• Based on potential response scenarios, the International Rescue Committee (IRC) estimates between 500 million and 1 billion infections, leading to between 1.7 to 3.2 million deaths, in 34 conflict-affected and fragile countries.

  • There remains a small window of time to mount a robust response to COVID-19 while it is still in early stages in fragile countries; urgent funding to frontline responses is needed.

  • Extreme social distancing unsustainable in most humanitarian contexts, local approaches are needed - as outlined in new IRC report “One Size Does Not Fit All: Mitigating COVID-19 in Humanitarian Settings.

Alarming new analysis by the International Rescue Committee (IRC) reveals that without swift action in coming weeks to mitigate the spread of Covid-19, the world could see up to 1 billion infections[1] and 3.2 million deaths due to COVID-19 over the course of the pandemic in 34 crisis-affected countries served by the IRC[2], including warzones like Afghanistan, Syria, and Yemen.

David Miliband, President and CEO of the International Rescue Committee, said: “These numbers should serve as a wake-up call: the full, devastating and disproportionate weight of this pandemic has yet to be felt in the world’s most fragile and war-torn countries. We are still in the critical window of time to mount a robust preventative response to the early stages of COVID-19 in many of these countries and prevent a further perpetuation of this epidemic globally.” 

Preliminary estimates compiled by IRC are based on epidemiological modelling and data produced by Imperial College London and the World Health Organization. This model takes into account the age structure, household size, and social contact patterns of different countries, as well as mortality patterns from the early outbreak in China. IRC’s calculations for the 34 countries in which we work highlight the extent of the burden on fragile countries of the COVID-19 outbreak, and the importance of immediate actions in coming weeks to influence the trajectory of the epidemic.

Scientists are still studying the drivers of the pandemic in lower-income contexts, including factors such as population health risks which may drive infection rates up, or others such as younger population age structure which may drive mortality rates down; these figures are nevertheless sufficient to spark significant alarm on the international trajectory of COVID-19.

However, three significant limitations of the current data suggest that estimates for fragile countries may be conservative at best: 

It is clear that the impact of COVID-19 in these settings will be different than in the developed countries first hit by the pandemic - and a “one-size-fits-all” model based on measures in countries hit first by COVID-19 is unrealistic and potentially counterproductive. In order to identify the bespoke measures that are not only appropriate but necessary for crisis-affected states, IRC has released a new report, “One Size Does Not Fit All: Mitigating COVID-19 in Humanitarian Settings” detailing the risks and possible solutions required to combat COVID-19 in fragile settings - and to avoid exacerbating humanitarian suffering.

David Miliband, President and CEO of the International Rescue Committee, continues, “The key now is for donors to urgently put flexible funding behind frontline efforts, already positioned to scale up and serve the most vulnerable. This requires consistent access to personal protective equipment, testing and isolation of all suspected cases, isolation units and handwashing stations. Donors, response actors and governments must work together to remove any impediment to humanitarian assistance- adapting restrictions to ensure access to COVID-19 supplies and equipment, food and other basic goods, as well as health, protection and livelihoods services. The IRC is implementing a comprehensive response strategy that aims to mitigate the spread of COVID-19 and treat patients, but also focuses on meeting our clients’ other health and economic needs and expanding our protection services for women and girls. Without immediate international action that supports the needs and unique challenges faced by people in these countries in the face of COVID-19, the consequence will be the loss of life and livelihood on an appalling scale.”

The IRC has launched a US $30 million appeal to help us mitigate the spread of coronavirus among the world’s most vulnerable populations, with a focus on mitigating and responding to the spread in vulnerable communities, protecting our staff and ensuring the continuation of life-saving programming.

As part of IRC’s COVID-19 response, IRC’s research and innovation team is helping create context-appropriate and cost-effective solutions to respond to this pandemic. The preliminary estimates of the burden of COVID-19 are a first step in supporting response planning, and further collaborative research is planned to improve pandemic models for low-income and conflict-affected states.

Editors Notes: 

[1]: Based on an R0 of 3.3 and response scenarios “Basic Mitigation” and “Suppression, 1.6 deaths per 100,000 trigger”, as laid out in the model and data set published by ICL / WHO’s March 26 Global Impact Study.

[2]: Afghanistan, Burundi, Bangladesh, Burkina Faso, Chad, Cameroon, CAR, Chad, Colombia, Côte d’Ivoire, DRC, El Salvador, Ethiopia, Greece, Iraq, Jordan, Kenya, Lebanon, Liberia, Libya, Mali, Myanmar, Niger, Nigeria, Pakistan, Sierra Leone, Somalia, South Sudan, Syria, Tanzania, Thailand, Uganda, Venezuela and Yemen.

[3]: Refugee camps are at particular risk due to overcrowding and paltry sanitary conditions: Bangaldesh’s Cox’s Bazar (40,000 per km2), Greece’s Moria camp (203,800 per km2), and Al Hol, Syria (37,570 per km2), all far exceed the density of the Diamond Princess cruise (24,400 per km2).