Consultant, COVID-19 and healthcare in the last mile At International Committee of the Red Cross

Reports to:

Policy Adviser, Policy & Humanitarian Diplomacy Division, Department of International Law & Policy. The Consultant will also have access to other colleagues at HQ working on areas relevant to the Deliverables set out below.

What we do

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance. The ICRC also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the Geneva Conventions and the International Red Cross and Red Crescent Movement. It directs and coordinates the international activities conducted by the Movement in armed conflicts and other situations of violence.

Background

While COVID-19 is – as a Public Health Emergency of International Concern (PHEIC) – a public health crisis, it is clearly not only a public health crisis. The pandemic is having a range of secondary social, economic, and political impacts, which for some are far worse than its primary health impacts and which, as social determinants of health, are also important to overall public health. It has revealed weaknesses and gaps in the international public health architecture and has brought pre-existing inequalities into stark contrast, with some people more severely impacted than others.

The pandemic’s impacts are amplified for people along the so-called ‘last mile’, which includes areas affected by armed conflict and/or violence where state authorities have limited or no reach due to lack of capacity and/or will. This may include people who are politically as well as physically difficult to reach, for example, undocumented migrants, detainees, or those living in areas controlled by non-state armed groups (where the ICRC estimates 60-80 million people live). As such, the formal or informal exclusion of last mile areas from national health activities poses a major global health risk.

Research shows that fragile states and ungoverned spaces – frequently characterized by armed conflict and causing large-scale displacement – constitute amplifiers of disease. By one estimate, over 75% of epidemics in the three decades to 2009 originated in countries affected by armed conflict and violence. Combined with poor governance and mistrust, health systems crippled by conflict make detecting, containing, and managing the spread of disease, and secondary impacts it causes, particularly difficult.

Ensuring primary healthcare services – including but not limited to COVID-19 and routine vaccinations – reach people in the last mile is therefore critical not just in the current pandemic, but in preventing and preparing for future disease outbreaks. It necessarily requires a strong community engagement component – since communities must be informed of, consent to, and be involved in the provision of such services. And it requires upholding International Humanitarian Law obligations on preventing and containing epidemics.

While this reasoning is not new, there is a need to make it more compelling in light of criticisms (for example, about creating parallel health systems) and of sometimes formidable operational challenges. This as part of wider efforts to strengthen global health security.

Purpose

The ICRC, based on its mandate and operational experience, aims to bring to the forefront of wider efforts to strengthen global health security the needs of people affected by armed conflict and violence who are overlooked or underserved in national health activities. In this context, and acknowledging the background set out above, this consultancy has three purposes:

1. To undertake research and analysis to strengthen the overall case for preparedness and providing primary healthcare for people along the last mile. This will involve articulating: what the ‘last mile’ means concretely in the contexts where the ICRC works, the reasons (epidemiological, social, political, economic, and other) why preparedness and providing healthcare in the last mile is important, key operational challenges, and recommendations to overcome these challenges.
2. To evidence the ICRC’s added value for people along the last mile in situations of armed conflict and/or violence, including with regards to access to COVID-19 and routine vaccinations, and addressing COVID-19’s secondary impacts.
3. To evidence the critical role of community engagement in the successful provision and acceptance of primary healthcare activities generally, including health surveillance activities.

This will support ICRC’s operational, diplomatic, and policy efforts to ensure access for people in the last mile to healthcare and other services to mitigate the pandemic’s primary and secondary impacts.

Deliverables

1. Early-term report (internal) – Friday 1 October 2021

a. This will include examples of the ICRC’s activities in last mile areas, including community engagement, addressing purposes 2 and 3 above.

1. Final report – Friday 10 December 2021

a. This aims to bring together the three purposes in a compelling research and analysis piece on the importance of preparedness and providing healthcare for people in last mile areas, similar to the ICRC’s report on Making the case for the protection of healthcare. The report will also contextualise access to healthcare services within the broader the social determinants of health (the economic, social, political, and other factors influencing an individual’s overall health) and COVID-19’s secondary impacts on people living in situations of armed conflict and violence.

Desired profile and skills

· Excellent analytical, research and writing skills in English.

· Demonstrated knowledge and experience in public health in conflict settings, for example experience in health systems analysis, relevant public health specialties, or relevant tertiary study.

· Networks or contacts with other organisations or individuals which/who have studied this topic before.

· Understanding of the ICRC’s primary healthcare activities; experience in ICRC primary healthcare activities an asset.

· Understanding of protection, and of the ICRC’s protection mandate and activities; experience in ICRC protection activities an asset.

· Understanding of the International Red Cross and Red Crescent Movement.

Desired qualifications / experience

· A relevant Master’s degree (e.g. international relations, international politics, international law, humanitarian action, development, peace/conflict studies, economics, public health, etc.);

· Qualifications or experience in public health and/or a demonstrated understanding of global public health architecture and contemporary debates;

· Publications, including blogs and articles (please hyperlink where relevant in your application).