COVID in crisis: The impact of COVID-19 in complex humanitarian emergencies

Two billion people are affected by complex humanitarian emergencies resulting from natural disasters and armed conflict. Many have been displaced into crowded camps and informal settlements with poor access to water, sanitation, and healthcare. Humanitarian response is challenging under these circumstances, raising concern about the impact of COVID-19 on crisis-affected populations. The current work examines complex humanitarian emergencies in the Democratic Republic of Congo, Bangladesh, and Yemen where protracted crises have displaced millions of people and increased malnutrition and infectious disease rates, while limiting access to health services and basic public health infrastructure. Barriers and facilitators to an effective COVID-19 response in these complex settings are examined and the future impact of the pandemic on crisis-affected populations is explored. Younger populations and existing response mechanisms including educational health messaging will likely facilitate the COVID-19 response in some complex humanitarian emergencies. However, pre-existing chronic illnesses and malnutrition, coupled with poor access to healthcare as well as limited water and sanitation infrastructure may increase COVID-19 infection rates and mortality. Exacerbated healthcare shortages, acute and chronic food insecurity, interrupted immunizations, increased insecurity and worsened poverty may have a particularly severe impact. COVID-19 risks are high for those living in complex humanitarian emergencies, and the health impacts, as well as secondary effects of the pandemic, will likely be severe and long-lasting. A wide-reaching global response, incorporating the voices of the most marginalized populations, is needed to effectively and equitably respond this global pandemic.