• Red Cross’s 11-district survey reveals broad-ranging domino effects of the crisis on all social strata

BY Sumudu Chamara   A survey conducted across 11 districts of Sri Lanka has revealed that around 96% of people who were interviewed have been affected by the prevailing economic crisis in some material way, with food insecurity, health concerns, livelihoods and nutrition related challenges being amongst the most pressing issues. Deteriorating physical safety and security, as well as violence against women and children also stand out as major concerns amidst the crisis, while the deepening economic crisis is forcing people to make heartbreaking choices between going hungry, buying lifesaving medicine, or finding money to send children to school. This assessment, titled “Sri Lanka Complex Emergency – Needs Assessment Report, October 2022”, was prepared by the Sri Lanka Red Cross Society in collaboration with the International Federation of Red Cross, and Red Crescent Societies (IFRC), and was launched last week in Colombo.   Assessing the nature of the crisis   The assessment was based on face-to-face household-level surveys of 2,871 respondents in 11 districts, a separate case study of 300 households from 10 estates in Nuwara Eliya, 24 focus-group discussions, 15 key-informant interviews, and an anticipatory analysis framed by secondary data. The aim of the survey was to establish the true extent and scope of the humanitarian emergency that the country is facing. The assessment had found that the purchasing power of households is constrained by food inflation, and that disruptions to livelihoods, and food insecurity have increased, in turn increasing worries about malnutrition. It added that people are suffering from poorer health because the healthcare system has become compromised, while household economic stresses have resulted in rising concerns over basic needs and protection for the most vulnerable, such as those already living below the poverty line, people living with disabilities, and marginalised people.  The assessment had found that 96% of households in the overall survey have been affected by the current crisis, with the three main priority needs at the household-level concerning food, health and livelihoods. Other major priorities include psychological wellbeing and the education of children. With regard to the food security situation within the country, the assessment confirms that effects on food security, nutrition, and livelihoods are widespread, affecting all types of households in both rural and urban settings, but finds that it especially affects those whose primary source of income is fishing or agriculture, those in estates, and those with existing vulnerabilities.  Approximately four out of every five estate households, two-thirds of rural households, and over half of urban households in the survey are in debt due to the current crisis. More than four out of every five households had significantly worsened access to food because of the crisis, while those with a main income from fishing, households with children, and households with pregnant women were the most affected. The report further said that among households with worse access to food, the increased cost of food was foremost, and that one in four persons cited a reduced income, while over half cited the lack of food available in the local market. In addition, the assessment report recognised that the lack of food in the local market is indicative of a systemic collapse, and that it undermines the effectiveness of household-level assistance. More than half of the households were consuming “much less” animal products (meat, fish, milk, and egg) since the crisis started, while around one out of 10 households have stopped eating animal products. The loss of livelihoods is one of the main concerns that had been highlighted during the assessment.   In terms of the health sector, the assessment report confirmed concerns about the breakdown in the health services because of the crisis, and suggested that predicted consequences will affect nearly every aspect of health. Most of the households in the survey had reported worse overall health in September 2022, compared to January 2022, and when it comes to estates, almost three out of every four households had reported worse health. Almost one-third of the households had reported that they could not access one or more needed health care services in the last three months. Due to the crisis, routine clinics had either been reduced in their frequency or discontinued, and transport difficulties had compounded the situation. In the household survey, over one out of 10 households had stated that pregnant women could not access hospital delivery services, while in the estates, this was much higher. It had been reported that ambulance services were limited or non-existent due to fuel shortages, and that alternative modes of transport were too expensive. Significant proportions of households with pregnant women had not been able to access antenatal or postnatal care, including over half of the estate households with pregnant women who could not access postnatal care.  In addition, among the estate survey population, approximately one-third had not been able to access child immunisation or Covid-19 immunisation. Nearly one-third of the households that needed treatment for non-communicable diseases and mental illnesses were unable to access services. Treatment for chronic illnesses such as diabetes and heart conditions, the postponement of major surgeries and minor surgeries were also among the services with which the survey respondents had difficulties, according to the assessment report. The report underscored that the assessment confirms perceptions of an increase in domestic violence, sexual and gender-based violence (SGBV), and serious child protection incidents, while the ability of Government agencies to respond is understood to be severely constrained. The welfare and safety of children who are left behind while their parents go for work is in doubt, and there are concerns that parents are increasingly placing their children in institutions, as per the report. Across all three sectors in which the household survey was conducted, the vast majority had said that their overall security and safety had worsened since January 2022. Some groups had mentioned this as their primary concern, while the secondary concern was violence against women and children. Many households had expressed that their physical safety and security will deteriorate in the next three to six months, if their immediate needs are not met, and that there is an increased risk for SGBV, especially for adult women, adolescent girls aged 12-18 years, and children. A significant proportion of the households had reported that domestic violence was one of the more immediate probable impacts if their immediate needs are not met. With regard to education, one third of the households had stated that their children’s education was severely affected due to the current crisis – the consequences being the inability to afford the high costs associated with transport, school supplies, and the discontinuing of meals provided at some schools, especially in the estate sector. In some districts, up to one in seven households had already stopped their children from attending schools. Overall, one in 10 households had admitted that their children will have to drop out of school if the situation worsens, which they had considered to be a major concern than requires urgent intervention. In addition, almost half of the households surveyed, had at least one member or occupant that had some form of disability. Considering the special requirements of people living with disabilities, the impact of the current crisis is likely to be a major challenge for these groups and their caregivers, according to the report. The assessment included an anticipatory analysis, which predicted that in the absence of immediate humanitarian support together with interventions to address the systemic issues, there will be wide-ranging and serious consequences. It was noted that there are concerns that without stronger support, these trends will continue. “If households are unable to meet their immediate needs in the next three to six months, nine out of 10 households expect to live ‘in minimal conditions’, almost half expect the deterioration of their family members’ health, two in five expect to become more indebted, over one in four expect to spend all their savings, and one in 10 fear that their children will drop out of school, and one in 10 households have members who intend to migrate,” the report further said. The rise in malnutrition in the face of increased poverty and food inflation, the increase of unsustainable household indebtedness, the risk of increase of poverty, the risks of livelihood related challenges, the reduction in access to clean water, medical care, balanced nutrition, declining of child education, and also the possibility of the healthcare sector’s capacity being reduced to an extent where it cannot prevent diseases, the rise in the number of school dropouts, and the increased impacts of the crisis on the people’s mental wellbeing were some of the possible challenges that the assessment cautioned about.   Finding solutions   Noting that the findings and recommendations of this assessment sit squarely with community priorities, which must be addressed in parallel to the macroeconomic and systemic concerns, the report said that support should be integrated as part of a wider co-ordinated approach, which targets vulnerable persons and households, spans the entire country, and reaches out to remote and hard to reach areas. This approach, it was noted, should involve several principles, including focusing on those who are “left behind”, including marginalised and vulnerable populations and individuals, people living with disabilities, migrants, older people, and those who are socially isolated and excluded, thus ensuring that communities and individuals are assisted in asserting their rights to food security and livelihoods, and healthcare, including mental health and psychosocial support.  The report also recommends protection within the framework of community-inclusion principles, while it also recommends prioritising access, participation, safety, and dignity, ensuring that the affected people are empowered, informed and sufficiently resourced in order to make appropriate choices, and can access quality and sustainable programmes and services. With regard to food security, nutrition and livelihoods, it was recommended that urgent food assistance as in-kind or cash and voucher assistance, to be provided, including in schools, school kitchens and food banks. It was also recommended to obtain community and household-level engagement to mobilise community resources for collective resilience in diverse areas such as support for gardening, agriculture and home food production, financial literacy, community kitchens, school-based initiatives, and vocational training. The assessment further presented a number of recommendations to deal with health-related challenges faced by people at present, which included scaling up dengue prevention and control programmes, as well as other environmental health programmes; rolling out community based health and first-aid programmes and community-based ambulance services; providing menstrual hygiene products; supporting mental health initiatives and psychosocial support services; developing community-based services to support the inclusion of people living with disabilities; and supporting mobile health and dental clinics, especially in the rural and estate sectors. In addition, the assessment put forward several recommendations to ensure the people’s protection from the economic crisis. These include facilitating and encouraging the formation of village and neighbourhood vigilance committees in order to prevent and address the trend in increasing robberies and thefts; advocating for local law enforcement authorities to increase their patrolling of vulnerable neighbourhoods; the provision of school supplies such as stationery and learning instruments to those in need; the setting up of child-friendly spaces as a means of addressing violence and psychosocial needs; the mapping of district-specific services, resources, and referral pathways; conducting community-based awareness sessions on preventing SGBV and response mechanisms; engaging men and adolescent boys in SGBV- and other violence-prevention and response activities; advocating for accessibility and the inclusion of people living with disabilities, while providing targeted support to ensure meeting the basic needs of people living with disabilities, and ensuring the inclusion of people living with disabilities during the development of community-based programmes.