Covid-19 and fragile states: Deaths underreported, health services overwhelmed and famine looming, says new report from leading aid agencies

The coronavirus pandemic is pushing people in fragile states towards catastrophe, with hunger levels rising dramatically and famine looming in several countries an in-depth report by the Disasters Emergency Committee’s coalition of leading UK aid agencies says today. 

The report finds that the pandemic has worsened the already dire humanitarian situation in fragile states such as Syria, Yemen and South Sudan, with aid workers saying they expect it to deteriorate further in the coming months. The economic impact of the virus has left people unable to afford food and other essentials, they said, with thousands likely to die from hunger this year in several countries. 

As the anniversary of Covid-19 being declared a global pandemic nears, the report provides stark new evidence of the impact of the virus on people in countries with high levels of conflict, displacement and humanitarian need, and paints a devastating picture of the outlook for the year ahead in these places. 

Other findings from the report include: 

  • Covid-19 cases and deaths have been chronically underreported in fragile states due to minimal testing as well as stigma and fear, with Afghanistan carrying out just 400 tests per day for a population of 40 million in November. 
  • Fragile health services have been overwhelmed, with maternal and newborn care and vaccination services being disrupted as a result. 
  • The situation in some fragile states is the worst it has been in a decade – including in Syria and Yemen where civil wars were raging before the pandemic – according to a survey of senior aid workers. 
  • The impact of the pandemic has been particularly severe on displaced people, making coronavirus and conflict a deadly combination. 
  • Aid funding is falling as humanitarian needs rise, meaning many aid agencies are having to cut back on life-saving services. 

The report, ‘Breaking point: How the coronavirus pandemic will push fragile states towards catastrophe in 2021’, covers six of the world’s most fragile states: Afghanistan, the Democratic Republic of the Congo (DRC), Somalia, South Sudan, Syria and Yemen, and also reviews the situation in the Rohingya refugee camps in Bangladesh. 

Drawing on extensive interviews with frontline aid workers as well as with representatives from the UN and WHO; a survey of senior aid workers working for DEC members; and detailed independent reviews of the DEC-funded response to the pandemic, the report provides an authoritative overview of how the pandemic is magnifying existing health and socio-economic challenges in these places to devastating effect. 

Parts of South Sudan and Yemen are now on the brink of famine, while Afghanistan and DRC are at risk, driven by the pandemic’s economic impacts. But the report points out that aid funding is reducing just at the time that the need for food aid, treatment for malnutrition and other essential aid is rising. 

The results of the survey of senior aid workers are also alarming. Almost all (98%) agreed or strongly agreed that the pandemic had worsened the humanitarian crisis in their respective countries and three quarters (73%) said it is the worst it has been in the last 10 years.  

Almost all (96%) said the economic impact of Covid-19 had affected people’s ability to buy food and other essentials, and 83% agreed that, without increased funding, thousands are likely to die from hunger in 2021. 

The DEC has joined together with its members and the UN’s Office for the Coordination of Humanitarian Affairs to produce the report to show the depth of the concern for what lies ahead this year for the world’s most vulnerable communities. The foreword is jointly authored by Saleh Saeed, Chief Executive of the DEC, and Mark Lowcock, United Nations Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator.    

The report concludes that:   

  • Support for the poorest communities with cash grants, vouchers for food and direct food aid such as supplies of rice, beans and lentils should be prioritised to reduce hunger levels and stave off famine. 
  • The delivery of vaccines, while extremely important, will be challenging and slow in these fragile states and will not be a panacea for all the effects of the pandemic on the world’s most vulnerable communities. Continued investment in tackling Covid-19 through prevention, suppression and treatment measures such as delivery of water, sanitation and hygiene services will therefore help with current and future waves of the virus as well as other disease outbreaks. 
  • As humanitarian needs grow and funding declines, strengthening local humanitarian action will be vital. Frontline aid workers and health staff will continue to need training and PPE as they grapple with the pandemic. Faith leaders and other community opinion formers will be instrumental in sharing public health messaging, busting myths and dispelling rumours.  

Since its launch in July, the DEC Coronavirus Appeal, which focuses on helping refugees and displaced people in the seven places covered by the report, has raised £36 million, including £10 million in Aid Match from the UK Government. The report also provides examples of how DEC charities used funds raised by the appeal during the first three months (July-October 2020) of the DEC’s 18-month pandemic response.    

DEC Chief Executive Saleh Saeed said: “People living in places made perilous by conflict, violence and climate disasters are coping with the coronavirus pandemic as best they can, but the odds are stacked against them. The knock-on effects of the pandemic have crippled economies, making the world’s poorest people even poorer.

“Country directors of DEC member charities fear having to re-prioritise which life-saving programmes should be funded and which of the most vulnerable people should receive humanitarian relief. Without continued support, many lives will be lost – not just from Covid-19 itself, but from the economic impact of the virus.”    

The report found that funding is making a significant difference: in the anonymous survey, 88% of aid workers agreed or strongly agreed that humanitarian action had helped prevent the spread of Covid-19 in their country.   

Mr Saeed said: “Unprecedented levels of need lie ahead  but funds to provide humanitarian assistance are and will continue to make a direct and practical difference. The Coronavirus Appeal remains open and the DEC urges anyone who is able to help to consider donating.”    


Notes to editors    

Media enquiries, please contact Nicola Peckett on, 020 7387 0200 or 07930 999 014; or Karen Garvin on and 07971 576917. 

For images and footage please visit the media page of the report.

The full results of the DEC’s survey of country directors/senior aid workers in the seven appeal places can be found here.

About the DEC: When large-scale disasters hit countries without the capacity to respond, the DEC brings together 14 leading UK aid charities to raise funds quickly and efficiently. In these times of crisis, people in life-and-death situations need our help and our mission is to save, protect and rebuild lives through effective humanitarian response.     

The DEC’s 14 member charities are: Action Against Hunger, ActionAid UK, Age International, British Red Cross, CAFOD, CARE International UK, Christian Aid, Concern Worldwide UK, Islamic Relief Worldwide, Oxfam GB, Plan International UK, Save the Children UK, Tearfund and World Vision UK.     

How to donate:      

  • Online:     
  • Phone: 0370 60 60 900     
  • SMS: Text SUPPORT to 70150 to donate £10.  Texts cost £10 and the whole £10 goes to the DEC CORONAVIRUS APPEAL. You must be 16 or over and please ask the bill payer's permission. For full terms and conditions and more information go to    
  • Post: Send a cheque to DEC Coronavirus Appeal, PO Box 999, London EC3A 3AA.     

Donations will help provide the following:    

  • £30 could provide six displaced families with enough soap for a month    
  • £50 could provide essential hygiene kits to two displaced families    
  • £100 could provide PPE for one frontline health worker for four months