The COVID-19 threat to the developing world

Season 2, episode 4

The COVID-19 threat to the developing world

As wealthy nations struggle with the impact of COVID-19, what is happening in countries already facing challenges related to a lack of healthcare, nutrition and education, where physical distancing, sanitation and hygiene are not possible in order to flatten the curve? Travel with us to Bangladesh’s Rohingya refugee camps, Uganda and Brazil for an inside look on how COVID-19 is affecting these countries and the potential long term impacts on children, if we don't act now.

Producer: Priyadarshini Mitra

Sound Mix: Chandra Bulucon

Episode Transcript 

[00:00:00.00] [ANGELIQUE KIDJO, "PATA PATA"] It's the time to sit it out. This is no pata pata. Stay at home and wait it out. And no pata pata. Uhm, this is what we gotta do, mama. This is no pata pata. Hayi, this is what we gotta do, papa. And no pata pata. We need to keep our hands clean. This is no pata pata. Don't touch your face, keep your distance please. This is no pata pata.

[00:00:23.95] That was UNICEF Goodwill Ambassador Angelique Kidjo singing her new version of the classic hit, "Pata Pata." The name of the song in Xhosa literally means "touch touch." So to help promote awareness around social distancing and handwashing during COVID-19, Kidjo has recorded this version, encouraging everyone to look after one another.

[00:00:51.07] Here in Canada, the weather's getting better and the number of new coronavirus cases are on the decline. Provinces are beginning to reopen. People are stepping out of homes. Small gatherings with friends and family have begun. But in other parts of the world, the scenes look quite different. In this episode, we will travel to Bangladesh, Brazil, and Uganda to see what their reality looks like during this pandemic.

[00:01:19.76] I'm David Morley, president and CEO of UNICEF Canada, and the host of the For Every Child podcast.

[00:01:28.31] [THEME MUSIC]

[00:01:38.44] A peculiar fact about the COVID-19 pandemic is that in its initial phase, the world's poorest were largely spared its worst impact. The virus overwhelmed wealthier countries, countries with modern hospitals and world-class medical infrastructure. But as the weeks have progressed, this is fast changing.

[00:02:00.07] The virus is forcing its way into countries with large populations, resource-limited settings, infecting those with the most limited access to prevention and care. One of the cheapest, easiest, and most important ways to prevent the spread of the coronavirus is frequent handwashing with soap and water. But for many children and families, even basic water and hygiene facilities remain out of reach.

[00:02:28.71] [NON-ENGLISH]

[00:02:31.47] 10-year-old Muna is one of over 1.7 million internally displaced children in Yemen. She lives with her family in al-Shabaab refugee camp in Aden, after fighting forced them to flee their home. She says, she knows it's important that people wash their hands regularly to help prevent COVID-19 from spreading. But residents in the camp don't always have soap. Imagine the impact this struggle is having on her childhood.

[00:03:04.76] And Muna is not alone. 40% of the world's population still lacks a basic handwashing facility with soap and water at home. And in least developed countries, this rises to nearly 75%. And when coronavirus strikes, these settings where basic soap and clean water are luxuries, its impact can be catastrophic. Perhaps, nowhere is the risk greater than in the world's refugee camps.

[00:03:36.01] Bangladesh, one of the world's most densely populated countries, is also home to the world's largest refugee camp. I was there a couple of years ago and saw how densely populated the Rohingya refugee settlements in Cox's Bazar are. They've recently seen the first few cases of COVID-19.

[00:03:58.77] Our first guest is Shairose Mawji, a chief of field services at UNICEF Bangladesh. A Canadian herself, she's currently in Cox's Bazar, actively supporting UNICEF's response in the crisis. Shairose, what are some of the challenges faced in the refugee camps there, especially now due to the impact of COVID-19?

[00:04:23.77] Just to give you a little background first, to your audience, for the Rohingya refugee camps in Cox's Bazar, the camps lie in the southeastern part of Bangladesh. And they are the largest and most densely populated refugee camps in the world. The camps are home to over 860,000 Rohingya refugees, one of the most discriminated communities in Myanmar, who fled from extreme violence in Myanmar in 2017 to Bangladesh. Over half of the refugees are children.

[00:05:04.09] So just how dense a space am I talking about that the refugees live in? Imagine Toronto city, the density, the number of people who are living in a square kilometer in Toronto is approximately 4,300 people per square kilometer. In Cox's Bazar refugee camps, it's almost 10 times more. That's 40,000 people living in that same square kilometer. And sometimes, the space between one shelter or one home and the next one is as little as 50 centimeters, and if you're lucky, then one meter.

[00:05:43.63] The refugees' homes are very fragile. They're made up of bamboo and tarpaulin or plastic sheeting. And sometimes, up to 12 people may stay in one of these units, though the average is around 5. And then the camp is built up in what was once a forested area. It's a hilly area, and when you stand on top of a high ground, you can see thousands of shelters across the rolling hills. So it's a very dense, very challenging environment. So already it was challenging, and now we have COVID-19.

[00:06:25.21] One of the key messages that we all hear is to protect ourselves and our families from COVID-19 by staying home. Now, you can imagine that same message for the Rohingya refugees. Staying home in a small, crowded space is extremely challenging, if not next to impossible.

[00:06:47.96] And why I say impossible is that the refugees don't have piped water, or bathrooms, or showers in their shelter. It's just that room where they sleep. They have communal facilities that are shared amongst a group of families who live in the same area. And on average, one washroom or toilet serves 20 community members. And so by sharing all these different services, it also increases their risk of COVID-19 in this particular time frame.

[00:07:24.43] The other thing we often talk about is the message about physical distancing. Now, again, in the camp situation, physical distancing measures are put into place in health facilities and distribution points, which the humanitarian community supports, for example, distribution of food or other non-food items.

[00:07:48.74] However, when it comes to the markets, the local markets where people will go to buy their vegetables, or fruits, or any other items, to go to the barbershop or to get your hair cut, there is no such thing as physical distancing there. It's crowded. And when you look at the household level, if somebody was to be infected with COVID-19, it's, like I say, almost impossible to have physical distancing in their own home. So it's definitely a very challenging environment which we are facing now.

[00:08:27.16] That's very unsettling. What's been UNICEF's response to it so far?

[00:08:32.41] You know, UNICEF, amongst many other actors, many other UN agencies, NGOs, and other humanitarian agencies, has been doing its very best to respond to the crisis in Bangladesh, and more specifically, in the camps in Cox's Bazar. UNICEF is focusing on three core pillars with its response. The first one is strengthening health care capacity. The second is expanding on the hygiene promotion activities. And the third is on sharing critical information with children and families. And I'll just elaborate a little bit on each so that your audience gets an idea of what I'm really talking about.

[00:09:19.66] With regards to the first pillar I mentioned, strengthening the health capacity, this is both for the refugee camps, as well as the government health facilities in Cox's Bazar district. Here, UNICEF is supporting to help set standards, adapt them to the Rohingya situation, and ensure that the staff are trained in various areas, for example, infection prevention, case management, et cetera. UNICEF is also providing medical supplies and equipment, and building an isolation and treatment center, along with other agencies, for caring for people with COVID-19.

[00:10:05.83] The next area I mentioned was about improving and ramping up our existing hygiene promotion activities. By that I mean, very simply, handwashing with soap at the right time. Handwashing is one of the best defenses we can have against the spread of COVID-19, so we are ensuring safe water and soap for the Rohingya refugees.

[00:10:31.96] And wherever possible, we're also supporting the Bangladeshi communities for ensuring that they have safe water. Our hygiene promotion partners we have-- we work with non-government partners-- are working to teach handwashing practices. They go house to house in the area that they work in. And they encourage behavioural change amongst the community leaders and advocate for handwashing.

[00:11:00.13] Here, I'd like to highlight the role that women and adolescent girls play. It's really a pivotal role. Our partners work with model mothers, so mothers who agree to support this cause, and they will volunteer to then teach other mothers the key information. So they role-play what needs to be done and ensure that the other household members also follow the good practices of hygiene promotion of handwashing, et cetera.

[00:11:38.20] And then, also, with adolescent girls, we work very closely with groups of adolescent girls through a radio listening club, where the adolescent girls come together. They have an opportunity to learn on many different things. And right now, the focus is on COVID-19 prevention, sharing with them the information. And then they go back as agents of change. And they will then speak to others in their community as well. UNICEF has also added thousands of additional water stations in the camps, ensuring that mandatory handwashing at all our health and nutrition facilities prior to entry.

[00:12:20.53] And then the last thing I mentioned was about sharing information. In Cox's Bazar, especially in the camps, we face internet and technology restrictions, and therefore, we have to rely on more traditional forms of media. Here, what I mean is that in the camps, we have a network of 650 trained Rohingya community mobilizers, of which 200 are religious leaders. And they and the volunteers ensure that children and families understand the symptoms of the disease, how to prevent transmission, and where to seek help.

[00:13:01.57] UNICEF is also working, as I mentioned, very closely with religious leaders, who are really the most trusted sources of information in the camps, as well as in the local Bangladeshi communities. And so far, we've reached 1.9 million people in the Cox's Bazar district and all of the camp residents through the mosque-based messaging. We're also reaching out to children in the Bangladeshi communities through cartoons, giving opportunities for daily radio broadcasts with live phone-in shows, and what we call public service announcements on COVID-19.

[00:13:40.46] And then, as I mentioned, we have community mobilizers, who use hand-held microphones in the camps, loudspeakers. And sometimes, these loudspeakers are attached to minivans, or tom-toms, or tuk-tuks, as they're called in Bangladesh, to deliver the messages in local languages. And they go around each of the small streets and blast out these messages.

[00:14:04.24] We have other programs in health, for example, maternal and child health, immunization, delivery services. Those are crucial, and we need to continue during these times. We also work on nutrition. Another area is on child protection. And here in Bangladesh, in Cox's Bazar, we have issues such as child marriage, children under the age of 18 that are getting married, child labor, and trafficking. And all of this, plus violence against children, is heightened during this time of COVID-19.

[00:14:42.28] The last area I want to mention, which is extremely important, is about education. UNICEF has been working on ensuring that children have access to education in the camps. However, during this time period, the classrooms, what we call learning centers, are closed. And here, we're looking at alternative ways in which children's families can help them at home with some learning that can take place until the restrictions or the situation changes.

[00:15:14.95] And because of the limited humanitarian access to the camps, we've scaled back about 80% right now, the humanitarian footprint, going to the camps, to really reduce the risk of disease transmission to the Rohingya refugees. But the core services do continue, and we ensure that they are maintained.

[00:15:39.35] Now, with the monsoon season around the corner, what are the challenges that you see could be added to the current ones against COVID-19?

[00:15:47.89] Absolutely. We've just actually faced a cyclone recently. And now, with the monsoon rains coming up, there are definitely additional risks. And although many monsoon mitigation measures are in place, the intense monsoon rains can cause a major impact in the lives of the refugees. And to give an example, last September, over 16,000 people were temporarily displaced due to the damage caused by heavy rains in the camps. Many people were suddenly displaced again.

[00:16:26.62] Now, with COVID-19 as well, this would place them at increased risk of infection. Because the refugees would end up living in a shared space while the repair efforts are underway, so they're going to be much more exposed being in tighter constraint locations.

[00:16:48.37] And in addition, some of the monsoon preparation and response efforts may be slowed down because of our reduced humanitarian access to the camps. So this is also another area, the challenge that we face. However, looking at it on a positive note, we are working together with the Bangladeshi authorities and humanitarian partners to minimize these risks and to ensure that we get support to people, to all the refugees, wherever it is needed the most.

[00:17:21.40] Thank you so much, Shairose, for speaking with us. And we hope that the efforts made by you and your partners help minimize the impact of COVID-19 in Bangladesh's refugee camps.

[00:17:33.66] [MUSIC PLAYING]

[00:17:34.99] Across the ocean, Africa has so far emerged with the least amount of cases among the most populated continents. But the number is rising and every country in the continent is now affected. Our next guest is Viorica Berdaga, chief of child survival and development at the Uganda UNICEF office. Viorica, how has COVID-19 impacted Uganda so far?

[00:18:00.93] Well, in terms of the impact, like all the other countries in the world, Uganda has been affected by the epidemic. The country reported its first case on March 21. And now, we're more than two months into the epidemic, we have over 220 Ugandans being affected, with zero deaths so far. I think this is a big achievement for a resource-constrained setting like Uganda.

[00:18:30.52] Outbreaks are not new to Uganda. As you may know, since August 2018, Uganda has been responding to the Ebola virus disease outbreak. But at any given time, Uganda can have between two to four different epidemics going on. So in this way, I think, Uganda has an advantage because the previous epidemics prepared the country to respond to this new challenge.

[00:18:56.62] When this global public health emergency was announced, Uganda started taking measures early, but firmly. So even from February, they had a plan in place. And they have introduced screening methods at the airports. They have applied special measures for travelers from high-risk countries, who already were recording a high number of cases.

[00:19:23.44] Also, what's interesting for Uganda is that they started very stringent containment measures even before the first case. And they closed schools before they had a first case. In this sense, their having experience of previous epidemics really, really helped.

[00:19:41.32] Having said that, Uganda is a low-resource setting and there's serious challenges in terms of, for example, ensuring sufficient personal protective equipment for health providers or for frontline workers, making sure they have enough diagnostic tests. Making sure they have WASH, water sanitation in schools, and health facilities, and in the community, because handwashing with soap is one of the key public health measures that the country has been promoting.

[00:20:13.45] Uganda is characterized by a high dependence on the informal economy, daily wages. Many people rely on day-to-day jobs, getting out of their houses to actually earn some little income to be able to access food. Uganda has been in the lockdown since the end of March. And during this period, Uganda has been preparing, building its own capacity for surveillance, identification of cases, contact tracing, isolation, quarantining, making sure that the hospitals are getting ready for the management of cases.

[00:20:52.57] But that is not an easy task in the context of Uganda. So while being in the lockdown, there have been reports that the most vulnerable people are heavily impacted. And the government, with support from some private sector companies, from the UN, from donors, has been mobilizing and distributing relief support, food, soap, covering the areas for the most vulnerable. But these measures remain limited in scope and coverage.

[00:21:25.43] So the containment measures have posed new challenges, along with the disease. What has been UNICEF's role in this response so far?

[00:21:34.97] We've been focusing on, if I may say, two main areas. And one is support to the COVID-19 emergency response. We focus on risk communication, community engagement, improvement of supplies, such as personal protective equipment, and WASH supplies, such as handwashing facilities, soap, chlorine. Then another area where we've been active has been supporting the Ministry of Health for strengthening mental health, psychosocial support in child protection capacity, and prevention of sexual exploitation, abuse, and gender-based violence.

[00:22:13.00] I wanted to highlight that one of the areas where UNICEF has been particularly active was preventing and addressing the secondary impacts of the outbreak on children, women, and their families, especially of containment measures. For example, the fact that the schools were closed, on the one hand, it prevented the spread of the epidemic. On the other hand, it denied children continued access to school. And in Uganda, distance learning is not-- or remote learning opportunities are not so easy to implement because of the limited connectivity or limited number of children having access to, let's say, internet and digital technologies.

[00:22:56.03] Physical distancing and washing hands with soap and water are interventions that are recommended to protect against the coronavirus, just like you mentioned. Is this simple to achieve in Uganda?

[00:23:07.37] Achieving physical distancing and handwashing is not a simple task in the context of Uganda. And public transportation is not so common and usually overcrowded. And the same can be said about schools. Very often, the schools are overcrowded. Access to water supply is also a real challenge. I think the latest data for Uganda say that 42% of primary schools and almost 30% of secondary schools lack water supply on the premises, and much the same proportion of schools do not have handwashing stations.

[00:23:41.75] What is challenging for Uganda is that even at home, children have to-- children and women are primarily those affected, who have to walk for hours, sometimes, to fetch water, to be able to have water for handwashing but also for other needs. Now, Uganda is preparing for the gradual lifting of the lockdown measures, and WASH becomes critical.

[00:24:06.03] So support from UNICEF Canada and the donors to support schools, to strengthen the WASH infrastructure facilities, to invest in behavior change communication, promote handwashing with soap, make sure that there's specific sanitation facilities or menstrual hygiene management support for girls, is extremely important. Because these schools are now better prepared for reopening.

[00:24:38.06] Not only these WASH facilities have been set up in schools, they are also operated by solar power, which makes them more sustainable and reduces the cost of paying for electricity. In Uganda, that's extremely important, because many schools have very small budgets and any additional cost imposes, sometimes, a burden that they cannot sustain, even if it is very small.

[00:25:05.27] It's encouraging to hear that the support from our Canadian donors has such impact in Uganda. Thank you, Viorica, for bringing that to us. Let's hope that Uganda's preparedness continues to help defend it against COVID-19.

[00:25:20.73] [MUSIC PLAYING]

[00:25:21.64] The WHO recently said that the pandemic's new epicenter is South America. And Brazil has been the hardest hit. My next guest can throw some light on how the country is coping with the pandemic. Florence Bauer is the UNICEF country representative for Brazil. Florence, we're watching on the news every day that the number of COVID-19 cases are rapidly rising in Brazil. Can you tell us a bit about the challenges that the country is facing in this fight against the disease?

[00:25:52.14] In Brazil, we are still in the phases where the virus is expanding in the country. And the number of cases is increasing every day, and the number of confirmed deaths, which is around 26,000 today, it's increasing, where we still haven't reached the peak of the curve. So in this context, the main challenges are still to prevent the expansion of the virus.

[00:26:19.46] And then the other challenge is to mitigate the impact that it's going to have on children and adolescents. Because while children and adolescents are not the population that is most directly affected by the illness itself, we know that children and adolescents are very much affected by the effect of the whole crisis that is impacting their whole life, basically. So those, I would say, are the two main challenges right now.

[00:26:49.58] If we could delve a little deeper into these challenges, why are the usual prevention measures against COVID-19 so complicated in Brazil?

[00:26:58.46] First of all, we know that one of the main prevention measures that can be implemented is the distancing, so, of course, there's many states that are encouraging people to practice social distancing. But when you live in a community, in a favela of a large city, of Sao Paulo here, or any other city, Manaus in the north of the country, and you are in a house that's a few square meters, and you have 10 people living together, it's extremely difficult to apply any measures of social distancing.

[00:27:30.47] Another aspect is that in many of those communities, or many of the vulnerable populations, they don't have easy access to water, for example, or even to soap. Brazil is a country of disparities, where you already have an extremely high level of poverty. At the same time, you have in the country part of the population that's very much comparable with other countries like Canada, for example, where they have the possibility to buy stuff, and so on. And you have another part of the population who is really suffering, and they don't have basic resources to be able even to buy soap.

[00:28:10.10] So what we see is that the COVID-19 crisis is making those differences and the disparities even more important and huger in terms of the disparities and also in terms of the impacts that it's having on the people. Something that we take for granted, for many people in Brazil, it's not easy, it's not affordable, in particular, at a time where many people have lost their income and are already struggling with getting basic food, for example.

[00:28:45.75] So the financial aspect is important. And then if you combine the lack of easy access to safe water and the difficulty with buying soap or alcohol, combining those aspects, it makes it very difficult for some of those families to protect themselves.

[00:29:04.07] How has UNICEF supported the COVID-19 response in the country?

[00:29:08.30] UNICEF has been in this country for many years. We have a presence at the feet level. We have 10 offices right now, one in Brasilia and the other ones are field offices, also at the border with Venezuela for the influx of migrants and refugees. And basically, all our programs have been reoriented towards the prevention of COVID.

[00:29:30.80] So the first priority is the prevention. And to do that, we are distributing supplies, kits of hygiene, kits to help, with alcohol, with products to clean your house, with soap, and all these products, that are being distributed. We're already reaching 140,000 families. And this is increasing. We get to a million quite soon.

[00:29:58.70] And that's key, because those people, they don't have access to this kind of products, and as we know, it's one of the key measures. And every time that we distribute this kind of first supplies, it goes together with information. Information has been spread [INAUDIBLE] in paper, in radio and television, in internet, in social media, et cetera, to around the region of 50 million people, with prevention measures, how to wash your hands, how to practice distancing, and so on.

[00:30:27.21] And then, in order to mitigate the effects that the crisis is having on children and adolescents, we, for example, are very concerned in terms of education. Even before the crisis, there were two million children and adolescents who were not at school. And we are very concerned that we'll have more of them not returning to school after that.

[00:30:49.94] Because we know if you have access to internet, you can have access to a number of information. But we're in a country with almost five million children who live in households that don't have access to internet, or they hardly have computers. Many people don't have computers. So what we're trying to do is to help those kids to maintain a link with school and with education.

[00:31:17.06] For example, even for small kids, we are producing a daily podcast of material that can be used by the children, with stories, with music, with games that they can do. And this is being distributed by internet, by cell phone, but also by radio, by all kinds of different ways, so that people have access to it.

[00:31:40.62] It has also an impact on mental health. We're very concerned with the situation of children and adolescents who have not been to our schools already for many, many weeks, and that's going to last still. So that, for example, we had a nice initiative for small children, to encourage them to grow. It's called Feelings On Paper.

[00:32:02.75] So children are invited to do a drawing on how they feel. And there was, for example, a mother who was looking at a drawing from her daughter, said she had not realized how sad her daughter was. And thanks to these initiatives, they started this dialogue and they started to think of what they could do for her daughter not to be so sad.

[00:32:25.91] UNICEF in Brazil is closely working with a network of 80,000 adolescents, which we are, basically, in daily contact. So we are providing them with information on how to protect themselves, how to prevent, of course, COVID-19, but also, how to prevent the effects that this can have on their mental health.

[00:32:48.41] We're encouraging them to stay connected with their friends, to stay connected with the school, and so on. So the whole question of mental health is a huge concern that UNICEF has been prioritizing over these times as well.

[00:33:05.18] You mentioned that UNICEF Brazil has offices near the border that works especially with migrant children and families. How has this been for them?

[00:33:14.52] So many of these migrants and refugees, in particular, to the north of Brazil, they are in shelters. And the shelters will be tents, where the level of proximity is very high, which makes it also difficult for this population to protect themselves. So what we have been doing is providing them information on the measures that they can take, in particular, washing hands, distancing when they have symptoms, and so on. So a lot of information.

[00:33:46.55] Access to water, in some of those places, or in the informal shelters, there was no access of water. So we've been, basically, providing water and providing facilities that are easy to be used by parents, by adults, and by children, on washing their hands. And also, that's together with the whole support that we're giving in terms of nutrition and health.

[00:34:12.77] We have to also take into account that many of these people, they are already weak. They have been going through all kinds of difficult situations. Some of them have been walking for long distances and many days. And when they arrive, they have, in some cases, health issues, and they are also affected psychologically. So this all creates a situation where they're very vulnerable in their ability to prevent for themselves for getting the virus.

[00:34:48.50] [MUSIC PLAYING]

[00:34:49.46] Thank you, Florence, for joining us. Through the voices you heard today, the message is clear. In our global fight against this unseen common enemy, it's important to remember those who are the most vulnerable, the ones who don't have access to clean water, those for whom soap is a precious luxury, who live in settlements where too many people share a room.

[00:35:14.33] For them, physical distance is not an option. It can only be a dream. COVID-19 is coming for them now, and they have nowhere to hide. Those children deserve a healthy and safe childhood. It is their right.

[00:35:34.32] UNICEF is working with governments and partners around the world to urgently reach them with safe water, sanitation, and hygiene facilities. Up to the end of April, we've reached more than 11.5 million people with such services and supplies. You can help support these efforts at unicef.ca/coronavirus. And with that, we come to the end of our episode. Thank you for listening and stay safe.