Recovery, Renewal, Resilience

Vulnerable groups of people are those that are disproportionately exposed to a risk. This can change dynamically and it is not a simple process of dividing populations into two groups of 'vulnerable' and 'not vulnerable'. Amid the pandemic, vulnerable groups have emerged from a diversity of communities. They are not only older people, those with ill health or disabilities, or homeless persons, but also people from a range of socioeconomic groups who might 'struggle to cope financially, mentally or physically' with crises precipitated by the pandemic. Consider:

• If the definitions and categories we use to identify vulnerable people, and consider their needs, adequately represents their lived experiences - whether their vulnerability existed prior to COVID-19, has been exacerbated by it, or has been newly created by it?
• Identify the people behind the 'vulnerable' label - who are they, where are they, and why are they vulnerable? - to increase our understanding of the person and the conditions or environment (root causes) that may be making them vulnerable to certain risks
• If there are different levels/spectrums of vulnerability, do we need to organise vulnerability with respect to different forms of risk (e.g. immediate risk to life, risk to mental health, social/financial security, geographic location)?
• Assessing those who may have been defined as vulnerable prior to COVID-19 and the conditions associated with this vulnerability, those who have become newly vulnerable as a direct result of COVID-19, and what factors lead to these people/groups becoming vulnerable
• The risk of under-supporting those who face severe risk if we rely only on our previous (to COVID-19) assumptions or understanding of vulnerability
• Whether re-defining vulnerability may support more effective recovery and renewal strategies e.g. classifying vulnerable groups according to risk levels/spectrums, creating vulnerability indexes and identifying the root cause of each
• Recovery strategies should aim to provide transactional aid to alleviate the negative effects of vulnerability exacerbated or caused by the pandemic
• Renewal initiatives should address the root cause of vulnerabilities through transformational initiatives that aim to prevent people from becoming vulnerable

Migrants and refugees face a multitude of health and safety challenges that have been intensified by the pandemic, such as: losing employment and income; eviction and homelessness; and lack of access to 'safety net' support. In addition, some countries have temporarily suspended issuing residency permits, leaving people with irregular status in their country of asylum and further impacting their access to employment and social services. To support migrants and refugees, consider:

• Participate in national resettlement programmes (e.g. SRP UK) to guide preparations, ongoing support and integration of migrants and refugees into local communities
• Establish a working group to enable collaborative working between local councils, community groups and related agencies to determine how local authorities can meet legislative requirements of resettlement programmes
• Inform and prepare local communities where migrants and refugees are to be resettled
• Identify registered and unregistered refugee populations in communities
• Conduct risk and vulnerability assessment mapping
• Include migrants and refugees in social protection schemes to support those who have lost income generating opportunities
• How systems will protect migrants and refugees from harm, irrespective of their status, with access to essential health and social care
• Agree that immigration status is not a legitimate basis to deny access to essential public services (e.g. healthcare, vaccination), and communicate this to public services, migrant and refugee populations, and wider groups
• Invest in risk communication and community engagement at local levels to disseminate information in the relevant languages of migrants and refugees
• Partner with humanitarian actors to provide services
• Establish humanitarian service points or 'safe spaces' which are not subject to immigration enforcement activities, where humanitarian actors can provide essential services to vulnerable migrants

Schools have an increased need for support during lockdowns to provide children with the resources they need to learn effectively. Many other organisations are also under significant pressure during COVID-19, but some are coping particularly well as customer demand has increased hugely. Such organisations may have the capacity, capability and willingness to support the parents of schoolchildren in their local community. Consider encouraging local organisations and others to:

• Coordinate community activities on behalf of a school, for example, to:
  • Collect unused computers from businesses and the public so they can be reformatted and given to school children to enable them to access online learning support
  • Provide computer training and skills for local parents so they can assist their children, particularly young children
• Offer free printing of schoolwork for parents of school children who do not have printing services at home
• Make servers available to host school content which can be downloaded by parents
• Contribute financially to support schools to pay for new forms of online schooling, new content, and access to privileged services
• Work with schools to support them to build capability, for example, to:
  • Evaluate and learn the technology that is available and how to use this in online learning
  • Convert materials to make them suitable for online learning
  • Remap donated computers to enable them to be distributed to school children
• Provide specialist services to schools, e.g. readers of braille, sign language, adapting written materials into the spoken word, supporting children with disabilities
• Provide COVID-19 hygiene supplies to schools (e.g. facemasks and hand sanitising stations)
• Actively help Head Teachers in their role, for example, to interpret guidance and its application in their schools, and to support networking and mutual aid between schools

Research into MNCH demonstrates that early-life determinants of health help create more resilient societies. Previous trends indicate that socioeconomic shocks lead to an increase in markers of poor MNCH including low birthweight, maternal and infant malnutrition, and maternal drug or alcohol misuse etc. These factors can have impacts across a person's life and effects the next generation. At particular risk are people from Black, Asian, or minority ethnicities who are more likely to be socio-economically disadvantaged, and at higher risk of pre-existing health conditions, contracting COVID-19, and having poor markers of MNCH. Consider:

• Research and data collection to monitor the immediate and longer-term effect of COVID-19 and related socioeconomic crisis on MNCH, using routine data collection systems and reinstating systems that have been suspended during COVID-19 e.g.:
  • the short, medium, and longer-term consequences of COVID-19 on neurocognitive development in children
  • disruptions as a result of COVID-19 e.g. on food insecurity, access to health services and impacts on MNCH
• Investment of resources into promotion of early-childhood health and development, including the training and provision of community health workers
• Promotion of MNCH care as an essential service and human right, including investment to access to contraception/reproductive health services, antenatal/postnatal care, and child health etc
• Strengthen community-based interventions to promote MNCH, such as home visits during and after pregnancy and in the early years
• Develop new policies to drive gender equity and reduce the penalties of motherhood e.g. parental leave for each parent on a use it or lose it basis

Inclusive recovery practices are essential as additional groups of vulnerable people emerge from the COVID-19 pandemic, alongside data on the disproportionate effects of COVID-19 on vulnerable and marginalised people. In particular, people living with visible and invisible disabilities have been adversely impacted by the virus due to challenges in accessing health services, and because they are at greater risk of experiencing complex health needs, worse health outcomes, and stigma[1].

While disability alone may not be related to an increased risk of contracting COVID-19, some people with disabilities might be at a higher risk of infection or severe illness because of their underlying medical conditions[2]. In particular, “adults with disabilities are three times more likely than adults without disabilities to have heart disease, stroke, diabetes, or cancer than adults without disabilities”2. In the UK, working-age women with a disability are more than 11 times more likely to die from COVID-19 than women without a disability, and for men, the death rate was 6.5 times higher than for men without a disability[3].

Health-care staff should be provided with rapid awareness training on the rights and diverse needs of people living with disabilities to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision[4]. Advice on how to do this is extremely important. In the UK, guidance on how to safely care for people with disabilities is provided to protect carers and the person they are caring for, and includes consideration of[5]:

• Protecting yourself and the person you care for e.g. appropriate use of PPE in specific settings
• Supporting the person you care for through change e.g. providing accessible information
• Maintaining the health and wellbeing of carers

In recovery, some people with disabilities may have restricted access to social networks, systems that provide support, job security, consistency of income, education – aspects that others may take for granted. “The more a person is excluded, the more challenging the recovery, and persons with disabilities often fall in this category.”[6] Recovery from COVID-19 must therefore reflect disability-inclusive strategies to provide action-oriented directions for government officials and decision makers responsible for post-disaster recovery and reconstruction.

The Disability-Inclusive Disaster Risk Recovery Guidance Note[7] developed by the World Bank / Global Facility for Disaster Reduction and Recovery (GFDRR) aims to accelerate global action to address the needs of persons with disabilities. Overall, the World Bank and GFDRR estimate that a quicker and more inclusive recovery could reduce losses to well-being by $65 billion a year[8].

Disability-inclusive recovery is about including people with disabilities in recovery planning and enabling equal opportunities through the removal of barriers. This can be done by gathering baseline disability data and incorporating it into needs assessments, by mainstreaming disability inclusion in recovery programmes, and by recommending specific interventions. There are four essential steps to support inclusive risk planning:[9]

• Collect data on barriers and accessibility improvements to understand and assess disability inclusion in recovery and reconstruction
• Adopt appropriate disability legislation to support a disability-inclusive recovery process that will prioritize needs and allocate resources. New policies should be in alignment with the UN Convention on the Rights of Persons with Disabilities to guide disability-inclusive recovery and reconstruction
• Establish institutional mechanisms to ensure the meaningful participation of persons with disabilities in the planning and designing of recovery and reconstruction processes. Also identify and designate an agency with responsibility for coordinating and overseeing disability affairs in recovery and reconstruction. Additionally, ensure standards for disability inclusion in recovery are established and communicated
• Target households and groups that have limited ability to self-recover, including households with persons with disabilities, to receive financial support and other interventions. Set standards for disability inclusion in budgeting and procurement quickly and ensure they are applied across the recovery and reconstruction process. Also require full consideration of accessibility, including the principles of universal design, as a condition of financial contributions and assistance by all involved in recovery.

Disability-inclusive recovery can help reduce poor representation of people living with disabilities in post-disaster recovery efforts. This provides an opportunity to build a more accessible environment that is inclusive and resilient to future disasters, and to reduce the disproportionate risks faced by people living with disabilities by[10]:

• Making infrastructure resilient and accessible (barrier-free buildings and land use planning)
• Setting up programs to actively employ persons with disabilities, such as hiring them in the recovery and reconstruction planning and implementation process
• Making healthcare and education readily available and ensuring healthcare is accessible to persons with disabilities before and after a disaster
• Communicating hazard exposure and risk information in a way that can be understood and acted upon (for example, sign language interpretation and plain language)
• Improved accessibility before and after a disaster also benefits older people, those who are ill or have been injured, pregnant women, and some indigenous and non-native language speakers

Recovery is often tumultuous and traumatic, but it is also an opportunity to renew systems and processes by understanding and addressing unequal practices and structures. By making disability inclusion a priority in the recovery agenda, we can ensure more self-sufficient, inclusive, and resilient societies for all.

[1] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[2] https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fpeople-at-higher-risk.html

[3] https://www.bbc.co.uk/news/uk-53221435

[4] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[5] https://www.gov.uk/government/publications/covid-19-supporting-adults-with-learning-disabilities-and-autistic-adults

[6] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

[7] http://documents1.worldbank.org/curated/en/559111587448620405/pdf/Disability-Inclusive-Disaster-Recovery-Guidance-Note.pdf

[8] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[9] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

[10] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

To read this case study in its original format follow the source link below to TMB Issue 19 (p.15-16).

Self-isolation, and limited access to school, has driven more children online during the pandemic. Spending more time on virtual platforms can leave children vulnerable to online sexual exploitation by predators (see also The Manchester Briefing Week 14). Increased and unstructured time online, alongside limited face-to-face contact with friends or partners, can lead to heightened risk-taking such as: sending sexualized images, exposure to potentially harmful content, and cyberbullying. Consider:

• Some children may be more vulnerable than others (e.g. those with learning disabilities) and may need specific types of support and training for them and their guardians
• Retaining access to child services and keeping guardians informed of where to find online safety information for themselves and for young people (e.g. antivirus software, parental controls on devices)
• Information for guardians on talking with young people about who they communicate with online
• Training health, education and social service workers on the impacts that COVID-19 may have on increased online risks for young people
• Educational initiatives on cyber safety and to provide local helplines and hotlines for adults and young people, including counselling
• Enhancing online safety measures, especially while using virtual learning tools
• Schools updating safeguarding policies to reflect the new realities for children learning online

The COVID-19 pandemic has been a challenging time for everyone, especially in trying to adjust to new routines and living and working environments. This may be particularly true for children with autism and their parents, as children with autism have trouble adjusting to, coping with, and understanding change. To help with this, help parents to explain the current situation in clear and simple ways and can help children with autism to adjust to the 'new normal'. One way of doing this is to provide parents with access to materials that frame COVID-19 as a germ that can make people sick, so it is important to stay away from others and not touch things.

Advise parents to reiterate important rules to children with autism is also important to help them cope, such as:

• Washing hands well and often (for at least 20 seconds)
• Not touching their nose, mouth, and eyes
• Keeping at least 6 feet away from other people
• Wearing a cloth face covering or face mask in public places

Face coverings may be difficult for autistic children, some parents have had successes in attaching the ear loops on masks to their child's favourite hat with buttons to reduce sensitivity. Make authorities (such as transport providers, Police) aware of "Facemask Exemption Cards" that have been produced by organisations for parents to print out for those who cannot wear a mask. Local government can support parents of children with autism by working with respected specialist organisations to advise parents e.g. one encouraging mask wearing

• Demonstrate using the face mask on a preferred object or person, such as a stuffed animal, a doll, or a family member
• Allow the person to choose among different types of fabric face masks to find one that is most comfortable
• Start by practicing wearing the face mask for short durations of time, allowing for breaks when needed
• Plan initial outings in low-demand environments that are quiet and calm, so that the individual can experience success wearing the face mask
• Use a printed photo or digital photo of the individual wearing a face mask as a visual cue to wear the mask before outings

In addition to these changes, losing the daily routine that going school provides adds an additional layer of complexity for children with autism, and outs them at risk of not receiving the social care and support they require. While, some children may have found home schooling difficult, the time spent away from school may have resulted in the development of a new routine at home where they feel safe. As such, returning to school may cause anxiety and distress. Local government should inform teachers that some ways of reducing these anxieties include:

• Providing a visit to the school before it reopens if possible, to help children familiarise themselves with their environment and staff again
• Encouraging homes to introduce changes that are made in school at home e.g. explain social distancing measures, ask for photos of new classroom layouts to show children
• Asking parents for information about your child during COVID-19 so they have an understanding of their needs and how these may have changed due to COVID-19 restrictions

COVID-19 has also been a challenging time for parents of children with autism. One parent in the UK stated that support for them and their child had been reduced to occasional phone calls and they felt like they had been "left to struggle alone". They also stated that they were repeating the same or similar activities with their child from before lockdown and that it felt like their child's development had stalled. They stated that increased resources from their child's support worker such as a timetable of activities and development would have helped and made the experience of self-isolation and lockdown "less distressing".

Providing specialised phone lines and centralised hubs with resources for parents is vital, to ensure their well-being and that of their children, via reliable information and support. Local government can help employers to realise that parents also need to find ways to balance work and childcare responsibilities this can include:

• Arrange to work from home to ensure supervision, or childcare sharing arrangements with friends and family
• Prepare information about the child's support needs and successful learning and behaviour strategies for anyone caring for the child
• Develop an emergency contact list, and discuss it with friends and family. Include names and numbers of your personal autism support network, as well as medical providers
• Contact local organizations who may be able to offer support.
• Look through the child's medical records or evaluations related to autism as these may have recommendations on areas to focus on and can help you with making learning plans while schools are closed
• Reach out to others to maintain social support for the whole family e.g. social media, social media groups for autistic people and their families, and other virtual support groups that provide online resources for finding empathy and ideas while self-isolating or in lockdown

To read this case study in its original format (including references) follow the source link below to TMB Issue 16 (p.19-20).

Including gender-inclusive perspectives can address gender inequalities in health outcomes, the economy and wider society. For example, in the EU, women make up: 93% of child care workers; 86% of personal care workers in health services; and 95% of domestic cleaners (https://eige.europa.eu/covid-19-and-gender-equality/frontline-workers). This exposes women to the virus, heighten the potential of poverty and mental health issues as these jobs are undervalued, precarious, and underpaid. Women also bear an unequal burden in unpaid household labour which can undermine access to paid employment. There is a need to assess the implications of COVID-19 policies to ensure gendered experiences are recognised and addressed. Consider:

• The level of exposure of genders to COVID-19 due to gender segregation in the labour market
• The increased risks to occupational health and well-being of women in caring professions
• Increased consultation with, and inclusion of, women in decision-making during crises
• Working with community/religious leaders to promote caregiving/caretaking as everyone's responsibility
• How gender-balanced teams can provide treatment or support for mental health and well-being
• Innovating to mitigate other social issues such as gender based violence
• Offering guidance on domestic violence into existing services e.g. give volunteers, who provide other services, information on victim support
• Educating organisations about the heighten risk of gender based violence since COVID-19 so that they can be part of safeguarding women and girls

The UN reports that measures to curb the spread of COVID-19 are exposing victims of human trafficking to further exploitation and limiting their access to essential services. The restrictions on movements, diversion in law enforcement, and reduced public health and social services is impacting victims of human trafficking before, during and after their ordeal. Children are also at increased risk of exploitation as a result of being forced onto the streets to find food or work; and women are at risk of sexual exploitation. Consider how to:

• Protect those still at risk from abuse from captors through maintaining dedicated law enforcement departments and social workers for victims of human trafficking. Including the need for adequate PPE for these departments
• Provide safe housing for victims who have been rescued from captivity but are unable to return home due to travel restrictions
• Support those experiencing delays in legal proceedings, including regular updates on the status of their case
• Provide hotlines to emotional, financial, legal and safe housing advice
• Encourage communication between schools, law enforcement and social workers to identify, and check-up on, children at risk of exploitation
• Increase attention to tackling online child sexual exploitation. Travel restrictions have spawned an easy way to groom children, gain access to (or create) child sexual abuse material and establish "delivery" services
• Conduct evaluations into the impact of COVID-19 on resources for victims, law enforcement and justice systems to better understand needs of victims and gaps in provision

COVID-19 has put a spotlight on wider socioeconomic and health inequalities and vulnerabilities which require long-term interventions. Social justice perspectives address creating fair and just relations between individuals and society through societal transformation to ensure the dignity and rights of people. A social justice perspective would support tackling a number of important inequalities highlighted globally during COVID-19 response and recovery. These include:

• Disparities in the risk and outcomes of COVID-19 for black, Asian and minority ethnic (BAME) people
• Increased risk to women from domestic violence within their homes
• Safety of LGBTQI+ community- safety at home for these communities may be more precarious as they're at a higher risk of homelessness (especially young people) and domestic abuse. Additionally, specific safe community spaces for LGBTQI+ communities have been lost, and access to healthcare can be difficult due to specific needs (this can be especially hard for trans people)
• Significant financial risk to those with precarious employment, which can lead to extreme poverty and homelessness
• Vulnerability of children as a result of any of the above issues - compounded by reduced safe spaces, such as schools, which also provide access to meals, pastoral care and resources e.g. internet and computers

TMB Issue 10 brings together the reflections of our learning from the first 10 weeks of gathering lessons on recovery and renewal from COVID-19. Follow the source link below to read all of the reflections from our team (p.9-15)

Consider:

• Women are more likely to carry out unpaid work or serve as care givers. The pandemic is likely to negatively impact their livelihoods and dramatically increase their unpaid care work
• Women constitute over two-thirds of workers in the health and social sector globally, placing them on the frontlines of the pandemic response, but with a persistent gender pay gap and fewer leadership positions than their male counterparts
• These issues can restrict access to resources, decision making and the ability to take preventive measures

Close consultation is needed with women's organisations i.e. groups for mothers, carers, women's rights, domestic violence

Including:

• The pressure on vital sexual and reproductive health services (including for women subjected to violence) and how provisions can be maintained
• The provision of hotlines, crisis centres, shelters, legal aid, and protection services and impacts of scaling these back
• Identifying and evaluating outreach methods to support those at risk of abuse within their own home
• Plans for the safety of health workers (the majority of whom are women) who may be at risk of violence in their own home and at work
• How to include men in conversations about violence towards women

Understanding children's perspectives is important to provide children with an outlet to express themselves, and for adults to gain a better understanding of how children view their situation.

• Consider creative activities where children can explore their feelings about COVID-19, this could include drawings, video blogs or music. One example, is a collection of drawings and messages collated by the BBC, showcasing children's perspectives about the world they are living in. These types of activities could be recurring, and could be developed to address a number of issues i.e. lockdown, not going to school, fear, bereavement.
• Similar activities could support communities in emotional and social recovery from the impacts of COVID-19 and could provide innovative ways for adults and children to explore bereavement, memorials and commemoration.
• Children's pictures of colourful flowers in windows can make their walks more enjoyable and brighten the nation. The rainbows can be refreshed to create a refreshed vibe for the children to engage with.

This includes elderly, those with pre-existing health conditions, migrants and homeless. Consult with organisations representing these groups to develop understanding of how they might be affected by complex emergencies and what measures could be taken. (UN -75 People's consultations established for this). For example, in the UK some LRFs are considering how to evacuate during lockdowns or social distancing.