COVID-19: Listening will mean life or death to millions

As we grapple with the twin health and economic crises created by COVID-19, nowhere is this challenge greater than in the camps and shanty towns that are home to the world’s 70 million refugees and displaced people.

For them, existence is already a daily struggle without the additional strains posed by the coronavirus. As the pandemic takes root in some of the most under-served and vulnerable communities on earth, a response informed by 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 communities that are the focus of humanitarian action, where aid agencies are already struggling to keep up.

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 let alone intensive care. In such hard places, it’s all about enabling people to help themselves. The extent to which they act in their own 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 we did regular surveys of citizens and frontline health staff in Sierra Leone, using their perceptions as an indicator of progress 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 working in the most challenging environments. Do people know what to do to keep the virus at bay? What are the drivers of compliance with measures intended to protect them? Do they believe the response is making progress against the spread of the disease?

We need to know how people see the adequacy, relevance, timeliness, and fairness of the response because we learned in Sierra Leone that the cooperation of an informed and engaged population is central to effectiveness.  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 polls we read are mostly conducted online and ignore the views of people who are not. When they cover low-income and fragile states, they are not representative of the broader population, certainly not those caught up in humanitarian crises. Significantly, they are not linked in a systematic way to decision making in the humanitarian coordination structures.

From Afghanistan to Yemen, people in humanitarian crises are affected by the Coronavirus. As it spreads, we need to understand how affected people experience the response and the shifting balance between activities designed to tackle the outbreak and those intended to meet broader humanitarian objectives. There is a raft of organisations involved in coordinating the response, which adds to the importance of making sure that all decision-makers have a common source of community feedback to guide their decisions and their messaging.

Perceptions of the people are central as this massive health emergency compounds the miseries caused by humanitarian crises around the world. As aid agencies scramble to respond, racing the clock to provide health supplies and information to the most at-risk communities, understanding the way people experience the crisis will be critical to whether the response averts catastrophe – or fails to do so.