COVID-19 socio-economic Vulnerability Assessment of Ethiopia COVID-19 socio-economic Vulnerability Assessment of Ethiopia August 2020 Authors: Alessandra Cancedda, Ecorys Corrado Minardi, Ecorys Jonathan Wolsey, Ecorys Vincenzo Vinci, UNICEF Amin Abdella, Ecorys Disclaimer: This publication was produced by UNICEF and was co- funded by the European Union. Its contents are the sole responsibility of Ecorys and OG Research and do not necessarily reflect the views of the European Union. 4 Table of contents 1 Introduction 9 1.1 Introduction 9 1.2 Scope of the assessment 9 1.3 Overview of potential impacts of Covid-19 and related measures 10 2 Error! Bookmark not defined. 3 Assessment of vulnerability in the health area 13 3.1 Introduction 13 3.2 Reduced access to health care 13 3.2.1 Description of impact 13 3.2.2 Baseline and early signs of impact in Ethiopia 14 3.2.3 Overall assessment of vulnerability 15 3.3 Interruption of and lower access to vaccination and preventative care services 21 3.3.1 Description of impact 21 3.3.2 Baseline and early signs of impact in Ethiopia 21 3.3.3 Overall assessment of vulnerability 21 3.4 Reduced access to WASH services 24 3.4.1 Description of impact 24 3.4.2 Baseline and early signs of impact in Ethiopia 25 3.4.3 Overall assessment of vulnerability 25 3.5 Reduced access to sexual and reproductive health services 28 3.5.1 Description of impact 28 3.5.2 Baseline and early signs of impact in Ethiopia 28 3.5.3 Overall assessment of vulnerability 29 3.6 Deteriorated mental health and psychosocial wellbeing 32 3.6.1 Description of impact 32 3.6.2 Baseline and early signs of impact in Ethiopia 33 3.6.3 Overall assessment of vulnerability 34 3.7 Worsened child nutrition outcomes 37 3.7.1 Description of impact 37 3.7.2 Baseline and early signs of impact in Ethiopia 37 3.7.3 Overall assessment of vulnerability 38 3.8 Summary assessment 40 4 Assessment of vulnerability in the welfare and social cohesion area 43 4.1 Introduction 43 4.2 Worsened educational outcomes for girls and boys 43 4.2.1 Description of impact 43 4.2.2 Baseline and early signs of impact in Ethiopia 43 4.2.3 Overall assessment of vulnerability 44 4.3 Worsened living conditions for people with disabilities 47 4.3.1 Description of impact 47 4.3.2 Baseline and early signs of impact in Ethiopia 47 4.3.3 Overall assessment of vulnerability 48 4.4 Increased exposure of women and children to violence, exploitation and abuse 50 4.4.1 Description of impact 50 4.4.2 Baseline and early signs of impact in Ethiopia 50 4.4.3 Overall assessment of vulnerability 50 4.5 Increase in evictions 53 4.5.1 Description of impact 53 4.5.2 Baseline and early signs of impact in Ethiopia 54 4.5.3 Overall assessment of vulnerability 54 4.6 Interrupted access to social protection, such as cash transfers, school meals or other social safety net programs 55 4.6.1 Description of impact 55 4.6.2 Baseline and early signs of impact in Ethiopia 55 4.6.3 Overall assessment of vulnerability 57 4.7 Lowered population morale due to cancellation of religious ceremonies, weddings, funerals and other socially important events 58 4.7.1 Description of impact 58 4.7.2 Baseline and early signs of impact in Ethiopia 58 4.7.3 Overall assessment of vulnerability 59 4.8 Increased social tensions, discrimination and stigma of persons perceived to be affiliated with the disease 60 4.8.1 Description of impact 60 4.8.2 Baseline and early signs of impact in Ethiopia 60 4.8.3 Overall assessment of vulnerability 60 4.9 Increase in community and political violence, riots and clashes 62 4.9.1 Description of impact 62 4.9.2 Baseline and early signs of impact in Ethiopia 62 4.9.3 Overall assessment of vulnerability 62 4.10 Increase of people without legal proof of identity 63 4.10.1 Description of impact 63 4.10.2 Baseline and early signs of impact in Ethiopia 64 4.10.3 Overall assessment of vulnerability 64 4.11 Restrictions on freedom of association and expression under the pretext of emergency 66 4.11.1 Description of impact 66 4.11.2 Baseline and early signs of impact in Ethiopia 66 4.11.3 Overall assessment of vulnerability 66 4.12 Increased exclusion of women from decision-making 68 4.12.1 Description of impact 68 4.12.2 Baseline and early signs of impact in Ethiopia 68 4.12.3 Overall assessment of vulnerability 69 4.13 Summary assessment 70 5 Assessment of vulnerability in the economic area 73 5.1 Introduction 73 5.2 Loss of income due to COVID-19 illness/death and health care costs 73 5.2.1 Description of impact 73 5.2.2 Baseline and early signs of impact in Ethiopia 73 5.2.3 Overall assessment of vulnerability 73 6 Outline of most exposed groups 75 5.3 Loss of income due to increased unemployment, in particular in certain sectors 76 5.3.1 Description of impact 76 5.3.2 Baseline and early signs of impact in Ethiopia 76 5.3.3 Overall assessment of vulnerability 77 5.4 Loss of income from remittances due to global downturn and exodus migrant workers from host countries. 82 5.4.1 Description of impact 82 5.4.2 Baseline and early signs of impact in Ethiopia 82 5.4.3 Overall assessment of vulnerability 83 5.5 Increased income poverty 84 5.5.1 Description of impact 84 5.5.2 Baseline and early signs of impact in Ethiopia 85 5.5.3 Overall assessment of vulnerability 85 5.6 Increased food insecurity 88 5.6.1 Description of impact 88 5.6.2 Baseline and early signs of impact in Ethiopia 89 5.6.3 Overall assessment of vulnerability 90 5.7 Summary assessment 93 6 Overview of most vulnerable groups 94 7 1 Introduction 1.1 Introduction As part of their Technical assistance on Public Finance Management (PFM) including a focus on social sectors project, Ecorys and OG Research are supporting UNICEF in addressing the Covid- 19 crisis in Ethiopia through the undertaking of a Vulnerability Assessment and a Socio-economic Impact Analysis of Covid-19. This present report constitutes the Vulnerability Assessment, identifying the most vulnerable groups and settings, studying the implications of the socio-economic shocks stemming from the crisis, and providing recommendations for addressing its consequences, both in terms of policy options for decision makers, as well as practical actions that UNICEF can engage in. The first step of the assignment consisted of a review of existing literature on the health, social and economic-related impacts of Covid-19 and other infectious disease outbreaks in middle and low- income countries. This review led to an inventory of potential impacts of Covid-19, and its associated vulnerability and resilience factors. Guided by this inventory, we have collected data and information on the situation in Ethiopia in order to assess the extent to which the impacts identified by the literature actually take place in the country, or are likely to take place because of the presence of the associated vulnerability and resilience factor. The results of this vulnerability assessment are presented in this report. Data collection from documentary sources has been supplemented by interviews with UNICEF Ethiopia staff responsible of various policy areas (health, education, social protection, gender, child protection and GBV, and WASH). By the use of this rigorous methodological approach, this vulnerability assessment stands alone from other related assessments quantifying the impact of the COVID-19 pandemic on the Ethiopian economy and assessing its effects on different groups which have been already published, including a comprehensive report by the United Nations and a analysis of the Planning and Development Commission.1 The report was written at the end of May-beginning of June 2020. Data on the country situation were collected during the months of April and May 2020 and may have changed since then. At the end of May, Ethiopia had just passed the threshold of 2,000 confirmed cases, the vast majority of which were concentrated in Addis Ababa. The situation is however still developing, and projections indicate that the peak of the infection could happen anywhere from July-October up to April 2021, with the total cases ranging between 1 million (London School of Hygiene & Tropical Medicine model, assuming 50% physical distancing) and 4.2 million (WHO AFRO model).2 1.2 Scope of the assessment This assessment is not an “ordinary” vulnerability assessment but is being conducted in order to reflect on the response to the COVID-19 crisis thus far and inform future steps. Therefore, we pay special attention to socioeconomic and health-related factors that are most closely related to the nature of the crisis. 1 See United Nations (2020), “One UN Assessment: Socio-Economic Impact of COVID-19 in Ethiopia”, United Nations Ethiopia, 2020. And Planning and Development Commission (2020), “The Impact of COVID19 on Ethiopian Economic Growth”, April 2020. 2 UNFPA, UNICEF, WHO. “Continuity of Essential Health Services During COVID-19 Pandemic in Ethiopia” May 2020. 9 According to the United Nations Office for Disaster Risk Reduction (UNISDR), a hazard is “a dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage.” UNISDR defines the term vulnerability as “the characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a hazard”.