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World risks up to 1 billion cases and 3.2 million deaths from COVID-19 across fragile countries, says International Rescue Committee

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 1bn infections and 3.2m deaths over the course of the pandemic in 34 crisis-affected countries 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 (ICL) and the World Health Organization (WHO). 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 the 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:

1. Healthcare capacity and virus reproductive rate. The ICL/WHO model uses the best available mortality data, from China, which pre-supposes that levels of medical care available therein would be available elsewhere.  As the IRC has previously warned, fragile states have nowhere near the healthcare capacity provided in China.

2. Pre-existing humanitarian vulnerability. These mortality figures do not account for excess deaths caused by underlying humanitarian vulnerability (including co-morbidity due to pre-existing health issues such as malnutrition) or by the economic and political instability which constitute a “double emergency” for fragile contexts. While strict lockdowns and social distancing will unquestionably save lives in wealthier nations, direct consequences such as market closures and income losses (without robust social safety nets) risk driving impoverishment, hunger, and domestic violence in humanitarian settings. Without sufficient social safety nets or relief packages in place to prevent people from spiraling further into poverty and hunger, these same measures risk harming populations already caught in weak states or unstable humanitarian contexts.

3. Disruptions to humanitarian aid delivery. Movement restrictions and disruptions to supply chains are already impacting the ability of agencies like the IRC to deliver life-saving humanitarian aid to people in need. South Sudan, a country with only 4 ventilators and 24 ICUs and where almost 65% of the population relies on humanitarian assistance, may for instance face famine with a toxic mix of restricted movement, economic instability, reduction in agricultural labor and pre-existing high levels of malnutrition and chronic food insecurity.

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