Analysis: Vulnerable countries face 3 times the risk of COVID-19 exposure, yet have 6 times lower access to healthcare services

London, 26 March 2020 – CARE’s analysis of INFORM Global Risk Index data has found that the world’s ‘highest risk’ countries have three times higher exposure to epidemics, such as COVID-19, but also have a six times higher risk in terms of their access to healthcare compared to the world’s lowest risk countries.

Somalia, Central African Republic, South Sudan, Yemen, Afghanistan, Chad, Syria, the Democratic Republic of Congo, Iraq, Ethiopia, Nigeria, Sudan, Niger, Haiti and Uganda are all considered ‘Very High Risk’ by INFORM and are amongst the countries with the weakest capacity to cope with the added stress of a pandemic such as COVID-19.

Sally Austin, CARE International’s Head of Emergency Operations, said:

While even wealthy and better prepared nations are struggling to cope at this time, the impact on the countries highlighted in this analysis shows how people living in insecure environments, with extremely weak health infrastructure, are going to be far worse off. Countries such as South Sudan and Syria are in the midst of conflict. Many countries on this list are already food insecure, with large parts of their populations reliant on international aid for survival. Add on COVID-19 and it is not only national health systems that will struggle to cope, but the entire infrastructure and basic services. This is a truly terrifying thought for all of us working in the humanitarian sector. 

As Tue Jakobsen, CARE Turkey’s Assistant Country Director – Humanitarian, notes:

In Northwest Syria, there is no functioning government and the health system has been destroyed over the past nine years. Hundreds of thousands of people are not able to do basic preventative measure, such as wash their hands. With no testing capacity, it is highly likely that the virus has been spreading around without our knowledge, so we might be weeks behind in our response. An outbreak will cause mayhem in an area that has already gone through so much suffering. We are currently at a stage where only around 900 testing kits have been made available this week in Idlib and there is only one lab that can that can handle about 20 tests per day. Since this is a global crisis, countries are prioritizing their own responses and Syria has been completely neglected. There is an urgent need to scale up the health response and increase health supplies going into Northwest Syria.

On top of poor access to healthcare these countries also face the highest levels of food insecurity, displacement and socio-economic inequality. All of which increase their vulnerability to COVID-19 and the likely levels of devastation the virus will have in a given country.

CARE’s analysis found that in comparison to the 36 ‘very low risk’ countries, including Norway, UK and New Zealand, the 14 most vulnerable and ‘very high risk’ countries are at:

  • Over 4 times (336%) higher risk of food insecurity
  • Almost 9 times (756%) higher risk of socioeconomic vulnerability
  • Over three times more likely to be providing refuge for displaced and uprooted people (210% greater risk level)

Austin said:

This data shows a stark and chilling picture of what we can expect as we start to see the COVID-19 pandemic spread to many Asian, Africa and Middle Eastern countries. In order to try and best prepare, at CARE, where possible, we are scaling up our activities to ensure that clear guidance on risk, prevention and awareness of symptoms are available in the communities where we work.  We are scaling up water supply activities to facilitate good personal and household hygiene.

But this alone is clearly not enough. We need strong commitments from all national Governments to immediately respect the global cease fire called for by the UN Secretary General earlier this week and we need to ensure humanitarians are seen as essential workers and supported to have unimpeded access to continue to deliver lifesaving assistance to already highly vulnerable communities. We also call on all major donors to show solidarity and contribute to the global appeal that was launched on 25th March.

If coronavirus has shown us one thing it is that we are all in this together. The sense of community this pandemic has created is truly heart-warming. We are asking people to go one step further and not just care for their local communities, but also to think about their global community, and those likely to be affected even worse.

ENDS -

Notes to editors:

CARE International works in 13 of the 14 countries considered ‘Very High Risk’ by INFORM.
The full INFORM 2020 analysis can be found here: https://drmkc.jrc.ec.europa.eu/inform-index/Portals/0/InfoRM/2020/INFORM...
The full INFORM category and ranking methodology can be found here: https://drmkc.jrc.ec.europa.eu/inform-index/LinkClick.aspx?fileticket=wU...
CARE International used data from INFORM Global Risk Index for this analysis. INFORM (Index for Risk Management) is a collaboration of the Inter-Agency Standing Committee Reference Group on Risk, Early Warning and Preparedness and the European Commission. INFORM is a composite indicator that identifies countries at risk of humanitarian crisis and disaster that would overwhelm national response capacity. We analysed risk indicators associated with vulnerability, lack of coping capacity and hazard and exposure, comparing averages against ‘very high risk’ countries against ‘very low risk’ countries across these indicators
INFORM risk scores are on a scale of 0 (very low) to 10 (very high)
Very high risk countries are: Uganda, Haiti, Niger, Ethiopia, Nigeria, Sudan, Congo DR, Iraq, Chad, Syria, Afghanistan, South Sudan, Yemen, Central African Republic & Somalia
Very low risk countries are: Singapore, Finland, Estonia, Liechtenstein, Luxembourg, Norway, Denmark, Czech Republic, Iceland, Slovenia, Bahrain, Qatar, Ireland, Lithuania, Netherlands, Switzerland, Latvia, Sweden, Austria, Brunei Darussalam, New Zealand, Portugal, Slovakia, Poland, Grenada, Kuwait, United Kingdom, Uruguay, Barbados, Belarus, Belgium, Hungary, Kazakhstan, Malta, Saint Kitts and Nevis,  and United Arab Emirates
Socio economic vulnerability risk scores are calculated by analysing data in areas that include development and deprivation, inequality (including gender inequality), and economic dependency.  Uprooted people risk scores analyse displacement data (IDPs and Refugees) as total numbers and as % of population.  Food Security risk scores analyse food utilisation data against food availability.  Access to healthcare risk scores analyse data associated with density of physicians, immunisation coverage, maternal mortality and per capita private and public expenditure on healthcare.  Epidemic risk scores are analysed based on data that includes the number of vets, IHR Capacity Score (food safety), and data on foodborne and waterborne diseases of any given country.
Between 2015 and 2019, CARE has run 57 projects that aimed to stop the spread of infectious disease epidemics—like Ebola, cholera, and zika—in 20 countries around the world. During these events, our existing networks, such as CARE-sponsored Village Savings and Loan Associations, were instrumental in dispersing information to communities during the 2015 Ebola outbreak in West Africa, helping combat the spread of the disease. These projects collectively worked with 9 million people directly and 16.7 million indirectly.

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