COVID-19 places millions of children at risk in fragile & displacement contexts

By Nathan McGibney, Syria Response Advocacy & Communications Director, World Vision

Though the full impact of COVID-19 on children is still being determined by the World Health Organization (WHO) and leading health authorities including Centres for Disease Control (CDC), initial analysis indicating that children do not appear to be at higher risk of infection or mortality than adults; however the secondary impacts on children in fragile and displacement contexts will likely be unprecedented. The World Health Organization (WHO) has warned of refugees and communities caught in crisis being left behind in the third wave of COVID-19 as the international community fails to respond collectively and adequately.

Globally, an estimated 800 million children live in fragile and conflict-affected areas and 1 in 10 live in extremely fragile contexts. 30 million children forcibly displaced by conflict, already reside in precarious and insecure conditions in low-income and fragile countries in precarious conditions including large over-crowded camps or densely populated urban settings with limited or no access to basic services and supports including basic healthcare; and are subject to a nexus of protection threats including physical and sexual exploitation and abuse, gender-based violence and child marriage, child labour, absence from education, and significant mental and psycho-social health challenges and trauma.

The impact of COVID-19 is likely to be disastrous and unprecedented for children, on their overall health, but also as a result of the interruption or total breakdown of already stretched or limited formal and informal child protection systems and other essential services including formal and informal education. Further, measures employed to prevent and control the spread of COVID-19 including service suspension and alteration, restricted freedom of movement, and humanitarian access can expose children to additional protection risks.

Below, 8 reflections/considerations (a non-exhaustive list) are outlined for States, donors, UN, and humanitarian agencies to consider in response to the COVID-19 Pandemic, including the ongoing revision of Global Humanitarian Response Plan (GHRP), HRP's, 3RP's, and JRP's, to ensure that children remain at the centre of every response.

1. Children affected by conflict, instability, and displacement could be left behind: Millions of children residing in fragile States affected by conflict, instability and displacement are at risk on an unprecedented level and if not addressed, may be left behind alongside their communities in the global response to the COVID-19 Pandemic according to the WHO.

Overwhelmed national and humanitarian systems and services including healthcare, water, sanitation and hygiene services, income and social protection, child protection and education services are becoming increasingly stretched or totally absent as Governments and communities try to respond to the primary and secondary impacts of COVID-19. National systems in high-income countries have struggled significantly to respond to the effects of COVID-19. Essential service depletion or redirection in fragile and low-income contexts will place millions of children at risk as basic needs are not adequately met.
High population density and inadequate housing conditions and social services including over-crowded urban, camp-based and informal settlements do not permit CDC Guided Quarantining and Social Distancing practices to prevent the spread of and provide adequate treatment for COVID-19.
Freedom of movement and access restrictions for communities, essential service providers, and humanitarian agencies owing to a number of pre-existing factors including conflict and instability and now COVID-19 related restrictions will significantly impact on the delivery of essential services including health, food and income security services including social protection, protection and child protection services; disproportionately impacting children and women.
The potential for further conflict and cycles of displacement increases as the pandemic evolves, as communities will take measures to avoid infection and mitigate the secondary impacts of COVID-19 including potential displacement internally and across borders, competition over increasingly limited resources, services are interrupted, reduced or collapse completely, and the increase of stigmatization and inter-communal tension.

2. Children on the move (CoM) face unprecedented risks: 30 million children (representing more than 52% of Refugees and 40% of Internally Displaced Persons[1]) are on the move as a result of conflict, violence and human rights violations. CoM already represent the most vulnerable group affected by conflict and crisis. The Principles of international law, Refugee Law and Refugee Protection are now coming under increasing stress, and must withstand.

As States adopt more severe measures that include stricter border controls to prevent the spread of COVID-19, there are reports of Refoulement, family separation, the increased use of detention in many cases resembling arbitrary detention, further restrictions on freedom of movement, and the suspension or curtailment of basic services for at-risk groups.
COVID-19 threatens to not only directly affect children but also act as a major multiplier of child protection threats faced by girls and boys on the move residing in over-crowded and poorly serviced camps or informal settings or precarious urban environments including other diseases and health risks, physical and sexual violence, exploitation and abuse, child marriage, child labour, gender-based violence, and limited or no access to basic services. COVID-19 also threatens to increase the number of separated and unaccompanied minors.

3. COVID-19 will impact girls, boys, and children with disabilities distinctly: The primary and secondary impacts of COVID-19 will be experienced distinctly and disproportionately by children of different genders, age, and diversity including disability; with variance across contexts. Increased pressure on formal and informal child protection systems and the potential reduction in essential services will result in distinct and disproportionate impacts for girls, boys, adolescent and children with disabilities.

Measures taken to prevent and respond to the spread of COVID-19 may have significant consequences for young and adolescent girls including increased rates of gender-based violence owing but not exclusive to significant changes in household income, restrictions on freedom of movement, requirements for families to stay confined to overcrowded and inadequate housing where children are unable to avoid abusive relatives, limited or absent access to essential services including protection, healthcare and hygiene services, the adoption of negative coping strategies including early forced marriage, reduced meal consumption and dietary diversity, and increased rates of domestic responsibility including caring for sick family members.
Adolescents have been identified by UNHCR as Person of Concern in contexts of displacement and conflict with distinct protection threats for adolescent girls and boys. For adolescent girls in particular, in crisis situations many face pressure to marry from families desperate to secure their safety and survival. Adolescent boys and girls may be forced to engage in hazardous and exploitative labour and in many conflict-effected contexts suffer the dangers of forced recruitment by armed groups[2]. COVID-19 threatens to act as a multiplier of these vulnerabilities while severely restricting existing opportunities for education and decent livelihoods opportunities and result in adolescent boys and girls participating in more hazardous and informal harmful work as a result of increased household responsibility.
Children with disabilities are at an increased risk of violence, neglect, and abandonment as a result of COVID-19 as households and communities struggle to respond. Children who require dedicated healthcare assistance may be at an increased risk as already stretched healthcare systems will be put under increased demand to respond to the outbreak, household capacity to meet basic needs is effected, and freedom of movement and access to services are limited.

4. Restricted and precarious status limit access to basic services: Millions of children in fragile and displacement contexts are vulnerable to a nexus of child protection risks owing to restricted or precarious status including refugee, returnee, and internally displaced children. Where national services are available and functioning including healthcare and education, access can be severely limited owing to a number of factors including cost and bureaucratic/status barriers and lack of information, social capital and networks, and referral systems. Refugee and internally-displaced communities can often be excluded from Disaster and Epidemic Preparedness Plans, National Action Plans (NAPs) and, in many contexts, existing public health plans, placing children and their communities at significant risk of marginalization and disproportionate vulnerability to the primary and secondary impacts of COVID-19.

5. The suspension or interruption of essential services and programmes: measures to prevent the spread of COVID-19 across fragile and humanitarian settings involves the reduction, adaptation, or complete postponement of services by national and international service providers, and potential redirection of funding away from perceived non-critical protection services to critical response sectors. The impact upon formal and informal child protection systems will likely have significant negative consequences for children now and in the long-term. While the containment of the public health emergency and protection of vulnerable communities takes precedent; the impact of such measures on households and children both in the immediacy and the medium to long-term must be fully understood and considered.

Determination of what is considered essential and life-saving supports must be made in coordination with affected communities where available and safe to do so. Postponement or severe restrictions on services that maintain basic community health and sanitation, food security, protection and life-saving child protection programming including education and social protection programming can have long-term and irreparable impacts on children including health, survival, and development. Efforts must be made to maintain essential services through alternative delivery options and or provide additional services in response to the increased demand.

6. Pro-longed absence from education could have irreparable consequences: in response to COVID-19 many schools and learning facilities providing services to millions of children in fragile and displacement has closed as a preventative measure. Protracted absence from education however can result in major child protection risks both in the immediacy and the medium to long term. The sudden removal of a dedicated safe space and a key source of information (including public health and hygiene) and referral for other services, reduced access to school feeding programmes, and the disruption of routine for children in fragile and displacement contexts can have significant impacts on children with distinct and disproportionate outcomes for young and adolescent girls, boys, and children with disabilities.

Immediate consequences can include decreased self-protective capacities, increased rates of child labour and child marriage, the adoption of negative coping strategies and poor mental and psycho-social health outcomes. In the medium to longer-term protracted absence from learning can result illiteracy, cycles of multi-dimensional poverty, and the risk of lost generations of children as dropout rates increase.

7. Changes in the household can impact children the greatest: COVID-19 threatens to disrupt household livelihoods and income generation as labour markets are significantly affected, freedom of movement is restricted, and assistance programmes (including social protection) are disrupted. Children and families who are already vulnerable due to socio-economic exclusion or those who live in overcrowded settings are particularly at risk.

A rapid and significant reduction in household income security and increased stress and mental health and psycho-social challenges for care givers can have major impacts on children including neglect, violence, the adoption of negative coping strategies, reduced meal consumption and dietary diversity disproportionately affecting women and girls, reduced or absent access to basic services including healthcare, child labour where opportunities are available for children to earn income, gender-based violence including physical and sexual violence and exploitation, and child marriage where households can no longer meet the needs of all children or view early forced marriage as a protective measure.

8. The mental and psycho-social health of children will be impacted: children affected by conflict, instability, and displacement face significant mental-health and psycho-social (MHPSS) challenges. The outbreak and potential spread of COVID-19 to fragile contexts threatens to act as a multiplier of existing MHPSS challenges and create new risks for children. Living conditions, mitigation capacities and service provision in fragile and displacement affected communities are wholly inadequate to respond to a major public health crisis.

Children will likely be directly affected or witness a family member or caregiver affected by COVID-19. Measures taken to stop the spread of COVID-19 including community and household quarantining can place significant psychological strain on children particularly in high density areas and over-crowded housing where privacy and personal freedoms are extremely limited. This will be further compounded where relevant and updated information is not made available by service providers and duty bearers.

To Mitigate the Primary and Secondary Impacts of COVID-19:

The international community must prioritize funding and resource support for Child Protection in Humanitarian Action (CPHA)[3] to represent at least 4% of total humanitarian aid[4].
Ensure prioritization of COVID-19 response to conflict-affected; internally displaced and refugee population[5] recognizing the extreme vulnerability these groups already face and their particularly acute risks related to the virus.
Provide financial, resource, and expertise support for National Action Plans and Health Systems and COVID-19 Response Plans for low-income and fragile States; and States with large displaced populations in keeping with the objectives of the Global Compact on Refugees.
Ensure the development and or adaption of National Action Plans (NAPs) and Strategies in response to the COVID 19 are fully inclusive of all populations at-risk within a State territory regardless of status and reflective of age, gender, diversity, and capacity.
Support the UN Secretary Generals Call for a Global Ceasefire in Response to COVID-19.
Ensure humanitarian access in conflict contexts is maintained. Reaching affected children in conflict contexts must be a global priority, pushed for by the UN Security Council with all parties to conflict, without exception.
Ensure the suspension of Refugee Resettlement Programmes are resumed and increased as soon as possible and safe to do so.
Measures taken to prevent and respond to COVID-19 must be undertaken in keeping with international law including Key Legal Considerations on access to territory for persons in need of international protection.
Minimize the time spent away from Education and learning services[6] and where possible and with the support of the international community, promote remote learning services with a particular focus on at-risk groups including young and adolescent girls.