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	In MSF projects around the world, staff members have died from the virus by MSF, Amnesty, Accountability Research Center   June 2021   In MSF projects around the world, staff members have died from the virus, by Chiara Lepora. (MSF)   Throughout the COVID-19 pandemic healthcare workers have been portrayed as heroes. Images of doctors and nurses on the frontlines have saturated the media, creating an illusion of superhuman medics working tirelessly to save lives, always knowing exactly what to do. It’s an attractive image.   It’s also one that ignores the huge personal impact of working on a pandemic response. Months of stress, fear and uncertainty have led to unseen repercussions. Many medics are burnt out, including those working in areas where humanitarian assistance is needed. Now, some of them need help.   I began working on Italy’s COVID-19 response in Spring 2020. I was in a team of 30 experienced Médecins Sans Frontières (MSF) staff who started working in the public health system after our international missions were cancelled due to travel restrictions.   We worked alongside medics who had no previous experience of epidemic situations. Many were preoccupied by not having the ‘expertise’ to know what to do. But even the experienced MSF staff didn’t know what was to come.   Shortages were the hardest part at the beginning. They existed at every level: hospitals, beds, ambulances, PPE, medical staff. Health workers had to make incredibly painful decisions about triaging patients to high-dependency units, regular wards or sending them home.   Many staff working in Italy’s privileged health system were not used to this. In Italy, like in the UK, we work on the fundamental principle that everyone has an equal right to healthcare. The idea that one person may gain a higher level of care than someone else due to scarcity of resources is unfamiliar and gut-wrenching.   But case numbers were growing daily, and we were up against more and more shortages. Medics would find consolation from hearing “every epidemic ends” but often they felt like it would never stop. The system was so overwhelmed, but nobody had time to rest.   When I joined the MSF team in Sudan later, the world’s understanding of COVID had changed. We had protocols and materials to protect ourselves and knowledge we could only have dreamed of earlier on. Epidemics are prevalent in Sudan all year round so there was also a good level of preparedness there. Nevertheless, we faced new and very different struggles to those I had seen in Italy.   The problem was not always COVID itself but the far-reaching consequences of the pandemic. There was a shortage of non-COVID related essential drugs due to global manufacturing and shipping delays. This meant that people we would have usually been able to save were dying and we couldn’t help them.   Shortages and restrictions led to an increase in maternal mortality, malnutrition and infant mortality. Social distancing measures imposed due to COVID meant we had to reduce the number of patients we could see daily, meaning pregnant women, children and those affected by HIV and TB couldn’t access healthcare.   Medical personnel were discouraged knowing many patients wouldn’t receive the care they needed. On top of this, Sudanese public hospitals and clinics were sometimes faced with having to turn away people who needed medical care because they didn’t own a mask and short supplies at the hospital meant they couldn’t give them one. This feeling of helplessness is crushing.   In both contexts, staff were often also worried about family members who had contracted COVID or about getting sick themselves. In MSF projects around the world, staff members have died from the virus or contracted it while providing healthcare.   A colleague in Yemen had been working 24/7 on the pandemic response when he got sick. He isolated alone for 21 days before going straight back to work. This situation takes a huge mental toll even for those who recover.   There is no doubt that the medical teams I saw working around the clock in Italy or Sudan are the reason things are slowly improving. But their relentless dedication has come at a cost, one that is mostly unseen and unacknowledged.   * Chiara Lepora is Deputy Medical Director and Head of the Manson Unit at MSF. During the pandemic she worked on MSF’s COVID-19 response in Italy and Sudan: http://www.msf.org/   Dec. 2020   Almost 2 billion people depend on health care facilities without basic water services – WHO, UNICEF   Lack of water puts health care workers and patients at higher risk of COVID-19 infection   Around 1.8 billion people are at heightened risk of COVID-19 and other diseases because they use or work in health care facilities without basic water services, warn WHO and UNICEF.   “Working in a health care facility without water, sanitation and hygiene is akin to sending nurses and doctors to work without personal protective equipment” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Water supply, sanitation and hygiene in health care facilities are fundamental to stopping COVID-19. But there are still major gaps to overcome, particularly in least developed countries.”   The report, Fundamentals first: Universal water, sanitation, and hygiene services in health care facilities for safe, quality care, comes as COVID-19 is exposing key vulnerabilities within health systems, including inadequate infection prevention and control.   Water, sanitation and hygiene (WASH) are vital to the safety of health workers and patients yet provision of these services is not prioritized. Worldwide, 1 in 4 health care facilities has no water services, 1 in 3 does not have access to hand hygiene where care is provided, 1 in 10 has no sanitation services, and 1 in 3 does not segregate waste safely.   “Sending healthcare workers and people in need of treatment to facilities without clean water, safe toilets, or even soap puts their lives at risk,” said UNICEF Executive Director Henrietta Fore. “This was certainly true before the COVID-19 pandemic, but this year has made these disparities impossible to ignore. As we reimagine and shape a post-COVID world, making sure we are sending children and mothers to places of care equipped with adequate water, sanitation and hygiene services is not merely something we can and should do. It is an absolute must.”   The situation is worst of all in the world’s 47 Least Developed Countries (LDCs): 1 in 2 health care facilities does not have basic drinking water, 1 in 4 health care facilities has no hand hygiene facilities at points of care; and 3 in 5 lack basic sanitation services.   But this can be fixed. The report’s preliminary estimates indicate that it would cost roughly USD 1 per capita to enable all 47 LDCs to establish basic water service in health facilities. On average, USD 0.20 per capita is needed each year to operate and maintain services.   According to the report, immediate, incremental investments in WASH have big returns: improving hygiene in health care facilities is a “best buy” for tackling antimicrobial resistance. It reduces health care costs because it reduces health-care associated infections (which are costly to treat). It saves time as health workers do not have to search for water for hand hygiene. Better hygiene also increases uptake of services. This all adds up to a return of USD 1.5 for every dollar invested.   These services are especially critical for vulnerable populations, including pregnant mothers, newborns and children. Improving WASH services in health care facilities is particularly important around childbirth when far too many mothers and newborns suffer and die, including from preventable conditions like sepsis. Better WASH services could save a million pregnant women and newborns’ lives and reduce still-births.   The report provides four main recommendations:   Implement costed national roadmaps with appropriate financing; Monitor and regularly review progress in improving WASH services, practices and the enabling environment; Develop capacities of health workforce to sustain WASH services and promote and practice good hygiene; Integrate WASH into regular health sector planning, budgeting, and programming, including COVID-19 response and recovery efforts to deliver quality services.   Implementation of the 2019 World Health Assembly Resolution on WASH in health care facilities is uneven. Of the nearly 50 countries for which WHO and UNICEF have data, 86 per cent have updated standards and 70 per cent have conducted initial assessments which show that these areas are generally on track. Yet just a third of countries have costed national WASH in health care facility roadmaps and only 10 per cent have included WASH indicators in national health systems monitoring.   More catalytic global funding, technical support, and domestic resourcing is needed to keep health care workers and patients safe and protected. Now, an opportunity exists to build on existing efforts and commitments and integrate WASH in health care facilities in all national COVID-19 plans, vaccine distribution and economic recovery packages.   “For millions of healthcare workers across the world, water is PPE”, said Jennifer Sara, Global Director for Water at the World Bank Group. “It is essential that financing keeps flowing to bring water and sanitation services to those battling the COVID crisis on the frontlines. Funding WASH in healthcare facilities is among the most cost-effective investments that governments can make.”   Data published by WHO in October indicates that COVID-19 infections among health care workers are far greater than those in the general population: Health care workers represent less than 3 per cent of the population, but account for 14 per cent of global COVID-19 cases reported to WHO. Ensuring health care workers have the basic WASH necessities to keep themselves, their patients, their families and children safe - is imperative.   “Millions have no option but to seek care from the 50% of health care facilities in the developing world which don’t have clean water on the premises. This cannot continue. Every day both healthcare workers’ and patients’ lives are being put at risk,” said Tim Wainwright, Chief Executive at international charity WaterAid.   “Without frontline health workers being able to wash their hands; provide their patients with clean water; or have somewhere decent to go to the toilet, a hospital is not a hospital at all - it’s a breeding ground for disease.” http://bit.ly/3hAPf5b   Oct. 2020   Voices from the pandemic frontlines by Jennifer Johnson for the Accountability Research Center.   The COVID-19 pandemic has put unprecedented strain on health care systems around the world. Frontline health workers have faced great risks, from lack of personal protective equipment (PPE) to discrimination and harassment. Some face repercussions for whistleblowing or walkouts.   This evolving situation has given rise to a new wave of hundreds of innovative protests and proposals from health workers on the frontlines.   The Health Worker Protest Project seeks to understand more about the relationship between health rights and the rights of health workers, as they risk their own lives to protect the lives of others. This pilot learning project is an open-source initiative to share and store reports of health worker protests around the world, launched in May 2020 by the Accountability Research Center (ARC).   The project aims to learn from patterns that emerge when we see the international diversity of health worker protests and proposals. Five months in, we have received and collected over 600 reports from 84 countries, which we share on our twitter account @HealthWorkerPro.   Reports of health worker protests and proposals are as diverse as the regions they come from, but common themes emerge:   Health workers in nearly every country have reported a dangerous lack of personal protective equipment, whether due to shortages or poor distribution.   In one hospital in South Africa, nurses were given only one mask per week, and were expected to wash their own PPE at home despite potential risks to family.   In India, an accredited social health activist (ASHA) community health worker reported being given only one mask in four months, despite having to interact with dozens of people each day as part of COVID tracking efforts.   Health workers across the US have expressed concern at lack of supplies or being asked by hospitals to re-use PPE or use PPE that has been “sanitized” for re-use. Several who have refused or voiced concerns have been fired or faced retaliation. Health workers are facing threats not only from the virus, but from hospital administrations themselves.   Health workers face risks outside of hospitals too. Multiple countries have seen health workers attacked or arrested by police for their protests.   In Pakistan and Iran, protesting doctors and nurses were badly beaten by police. Police filed a report against ASHA workers for a peaceful sit-in protest on the grounds that it defied lockdown rules, despite the fact that these women were expected to interact with the public with almost no PPE and very little salary, the very reason they were protesting.   In Malaysia, members of the National Union of Workers in Hospital Support and Allied Services (NUWHSAS) were arrested by the police for carrying out a peaceful protest against their employer. Reports emerged of police in Zimbabwe arresting nurses engaged in peaceful protests for a living wage. Doctors in Nigeria went on strike following continued harassment by police for violating lockdown orders to treat patients.   Some health workers were attacked by police at Black Lives Matter protests in the United States, where many marched and kneeled in solidarity or volunteered as medics attending to protestors even after grueling hospital shifts at the height of the pandemic.   Sadly, health workers around the world have faced violence and harassment from the general public in their own communities. In Mexico, health workers were forced off of public transport, and even out of their own homes, for fear that they were a source of contagion. Several nurses and doctors had hot coffee and bleach thrown at them. Health workers have reported being physically assaulted, in some cases by family members angry that they could not do more for a relative who had died from COVID. In India, ASHA health workers visiting coronavirus containment zones complained that they were “spat upon by some people, pelted with stones and abused at times while conducting surveys.”   Despite the challenges they are facing, health workers are finding increasingly creative ways of raising their voices and protesting the abysmal working conditions. Many do it not just for themselves, but the patients they take care of every day.   “If I get sick, who will take care of you?” asked Peruvian health workers at a protest demanding better working conditions. Several innovative protests stand out, from health workers in France holding a “dancing protest” for better working conditions, to a Doctor in India attending patients outside as a form of protest against non-functioning air conditioning and unhygienic conditions inside of the hospital.   COVID-19 social distancing has made organizing protests harder, but online protests have allowed many health workers to express their concerns from a safe distance. The “naked doctor” protests of Argentina, France and Germany have seen health workers posing nude on social media as an allegory for how vulnerable and unprotected they are on the frontlines without adequate PPE.   In the United States, National Nurses United held a socially distant vigil in front of the White House, laying out 88 pairs of empty white shoes in remembrance of nurses that had died of COVID-19.   In Brazil, a country that has reported one of the highest numbers of nurses’ deaths, health workers stood 6 feet apart in their masks and white coats, holding crosses in memorial to their fallen colleagues.   As the coronavirus pandemic rages on, health workers are still at risk. A recent report from Amnesty International revealed that over 7,000 health workers have died from COVID-19 around the world.   There is still much to learn about the diversity and dynamics of health worker protests and proposals in the time of COVID-19, but one thing is clear: as health workers continue to raise their voices, we need to listen and act. There is no one more informed about the challenges faced in the coronavirus pandemic, and no one more crucial in fighting it worldwide.   Sep. 2020   COVID-19 has infected some 570,000 health workers and killed 2,500 in the Americas, reports the Pan American Health Organization (PAHO)   Health workers are especially vulnerable to COVID-19, and in the Region of the Americas, “We have the highest number of health care workers infected in the world,” PAHO Director Carissa F. Etienne said during a press conference today. “Our data shows that nearly 570,000 health workers across our region have fallen ill and more than 2,500 have succumbed to the virus.”   With almost 13.5 million COVID 19 cases and over 469,000 deaths reported in the Americas, including around 4,000 deaths a day in our region, the scale of this pandemic is unprecedented. “No other group has felt this more acutely than the very men and women who make up our health workforce,” Etienne said.   She noted that “in the U.S. and Mexico—which have some of the highest case counts in the world—health workers represent one in every seventh case” and these two countries account for nearly 85% of all COVID deaths among health care workers in our region.   To combat these trends, “countries must ensure that health workers can do their jobs safely. This will require maintaining sufficient supplies of PPE and ensuring that everyone is effectively trained in infection control to avoid risking their own health.”   Countries should also ensure safe working conditions and fair pay for health workers, highlighted Etienne. “This is particularly important for women, the majority of our health work force, who must be supported to fully participate and lead the response to the pandemic.”   The PAHO director cited several reasons for the high rates of infection in health workers in the Americas, noting that as countries scrambled to respond to the virus, “many health workers were redirected to the outbreak response without sufficient training to protect themselves as they were treating COVID 19 patients.”   As patients surged, “hospitals became overcrowded and many were too slow to implement triaging protocols. This meant that COVID 19 patients were exposed to others who may have been seeking care for different conditions, and soon everyone carried a risk of infection, leaving health workers more vulnerable,” she said.   Early in the pandemic, supplies of Personal Protective Equipment were scarce. “Health workers were forced to reuse masks and gowns, seek alternatives or forgo protection altogether to care for those in need,” Etienne said.   Maintaining sufficient supplies of PPE and ensuring that everyone is effectively trained in infection control to avoid risking their own health is key, she said. PAHO has been supporting countries in building designated triage and case management zones to protect health workers and patients. “We have also donated over 31 million masks and more than 1.4 million gloves and gowns to protect our frontline response.”   Months of operating under enormous pressure have also had strong mental and psychological impacts on health workers, including isolation from family and friends. “Shockingly, dozens of health workers have been assaulted over the last few months as a result of the public’s misplaced fear, misinformation or frustration from this pandemic,” she added.   Etienne also cited a recent Epidemiological Alert from PAHO, which says “In light of the increase in cases and deaths of COVID-19 among healthcare workers in the countries and territories in the Region of the Americas, the Pan American Health Organization/World Health Organization (PAHO/WHO) urges Member States to strengthen the capacity of healthcare services across all levels and to equip healthcare workers with the appropriate resources and training in order to ensure an adequate and timely response to the pandemic within the healthcare system.”   http://reliefweb.int/report/world/covid-19-has-infected-some-570000-health-workers-and-killed-2500-americas-paho-director   Sep. 2020   Amnesty analysis reveals over 7,000 health workers have died from COVID-19   New analysis by Amnesty International has found that at least 7,000 health workers have died around the world after contracting COVID-19. At least 1,320 health workers are confirmed to have died in Mexico alone, the highest known figure for any country.   Amnesty International also recorded high numbers of health worker deaths in the USA (1,077) and Brazil (634), where infection and death rates have been high throughout the pandemic, as well as alarming figures in South Africa (240) and India (573), where infection rates have soared in recent months.   “For over seven thousand people to die while trying to save others is a crisis on a staggering scale. Every health worker has the right to be safe at work, and it is a scandal that so many are paying the ultimate price,” said Steve Cockburn, Head of Economic and Social Justice at Amnesty International.   “Many months into the pandemic, health workers are still dying at horrific rates in countries such as Mexico, Brazil and the USA, while the rapid spread of infections in South Africa and India show the need for all states to take action.   “There must be global cooperation to ensure all health workers are provided with adequate protective equipment, so they can continue their vital work without risking their own lives.”   The countries with the highest estimated numbers of health workers who have died from COVID-19 include Mexico (1,320), USA (1,077), UK (649), Brazil (634), Russia (631), India (573), South Africa (240), Italy (188), Peru (183), Indonesia (181), Iran (164) and Egypt (159).   Figures for countries may not always be directly comparable due to different methods used to collect data, and definitions of health workers used in different countries.   These figures are likely to be a significant underestimate, due to underreporting by many of the countries included in the analysis.   http://oxfamblogs.org/fp2p/voices-from-the-pandemic-frontlines-health-worker-protests-and-proposals-from-84-countries/ http://accountabilityresearch.org/publication/voices-from-the-pandemic-frontlines-health-worker-protests-and-proposals-from-84-countries/ http://www.care.org/news-and-stories/health/our-best-shot-women-frontline-health-workers-around-the-world-are-keeping-you-safe-from-covid-19/ http://www.amnesty.org/en/latest/news/2020/12/what-health-workers-want-us-to-know/ http://www.amnesty.org/en/latest/news/2020/09/amnesty-analysis-7000-health-workers-have-died-from-covid19/ Visit the related web page
	The socio-economic impact of the COVID-19: 150 million more children living in poverty by Save the Children and UNICEF   The socio-economic consequences of the COVID-19 pandemic are already having devastating effects on children’s ability to access health, education, nutrition, water and sanitation and housing services, with a projected additional 150 million children living in multidimensional poverty.   Yet, with parents losing jobs and income, it is equally important to understand what the consequences will for children living in monetary-poor households.   By the end of the year, between 122 and 142 million additional children will live in households who cannot make ends meet due to the impact of the coronavirus pandemic, according to updated Save the Children and UNICEF estimates.   For 2021 – based on projections with a higher uncertainty – we expect only a modest reduction in the best-case scenario and numbers largely to remain unchanged in the worst-case scenario.   Our analysis reveals that even before the pandemic struck, 591 million children – almost 1 in 3 children in the mostly low- and middle-income countries included in our analysis – lived in households considered poor by national definitions. The vast majority of them lived in sub-Saharan Africa and South Asia.   As new evidence emerges and projections turn into facts, our end-of-year scenarios unfortunately become more pessimistic. When we first published those estimates in May, we projected an increase of children living in monetary poor household by 63-86 million.   When we updated those estimates based on new economic forecasts in June, the additional number of children in those families was estimated at 90-117 million. Incorporating the latest (October) forecasts of economic growth by the IMF and the World Bank, we now expect an increase of 122-142 million children in monetary poor households in comparison to the pre-COVID baseline.   This increase is due to more pessimistic economic outlooks across most regions and is driven by much gloomier picture for South Asia.   With the economic outlook for 2021 still very unclear, our estimates for this time next year come with a large degree of uncertainty.   In the best-case scenario, we may see the total number of children in monetary-poor households decrease by 44 million from the end of 2020 – or only one-third of the potential increases this year.   However, in the worst-case scenario, the numbers might be largely unchanged as compared to end-of-2020. This is a sobering reminder that monetary poverty for many families is not going to disappear any time soon and will have long-lasting impacts on the well-being of millions of children.   Our estimates take into account both an income effect – as the economic downturn will reduce household incomes – as well as a distribution effect. The latter accounts for the fact that changes in economic outputs will not impact all people equally and the fact that averages hide wide disparities underneath. Different estimates for both effects provide us with a range of scenarios, and as a consequent, a range of poverty estimates.   For now, these numbers are projections, and we hope that they do not become a reality. This would require further government actions addressing and mitigating the impacts of COVID-19.   UNICEF and Save the Children call for rapid and large-scale expansion of social protection in terms of coverage, type of interventions, and amount of support. These efforts could include cash transfers, school feeding and universal child benefits.   Governments must also invest in other forms of social protection, fiscal policies, employment and labour market interventions in order to support families.   These include expanding universal access to quality healthcare and other services, and investing in family-friendly policies, such as paid leave and childcare.   Given that many governments themselves face financial constraints, there is a need for predictable and enhanced official development assistance (ODA) as well as further debt relief above and beyond the efforts already under way.   * Note: These projections are as of November 2020.   http://blogs.unicef.org/evidence-for-action/children-in-monetary-poor-households-covid-19s-invisible-victims/ http://www.unicef.org/social-policy/child-poverty/covid-19-socioeconomic-impacts http://www.unicef.org/documents/lifeline-risk http://www.younglives.org.uk/content/news-release-covid-19-poorest-young-people-developing-countries-hit-deepening-inequalities http://bit.ly/3gPabok http://www.endchildhoodpoverty.org/publications-feed/2022/10/11/briefing-paper http://www.endchildhoodpoverty.org/publications-feed/2021/10/15/briefing-paper-edp4t http://www.endchildhoodpoverty.org/child-poverty-reports http://www.savethechildren.org.uk/news/media-centre/press-releases/11m-children-under-five-at-risk-of-extreme-hunger-or-starvation http://ophi.org.uk/ophi_stories/2020-release-of-the-global-mpi-2020/ http://reliefweb.int/report/world/asia-and-pacific-regional-overview-food-security-and-nutrition-2020-maternal-and-child Visit the related web page
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