Collateral damage: Child health under threat in humanitarian settings from COVID-19
In 1971, the year Médecins Sans Frontières (MSF) was founded, over 15 million children under the age of five died. In the years since then, this number has fallen dramatically, in large part thanks to life-saving medical programs, like those run by MSF. Each year we treat around six million children. We vaccinate almost two million children for measles and safely deliver more than 300,000 babies. We work in some of the world’s hardest to reach, poorest and most dangerous places. The lives that are saved are hard won, and easily lost.
Now the world faces the COVID-19 pandemic, a crisis unprecedented in MSF’s history of international medical humanitarian action. While children are less likely to directly fall victim to the virus, the collateral fallout of the pandemic represents perhaps the greatest threat to child health we have seen in our lifetime.
In contrast to countries which have so far experienced COVID-19, where the greatest focus of concern is on elderly loved ones, in countries with few resources and weak health systems, children’s health is often much more fragile. Many families already know the pain of losing a child. As countries grapple with the COVID-19 pandemic, parents in these places now see their children’s futures at risk due to the loss of basic, life-saving services, which have been severely compromised or even put to one side.
Though it is imperative for us all to respond swiftly and directly to this global health threat, the effects of the pandemic response on child health, particularly in humanitarian contexts, could be devastating. Previous outbreaks of Ebola demonstrated that those who die from indirect causes can outnumber those dying from the disease itself. With an increasing global shift in priorities and resources towards COVID-19, the decisions we make right now, as funders and implementers of healthcare, will have a crucial impact on child health, both during and after the pandemic.
The direct effect of COVID-19 on children in humanitarian settings is likely to be greater than that seen so far in wealthier countries. While severe COVID-19 disease has so far overwhelmingly affected adults, we don’t yet know how it will affect children in the places where MSF works, who often have underlying conditions and illnesses, such as malnutrition, TB or HIV. Nor can we predict how it will interact with the common infectious diseases seen in these places, like malaria and measles.
However, the most dangerous threat to child health will not be the disease itself, but its extended indirect fallout. We will see many more children die as a result of the downsizing or closure of regular child health services, and increased newborn deaths due to the loss of access to safe delivery and post-natal care. Even where child health services are maintained, fear and misunderstanding about COVID-19 means parents will avoid bringing their sick children to healthcare centers, resulting in children with life-threatening illnesses arriving too late to be treated. This is already being reported in high-income countries, but will undoubtedly have far greater consequences in places with fewer resources and weaker health systems.
COVID-19 is arriving at a very precarious moment for children. Severe hunger in 2020 in many parts of the world was already being predicted before COVID-19 erupted, but now malnutrition is set to rise dramatically as a consequence of the pandemic. ‘Biblical’ levels of famine are forecast by the World Food Programme, at the same time as children lose vital nutritional support because their schools and learning centers are closed or food aid has been cut short.
Furthermore in recent years, we have already seen diseases like measles and diphtheria, which should be easily prevented with vaccines, begin to surge again in countries including the Democratic Republic of Congo and in the Rohingya refugee camps in Bangladesh. These types of outbreaks will multiply as vaccination activities are suspended in several countries due to COVID-19.
It is predicted that for every adult COVID-19 death avoided by suspending vaccination activities, more than 100 children’s lives could be lost as a result. Since the year 2000, over 20 million child deaths have been prevented by measles vaccinations; combined with an increase in malnutrition, which exacerbates deaths from measles, the reversal of this progress could be devastating.
As seen every year, malaria will kill many times more children in 2020 than COVID-19 ever threatened to. Countries that will experience a peak in both epidemics at the same time, like many in West Africa, cannot allow COVID-19 to take precedence over malaria activities. The World Health Organization predicts hundreds of thousands more malaria deaths, the majority of them children, if control and prevention strategies cannot be sustained.
With donors already withdrawing funds from multilateral institutions, it is uncertain if the losses to child health activities in places where MSF, and organizations like ours, work could be easily regained during or after COVID-19.
At the time of writing, just over 300,000 people have died from COVID-19. This figure has shocked the world. Yet if the coverage of child health services is reduced over a similar period it could result in anywhere from 253,500 to 1,157,000 additional child deaths from diseases that will not stop just because the world’s attention is focused on COVID-19.
The extent to which organizations like MSF, and others, can prevent the deaths of children in humanitarian settings during this crisis will depend entirely on our ability to maintain and expand life-saving child health activities. If there was ever a time when this was needed, it is now. While the spotlight remains on COVID-19, vulnerable children risk dying in the shadows. We must not allow this pandemic to rob the next generation of their future.