Learning Lessons in the Midst of the African Covid-19 Outbreak

By Dr Enida Friel, Vice Chair of the Irish Global Health Network and Head of Monitoring and Evaluation in GOAL

Covid-19 will not be beaten until it’s beaten by all countries

THREE WEEKS AGO, I, like you, entered a profoundly unsettling new reality as Covid-19 took hold.  We are all grappling with the scale of this crisis and its siege on our lives.

However, as a doctor who has worked in public health, infectious diseases, and tropical medicine in more than 30 countries, my greatest concern is the impact Covid-19 could have on low- and middle-income countries, particularly in Africa.

With the scale and speed of infection, we have all been alarmed by the devastating capacity for this virus to consume lives, resources and staffing in the most capable healthcare-systems in the world. Consider then the countries with weak or non-existent healthcare provision, systemic underlying malnutrition, as well as a scarcity of resources (chief among them water and hygiene) to respond, and it is deeply troubling to contemplate the toll this crisis could exact. 

The new and terrifying Covid-19

In my 21 years of working in crises in the Balkans, South East Asia and Africa, I have not seen one that poses a more dramatic challenge for the international humanitarian sector. The challenge is principally two-fold: first, the profound organisational and logistical constraints that have or will be implemented pose serious limitations to the continuation of basic services. Perhaps for the first time, GOAL may be prevented from being able to surge additional staff and expertise from Ireland or elsewhere to help directly with the response; and second, is the staggering inadequacies of the food, water, and health systems.

The Monitoring and Evaluation team that I lead at GOAL, in conjunction with other functions, have been grappling with the potentially seismic implications for our countries of operation. What is clearly emerging, as this virus moves east to west, to south, is the lag effect, with different needs emerging in different countries at different times. 

There are considerations in the global south which may mitigate the worst effects of the virus. First, Africa presents different demographic characteristics than the West, with a younger population and rural living more commonplace.

As elsewhere, the virus will likely thrive in Africa’s urban settings, but much higher levels of dispersed countryside living might provide somewhat of a buffer against widespread community transmission.

Experience is another factor we can lean on. While no one, NGO or otherwise, has faced a crisis of this scale before, GOAL was on the ground from start to finish of the more deadly, but less transmissible, West African Ebola outbreak. As a result, we developed valuable competencies in relation to contact-tracing, specific community engagement campaigns, and specialised logistics. These hard-earned skills are now a cornerstone in our fight against Covid-19.

GOAL’s refugee programme staff demonstrating how to wash hands properly and applying social distancing to Eritrean refugees in Aysaita refugee camp.

Source: GOAL

We’re learning from Irish response

Of further encouragement is the Irish Government’s leadership during this time, and moreover, the positive response of the Irish public.  When the dust settles from this crisis, it is likely that Ireland will be at the vanguard of those nations who implemented the correct approach.

GOAL has sought to channel some of the relevant learnings from the Irish response into our programming. For instance, an alarming statistic is that about 25% of infections in Ireland comprise healthcare workers. To this end, we are sourcing appropriate personal protective equipment (PPE) for our field staff and healthcare workers engaging with community members. The protection of frontline workers is a top priority. Yet with global supply chains under pressure, this is going to be a major challenge. 

Another striking feature of the Irish response has been the capacity of the community to respond, whether through the mobilisation of community groups or simply widespread neighbourly kindness. GOAL has long championed community-led social and behavioural change initiatives as a powerful and cost-effective tool for transforming vulnerable communities. 

While economic life has largely ground to a halt in Ireland and beyond, the supply of food, water, electricity, internet and other basic services has been prioritised.  So too for GOAL, as our teams work hard to sustain the essentials of food, water, livelihoods and health care to the six million people we serve in our 13 countries of operation. In particular, the provision of potable (safe) water, most acutely in camps with displaced families, but also in our wider programming, is vital to underpin a sufficient hygiene regime.  The 1.1 million people displaced in north-west Syria where GOAL is operating are our chief concern in this regard, with the virus likely to heap yet more suffering on a beleaguered people.

Africa needs to get ahead of Covid-19

That Africa faces this crisis more exposed than the rest of us merely serves to heighten its primary lesson: to minimise the capacity for transmission before that opportunity is lost. GOAL is cascading health messages as well as leveraging all our experience and competencies to prepare for, and mitigate, the worst ravages of this crisis in the communities we serve, always working in partnership with national and local governments, ministries of health, World Health Organization (WHO), donors, other NGOs, and Irish Aid. 

As ever, Ireland’s solidarity at this time is not just focused on ourselves but also further afield. The commitment of €10 million by the Irish government to the UN Global Humanitarian Response last week was both brave and welcome. Ireland’s Dr Michael Ryan of the WHO summarised it best when he said: “We are not safe until we are all safe.”

If this crisis has highlighted anything it is the simultaneous vulnerability and strength of our interconnectedness. We may be flattening the curve in Ireland, but we are not safe until all members of our global human family are safe.

Dr Enida Friel is a medical doctor with experience in public health, infectious diseases and tropical medicine in 30+ countries. She is head of monitoring and evaluation in GOAL and Vice-Chair of Irish Network for Global Health.