of complacency. As governments are opening up states, cities or districts, there is this sense that the crisis is over and that things are back to normal. There is nothing normal about the situation. The number of cases is rising. The reality is that there is no treatment today. There is no vaccine yet available and, even if it is, it would take months before most of the population worldwide is covered.

Even if things seem to be coming back to normal, let us keep our alert, our commitment and our work to contain and prevent the spread of this virus as if it was the first day. Complacency will be a killer if we allow it to seep into our daily lives.