A toxic triple combination of conflict, weather extremes and the economic impact of COVID-19 pandemic risks decades of progress in health and development

Delegates attending Lives in the Balance summit: Delivering on Commitments in Humanitarian and Fragile Settings called for urgent multi-sectoral investment to ensure continuity of health services and supplies during the pandemic response and recovery, with additional support for those caught up in humanitarian and fragile settings.

The Lives in the Balance virtual summit co-hosted by PMNCH, the largest global alliance for women’s, children’s and adolescents’ health and CORE Group, brought almost 900 participants from more than 90 countries together to discuss the challenges to protecting the health and wellbeing of women, children and adolescents in the context of COVID-19 and increasing instability across the world, and the policies and financial investments required to provide continuity in vital services.

“The question we need to ask ourselves and our political leaders is what kind of a world order are we building for our children?” said Rt Hon Helen Clark, PMNCH Board Chair, and Former Prime Minister of New Zealand. “Is it a world marred by global health emergencies, climate disasters, famine, war, gender inequality and increasing poverty? Or a world as envisioned by the Sustainable Development Goals where universal health coverage, and a better and more sustainable future is the reality for not some, but all. Our meeting sends a powerful message: Lives are in the balance. We do not accept that women and children must bear the burden. We bear witness and we are resolved to resist – to speak out with one voice for a more equitable and peaceful world. This is what the fourth Lives of the Balance is about.”

Approximately one-fifth of the world’s population of women and children live in countries experiencing armed conflict, with a record 56 active conflicts documented in 2020. According to the Global Humanitarian Overview for 2022, the number of people in need of humanitarian assistance globally has increased to 274 million people this year, breaking the record high of 235 million people set in 2021. Maternal mortality increases by 11% on average and 28% in relatively more intense conflicts, relative to conflict-free periods.

Fragile regions with already high poverty rates and precarious economic structures have been hit much harder than others by the COVID-19 pandemic. About 97 million more people are living on less than $1.90 because of the pandemic, increasing the global poverty rate from 7.8 to 9.1 percent.

The COVID-19 pandemic has also exacerbated child hunger and malnutrition. In 2022, COVID-19 disruptions and supply chain challenges may push an additional 9.3 – 13.6 million children into acute malnutrition.

The war in Ukraine is just the latest in a succession of devastating conflicts and crises affecting the world. More than two billion people, including half the world’s poorest populations, currently live in humanitarian and fragile settings. These crises are being driven by multiple factors. Conflict, political fragility, COVID-19, food insecurity, a recessionary global economy and climate change are affecting the health and opportunities of the world’s poorest and most vulnerable citizens. Such crises particularly exacerbate existing inequalities and vulnerabilities for women, children and adolescents and broaden the rift between the world’s richest and poorest communities. In Afghanistan, example, the impact of decades of conflict and political upheaval is all too apparent.

“Afghanistan, unfortunately, has remained politically unstable for many decades and it is a very low-income country,” said Wais Qarani, President, African Nurses and Midwives Council. “In total there are around 6,000 nurses in the entire population and it is estimated by 2030 we will need around 19,000 thousand nurses which is beyond imagination. Nurses and midwives faced numerous challenges for a long time and this was doubled with the COVID-19 pandemic in 2019, and unfortunately it tripled with the recent political turmoil, which happened in August 2021, and these all have further disrupted health systems and are directly impacting services for women, children and adolescents.”

Climate change and natural disasters place immense stress and pressure on governments and societies, especially in fragile settings that are already struggling to cope with other socio-economic and political pressures. The last 10 years were the hottest on record and the number of climate-related disasters has tripled in the last 30 years. Today, over 400 million children live in areas of high or extremely high-water vulnerability.

If the global community is serious about leaving no one behind, it must implement a rights-based approach and equity enhancing strategies that fully address the needs of the most marginalized, who too often live in humanitarian settings. They should be properly funded, preferably with multi-year, unmarked and diversified funds. Programmes should enable and equip local actors in decision-making to ensure that necessary and appropriate services are being delivered to women, children and adolescents in humanitarian settings.

The full spectrum of essential health services (in particular, sexual and reproductive health services) for women, children and adolescents should be provided in humanitarian and fragile settings, with designated funds for such programming and services to continue, or even expand. In addition, we need to improve the quality and quantity of data collected around women’s, children’s and adolescents’ health, which has historically been poor, and hinders efforts to respond quickly and effectively.

Health workers are key to ensuring continuous essential health care provision for women, children and adolescents both during the pandemic, and in times of conflict.  Any preparedness and response mechanisms for dealing with future pandemics should specifically address humanitarian settings and prioritise the protection of humanitarian health-care workers, including nurses and midwives.

The Lives in the Balance series of e-summits has served as an innovative and inclusive platform for partner-led dialogue and action on COVID-19 and women’s, children’s and adolescents’ health (WCAH). The first Summit in 2020 saw the launch of the PMNCH Call to Action on COVID-19, which outlined seven asks to protect and promote WCAH and serves as basis for PMNCH’s ongoing advocacy. To date, 21 commitments have been made pledging USD 32,1 billion. This fourth summit in the series focused on delivering on commitments in the context of COVID-19 and the growing number of crises in humanitarian and fragile settings.

“Lives in the Balance provided an opportunity for all of us to learn, to listen, to jointly reflect and to share and identify ways to collaborate for a fairer and a more equitable world, where all are able to realise their human rights,” said Lisa Hilmi, Executive Director, CORE Group. “Our aim and effort with each of these Lives in the Balance summits have been to listen to what others in the community have to say, so that our collective response is targeted and fit for purpose, especially in crisis situations where the stakes are so high.”