UNICEF UK SUBMISSION INTERNATIONAL DEVELOPMENT COMMITTEE INQUIRY HUMANITARIAN CRISES MONITORING: IMPACT OF CORONAVIRUS UNICEF UK UNICEF, the Children’s Fund, is mandated by the UN General Assembly to uphold the UN Convention on the Rights of the Child (UNCRC) and promote the rights and wellbeing of every child. Together with partners, UNICEF works in over 190 countries and territories focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.

UNICEF globally is at the frontline of the humanitarian response to the Coronavirus crisis. UNICEF has a core role to play in the provision of critical supplies; as global lead of the Nutrition, Water, and Hygiene (WASH) clusters and co-lead of the Education cluster; co-lead in risk communication interventions; and as leading member of the UN Crisis Management Team.

Unicef UK is submitting evidence to the International Development Committee with the aim of ensuring that the UK Government continues to protect the most vulnerable children from the impact of Coronavirus by supporting their health, education, and future opportunities. 1. SUMMARY 1.1 Significant progress has been made globally over the past three decades in realising children’s rights, improving their lives and enabling them to develop to their full potential. The UK Government has played an important role in achieving this progress.

1.2 With the Coronavirus pandemic, the world now faces an unparalleled crisis. Not only does this challenge governments and communities the world over, it jeopardises the vital progress made on children’s rights and poses a significant risk to children’s health, education and futures.

1.3 Unicef UK is calling for urgent action from the UK Government to mitigate the impact of this pandemic and the response on children’s rights. In the long term, we want the UK Government to learn from this pandemic and strengthen international health and education systems so they are prepared for future non-conflict crises.

1.4 Now and in the future, the global community, including the UK Government, must work together to protect children’s lives and their rights. 2. THE EMERGENCE, INCIDENCE AND SPREAD OF CORONAVIRUS VIRUS INFECTIONS AND -19 DISEASE IN DEVELOPING COUNTRIES 2.1 Since the start of the outbreak in December 2019, Coronavirus has spread to nearly all countries and territories around the worldAs of 5 May 2020, there have been over 3.5 million confirmed cases of coronavirus disease 2019, with over 243,00 deaths reported, including among children.1 UNICEF reports the following geographic breakdown and specific concerns:

. As of 5 May 2020, 151,000 cases were confirmed positive in the East Asia and Pacific with and more than 7,000 deaths.

1 https://www.unicef.org/appeals/files/UNICEF_Global_CoViD19_Situation_Report_No4__16_30_April_2020.pdf . As of 29 April, a total of 58,120 cases and 1,651 deaths were recorded in the South Asia region. Recent assessments have shown that due to the ongoing lockdown measures there is a significant decrease in access and provision of essential health services. The South Asia region could face a further public health crisis as children miss routine vaccinations as lockdown measures across the region have halted immunization drives and parents refrained from taking their children health facilities for vaccinations. . The Eastern and Southern Africa region continues to report an increase with a total of 6,570 confirmed cases and 152 deaths as of 27 April 2020. Multiple collateral impacts from the outbreak control measures, especially strict containment measures, have been reported in the region, with social and economic repercussions for the impacted populations. . The pandemic continues to escalate in West and Central Africa with the region surpassing 10,000 confirmed cases in the last week of April 2020. The number of reported confirmed cases has doubled, growing from 5,820 to 13,718 (136% increase) within two weeks. A total of 371 deaths associated to coronavirus were reported as of 30 April 2020. On top of the pandemic needs, there are also ongoing outbreaks of measles in Burkina Faso and Central African Republic as well as resurgence of new cases of the Ebola virus disease in DRC. . In the Middle East and North Africa, a total of 162,966 cases were reported as of 29 April, with a 32 per cent increase in just one week. Iran has the highest number in the region with more than 57 per cent of total cases and 80 per cent of total deaths. Of concern is the first cases recorded in refugee camps in the Djibouti, Lebanon, and the State of Palestine. In Yemen, five new cases were reported in Aden - three weeks after the only previous laboratory- confirmed case was detected in the Eastern governorate of Hadramout. Health systems of are under tremendous strain to detect and isolate coronavirus carriers, suggesting that the epidemic could be progressing faster than recorded. . In Latin America and the Caribbean there have been over 200,000 reported cases in all 36 countries and territories, and more than 10,000 deaths by end April. Globally, Brazil, Peru and Ecuador are amongst the 20 countries with the highest numbers of confirmed cases; while Brazil, Mexico and Ecuador are now part of the 20 most affected in terms of deaths As many countries lack capacity to adequately test, monitor and report new cases, available data is considered to vastly underreport the severity of the situation. . In the Europe and Central Asia region, cases continued to rise, with 210,453 (excluding Italy) at 28 April, a marked increase in Turkey (now 114,653) and 190 cases within the refugee/migrant population in Greece. Belarus (12,208), Romania (11,616), Ukraine (9,866) and Serbia (8,497) reported large numbers and Tajikistan announced its first (15) on 30 April.

The situation is rapidly evolving and the latest global, regional and national UNICEF Situation Reports are available here. The above data is from the 6 May Global Situation Report.2

2.2 In countries facing humanitarian crises, the Coronavirus outbreak is creating significant additional pressure on already overburdened social and health service delivery systems and exacerbating the vulnerabilities of affected populations. These countries are already grappling with multiple shocks such as conflict, large-scale-displacement, disease outbreaks, droughts, cyclones, and invasion of locusts and are more likely to have weak health systems that are heavily reliant on the support of donors, UN and NGO partners to subsist. Of particular concern are countries such as the DRC, Somalia, Yemen, South Sudan and Nigeria that are battling measles, upsurges, cholera, (vDPV) outbreaks and malnutrition while responding to Coronavirus cases.

2.3 UNICEF is working to prevent further spread of the virus and care for those with the disease, protect and improve access and availability of life-saving services for mothers, newborns, children and adolescents, and focusing on a health systems strengthening approach wherein health systems can respond to Coronavirus immediately, as well as reliably provide affordable and quality in the long term.

2 https://www.unicef.org/appeals/files/UNICEF_Global_CoViD19_Situation_Report_No4__16_30_April_2020.pdf 3 THE DIRECT AND INDIRECT IMPACTS OF THE OUTBREAK ON DEVELOPING COUNTRIES, AND SPECIFIC RISKS AND THREATS 3.1 Children are at risk of being the invisible CASE STUDY: COMMUNITY victims of the Coronavirus pandemic, with both the disease and the response RESISTANCE IN THE DRC affecting their rights. In particular, the poorest and most vulnerable children will The Democratic Republic of Congo was expected to experience the greatest loss during this declare the end of Ebola on 12 April. Then, after 52 time as vital public services are greatly days without any confirmed cases (from 18 February impacted. Poor children living in unsafe, 2020), a new case was reported in Beni on 10 April unhygienic slum settings; children with 2020. This was followed by another new case on 12 disabilities unable to get the support they April. need; undocumented migrant children – these are all groups who are at risk of The community is questioning the reasons for this falling further through the cracks during this resurgence and has shown resistance to response time. workers, making it difficult to carry out health promotion work to prevent the spread of 3.2 Around the world, an estimated 800 million Coronavirus. children live in conflict-affected and fragile areas.3 These children experience a double UNICEF has strengthened the existing Risk (perhaps even triple) crisis, having already Communication and Community Engagement team had their lives uprooted and now affected in Beni and is working actively with the Community by the global pandemic. These children Animation Cells and civil society to address may live in refugee camps or areas that are community resistance, follow up of contacts and hard to reach or do not have access to facilitate the other essential response activities. suitable health or child protection services. Their access to safe, clean It is likely we will see more instances of Coronavirus and open spaces may also limit their ability exacerbating existing tensions and creating serious to keep a safe social distance to prevent secondary impacts. the spread of the virus.

3.3 At the end of 2019, 19 million children were internally displaced by conflict and violence – more than ever before. The numbers of internally displaced people regularly outpace refugee figures, but regretfully these populations are often overshadowed by the needs of refugees and migrants.4

3.4 RECOMMENDATION: The UK Government must not lose sight of internally displaced children in their response to the Coronavirus pandemic, and should encourage other stakeholders to similarly address the needs of these children.

3.5 Children living in poverty around the world will also experience challenges due to their living situations, with overcrowded communities or slum dwellings not affording them the luxury of social distancing nor handwashing. Their lack of access to services, open spaces and water, sanitation and hygiene (WASH) facilities all compound to put these children at the very greatest risk.

3.6 Other emerging crises are at risk of going un-tackled. For example, people affected by locust infestations in the Horn of Africa or children in the Pacific affected by Cyclone Harold may not receive the attention and support they desperately require.

3 https://www.unicef.org/stories/fast-facts-water-sanitation-hygiene-conflict 4 Available at https://data.unicef.org/resources/lost-at-home-risks-faced-by-internally-displaced-children/ 3.7 Finally, despite critical needs, UNICEF’s common response management approaches are not possible in wealthier contexts where we are not already operational. This is compounded by the significant operational challenges we face across the board with border closures restricting supply access and human resource support. UNICEF is also dealing with the risk-of-exposure of staff, and partners requiring risk assessment for emergency and regular programme delivery across the board.

3.8 Unicef UK is especially concerned about the consequences the crisis will have on children’s rights to health, education and their futures.

RISKS AND THREATS TO THE RIGHT TO HEALTH AND SURVIVAL

3.9 As a result of limited resources from the outset, as well as depletion and diversion of funds, resources and personnel from routine healthcare, weak and fragile health systems are unable to cope with delivering regular health services during major infectious disease outbreaks and unable to minimise child illness and loss of life. Coupled with infection control measures such as physical distancing, travel restrictions and fear, this can lead to the most vulnerable children being unable to access life-saving treatment, and result in additional deaths from other diseases, acute and severe malnutrition, decrease in routine childhood vaccinations and decline in maternal health services.

3.10 Economic hardship experienced by families as a result of the global economic downturn could result in hundreds of thousands of additional child deaths in 2020, reversing years of progress in reducing infant mortality in just 12 months.5 And this alarming estimate does not even take into account the services disrupted due to the crisis – it only reflects the current relationship between economies and mortality, so is likely an under-estimate of the impact.

3.11 Interruptions to routine and essential health services, especially in low- and middle-income countries, is one of the greatest risks to children’s health during this pandemic. Humanitarian crises in countries that are also tackling the outbreak are creating significant additional pressures on health services delivery. Countries that are battling measles, malaria upsurges, cholera, polio outbreaks and malnutrition while responding to Coronavirus are of particular concern. In 2018, more than 140,000 people died from measles worldwide, with deaths concentrated among children under five.6 Many Coronavirus affected countries are already stopping immunisation services and the latest evidence shows that 117 million children may miss out on receiving life-saving measles vaccine.7

3.12 Even before the pandemic, 20 million children around the world were not receiving the vaccines they need. 5.3 million children under the age of five died in 2018, largely from preventable causes, and the indirect effects of the pandemic, such as disruptions to routine health care, may cause an increase in .8 A new report from The Lancet and John Hopkins University estimates that a 15% reduction in coverage of essential health services for 6 months would result in 253,500 additional child deaths and 12,190 additional maternal deaths, while reductions of around 45% for 6 months would result in 1,157,000 additional child deaths and 56,7000 additional maternal deaths.9

3.13 In addition, there is a risk of cuts to critical funding for global health mechanisms in efforts to fund the global Coronavirus response.

5 https://unsdg.un.org/resources/policy-brief-impact-covid-19-children 6 https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide 7 https://measlesrubellainitiative.org/measles-news/more-than-117-million-children-at-risk-of-missing-out-on-measles-vaccines- as-covid-19-surges/ 8 https://www.unicef.org.uk/campaign-with-us/child-health-report/ 9 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3576549 3.14 RECOMMENDATION: To prevent further and indirect loss of children’s lives, it is vital that global fundraising efforts do not negatively affect critical funding for children and that the UK remain committed to supporting existing health multilaterals.

RISKS AND THREATS TO THE

3.15 At its peak, the Coronavirus pandemic caused more than 1.5 billion learners to be out of school.10 This equates to billions of hours of classroom-based instruction time lost and is likely to have a significant and lasting impact on the children and young people affected.

3.16 Like in the UK, schools around the world are implementing distance learning as a way to limit educational disruption during lockdown. UNICEF programming explores various delivery methods for distance learning, including radio, television, written materials and internet-enabled solutions. With the latter driving innovation in distance learning, it is deeply concerning that 4 out of every 5 people in the least developed countries are not online.11 The need to reduce the digital divide and invest in low-tech solutions is clear. Online learning could be part of the problem or the solution, depending on how greatly the global community focusses on equity.

EDUCATION CASE STUDY: TIMOR LESTE

In Timor Leste, all schools closed on 23 March affecting more than 400,000 learners. Following this, the Ministry of Education, Youth and Sport (MoEYS) partnered with UNICEF to quickly to deliver remote education for all learners.

In just two weeks, MoEYS and UNICEF developed the distance learning programme Eskola ba Uma, or “School Goes Home”. The programme includes four channels for continued learning, including TV, radio, UNICEF’s online learning platform the Learning Passport, and printed workbooks for the most marginalised. The MoEYS placed equity at the heart of its response, ensuring every child was able to continue learning.

The implementation of Eskola ba Uma, while undertaken during an emergency, could prove to be a catalyst to improve inclusive education in Timor Leste, allowing the MoEYS to reach children previously left behind. These include children with disabilities, pregnant girls and teenage mothers, out-of-school children, and children in remote rural areas. The new learning materials, platforms and resources produced during this time are expected to pave the way for more inclusive education systems through ICT-based learning and alternative education pathways.

3.17 RECOMMENDATION: The UK Government must ensure that equity is at the heart of its Coronavirus education response. All programmes, including distance learning, must follow the Do No Harm principle, and must respond to the different needs faced by vulnerable children including refugees, migrants, internally displaced children, girls, the poorest, and children with disabilities.

3.18 The children most affected are, among others, children with disabilities. Even before the pandemic over half of children with disabilities were out-of-school at the lower secondary level in low and lower-middle income countries.12 For these children, the innovative solutions to distance learning prove even more challenging, as many interventions are not designed with inclusive education in mind. Children who are not native speakers in the language of instruction could also struggle to

10 https://en.unesco.org/covid19/educationresponse 11 https://www.itu.int/en/ITU-D/Statistics/Documents/facts/FactsFigures2019.pdf 12 https://www.unicef-irc.org/publications/pdf/IWP3%20-%20Towards%20Inclusive%20Education.pdf access resources they can understand, and children of migrant parents or of minority ethnic groups may find their families unable to support their access to distance learning resources due to language barriers.

3.19 Being out of school presents challenges both in terms of learning and child protection. When children are out of school, they are at increased risk of exploitation, maltreatment, and child labour. Schools are central to delivering key interventions such as school feeding programmes, eyesight tests, and menstrual hygiene management. Schools also deliver psychosocial support and mental health interventions – both of which will be critical for children upon returning to school, particularly those who experienced bereavement or abuse.

3.20 Without prioritisation and increased support, some children affected by school closures during the pandemic may never return to school. Not returning to school could similarly be a reality if governments do not continue financial investment in education. The global economic downturn expected as a result of the pandemic could put education sector spending at risk, with lower GDPs resulting in reduced education budgets. Some countries, including the UK, may also be tempted to rethink and reduce aid spending. This, in turn, puts children’s education at risk.

3.21 RECOMMENDATION: The UK must continue to invest in education, including through the multilateral system, during the pandemic, response, and into the future.

3.22 RECOMMENDATION: The UK should use key moments, including during its leadership of the G7, and through international partnerships to continue to shine a spotlight on the most vulnerable children. This should include a focus on the need to build back better after the pandemic.

3.23 While the Coronavirus pandemic and response are causing massive disruption to the realisation of children’s right to education around the world, it is also an opportunity to learn from these challenges and build back better.

3.24 RECOMMENDATION: The UK Government should ensure ringfenced funding for age- and gender-disaggregated data and monitoring and evaluation of interventions to enable comprehensive learning during this time. These lessons must be used to inform future programming and support for national systems.

3.25 RECOMMENDATION: DFID should develop and lead an intersectoral, inter-agency learning project on Coronavirus response. Using the knowledge and experience it has collected through Coronavirus programming and policy development, as well as its work during Ebola and in crisis contexts, the UK should steer this group to focus on building back better and ensuring more inclusive and resilient education systems. 4 THE UK’S RESPONSE, BILATERALLY AND WITH THE INTERNATIONAL COMMUNITY, TO THE SPREAD OF CORONAVIRUS TO DEVELOPING COUNTRIES 4.1 The UK continues to provide global leadership in development, a position Unicef UK welcomes wholeheartedly. The UK’s role in co-hosting the Coronavirus Global Response Summit was a clear articulation of the Government’s ambition and its ability to coordinate internationally to deliver results. Unicef UK encourages the Government to build on this achievement and consider undertaking similar initiatives in child health and education.

4.2 We welcome the UK’s pledge to commit £330 million per year between 2021-25 to GAVI, the Vaccine Alliance, which will help vaccinate 75 million children. As host of the Global Vaccine Summit on 4 June, the UK has an important role to play in galvanising other donors to pledge funds towards GAVI’s $7.4 billion USD ask and commit to saving 8 million lives. This strong support for GAVI is a testament to the UK Government’s commitment to protecting and strengthening health and immunisation systems in the poorest countries and delivering on their action plan to end preventable deaths.

4.3 The UK is leading the way in improving the global response to this pandemic, including by committing £250 million to the Coalition for Epidemic Preparedness Innovations (CEP) and £388 million towards research for vaccines, tests and treatments. However, the UK cannot do this alone.

4.4 RECOMMENDATION: The Government must ensure that newly developed vaccines, tests and treatments reach every community, including the most vulnerable, and are affordable to all. The Government should urge other countries to take a similar approach.

4.5 RECOMMENDATION: Since the effectiveness of the health response and the delivery of an affordable vaccine relies on strong multilateral collaboration, the UK’s global leadership must prioritise action through G7 and G20 so to deliver increased coordination and investment into health systems strengthening.

4.6 Urgent action is also needed to tackle malnutrition and rising insecurity as a result of closed markets and high food prices during the pandemic. Even before the pandemic, nearly half of all under-five deaths were linked to malnutrition, and low-middle income countries had the highest number of malnourished children under five. Undernutrition can compromise a child’s immune system and put them at greater risk of dying from infectious diseases, including Coronavirus.

4.7 Coronavirus is also impacting fragile food systems and preventing the most vulnerable from equitable access to proper food and nutrition. With DFID’s global nutrition funding and strategy coming to an end in 2020 and the postponement of the Nutrition for Growth (N4G) Summit, the UK Government must not delay renewing its commitments for nutrition.

4.8 RECOMMENDATION: The UK Government should urgently pledge new and multi-year funding to tackle malnutrition in all its forms in order to prevent a cliff-edge in nutrition funding and avoid a nutrition crisis.

4.9 Access to safe water, sanitation and hygiene (WASH) are also central to the current Coronavirus response and to preventing future resurgence of infectious diseases. Already, billions of people do not have access to safe water and handwashing facilities with soap, placing them at greater risk of exposure to coronavirus. Children under five are 20 times more likely to die from causes related to unsafe WASH than from direct violence.13 Coronavirus has led to a decrease in the capacity of WASH workers and services as they are being redeployed to respond to the pandemic, as well as an increase in demand for WASH services which is outpacing supply.

4.10 Children suffer disproportionately without access to WASH services in fragile and conflict affected states (FCAS), experiencing increased risks to their health, their education and their safety. The children in FCAS who lack access to WASH are the most vulnerable in the world, who are excluded from a development agenda and caught in continuous, recurrent crises. To address these challenges, and ensure the spread of coronavirus can be slowed, funding of WASH needs to be improved to address the most critical challenges – through providing funding that is long-term and

13 https://www.unicef.org/press-releases/children-living-protracted-conflicts-are-three-times-more-likely-die-water-related predicable, flexible and increased.

4.11 We welcome the UK Government’s £100 million partnership with Unilever to reach up to a billion people in a global handwashing campaign. However, without further multi-year and flexible funding for sustainable WASH systems, children will remain vulnerable to deadly diseases and outbreaks, including Coronavirus.

4.12 RECOMMENDATION: The UK Government must increase its investment in sustainable and inclusive WASH systems targeted at the poorest and most vulnerable children, including those living in slums. This funding needs to be long-term, predicable and flexible.

4.13 In education, we welcome the UK’s continued partnership and leadership within key international education bodies, including Education Cannot Wait (ECW) and the Global Partnership for Education. The immediate commitment of £5 million made to ECW is a welcome start, but we recognise that much more will be needed to minimise the effects of the pandemic on children’s learning. For example, significant additional financial support is needed to close the education financing gap in the Covid-19 Humanitarian Response Plan.

4.14 Unicef UK recognises the UK Government’s support for the multilateral system.14 The agencies of the United Nations have come together during this global pandemic to provide a cohesive, and comprehensive response. Funds have worked together to produce a Policy Brief on the Impact of Covid-19 on Children15 and continue to coordinate through the COVID-19 Global Humanitarian Response Plan.16 The UK Government remains the second largest donor to this fund. 5 LESSONS IDENTIFIED AND LEARNED/APPLIED FROM PREVIOUS EXPERIENCE WITH INFECTIOUS DISEASES 5.1 The Ebola epidemic of 2014-2016 had significant consequences for children and young people’s access to health and education in West Africa. In , for example, schools were closed for nine months. While the impacts were significant, there were also important lessons learnt through the pandemic.

5.2 During Ebola, UNICEF worked with partners to develop and implement protocols and prevention measures that led to no cases of Ebola transmission in schools, including mapping schools to identify their proximity to confirmed cases, training teachers on Ebola prevention, as well as providing infrared thermometers and handwashing kits including clean water to schools. These measures also ensured that some classes continued and children and their families benefited.

5.3 UNICEF also took action to respond to the risk of Ebola spreading in the region by helping neighbouring countries prepare – these measures included risk communication and community engagement to protect local populations and tackle community level hostility and stigma about the disease. UNICEF also ensured access to health services for local populations, as well as Ebola related supplies and training for health workers.

5.4 Some key learnings from the Ebola response which can be applied to the Coronavirus pandemic response include the need for a multisectoral approach to tackle a heath epidemic in order to ensure support for children across all sectors. For example, widespread school closures, reduced

14 https://www.telegraph.co.uk/global-health/science-and-disease/protect-populations-economies-covid-19-world-must-work- together/ 15 Available at https://www.un.org/sites/un2.un.org/files/policy_brief_on_covid_impact_on_children_16_april_2020.pdf 16 https://fts.unocha.org/appeals/952/summary access to routine and essential health services, and separation of children from their families directly violated children’s rights to health, education and safety, and neglected their best interests. It also highlighted the need for direct communication with and engagement of children and young people to ensure the response was relevant for and understood by them. UNICEF’s work with partners on the ground also showed the importance of prioritising a context-specific and community-based response as a one size fits all approach can cause further hostility and fear among communities.

5.5 Ebola also taught the international development community, including UNICEF, significant lessons on the long-lasting consequences of school closures. During the Ebola epidemic in Sierra Leone in 2014-16 (and subsequent school closures), sexual assaults and teen pregnancies increased dramatically.17 This could cause further disruption to education, with countries such as Equatorial Guinea banning pregnant girls and young mothers from school. Drawing on lessons from Ebola, the Malala Fund estimates that ‘10 million more secondary school-aged girls could be out of school after the crisis has passed’.18 IMMUNISATION CASE STUDY: EBOLA

Many Coronavirus affected countries are already stopping immunisation services.

Similar interruptions during the Ebola epidemic in West Africa saw a measles outbreak as a result of healthcare services falling by half, and led to increased deaths from malaria, HIV/AIDS and tuberculosis. In Rwanda, maternal and child health significantly declined during the Ebola outbreak and have not yet fully recovered. During this pandemic, people are delaying routine and emergency health care visits due to movement restrictions, and there is reduced focus on campaigns for new early childhood development programmes typically implemented by community health workers. In Liberia, the proportion of children under one who were fully immunised fell from 73 percent before the Ebola epidemic to 36 percent during.19

To avoid increases in maternal and newborn health mortality, access to affordable and quality health care needs to be continued for all women of reproductive age, pregnant women and newborns, including routine care and Coronavirus care. Efforts must also be made to maintain context-specific quality clinical services such as antenatal care, childbirth services and postnatal care.

5.6 Like Ebola, this pandemic has highlighted the weaknesses in preparedness, resilience and response capacities across the globe. With the World Health Organization recognising that ‘the combined impacts of rapid demographic, environmental, social, technological and other changes in our ways-of-living’ are leading to an apparent increase in infectious diseases, it is highly likely this is not the last pandemic we will see this century. At the same time, climate change is leading to an increase in natural disasters and long-term environmental changes (both of which drive displacement and migration), necessitating even greater investment in system strengthening and resilience.

5.7 RECOMMENDATION: During and after the response, the UK Government must not only look backwards, but also forwards. Interventions and responses must address future crises and

17 https://theirworld.org/news/ebola-to-Coronavirus-education-vital-in-health-crisis 18 https://malala.org/newsroom/archive/malala-fund-releases-report-girls-education-covid- 19https://downloads.ctfassets.net/0oan5gk9rgbh/6TMYLYAcUpjhQpXLDgmdIa/dd1c2ad08886723cbad85283d479de09/GirlsEdu cationandCOVID19_MalalaFund_04022020.pdf 19 https://unsdg.un.org/resources/policy-brief-impact-covid-19-children ensure resilience of systems.

5.8 As countries refocus their capacities to tackle the virus, health resources are under strain like never before. In finding solutions to the immediate needs it will be critical to ensure that investments elsewhere in the health system are not reduced, and we are instead catalysing public investment to build longer term resilience into health systems.

5.9 Similarly, the strain on resources could undermine education systems at a time when we must be building back stronger. The impact of school closures on children’s learning, health and wellbeing is clear and critical. Yet we know from conflict that in times of crisis, education is often the first thing to go. Indeed, 37% of primary-aged, more than 76% of secondary-aged, and 97% of tertiary-aged refugees are out of school, percentages far higher than that of their peers.20 We risk more children experiencing gaps in education for longer periods of time unless we learn from this and other crises and build back better.

5.10 Education systems, and indeed all public services, must be built so that children are supported before, during and after a crisis. Pandemics and other crises risk the precious progress we have made to date on the Sustainable Development Goals. If we do not learn from this pandemic and ensure our systems are more resilient in future, we risk leaving millions of children behind. 6 THE IMPLICATIONS FOR DFID’S POLICY ON A GLOBAL HEATH STRATEGY 6.1 Although the UK Government has made a number of formal and political commitments on global health, including most recently, a commitment to prioritise ending preventable deaths of mothers, new-born babies and children in the developing world by 2030,21 many of the UK’s Government strategies and position papers on global health are outdated, as the Heath is Global strategy, covering the breadth of UK‘s global health work, expired in 2013.

6.2 It is critical for the UK Government to publish a new cross-governmental global health strategy to encourage coordination across government, including DFID, DHSC and the FCO, to publicly set out a new and comprehensive vision for global health, with child health as a key component. This strategy should be complemented by DFID publishing its Health Systems Strengthening (HSS) framework in order to better facilitate monitoring and coordination of DFID’s work, in country and internationally. Within these documents, there is a need for a detailed approach to tackling the international health worker crisis, placing the recruitment and training of skilled community health workers as the foundation of strong health systems and UHC.

6.3 The UK has been leading the global response to tackle coronavirus and a global health strategy will help DFID set out a clear plan and framework for accountability for its work on issues of global health security including infectious disease outbreaks. This piece of work will be crucial for ensuring DFID has the resources and rationale it needs to coordinate across the range of government departments who are also spending on health and be on the front foot to tackle a future pandemic at home and across the world.

6.4 RECOMMENDATION: The UK Government should publish a new cross-governmental global health strategy and accompanying HSS framework as soon as possible.

20 https://www.unhcr.org/uk/education.html 21 https://www.gov.uk/government/news/uk-will-step-up-efforts-to-end-preventable-deaths-of-mothers-new-born-babies-and- children-in-the-developing-world-by-2030 7 PROTECTING QUALITY UK AID

7.1 The UK is a leader in development, with a reputation that we can rightfully be proud of. UK Aid has saved millions of lives, ensured millions of children are learning, and supported the realisation of children’s rights the world over. However, this is not a time merely to celebrate what has been achieved, but to recognise that this achievement is at risk. Without supporting systems strengthening in both health and education, we risk losing the progress made for children to date. This will require continued leadership and investment from the UK Government.

7.2 RECOMMENDATION: The UK Government should continue to invest in and champion education and health for all children, including the most vulnerable, despite future economic instability. It should use its position on the global stage to galvanise other countries to step up commitment to aid and development.