Lockdowns, lives and livelihoods: the impact of COVID-19 and public health responses to conflict affected populations - a remote qualitative study in Baidoa and Mogadishu, Somalia

Abstract

Background Authorities in Somalia responded with drastic measures after the first confirmed COVID-19 case in mid-March 2020, closing borders, schools, limiting travel and prohibiting most group functions. However, the impact of the pandemic in Somalia thereafter remained unclear. This study employs a novel remote qualitative research method in a conflict-affected setting to look at how some of the most at-risk internally displaced and host populations were impacted by COVID-19, what determined their responses, and how this affected their health and socio-economic vulnerability. Methods We conducted a remote qualitative study, using Katikati, a 1-to-1 conversation management and analysis platform using short message service (SMS) developed by Lark Systems with Africa’s Voices Foundation (AVF), for semi-structured interviews over three months with participants in Mogadishu and Baidoa. We recruited a gender balanced cohort across age groups, and used an analytical framework on the social determinants of health for a narrative analysis on major themes discussed, triangulating data with existing peer-reviewed and grey literature. Results The remote research approach demonstrated efficacy in sustaining trusted and meaningful conversations for gathering qualitative data from hard-to-reach conflict-affected communities. The major themes discussed by the 35 participants included health, livelihoods and education. Two participants contracted the disease, while others reported family or community members affected by COVID-19. Almost all participants faced a loss of income and/or education, primarily as a result of the strict public health measures. Some of those who were heavily affected economically but did not directly experienced disease, denied the pandemic. Religion played an important role in participants’ beliefs in protection against and salvation from the disease. As lockdowns were lifted in August 2020, many believed the pandemic to be over. Conclusions While the official COVID-19 burden has remained relatively low in Somalia, the impact to people’s daily lives, income and livelihoods due to public health responses, has been significant. Participants describe those ‘secondary’ outcomes as the main impact of the pandemic, serving as a stark reminder of the need to broaden the public health response beyond disease prevention to include social and economic interventions to decrease people’s vulnerability to future shocks.

COVID-19 and its prevention in internally displaced person (IDP) camps in Somalia: Impact on livelihood, food security and mental health

“…Nevertheless, there was a signi cant socio-economic impact on the livelihoods of African communities that depend on daily earning wages [38], including in Somalia [39]. Livelihood concerns expressed by participants in this study are similar to those reported in recent studies conducted in Somalia's con ict-affected and displaced communities that similarly reported livelihood interruptions, a decrease in household income, and failure to buy basic food items due to movement restrictions [40,41]. This highlights the intrinsic vulnerability of the populations to multiple shocks and points to the need for future pandemic prevention strategies to speci cally address displaced communities as they cannot observe movement restrictions that hobble their daily earnings for survival.…”

“…This highlights the intrinsic vulnerability of the populations to multiple shocks and points to the need for future pandemic prevention strategies to speci cally address displaced communities as they cannot observe movement restrictions that hobble their daily earnings for survival. Other researchers have recognized that such interventions duplicated international responses without being contextualized to local circumstances [41].…”

The Impact of COVID-19 Pandemic on Food Security and Food Diversity of Iranian Rural Households

“…The COVID-19 has formed a pandemic that is very different from previous pandemics and covers almost all countries around the world, especially the major economies. In addition to the negative effects on health, the COVID-19 crisis has put both people's lives and livelihoods at risk ( 1 , 2 ). COVID-19 threatens the years of progress in health care, hunger, poverty, and education.…”

Evaluating COVID-19 decision-making in a humanitarian setting: The case study of Somalia

“…The unprecedented nature of this epidemic generated panic both in the general population and in responders. The Somali public exhibited ambivalence [34] with a large proportion of the population considering COVID-19 as non-existent or irrelevant to Somalia whilst others feared becoming infected [35,36]. This resulted in a situation in which people were simultaneously not practising preventative measures but also not using routine health services for fear of infection.…”

“…This compromise was illustrative of the influence wielded by religious constituents, the degree to which the government was keen not to alienate them as well as the government's limited capacity to unilaterally enforce closure in the face of opposition. In the end, while schools were successfully closed [35], a brief attempt at a general curfew was ineffective [31] and the closure of mosques was never implemented.…”