IRC: World risks up to 1 billion cases and 3.2 million deaths from COVID-19 across fragile countries

COVID-19 :: Global Impact

IRC: World risks up to 1 billion cases and 3.2 million deaths from COVID-19 across fragile countries
April 28, 2020
:: Based on potential response scenarios, the International Rescue Committee (IRC) estimates between 500 million and 1 billion infections, leading to between 1.7 to 3.2 million deaths, in 34 conflict-affected and fragile countries.
:: There remains a small window of time to mount a robust response to COVID-19 while it is still in early stages in fragile countries; urgent funding to frontline responses is needed.
:: Extreme social distancing unsustainable in most humanitarian contexts, local approaches are needed – as outlined in new IRC report “One Size Does Not Fit All: Mitigating COVID-19 in Humanitarian Settings.

New York, NY, April 28, 2020 — Alarming new analysis by the International Rescue Committee (IRC) reveals that without swift action in coming weeks to mitigate the spread of Covid-19, the world could see up to 1 billion infections[1] and 3.2 million deaths due to COVID-19 over the course of the pandemic in 34 crisis-affected countries served by the IRC[2], including warzones like Afghanistan, Syria, and Yemen.

David Miliband, President and CEO of the International Rescue Committee, said: “These numbers should serve as a wake-up call: the full, devastating and disproportionate weight of this pandemic has yet to be felt in the world’s most fragile and war-torn countries. We are still in the critical window of time to mount a robust preventative response to the early stages of COVID-19 in many of these countries and prevent a further perpetuation of this epidemic globally.”

Preliminary estimates compiled by IRC are based on epidemiological modelling and data produced by Imperial College London and the World Health Organization. This model takes into account the age structure, household size, and social contact patterns of different countries, as well as mortality patterns from the early outbreak in China. IRC’s calculations for the 34 countries in which we work highlight the extent of the burden on fragile countries of the COVID-19 outbreak, and the importance of immediate actions in coming weeks to influence the trajectory of the epidemic.

Scientists are still studying the drivers of the pandemic in lower-income contexts, including factors such as population health risks which may drive infection rates up, or others such as younger population age structure which may drive mortality rates down; these figures are nevertheless sufficient to spark significant alarm on the international trajectory of COVID-19.

However, three significant limitations of the current data suggest that estimates for fragile countries may be conservative at best:

:: Healthcare capacity and virus reproductive rate (R0): The ICL/WHO model uses the best available mortality data, from China, which pre-supposes that levels of medical care available therein would be available elsewhere. As the IRC has previously warned, fragile states have nowhere near the healthcare capacity provided in China. In Venezuela alone, the long-standing economic and humanitarian crisis has forced more than half of doctors to leave the country and 90% of hospitals already faced shortages of medicine and critical supplies. In addition, refugee camps in countries included in the analysis like Syria, Greece and Bangladesh represent some of the most densely-populated areas in the world — up to 8.5 times more densely populated than the Diamond Princes cruise ship, where transmission of the virus was up to four times faster than in Wuhan, China[3]. Beyond demonstrating the infeasibility of extreme social distancing in these contexts and the scarcity of basic health capacity, this suggests that the reproduction rate of the virus in significant pockets of these states are likely to be far higher than the current projections suggest.

:: Pre-existing humanitarian vulnerability: These mortality figures do not account for excess deaths caused by underlying humanitarian vulnerability (including co-morbidity due to pre-existing health issues such as malnutrition) or by the economic and political instability which constitute a “double emergency” for fragile contexts. While strict lockdowns and social distancing will unquestionably save lives in wealthier nations, direct consequences such as market closures and income losses (without robust social safety nets) risk driving impoverishment, hunger, and domestic violence in humanitarian settings. Without sufficient social safety nets or relief packages in place to prevent people from spiraling further into poverty and hunger, these same measures risk harming populations already caught in weak states or unstable humanitarian contexts…

:: Disruptions to humanitarian aid delivery: Movement restrictions and disruptions to supply chains are already impacting the ability of agencies like the IRC to deliver life-saving humanitarian aid to people in need. South Sudan, a country with only 4 ventilators and 24 ICUs and where almost 65% of the population relies on humanitarian assistance, may for instance face famine with a toxic mix of restricted movement, economic instability, reduction in agricultural labor and pre-existing high levels of malnutrition and chronic food insecurity.