The last time the world was gripped by fears of a pandemic in late 2014, my wife was not amused when I traveled to Sierra Leone – the epicenter of the Ebola crisis – a few weeks before our family assembled for the end of year celebrations. She was less worried about me – I am always doing crazy things – than endangering her children because of what she considered the irresponsible exploits of their father. Fast forward to 2020 and we are once again in the grip of health-related fears, this time the impact of Covid-19 – not just on our families but on the as we know it.
As we northerners ‘shelter in place’ – washing our hands, covering our faces, and avoiding each other – we must not forget people living on the fringes of our societies, such as the homeless, or those in the developing world who live in camps for refugees and the displaced, and the crowded shanty towns that surround so many third-world cities. For them, existence is already a daily struggle without the additional strains posed by the Coronavirus. As the pandemic takes root in under-served and vulnerable communities around the world, a response that considers their own perspective is vital if the current crisis is not to become a catastrophe.
The Imperial College London report on the pandemic, which convinced governments in the US and the UK to get serious about special measures, talks about the possibility of 40 million deaths worldwide; Bill Gates has warned that 10 million people in Africa may die. Whatever happens, a disproportionate share of the victims in low-income and fragile states will likely be in the poorest communities of the Global South, where national authorities and aid agencies are already struggling to keep up.
Nigerian refugees. People need to know how they can protect themselves. (Photo: Ground Truth Solutions)
If the response is to have half a chance, people need to know how they can best protect themselves and their families in crowded conditions that don’t allow for physical distancing and in places where there are no ventilators or intensive care units. In such hard environments, it’s all about enabling people to help themselves. The extent to which they act in their own individual and collective self-interest depends on whether they know what to do and this, in turn, depends on whether they trust and adhere to the advice they get. Where compliance with that advice is physically impossible, they need a means to say so and for decision-makers to hear their voices.
It is critical that community participation is at the core of the response, no matter how hard this seems from a distance. Tracking the perceptions of people hit by crisis is now increasingly accepted as a tool in managing performance in the world’s trouble spots. During the Ebola crisis in 2014-15 our organization, , did regular surveys of citizens and frontline health staff in Sierra Leone, using their perceptions as an indicator of progress in the fight against the disease and helping guide the emergency response.
We need this same approach to deal with Covid-19 if we are to determine whether or not people trust and understand the messages and actions of health specialists. Do people know what to do to keep the virus at bay? What will encourage them to comply with measures intended to protect them? Do they believe the response is making progress against the spread of Covid-19?
We need to know whether people understand what they should do – and the extent to which they will do so – because we have learned that the cooperation of an informed and engaged population is central to effectively tackling killer diseases. It is also important to explore people’s take on other factors that will determine their resilience, such as social cohesion as communities unravel under the pressures and livelihood support as they struggle to make ends meet.
Right now, there is a major gap in our collective understanding of the way ordinary people see things. The many polls we see are mostly conducted online and ignore the views of people who are not. When they do cover fragile states, they are not representative of the broader population, certainly not those at the bottom of the socio-economic ladder. Significantly, they are not linked in a systematic way to decision making in the health coordination structures.
From Afghanistan to Zimbabwe, people will be affected by the Coronavirus. As it spreads, we need to understand how ordinary people experience the response in their cities and villages, and the shifting balance between activities designed to tackle the outbreak and those intended to meet the long-term economic challenges. There is a raft of national and international organisations involved in the response, adding to the importance of making sure that decision-makers have access to community feedback to guide their decisions and their messaging.
My family, thankfully, never got close to contracting Ebola. But my wife’s concern highlights how perceptions are central in health emergencies. As national health authorities and aid agencies scramble to respond to Covid-19, racing the clock to provide health supplies and information to the most at-risk communities, understanding how people experience the crisis will be critical to whether the response averts catastrophe – or leaves individuals and families in the world’s hardest places to grapple helplessly with the unimaginable fallout.
a based in Vienna, that helps people affected by crisis influence the design and implementation of humanitarian aid.