Humanitarian groups say they've never had to face a challenge like the novel coronavirus.
"We've never had to respond to a crisis that has simultaneously impacted every single office that we run in the world at the same time," says Elinor Raikes, head of program delivery at the International Rescue Committee, a humanitarian organization that operates in 40 countries.
It comes at a time when they're dealing with many crises already, from devastating drought in countries such as Angola and Pakistan to conflicts that have forced millions from their homes in Syria, Yemen and other regions. These groups provide aid in the form of food, housing, education and income to people living in some of the most desperate conditions on the planet: crammed inside refugee camps, under plastic sheeting in remote villages.
Even before the pandemic, the U.N. estimated that 168 million people will need humanitarian relief this year.
We spoke to international aid groups about how the pandemic has affected their ability to provide care in emergency settings. Here's what their top concerns are.
Billions of dollars are needed but who will give?
In December, before the coronavirus pandemic exploded, the U.N. was asking donor countries and the private sector for a whopping $29 billion in funds for their work to help people in vulnerable communities this year. It said a record number of people will need help in 2020, as a result of continued conflict in countries like Yemen and an increase in climate-related disasters.
Four months later, the pandemic hit — and the U.N. had to ask donors for an additional $2 billion so it could ramp up its work to fight the disease. These funds would help provide laboratory supplies for testing and medical equipment to treat the sick in the world's poorest countries.
Meanwhile, some in the humanitarian sector fear that donors will be less likely to give. Rich countries that typically donate millions are now affected by COVID-19 and will need to devote money to their own needs. And the pandemic has wreaked havoc on the world's economies, further constraining resources, says Manuel Fontaine, director of emergency response at UNICEF, the U.N.'s agency for children.
For now, governments and private donors are still contributing funds to non-COVID-19 emergencies, but Fontaine says he's not sure how long that will last. "There's always a risk that the part that is going to get cut off from budgets is going to be [development] assistance."
Meanwhile, international aid organizations like Mercy Corps are bracing for a downturn in funds. "The countries we work in will not have $2 trillion stimulus packages to support their citizens," says Michael Bowers, vice president of humanitarian leadership and response. He and his group are working on ways to remind donors not to "lose sight of that massive need that still exists out there, even as people are rightfully so concerned about their home needs."
Staff can't go where they're needed
It's never easy to get an aid worker to a trouble spot. Perhaps the area is in the middle of a conflict zone or roads were damaged by a natural disaster.
Now it's even harder. Airlines have canceled hundreds of thousands of flights — and some are suspending international flights. Countries are shutting borders to international visitors.
"It's a lot more difficult to bring colleagues and staff and personnel on the ground to actually respond simply because the flights are not there," says Fontaine.
If an aid workers do manage to reach a country in need, they may have to be quarantined for two weeks in case they harbor the virus, he adds. "That means they're not able to hit the ground running and do their work immediately."
The lockdowns have stifled the movement of local staffers, too. An increasing number of countries have ordered citizens to stay home to prevent the spread of COVID-19. Raikes of the IRC says as a result, "offices have closed and most staff are working from home. Some programs have had to be either temporarily suspended or adapted to deliver remotely."
"That affects our ability to get supplies in and out, move staff around and just function," she adds.
The impact on movement is slowing down other life-saving activities — like vaccine delivery. "Usually we take commercial airlines to transport vaccines," says Fontaine. "If airlines stop flying, we won't have that facility anymore. So we need to find new ways to transport vaccines with humanitarian [charter] flights, which are a lot more expensive and difficult — and not always possible because some airports are closed."
Rich countries may hold onto medical equipment for their own fight against the coronavirus
Even the wealthiest country in the world — the United States — reports shortages of PPEs and ventilators. Aid groups say countries that already have a fragile health-care system will be even worse off.
Fontaine of UNICEF says countries that are usually generous about sharing supplies are now "hoarding stocks" as they grapple with their own coronavirus crises. Nevertheless, the agency has managed to secure tens of millions of items like surgical masks, surgical gowns and coveralls for health-care workers and thousands of ventilators and oxygen concentrators to treat severe cases of COVID-19. But it's hardly enough to meet global demand, says Fontaine. This supply will only last until June.
The availability of PPE can be a major deciding factor on whether aid groups can help in an emergency — and not just COVID-19. "We're seeing that our supplies to protect our staff are becoming the critical barrier to continue the regular programs that we run in humanitarian settings," says Avril Benoit, executive director of Doctors Without Borders (MSF). The group will now need additional PPE for routine tasks, including measles vaccinations, treating the war wounded and delivering babies. "If we can't get the right people in place with the protective gear necessary to keep them from getting sick, we are going to have a lot of difficulty maintaining those medical activities."
Lack of proper gear has also scared off some aid workers from showing up to work, says Sudhanshu S. Singh, CEO of Humanitarian Aid International, a local aid group in New Delhi. Without protective gear, he says he's on a "skeleton crew" of staff, and that's slowed down his group's ability to deliver food aid and hygiene kits to the refugee populations he serves.
The lack of supplies has also given aid groups a wake-up call: If health workers don't have the equipment they need to treat severe COVID-19 patients when a country hits peak COVID-19 infection, they will have to resort to triage, choosing who they try to save and who they let die — a situation that even the U.S. is preparing for.
"If we're overwhelmed with a wave of patients in a place like Port au Prince, Haiti, a lot of those people will simply not survive because we don't have the ventilators," says Benoit. "We're going to have to face the impossible choices that the Italian physicians and nurses have had to face. We will have to turn away a lot of people."
Benoit says that Doctors Without Borders has already had to pause some of their life-saving medical programs due to COVID-19. In Haiti, for example, the group has stopped admissions in the Drouillard burn hospital in Port-au-Prince in order to respond to the COVID-19 outbreak.
In spite of everything, all hope is not lost
Epidemics can bring out the best of people, even in the toughest scenarios.
"We've seen time and time again that people are extraordinarily resilient," says Raikes of the International Rescue Committee. "And local communities are able to deal with crises when they hit."
Last month, she visited an Ebola health facility set up by the IRC in a conflict-affected part of the Democratic Republic of Congo. Raikes was heartened to see that the program was still running — thanks to the commitment of local health workers.
Although the staffers' personal lives have been impacted by conflict in the region — some have had to flee their homes — they continue to come to work, "despite everything that's going on for themselves and their families to prevent and reduce the risk of Ebola in their communities," she says.
"Honestly, that's just what keeps me going every day," says Raikes. "And that's what's going to keep me going through this."