How is coronavirus changing aid work?

Jorge Abreu, Chief Operating Officer of US-based global nonprofit All Hands and Hearts

What decisions are you facing and what is changing?

On 12 March, we made the difficult, but necessary, decision to pause our operations worldwide. Taking the guidance given by the World Health Organization and the US Centers for Disease Control and Prevention, we explained our decision to the communities we were serving, including their community leaders and our staff in country partners. Our decision was based on our desire to protect our volunteers, staff, and ensure we did not bring the virus to the communities in which we serve. Over the course of a few days, we evacuated more than 400 staff and volunteers spread across eight countries and five continents.

Now, two months later, our team is being challenged to prepare for what will be the “new normal” for our volunteer-based model in this COVID-19 world. Like so many organisations and companies, we need to re-think many aspects of our model and likely will need to adjust how we deliver our intervention on our disaster relief programs around the world. We are making extensive efforts to engage with our partners, donors, and beneficiary communities to understand how the situation is evolving and ways we can safely restart our work. It is impossible to say exactly when but we know deep in our hearts that returning to our mission is just a matter of time.

What worries you the most about COVID-19 with regards to your work?

We focus our efforts to address unmet needs in remote and almost forgotten places. We bring amazing people from all over the world to engage with these communities in a very personal way, bring them hope, and show they are important to us. We can’t fulfill our mission without “being there.” Deciding when it will be the proper time to return to help without putting these fragile communities at risk is my biggest concern.

What gives you hope right now?

Our people. The results of our current efforts to adjust our organisation to navigate this trying time, remotely support our beneficiary communities, prepare for COVID-19, and also distribute personal protective equipment to first responders have exceeded expectations. The support we have been receiving from our alumni network, partners, donors, staff, and families is what keeps me confident that our organisation will not only get through but become stronger after this pandemic.

What advice do you have for others, perhaps those not in the aid sector?

Humanity has progressed through time due to our ability to learn and adapt. There is something to be learned from every occasion and this one is no different. What we are going through as individuals and society during this pandemic is unique to our most recent generations – a huge learning opportunity. It is important to create the necessary space in our lives – and minds – to process this experience and understand how it can make us better people at home and at work, for the world we live in, and for one another.

Sorcha Fennell, Trocaire

I am reminded of 2014 when Ebola emerged in West Africa.  As the region prepared to deal with one of the most challenging crises they had ever confronted, airlines stopped flying, many international staff left and those who stayed were restricted in their movements – observing ‘social distancing’. Ironically at a time when international humanitarian assistance was desperately needed, it proved difficult to find staff willing to work in the region.

What we are now observing, as a result of the COVID-19 pandemic, feels strangely similar. Comparisons have been made between the measures required to manage the transmission of Ebola and the transmission of COVID-19 but one significant difference is the fact that whole countries have now ‘self-isolated’ as entry into and out of many states is now blocked.

This means that the response to the COVID-19 pandemic will need to be locally led. During the Ebola outbreak in Sierra Leone we witnessed how local agencies moved out of their traditional programming areas to take up new activities to support the Ebola response.

A key feature of the Ebola response was the role that communities played in mitigating the scale of the outbreak. The scaling down of international operations and the restrictions on international staff movements meant that a space opened up for local organisations. Similarly, the COVID-19 response context in many countries now provides an opportunity for the humanitarian sector to endorse localisation by enabling and empowering local organisations to lead the response.

It is important to remember that local humanitarian workers are not immune to this virus. Instead of transferring the risk to local humanitarians we must ensure that they are supported to take all necessary precautions.

When the crisis ends and when international travel resumes will international agencies and personnel return to take up their roles again? Will they re-occupy the spaces, will they displace local agencies, will they command the same respect, or will the relationship and power dynamic have forever changed?

This is a time for focus and solidarity. The effects of the COVID-19 pandemic may well prove profound but the crisis also presents a major opportunity to invest seriously in local and national capacities.

Woman, wife, mother, daughter, minority. Still human.

Our organisation has faced full upheaval at HQ, regional, and national levels, with all angles of the response shifting to combat COVID-19. I chose to telecommute to be closer to my family when I already “sensed” that this pandemic was going to be a game-changer. I wonder what I would have done if I was out in a hardship, field location. I cannot honestly say I would have stayed.

One worry is if we will truly learn from the experience? Will it mark an actual change from the self-serving way in which we have “worked” in the past, where the humanitarian mandate was spouted at people without true intentions of upholding the values. I come from a country in the midst of a bloody civil war. I have never really lived there but it remains my motherland. I watch in despair as we self-destruct (with little heart to the people and the nation’s wellbeing). The humanitarian community was already perceived with barely concealed disdain for doing little more than “issuing statements and bland resolutions” and providing its usual Band-Aid. And now with COVID-19 the war has escalated. In my country, people fear that they will be damned if they try to “social distance” and die in the middle of fighting or damned if they leave and die from COVID-19. In the face of this despair, more statements and calls for global ceasefires will not make these warmongers stop. What will make them stop is accountability. I worry that this may not emerge from this experience until and unless a lot more people die.

Another worry is the sheer scale of what is to come in terms of the needs (health, food security, socio-economic, and oh so much more), and whether this current aid structure will have any added value to the lives of the people we are meant to be there to serve. I fear that we will be paralysed by the scale and breadth of the work. I fear that we will basically only scratch the surface of what will be a defining moment for our humanity. It may well help us learn to fix this broken aid system.

What give me hope: That we may well be at the cusp of a new world, with people wiser to what they are in its midst – that we can show that so-called respect and love to one another in a truer form. That we will look at the world with fresh eyes, and respect the advocates like Greta and Malala for their true leadership. Speaking of which, the leadership of care shown by women leaders will hopefully show us all that when it comes to being decisive and truly taking on the “whole of society” approach on board.

I am no one to give you any advice. Go ahead and feel what you feel, experience what it is from your own lens. So, if you have moments of despair, know you're not alone. And if you have moments of light, enjoy them without any guilt.  Don't let anyone discredit what you feel and experience. My only plea is to be kind to yourself, your loved ones and the community you live amongst. In the hope that this kindness will ease your mind, heart, soul, and wellbeing.

Anonymous

I stayed because where I work there was no option. Before we could notice, they had closed all airports. The COVID-19 crisis caught us where we usually live: geographically, a world apart from our families and loved ones.

It is not a secret that many aid workers sacrifice time with their family and friends at home to be able to carry out their jobs. How many of us were caught suddenly by social isolation measures in foreign countries where many of us live alone in a country where one might not speak the language, which makes it confusing to understand the local news outlets and social isolation rules? How many of us are single mothers living with small children in a foreign country far away from our families and emotional support systems, who worry about what will happen to the children if we get coronavirus and have to suddenly be hospitalised? And the cases of family separation where a partner was abroad and was not able to make it home due to airport and borders closure. How many of us are pregnant or just gave birth, praying that our parents and/or grandparents will stay alive to meet the baby whenever airports open and we make it back home again?

Instead of being in social isolation with their families at home, as most people around the world are doing, we simply don’t know the next time that we will be allowed to see our elderly parents. We simply have to plead with them by phone or Skype so they stay home, and arrange with other family and friends to make sure they have the groceries and medicine they need without going out of the house. How many of us were going to be deployed or reassigned to another country around this time of the year and are now in a limbo.

What worries me: The knowledge that many life-saving field operations are currently being disrupted. And with the fear of what will happen as COVID-19 hits informal settlements, refugee camps, and other places where people live in overcrowded conditions with less-than-ideal access to hygiene facilities, water and sanitation, and healthcare services. Social isolation means that for many women and girls around the world they are quarantined at home with their abuser. Services for survivors might be slowed down by the preventive COVID-19 measures. Usually, the organisations we work for are the first to step forward to solve these problems. Except that now global movement restrictions have slowed down the pace of response.

What gives me hope: The good news is that no humanitarian organisation is planning to close operations. What we have seen in the last weeks is an impressive rate of productivity in working from home, and a commitment to do all we can to keep doing all we can for those most in need.

My advice: Do not watch the news all day. Keep healthy habits, positive coping mechanisms. Reach out if you're feeling bad. Don't be afraid of seeking therapy.

Stayed, anonymous.

For those who stayed, and I am among them, it is hard this time to stay strong and hold the position and remain here especially when you see that your very same colleagues, professionals and experts in handling emergencies, believe more and more that it is better to go home. And once you have gathered the strength to make a decision, being reminded constantly of this dilemma does not help to finally come to terms with the decision and move ahead. All of us, even those without dependents, we are not being daughters and sons, or brothers and sisters, or nieces and nephews these days. We continue taking care of other populations and crises, while our own people are now at stake. What is happening was before only in the plots of fantasy movies, you know when you ask yourself what would you do if the world would stop rotating? To some extent, this is what it is happening and it is hard to keep the promise that we first gave when we committed to this job.

We do, or at least I do it, out of an atrocious sense of commitment and maybe because I am not strong enough to live with the sense of guilt if I would leave, but definitely it hurts till the bottom of my heart to read about my country and know about my family there and not be with them right now. And, of course, I know that half of the planet knows crisis and disasters, but many of us were not prepared to this.

What I am afraid of today? That I could die and I wouldn’t be home. Or that some of my family members could die and I haven’t been with them, not even when the world stopped. I do not know what is wrong and what is right any longer. Or maybe we all know, but facing the consequences is bitter for everyone.

Anonymous

The “stay and deliver” line, without due consideration of the variables (NGO mandate, context etc.), and putting public image before “do no harm” principles could be a decisive turning point for the aid sector as a whole.

For years, donors have been pushing for a streamlined approach, often through channeling funding through consortium: for me, the writing is on the wall that the sector is too crowded. I believe that how organisations respond to this crisis will determine their longer-term relevance, especially as we enter a global recession which will inevitably impact on donor budgets.

My biggest fear is that the aid sector is not prepared for the wider impacts of COVID-19. As we scramble to provide an immediate response, warning signs of the secondary impacts seem to be ignored. Long-term strategic programmes are being dismantled through modification requests: shifting objectives from strategic to immediate. The long-term ramifications of this will only emerge in the years to come.

Given NGOs are largely driven by donor priorities, I am concerned that institutional donors are widely channeling (to non-health actors) funding to an immediate response with no evidence that the emergency response is lifesaving. Donors need to shape the strategic direction of this response, which goes far beyond what happens in the coming weeks or months.

What gives me hope: Children in cities such as Delhi will see the see the stars tonight.

Syria

Let me start from the beginning, I am introvert, environmentalist, and nihilist, for a long time the world worked in a way which, the least to say about it, was “not comfortable” to me. I had to follow the system to be “good”: study in a bias education system that doesn't make any sense, work in capitalist humanitarian organisations that don’t achieve anything, and socialise in selfish human communities that don’t care about anyone. Is it wrong if I feel happy that the world, for once, is working in harmonisation with my style? As an introvert, I had to work in open offices that are not productive at all. It is perfect for me to work from home and actually I am achieving more than when I worked in the office. Besides, I don't feel completely drained and exhausted from daily meaningless conversation that I have to do “out of courtesy”. Also, after years trying to convince people in humanitarian organisations that they should follow environment friendly system otherwise they would be helping people with one hand and killing them with another, it is amazing to see the machine of the world stopping for a while and giving the environment and ourselves “a breath” literary and figuratively.

Finally, being in control for ages as “humans” and transferring everything for our own interests regardless of all, shouldn't we have expected that this will have consequences and “natural selection” will play it is role as always? Don't get me wrong, I am sad for the people who are getting sick or dying and my family is at risk just like anybody else. I am just hoping that this could be a wakeup call to remember again, as humans, “our size” in this huge universe and our limits in the ecosystem, especially for those who are so taken by fortune, authority, or position.

I am a local staff and the least I expect in this situation from international staff, since we are all “together” in this crisis, is compassion not dominance and understatement. As a Syrian, I am used to not be consulted or heard in anything related to my country, it is a practice that has been historically used internationally since the beginning of the crisis but humanitarian treatment in humanitarian organisations is intrinsic, at least from “professional” point of view.

What worries me: Where can I start? Globally, the competition between countries over medical equipment, health material, and fund is fucking scary. People, this is not a trade, this is people lives. I don't want any items for my country if it is needed somewhere else, stop pretending that you care about people while you care only about your professional development and career success by proving that you made the best plans, you got the highest funding, and you made the best preparedness.

Nationally, thanks for all your effort but stop underestimating my country’s capacity if responding to its crisis. I mean, we have been here long before you existed and we have faced worse, it is not just because now it is politically important so, suddenly, we can’t do anything without a humanitarian organisation’s support. And sorry, but your plans are a bit alien to our reality. Also, why for god’s sake does our country need four preparedness and response plans. What did any of the countries that have been affected hugely by COVID-19 do for preparedness and response plans? If you want to stay in our country, you are welcome but stop creating work for yourself and for us just to prove that the organisations are important and needed at all times.

My third worry is for international staff, people in time of crisis should be with their families. No humanitarian organisation should accept that international staff stay far from their families, worried about them, and especially in case that in happened, they can’t fly to them immediately. This is not humanitarian and if humanitarian organisations are not humanitarian from inside, they can’t be humanitarian with other people.

And finally, yes, it is a pandemic, yes, it is a health crisis, but allow me to insult your intelligence for a moment and tell you the obvious: people die from hunger too. People need economic support too. Actually, the majority of them will need economic support rather health services according to the statistics in other countries.

I have a big hope in people caring for each other. I have a hope that this also shall pass as everything else and that it may bring people closer and make them wiser. I have a hope that for once we will learn the lesson, and that finally will know the right priorities. I have a hope that after this crisis we will finally realise that we are not alone in this universe and that we are all connected, we are all equal "at least for the virus". I have a hope that people would understand that borders are fake and understand what it means to be locked down so they will remove all the barriers between people and countries.

My advice: Don't panic, I repeat, don't panic. And stop watching the news, especially these ones that talk about finding a new medicine every day and please, please, please stop being racist. The virus has proved that there is no such thing as the "pure race" neither the "best country" nor the "chosen nation". Also, be nice to animals, it is not their fault. And don't stockpile food and hygiene items, it is not the end of the world.

The Old Humanitarian: Off home to deliver…

World Health Day this week crept up on me as if it had the same difficulty that I do getting up the stairs to my “home office”. Fellow “desk humanitarians” are also telecommuting from residences around the capital. The difference is I did not choose to be working from home in a tiny mountain village in the heart of Europe, watching punctual but eerily empty commuter trains from my balcony. No, I was instructed to leave my foreign posting and provide “technical support” remotely. My own country is at the height of its fight against community transmission of coronavirus, with peak hospitalisations and many deaths among older people especially those in “risk groups” (mine being the immune-suppressed). 

Three weeks ago I was happy in Africa, busy in the health and development contexts where I started my international life decades ago. As the gravity of the pandemic loomed over a conflict zone where my job is meant to intervene, I reflected on the field mission, considered my own health status and assessed the privileged, secure circumstances of myself and my friends-turned-family in our compound. My partner (based in an even more risky place but at least on the same continent) and I discussed at length what we should do. Both decided to stay put, respect our mandates and timetables, aware of the personal health and safety risks in cities with fragile medical and social systems. So strong was our mutual agreement that when the order came to me not long after to get on the last commercial flight out, I had to keep silent about my obviously dangerous do-it-yourself repatriation until I was an hour from home. We are only just on speaking terms after my perceived dereliction. Correction: my dereliction. For if I were in conscience sure that leaving was the right thing to do, then why deliberately pack my things in anonymous bags and not in the smart, official issue trolley cases and rucksacks adorned with the logo of my employer? While of course that dilemma persists, I know better than let it interfere with what I have to do now, as a home-based humanitarian.

First, I worry about not fully grasping COVID-19 plans and precautions. I still see the earnest facial expression of a colleague who had popped-in to my office to follow-up on the business continuity protocol. Thirty minutes earlier we were together at a meeting explaining social distancing measures. Yet I was too polite to impose those two metres and watched motionless as a droplet of saliva projected over the side of my cubicle, catching the sun as it landed on my face. I worry about the resilience of ministry officials to whom we are proposing a national framework to reduce potential impact. For months, they were unable to get an operational memorandum signed authorising services to be provided, even before the crisis. Now, stuck in their crowded homes with ropey internet they point out that they have no official headed paper on which to submit a formal letter of request for assistance. Will decades of bureaucratic sclerosis, rendered chronic by external aid resources, somehow be cured by the shock of a pandemic? I long to cry, I’m out of your way, go ahead and shine!

Hope has never been much of a method in public health, but four-year-olds like Angela can inspire confidence. Before lockdown, I was officiously showing the local staff including her father, how to wash hands the WHO way. A nice smile of recognition came over his face. Angela and her classmates had learnt the same routine and were already showing it to those around them in the “child-to-child” manner developed in the 1970s in a village only 200 kilometres away. If the first child health manual I ever read (My Name is Today) seems still to be saving lives, maybe I can indeed hope.

My advice: Back to the title of this piece. I have been old only a couple of years; the phenomenon arose when a museum cashier spontaneously offered me the senior citizen rate, on a sixtieth birthday unknown to her. Later, once into the official category of “pensioner” I resisted retirement, fearful of redundancy. Thankfully, parole came through secondments and consultancies, until (and I add thankfully) I was shown last month the burden of responsibility I could be during a crisis. Being unequivocally recognised as having a risky “footprint” by the decisive head of agency who sent me home reminded me, that despite any idea of being “young at heart” yet “experienced”, I really should know my place, literally. Having let go of a certain cracked picture of irreplaceable me, my advice (to myself) is to trust committed younger professionals. Making way for them is not after all abandonment. Embrace without an afterthought a new role in the back office, delivering with passion whatever policy, advocacy or research paper, data spreadsheet, service guideline, incident report form or strategic budget excel sheet is needed to support the front line.

Anonymous

I came home for a week and got shut down in the UK. No organisations can really move people where they are needed right now.

What worries me: I can't do my work. I'm an expert in diagnostics – implementation of new tests, including during outbreaks, and I'm stuck at home. People will never get a diagnosis and die because all the preparedness plans didn't account for getting people through borders in a global pandemic.

What give me hope: The global North is experiencing what the global South can be like. Low resources, no PPE (personal protective equipment), unnecessary deaths, perhaps when this is over we can apply the COVID-19 solutions to older enemies like tuberculosis.

My advice: Give yourself time, loads of mental space. It's OK to be scared. It is scary. People are resilient and you are in this with everyone else in the world.

Anonymous

I am grateful that my organisation saw this coming and did a remote work dry run before the national lockdown was announced. While some operational activities have stalled, others have intensified since we are supporting the COVID-19 response. All staff, local and international, were encouraged to prepare to work remotely in the near future. Management held meetings with team leaders to ensure that ALL staff had the necessary conditions and equipment at home to be able to work from home. In a country where power outages are frequent and internet is not always reliable, management provided data plans to those who needed it, provided transport to staff to make provisions in order to reduce the risk of exposure in public transport, and even arranged to move desks and chairs to staff homes where needed: all of this to ensure that we have what we need to continue working. No one is being evacuated as there is the understanding by all that we are here to support the national response.

I'm not specifically worried about my work as management has taken all precautions in terms of work-from-home protocols: staff transport and provision of PPE for the few who are still required to move around. However, what concerns me most is the level of disorganisation and seeming lack of transparency from the government. The Ministry of Health’s daily updates on COVID-19 are confusing and often riddled with spelling errors and inconsistencies, and this is not reassuring. The figures of confirmed positive cases, number of tests conducted and mortality released by the government appear abysmally low considering the size of the population. I am therefore very sceptical of this official source of information. Nonetheless we are required to support the government and work along with their fishy figures.

My advice: I learned the hard way in a previous mission that you cannot pour out of an empty teapot! So it is important to take time for yourself. Self-care doesn't mean that you're being selfish. Taking care of one's mental health is key in order to do no harm to those around you. Sing, dance, eat chocolate, meditate, stretch... take some form of time out for SELF!

Anonymous, Southeast Asia

My organisation enabled a teleworking and working from home policy later than other non-profit organisations here (we were doing it about one week later than others), even though the evidence of COVID-19 local transmission was already happening weeks before.

Projects are still continuing, staff are not being evacuated and not allowed to go back to their home or go outside their duty stations, but this policy is not applied to everyone. I don't know why.

What worries me: I don't know when COVID-19 will end. Our existing plan and advocacy plan have to be shifted. But, the scary part is, not all people in my organisation realise how external communication and community engagement is crucial at the time like this.

Not all people in my organisation are able to do “WFH (work from home) way of doing things”. Some responsibilities are not being fairly delegated, because of so many people in the middle and upper level not doing their things, running away from their responsibilities in expense of other departments.

Several weeks ago, there was an official holiday in the country, all people have their one day off, except my department, because we have to keep working on other people's chaos. It took a huge emotional toll on me and other staff in my department.

What gives me hope: The fact that we are facing this together, globally. There are also strong initiatives from local communities to help out each other. 

My advice: Before COVID-19, we were already working under crisis. This time is kind of different though. Don't forget to unplug, even if it's only for 15 to 30 minutes before sleeping. Keep ourselves entertained and make this situation a chance for you to pick up old hobbies or another aspiration.

Anonymous

Given the nature of my work and the increasing travel and lock-down restrictions, my organisation encouraged staff to travel back to their home countries and work remotely. However, I have friends who were not given that option or travel restrictions have meant that they are now in lock-down in their duty stations with no clear idea of when they would be able to travel back home.

I am worried about the blind adherence of some organisations to the principle of "stay and deliver". I am worried by the lack of debate and discussion within organisations on what it means to stay and deliver, the lack of appetite within organizations to engage in a discussion on the nuances, the challenges, the realities, and implications of staying and delivering. Staying and delivering can mean different things depending on the type of organisation you are working for (UN vs. NGO), the nature of your programming in country (health focused vs. stabilisation and resilience building), the type of country (Yemen, Afghanistan, and Syria vs. Jordan, Colombia, or Kenya), the capacity of your team in country, and what you are intending on delivering. I am worried about how organisations are calculating risks and assessing the overall impact they are intending to have vis-à-vis the enormous risks placed on staff in country (especially national staff and local actors). I am worried that in some operations, NGOs are reverting back to the “old ways of working”, pushing for action (and public image) before “do no harm”.

What give me hope: Increasing discussion, debate, and sharing of experiences on the nuances/challenges of staying and delivering, including the satirical videos circulating among humanitarians (though painfully accurate, they do provide some comic relief in these stressful moments).

My advice: Try to make time to exercise/move even if it is just for 15 minutes each day.

Anonymous

I think one of the toughest decisions will not be now, but in 6 to 12 months. We are seeing many traditional donors currently being overtaken with COVID-19 response as a priority. The economic impact facing us is currently predicted to be worse than the 2008 financial crash. As there is no quick solution for the pandemic in sight, the funding for many protracted emergencies may take a severe nose dive for 2021. If donors do provide funds, they may strategically re-prioritise towards WASH (water, sanitation, and hygiene) and health. Trying to plan for an uncertain future is mainly what we are looking at right now, while also working to respond to the needs on the ground as quickly as possible.

Personally, I chose to leave as I was based in an emergency context similar to the author (employees were not being evacuated, but those that wanted to go were allowed to leave). My choice was shaped by a mix of professional drivers and personal family matters. Professionally, as I work in donor relations, I felt there was little I could add to being on the ground. With donors and ministries of EU, US, Canada, etc. all shifting to digital communication, there was no added benefit to taking the increasing risk of staying in a context where health facilities were limited and likely to be significantly strained. On a personal level, I have an elderly parent with high-risk pre-existing conditions, and I knew that as borders were closing, it was either now or never. God forbid that something was to happen, being close rather than far seemed like the better personal choice.

What worries me: The balance between “stay and deliver” and “do no harm” is extremely murky during this time. For example, are educational services something that we can say requires staff to be on the ground and deliver (when education is now mainly done remotely)? What about activities such as psycho-social support? The activities must go on, but my worry is that the humanitarian sector has massive foot-prints in countries like Yemen, Afghanistan, Syria, South Sudan etc. Across the system, we are talking about hundreds of employees. We know that the amount of respirators and oxygen tanks is minimal in all of these operational environments – in a best case scenario roughly 500 or less. More worrying, is that in many of these contexts the humanitarian community lives in “clusters” (shared military bases, hotels, apartments, etc.). My worry is that the “duty of care” that humanitarian employers often think about has been turned on its head – in a country where tests are scarce, can we guarantee to employees that develop symptoms that they will have access? At a time when borders are shut almost globally, can agencies rely on the old approach of 'med-evacs', and will any countries accept such cases? I feel, unfortunately, there may be an underlying inequality in much of this – how can we support staff (both local and international) whose countries either don't have the resources or don't want to come to terms with COVID-19? The worst-case scenario is really an operational stand-still with preventable deaths of humanitarians (i.e. a “break-out” in a compound, resulting in a high percentage of staff getting sick, overwhelming medical support available).

What give me hope: The quality time I get to spend with my family – which, for humanitarians, is a rarity (i.e. not having a set date for going off). I am perhaps more of a pessimist by nature, but it's clear that we are in uncharted waters both for the humanitarian and development sector. If anything gives me hope, it's that.

My advice: Try to keep to a routine – I push myself to still wake up at 8AM, rather than sleep in. I do short work-outs and try to read and do some language learning. However, if you fail on any given day, just give yourself a pass and promise to pick it up the next day. Self-love is key during times like these.

Homo-Universalis, Greece

The NGO I was engaged with, as a field coordinator, had spent the last year preparing to deliver medical services in refugee camps in mainland Greece. Badly needed frontline non-acute prevention and medicines in paediatrics, women's health, dental, and vision. Access to these vital services for the camp communities was almost non-existent, or very difficult to access due to many barriers. With the evolving COVID-19 outbreak and lockdown, the project has been postponed as it involved international volunteers and scarce local medical personnel.

The refugee communities are living in unsanitary conditions with high levels of food insecurity, very limited access to health services, and their living environment does not make social distancing practical. I worry, as the first case of COVID-19 has already been detected, that it will spread rapidly in these communities who are already immune-compromised, malnourished, and have experienced trauma and mental health issues. In our last intervention in one camp we confirmed many children suffering from stunting, gastrointestinal problems, and viral bronchitis running rampant in the population. 

My hope: That humans are capable of resilience even when facing devastating circumstances. 

My advice: We need to believe in the resilience and innovation of humanity and, above all, to stand unified as communities and global citizens to support each other, and for the strong to lift up the more vulnerable members of our communities regardless of politics, religion, and race. We are stronger united than divided.

Andrew Adams, QT Institute, New Zealand

We have cancelled all our existing plans and implemented a plan we developed in 2012. We ended up closing down the NGO model in 2017 in frustration, but have now restarted in a new capacity. We are no longer an NGO, but a limited liability company using a social enterprise model. All staff are now tele-remote and we do tele-health. Our main effort now is to direct clients to navigate the government network to access goods.

My worry: Lack of access to PPE and authorisation to travel for staff.

My hope: Change that is overdue is coming to fruition. Especially with using tele-health tools. Government departments are not coping, so we can pivot much quicker.

My advice: “Upskill” fast and understand that this is the start of the new 'normal'. It is not the new “normal” yet. It will take 3-4 years to come. Any sunk costs or prior knowledge is now obsolete.You now need to assess everything on a here and now basis too, but be mindful of what you want to achieve."

Anne Louise, Denmark (Mozambique)

I was working in an already insecure context. The day after I returned home, all staff were evacuated due to insecurity. It is still up to each person to decide whether they wish to discontinue their mission or not. The project now hangs by a thread. How can we continue regular activities when COVID-19 is all there is on anyone's mind these days? Do we even have the resources to support regular activities, without mentioning a COVID-19 outbreak? Does it make any sense to stay? General insecurity, staff health insecurity, and potential aid-worker stigmatisation taken into consideration? Are we making a difference or are we only making it worse? Will we be blamed for leaving, when we were needed the most?

I worry that the numbers reported out of Africa are monstrously underestimated. That even with some experience in management of outbreaks such as malaria, measles, cholera, and Ebola, the healthcare systems still don't have the resources it would take to fight this pandemic off. I worry that we, in more industrialised countries, become blindsided by the overwhelming news of lack of PPE and ventilators within our own borders, so much that we forget that there are countries that are unimaginably more in need than us. I worry about these already vulnerable healthcare systems, who support vulnerable populations with heavy burdens of immunocompromisation because of infectious diseases or malnutrition. I worry that these countries' populations, even though younger on average, are much more vulnerable and the scale of what that would mean in terms of death tolls is unacceptable. I worry that the economic recession will be catastrophic for the humanitarian sector and I worry about the consequences of that in the longer term. And right now, most of all, I worry about the safety of my colleagues still working in the field, with compromised access to healthcare and medical evacuation, escalating insecurity, and borders closing all around them.

Seeing how people are turning to each other in times of isolation gives me hope that we will come out of this pandemic as a more grateful and compassionate people. It is my hope that the difficulties that everyone is going through these days will open up the eyes of a more general public to the difficulties refugees or people in war-torn countries face every day. It is my hope that we as a people will be more united on the other side of this and that the earth will recover to a more peaceful and loving version. Sometimes it takes a common enemy to unite people.

Advice: Find one or more activities that soothes you and calms your mind and incorporate this into a routine. In confusing and stressful times, it is crucial to have something constant to fall back on. Identify your "persons" and call them whenever your calming activities are not enough and when everything feels too overwhelming. Perhaps they are in the same situation and you can feel less alone, perhaps articulating to them how you feel is already a step in the right direction, or perhaps they say exactly that thing that you needed to hear to remember that you're going to be ok. Because you are. It's always going to be ok.

Syed Kamal, Founder TAGHEER Research

We are still working with a balanced approach, which is always needed in fragile economies like Afghanistan. I believe humanitarian crises and hunger can lead to more deaths than the virus, which may take away lives, but hunger and basic needs can wash out all.

My worry: We understand that we should listen to the bigger and larger context – which slows the economy and business performance – and act cautiously to ensure a balanced move. We can't ignore the realities in Afghanistan, in which there will no doubt be many deaths without having coronavirus or any other disease. We are already facing many “pandemics” and COVID-19 is just a new one.

Monte McMurchy, DR Congo

As the only international, long-term health concerns predicated my decision. If my health were to be compromised, I would be of no positive use and most possibly an impediment to the university where I lecture 'pro bono' in providing public administrative leadership.

What gives me hope: Evidence-based science will prevail.

My advice: Be conservative in managing risk, particularly in regions of stress and strife, as being overly ambitious when confronting health-related pandemics may not be the best professional course of action.

Emma K., Australia

I'm concerned that the procedures we are honing in the Pacific and Asia will not be easily transferable into other contexts – especially refugee camps.

My advice: Don’t try to recreate your normal life if you’re in shutdown or confinement. Take a bit of time to adjust... embrace opportunities to ‘be’ different, but resist the pressure to do it all – get fit, cook, study, etc. – you need time to adapt – and so does your family – to prepare for the long run.

Emily, Portland, Oregon

All of our projects have shifted to respond to the COVID-19 crisis. Headquarters staff are working from home. All non-essential travel is banned. All our volunteers have been sent home from our international offices.

I worry about our international offices. Our programme has medical clinics in refugee camps – in Cox's Bazar, Bangladesh, in Uganda, Lebanon, Tanzania, and Colombia. When COVID-19 reaches these areas, it will be catastrophic. We are low on PPE (personal protective equipment) for our medical workers, and disease already spreads so easily through close quarters with at-risk populations. I can't imagine the tragedy that will occur when this starts spreading amongst refugees.