June 2020

The Impact of The COVID-19 Pandemic on Global Humanitarian Efforts: A Crisis Within a Crisis

By Windy Cole, DPM

The sun is rising as a mass of people gather outside the Landmark Hotel in Amman, Jordan. It is the first day of the Atlantic Humanitarian Relief (AHR) October 2018 Medical Mission. One hundred volunteers from 15 different countries including the United States, United Kingdom, Sweden, Ireland, South Africa, Portugal, Greece, Kuwait, Qatar, Syria, and Jordan have descended upon this capital city as part of an international humanitarian effort to provide medical care to a large population of displaced Sryrian refugees. Alongside me in the crowd are surgeons, pediatricians, internists, primary care physicians, EMTs, psychologists, RNs, PAs, pharmacists, medical students, and humanitarians. We all are issued our daily schedule as we part ways to look for our assigned bus numbers. We are strangers now, but we will soon find out that we are kindred spirits.

The Syrian Civil War has left over 7.4 million people without a home; and more than 5 million have sought refuge in surrounding countries like Lebanon, Turkey, Egypt, and Jordan.1 Some of these countries have been stretched beyond their limits with resources, thus leaving women, children, and the elderly especially vulnerable. Many Syrians are living on less than the bare minimum. In Jordan, there is an estimated total of 5.5 million refugees, and that number is growing as tensions rise in many parts of the world.1 Many are struggling to rebuild their lives in these countries.

During this 6-day medical mission, AHR teams will travel throughout Jordan to refugee camps, make-shift medical clinics, school yards, group housing, and private hospitals  and will conduct roughly 5,000 patient consultations including 522 dental visits and over 1,000 surgical screenings and procedures. I provide care to patients suffering from traumatic war injuries, pressure wounds, lower extremity amputations, and chronic wounds as a result of uncontrolled diabetes and peripheral vascular disease. While the focus of humanitarian efforts is outward, the benefits are also felt inward. This amazing experience helped me rediscover my purpose and taught me to better listen to patients and consider their economic and social needs when determining care plans.

In recent years there has been increasing interest in global health initiatives. Both the private and public sector have recognized the need to address the disparity in access to healthcare throughout the world. The World Health Organization reports that the highest proportions of the global burden of disease and disability falls on regions that also suffer the most significantly from physician shortages.2 Although there is no one central monitoring group or agency for medical missions, conservative estimates, not including travel costs incurred by volunteers, tallied annual expenditures over $250 million in 2014 from the United States alone.3

In the wake of the COVID-19 pandemic, international travel has become restricted and countries have closed their borders. As an effort to protect the safety and security of volunteers, aid organizations such as AHR have suspended all medical missions. The coronavirus has made it impossible for these organizations to travel in and out of countries that need the most help.

In places like Syria, years of conflict and deliberate targeting of healthcare facilities has significantly weakened the healthcare system. According to a recent report from the International Rescue Committee, only half of the health centers and hospitals in Syria are currently functional, thus leaving only 28 ICU beds and 11 ventilators for a population of nearly 17 million.4 One-third of the country remains displaced with most living in overcrowded camps. Nearly an additional million more people have been displaced from northwest Syria since December 2019 alone.4  How are people to wash their hands if they have no soap or running water? How can you maintain social distancing when you live in a camp that is 4-times more densely populated than New York City? The COVID-19 pandemic will exacerbate the economic crisis as humanitarian efforts that provide life-saving medical supplies are hindered.

This pandemic continues to cripple developing countries around the world. The long-term ramifications of the COVID-19 crisis could decimate refugee communities already suffering from malnutrition, poor sanitation, lack of clean water, and basic medical care. History here at home has taught us that those with fewer resources are hit the hardest by pandemics. During the H1N1 outbreak, the US Native American population suffered a mortality rate 4 – 5 times that of the general US population.5 Evidence also continues to mount during this current coronavirus pandemic that there have been a disproportionate number of COVID-19 infections and deaths within the African American community.6 War-torn third world countries already suffering under corrupt governments and burdened with large refugee populations will be the hardest hit. This disruption in medical supplies and other resources will continue to impact these areas slowing their recovery. When we consider the fact that pre-pandemic health disparity and humanitarian funding was already barely able to keep up with global demand, the need for reallocation of funding and perhaps a call for a global health response stimulus plan seems eminent.

We have seen the rapid global spread of the coronavirus as a result of the interconnectedness of today’s world. Cooperation between both governmental and private organizations will be imperative to rebuild infrastructure in the aftermath of this current healthcare crisis. The burden will fall on the developed world to share best practices, knowledge, experiences, and remaining resources. New innovations in artificial intelligence, telemedicine, and other virtual platforms may allow improvement in care and education in the US and abroad without the need to physically cross borders. In an increasingly globalized world, humanitarian efforts during the COVID-19 pandemic and beyond will remain of utmost importance. I encourage readers to continue to find ways to help underserviced populations both locally and abroad.

Windy Cole, DPM, serves as Medical Director of the Wound Care Center, University Hospitals Ahuja Medical Center and Adjunct Professor and Director of Wound Care Research at Kent State University College of Podiatric Medicine, both in Cleveland, Ohio. She is a dedicated healthcare advocate with interests focused on medical education, diabetic foot care, wound care, limb salvage, clinical research and humanitarian efforts. Dr. Cole has published extensively on these topics and is a sought-after speaker both nationally and internationally. Dr. Cole also serves as a member of the Editorial Advisory Board for LER.

REFERENCES
  1. Atlantic Humanitarian Relief Organization. Available at www.atlantichumanitarianrelieforganization. Accessed June 30, 2020.
  2. Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR. Forecasting the global shortage of physicians: an economic- and needs-based approach. Bull World Health Organ. 2008;86(7):516-523.
  3. Maki J,Qualls M,White B,Crone R. Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC Health Serv Res. 2008;8:121.
  4. International Rescue Committee Report. COVID-19 in humanitarian crises: a double emergency. Published April 9, 2020. Available at https://www.rescue.org/report/covid-19-humanitarian-crises-double-emergency. Accessed June 30, 2020.
  5. Centers for Disease Control and Prevention. Deaths related to 2009 pandemic influenza A (H1N1) among American Indian/Alaska Natives—12 states, 2009. MMWR Morb Mortal Wkly Rep. 2009;58(48):1341-1344.
  6. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891-1892.

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