As the employment opportunities have been shrinking in Nepal, especially in development and humanitarian sectors, there is a high tendency of aid workers making a move to international humanitarian work. There is no accurate data available of how many and of which kind of individuals are deployed, however from general assessment mostly the high skilled human resources, such as: Doctors, Engineers, programme Managers, Policy developers and social experts are the one getting engaged with international aid agencies as an expat.
With emergence of COVID -19 some of the world’s most vulnerable countries like Sudan, Yemen, Syria, Mali and Somalia are becoming a breeding ground for virus where hunger and death from malnutrition and communicable diseases like cholera are the common phenomenon. Most of the institutional donors have significantly increased their funding which is creating additional opportunities for aid workers. Nepalese seemed to be attracted to Aid business regardless of the fear of disease and being away from the families mainly of those laid off from INGOs and NGOs.
Social and cultural impacts
In many countries COVID is considered as an exotic diseases essentially brought by international people, which turns to stigma against expat. Accusing and targeting of aid workers continues to be a concern for the humanitarian community. However, risks to staff are not uniformly distributed across the humanitarian landscape. Ongoing assessment of stigma against humanitarian and disaster relief aid workers continues to demonstrate specially countries like Sudan, South Sudan, and Yemen account for most of these events.
While I was visiting the stores in Khartoum- Sudan, people used to stare at me and taunt, “Corona lady came”. Pharmacies were emptied or run out of essential drugs, as self-medication is common. Expat would rarely get the drugs they want, since the pharmacist either don’t speak English or ignore the expat, they may have the fear that expat would transmit the virus. Many of my international colleagues have told me the similar stories. Our Guards used to put a mask while they was in the guest house, strangely they used to eat together with many other guards, and never puts the mask while they visit to the crowded bakery and stores collecting their things.
Physical and mental health
Generally, humanitarian aid and disaster relief workers demonstrate considerable resilience and adapt to the stressful environments, but chronic stress and elevated uncertainty of treatment and care due to COVID had led to psychological deterioration and decompensation in certain people. “It’s been month I have lost my sleep” my close friend working in South Sudan said. Expat in these countries are found to be frisked out not only because of the fear of diseases but also to movement restrictions, beings away from families and loved one in this difficult time.
Aid workers are also facing challenges accessing healthcare. Most of the health care providers, especially those are run through international doctors and nurses are either shut down or functioning at the lower scale. Expat due to the language and cultural barriers face challenges accessing health care through government outlets, those are the only functional health services during COVID pandemic.
With ongoing conflict and vulnerability, COVID pandemic has added an additional burden to already fragile health care services in these countries. COVID testing and treatment services are strained or nonexistent. In humanitarian emergencies, direct infrastructure damage; lack of equipment, supplies, and human resources; or a surge in medical need can all contribute to a medical facility becoming compromised or overwhelmed.
Moreover, denial to COVID and ignorance has put the society at brink of an additional catastrophe, there is a tendency of non-testing, non-treatment and hiding the diseases mainly because of fear of stigma and social isolation. In some locations putting mask is considered to be infected of suspected to COVID, so most of people don’t put mask. Additionally, people believing on God and superstition of doing common pray will save from Covid-19 is the most scary part, particularly in Sudan, south Sudan and Somalia.
An in-depth interview conducted with the Nepalese working in humanitarian settings, they are working in insecure environments and facing emotional stress. Risks to the health and well-being of aid workers include exposure to infectious diseases, safety and security threats, and mental health challenges. Studies of long-term humanitarian workers indicate that >35% report a decline in their personal health during the mission[i]. According to CDC, among humanitarian aid workers, accidents and violence cause more deaths than disease or natural causes.
Movement and travel
Travel is the most essential part of aid work, since the workers needs to assist people in needs through field visits, delegation interaction and coordination. Many countries have halted some or all international travel since the onset of the COVID-19 pandemic but now have plans to re-open travel Aid workers traveling amidst COVID 19 encountered a number of hazards. In situations associated with damage or destruction to local services and facilities, humanitarian aid workers are experiencing limited accommodations and logistical and personal support. COVID-19 is making a significant social cultural and operational shift in the humanitarian sector. It has added extra difficulties onto humanitarian access, contact with vulnerable populations, and operational capacity and led to travel restrictions for many expats.
Here is no “zero risk” when considering the potential importation or exportation of cases in the context of international travel. Therefore, thorough and continuous risk assessment and management will help identify, reduce and mitigate those risks, while balancing the socio-economic consequences of travel measures (or temporary restrictions) against potential adverse public health consequences.[ii]
Expat whose travel is essential should ensure they follow all the travel instructions prescribed by WHO that includes personal and hand hygiene, respiratory etiquette, maintaining physical distance of at least one meter from others and use of a mask as appropriate. Sick travelers and persons at risk, including elderly travelers and people with serious chronic diseases or underlying health conditions, should postpone travel internationally to and from areas with community transmission
Women and aid work
In times of crisis, when resources are strained and institutional capacity is limited, women and girls face disproportionate impacts with far reaching consequences that are only further amplified in contexts of fragility, conflict, and emergencies[iii]. There are more than half a million humanitarian workers on the front lines of war and disaster around the world, about 40 per cent of them are women, many of whom work in some of the most dangerous corners of the globe[iv]. Unlike local trend of women being engaged in aid work, very few of them are getting an opportunity working as an expat. Leadership and management of aid sector is dominated by male. Studies revealed around 10% of the women are in the leadership role in humanitarian aid work. This disparity is seen throughout the globe, which is Significant in the Middle East and Africa. Gender equality will remain one of the primary areas of concern during the time of emergencies and COVID-19. There are a number of incidence related to sexual and physical violence reported during emergencies and especially during COVID-19 pandemic. Nevertheless, there are no evidences available until now how expat women are affected, however individual experiences shared by some female expat revealed a number of situations female expat being exploited specially through their supervisors. During the time of COVID because of men being confined within limited movement and lack of external social life making them temptation to sexual act.
Keeping in mind that COVID 19 is more serious among the people with low immunity and having secondary disease conditions, Aid agency while recruiting their employ should screen for such conditions A detailed evaluation of risk factors (psychiatric illness, family history, history of chronic disease) may direct additional evaluation and identify previously unrecognized psychological problems or chronic conditions., depression, or other psychiatric illness is particularly important, as stressful humanitarian environments along with COVID may exacerbate these conditions; they are often the reason for emergency repatriation.
Medical illness or conditions of deployed staff, particularly serious conditions that require repatriation, are not only troublesome and possibly precarious for the for the aid worker, such situations readdresses imperative for any humanitarian agency. So agency should identify the location and process of medical evacuation specifically for COVID19, which is totally a different procedures than other medical conditions and evacuations.
All the humanitarian organization should make sure that pre-deployment comprehensive medical examinations of an expat is done and specific medical conditions are identified with provision of treatment before travel. Expat should have gone through essential vaccinations and pre medications and prophylaxis. Exposure or post exposure interventions is necessary. Medical humanitarian workers responding to outbreaks of communicable diseases are often at increased risk of exposure and infection by specific infectious pathogens, and particular attention to infection control and personal protective measures protocols may be required. All the travelers should ensure having personal protective equipment such as masks, gloves, and eye protection. Aid workers should prepare a health kit that is more extensive than a typical kit such as: pharmacologic and other medical supplies for acute care treatment from the organization. They should also be familiar with basic first aid to self-treat any fever and pain.
There is no” zero risk “in the contest of international travel. Thorough and continues risk assessment and mitigation measures should be identified, limiting the travels would be a wise option until and unless it is imperative. World Health Organization recommends that priority should be given to essential travel for emergencies, humanitarian actions including emergency medical flights and medical evacuation, travel of essential personnel including emergency responders and humanitarian aid workers whereas minimizing and limiting or delaying the travel of personals where community transmission is prevailing. Aid workers with chronic medical conditions required medical evacuations mainly in the countries and field locations where required pharmaceuticals are not available. In the situations where the deployment of an expat to be extended, an alternative arrangement should be made making sure that the will not deprive from regular health care. Which can be done through importing essential drugs having remote consultations.
The decision process should include an analysis of situation, taking in to considerations of mental and physical state of an expat. Pre-departure briefing on prevention of COVID-19, use of most reliable travel means should be used. To protect others, self-protection is a key. A carefully conducted pre-travel evaluation, both medical and psychological, can reduce the likelihood of illness and the need for emergency repatriation. Aid workers especially women expat require support from senior leadership within agencies to make serious actions and drive change. Appropriate living environment should be provided to all expect, enabling them to relax and perform work effectively.
To summarize, the Humanitarian Aid sector has a critical role in saving lives of vulnerable people in needs. Emerging situation brought by COVID-19 has put additional challenges and risk to the humanitarian sector. Aid workers are now more responsible and accountable to provide the Aid with precautions, high alert keeping in mind. Making Aid workers safe, and resilient is the most urgent need today. Crises brings opportunities and are the turning points for change. Impossible may become possible and there will be a force to act in the way we were acting before. Each event have defects in delivering the aid however it evolves for the good. Aid sector has learnt from the bigger disasters like 2005 Asian Tsunami, 2011 Earthquake in Haiti, and 2017, 2015 Earthquake in Nepal, 2027 Cholera outbreak in Yemen, ongoing civil war in Syria, Libya, crisis in Sudan, Afghanistan and Nigeria that humanitarian and sector is reformed and new ways and approaches are adopted. Likewise covid-19 has taught the new normal life and work culture, managing programme virtually. Aid workers can work from home using all means of remote programme management. This is not easy way for aid providers, it might be less effectiveness, nevertheless aid have to be delivered in a timely mangers keeping aid workers safe and intact. Time will pass hence hope should be high.
The writer is a Humanitarian Aid Worker, working with International NGO in Sudan.
[i] Centre for Disease Control, measures for COVID risk mitigation
[iv] Centre for Disease Control, measures for COVID risk mitigation