Hunger in the time of COVID-19: Our lifesaving strategy
In the span of a few months, the COVID-19 pandemic has caused ripple effects across the world. These effects have combined to trigger a severe hunger crisis affecting people with limited access to health care and healthy food.
A Mounting Threat
As we have become all too aware, the first ripple of the virus harms human bodies directly: COVID-19 attacks the respiratory and immune systems, leading to a cascade of symptoms. A subset of those infected develop severe illness, and about 1 in 50 infected people die. As of early November 2020, over 50 million people had been infected worldwide, more than a million of whom have died. The true toll of the disease is likely to be even greater than these official numbers.
The second ripple is indirect; it results in reduced access to health care. COVID disproportionately affects health care workers, who are then not available to address other conditions. Many facilities have been forced to close. Even when facilities are open and health care providers available, many people are reluctant to seek medical attention, as they are – rightly – afraid of becoming infected at clinics and hospitals.
This indirect effect of COVID-19 has been clearly documented in Europe and the United States, where systems are in place to count deaths and determine their cause.
In the countries where Helen Keller Intl works, this second ripple effect has not been as well documented with official counts, but we are witnessing it firsthand; particularly in areas of West Africa where people previously suffered from Ebola. In those places, fear of COVID-19 infection is deterring parents from bringing their infants for preventive care such as immunization, and people who are ill are staying home and not getting treatment.
The third ripple effect is harming the availability of diverse food and depressing livelihoods. Trade and travel have slowed dramatically in many places, both because of government mandates and because businesses and clients are taking steps to protect themselves. This effect is felt by nearly everyone, but it is particularly severe for vulnerable people living in low-income countries. They feel the crisis in their own economy, but also the slowdown in other countries as family members working abroad can’t send as much money home. Border regions are also particularly affected by diminished trade, which directly impacts food supplies as well as the economy.
A Dire Risk for Children
This third ripple affects our world unequally.
Children are the hardest hit, because they are most vulnerable to malnutrition and other deadly effects of poverty and hunger. In the communities where Helen Keller Intl works in Africa and Asia, many more children are likely to die from the indirect effects of COVID-19 than adults are to die of the virus itself.
Women are also at increased risk. One reason is anemia, which is common in the places where we work. There is emerging evidence that people with anemia are at increased risk of death and serious illness from COVID-19. COVID-related poverty and malnutrition are likely to make anemia worse and more prevalent, in turn leading to a host of other negative consequences, including fatigue, susceptibility to illness, and death.
Ripple effects grow to crisis proportions
More than a billion people in the most vulnerable countries and communities in the world are facing COVID-19’s catastrophic impact on their livelihoods and food availability, causing widespread disease and malnutrition.
We at Helen Keller Intl see the effects of this crisis first-hand.
In Senegal, a phone survey done early in the course of the epidemic indicated that 85 percent of the country’s population has experienced a significant loss in income. The authors of a recent LANCET study (led by the Standing Together for Nutrition consortium of which Helen Keller Intl plays an important role) estimated that an additional 6.7 million children would become acutely malnourished, with a majority of these in South Asian countries such as Bangladesh; and more than 118,000 children would die in 2020 alone, with the majority of these deaths in sub-Saharan African countries such as Nigeria.
A Tragic Legacy
Double the number of children will die of malnutrition as will have died from the coronavirus itself, experts predict.
But the devastation doesn’t end there. In fact, the most lasting legacy of the COVID-19 pandemic could be a generation of children who survive but are robbed by malnutrition of their full physical and intellectual potential.
We are determined not to let this happen. And, as a global community, we can change the future if we respond effectively and powerfully now.
Global crisis, local solutions
The situation may be dire, but despair is not an option. We know this because, in our decades of work to alleviate poverty and malnutrition, we have seen concrete solutions work miracles—in the most challenging of circumstances.
We know that it’s not only what we do, but how we do it: solutions work best when they are developed with people, rather than just delivered for them. We know that these solutions work best when they build on a community’s own inherent strengths.
We know that, for COVID-related hunger as for so many of the issues we work on, women are going to be at the heart of the solution. This is because women provide direct care to children, make decisions about medical care in times of COVID-19 as in all other times, and play a crucial role in household income. We have seen, over and over again, that solutions work better when they are designed and led by women, and with women and children in mind. This has not changed during COVID-19.
The Way Forward
Our work is focused on preventing malnutrition, while keeping families and our staff safe. Our first – and ongoing – priority has been to make sure that families, and children in particular, have nutritious food to eat.
In the south of Senegal where food insecurity is the most prevalent in the nation, we have adapted an intervention aimed at treating malnourished children using locally produced enriched foods in a larger food distribution effort aimed at the entire population, as a social safety net. In Cox’s Bazar, Bangladesh, where thousands of Rohingya people have taken refuge, COVID-19 has severely curtailed the ability of families to make a living. We are providing direct food and cash support to refugees and their hosts, building on our ongoing work in this crisis. Donations of any amount can make a difference in preventing malnutrition—and give a family the resilience needed to make it through the crisis.
Our next priority has been to restart life-saving services. Vitamin A supplementation is one of the most effective known interventions in public health. A small capsule, given every six months to children five and under, can prevent blindness and death.
Helen Keller Intl played a leading role in discovering the benefits of Vitamin A more than three decades ago and has been a leader in distributing millions of Vitamin A tablets each year ever since. After a pause of several months due to the pandemic, we have restarted distribution campaigns in countries including Mali, Niger, and Guinea. We’ve done so by working closely with partner governments and finding ways to keep families and staff safe, including handwashing and mask-wearing, in even the most remote areas.
As the crisis continues, we are intensifying our longer-term work to build up the local supply of safe and nutritious foods. The most nutritious foods, such as fruits, vegetables, and eggs tend to be highly perishable. As such, these items are susceptible to shortages and price spikes when food supply chains are disrupted. In areas of greatest risk, such as in Bangladesh, Myanmar, Nepal, and Vietnam, we are intensifying existing programs to support local agricultural production of nutritious foods.
In Bangladesh, for example, we are working in a remote, marginalized part of the country where COVID-19 has exacerbated existing food insecurity due to trade disruptions. In Mozambique, we are preparing to distribute fast-growing vegetable seeds to farmers in anticipation of upcoming food shortages. As the borders with neighboring countries close, these supports can provide food and income to farmers and increase the availability of nutritious foods to neighboring communities where markets safely operate.
In Myanmar, we are working with the Department of Agriculture to get seeds and fertilizer to households covered by our existing project.
In Nepal, we are supporting more than 3,500 farmers, working with the government to link those farmers with agriculture and livestock services. We are also working with authorities, through a permit system, to link the farmers with local traders so that food can get in and out.
A call to innovation
This crisis has made it even more urgent to develop better ways of treating malnutrition; interventions that have been proven in studies, but not yet delivered to millions. We are working to roll out several interventions that have the potential to have enormous impact in protecting children from malnutrition—at a time when they need it most. These interventions include:
- Multiple micronutrient supplements. These supplements, delivered to pregnant women, have been shown to improve the health of mother and baby. They are better tolerated than iron and folic acid alone. We are working in countries such as Sierra Leone to get these supplements to the women who need them; and confirm, on a large-scale, their positive impact on nutrition.
- Lipid-based nutrient supplements. These are mixtures of essential nutrients, formulated for toddlers as an add-on to their regular food, and which have been shown to reduce mortality.
- Simplified treatment for acute malnutrition. Currently, less than one in five malnourished children receives life-saving treatment. We are introducing a new approach to diagnosing and treating malnutrition that is simpler, cheaper, and can be administered directly in the community, saving families a weekly clinic visit. We are already putting this treatment in place for communities in southern Senegal hard hit by COVID-related food insecurity. We will then extend this approach to thousands more in surrounding countries. We are also testing an approach for less severely malnourished children which involves giving families vouchers for local markets.
Measuring life rather than death
Measuring the impact that we can have on people’s lives will help us understand what’s working, where we can do more, and how we can do differently. We measure impact not only for our own understanding, but for that of our global community of sister organizations, government agencies, and funders. Each improvement will help our global community reach more children and families, sooner. Below are some of the specific results that we are measuring.
Helen Keller will seek to:
- Stem the number of children falling into malnutrition;
- Increase the proportion of young children who survive to age five;
- Reach a greater number of malnourished children with life-saving treatment;
- Help families grow, buy, and eat nutrient-rich foods;
- Ensure that infants receive vitamin A supplements to ensure their sight and immune systems develop;
- Increase the proportion of children receiving vitamin A, and with the proper safety protocols;
- Help children receive a rich, varied diet, measured through an index called the dietary diversity score;
- Enable a higher number of children to recover from malnutrition; and
- Increase the proportion of pregnant women who forestall anemia.
Where we can make a difference, together
Our work has been, for decades, focused on some of the most underserved communities in Africa and Asia, reaching those who are most vulnerable to malnutrition, diseases of poverty and other serious threats to health. This is also where we are working to ensure that children are protected from the deadly indirect effects of COVID-19.