COVID 19 EMERGENCY - Support to United Nations High Commissioner For Refugees (UNHCR) in Niger

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Project location: Niger
Project start date: March 2020 - Project end date: December 2020
Project number: 2020-032
Beneficiary: United Nations High Commissioner For Refugees

Since the WHO has declared the coronavirus a pandemic, all countries in the world are facing health challenges that have not been seen for a century. These challenges are bigger for underdeveloped countries with fragile health infrastructures and/or in the grip of a security crisis.
80% of the world’s refugee population and nearly all the world’s internally displaced people are hosted in low to middle-income countries, and over 26% of all refugees and asylum seekers live in Sub-Saharan African countries, which have weaker health and water and sanitation systems. Refugees are at the same risk of contracting and transmitting the COVID-19 virus as local populations.
In many of the countries where UNHCR operates, the COVID-19 pandemic is an “emergency on top of an emergency”,
and is worsening humanitarian crises like the one in Central Sahel region, where the proposed intervention would take place. 
In light of the unprecedented impact that the COVID-19 outbreak is having in refugee and IDP situations worldwide and the multiple crises that people already scarred by having been forced to flee are facing in terms of loss of lives, livelihoods and protection, UNHCR launched an appeal focused on COVID-19 preparedness and emergency response, which is part of the  Global Humanitarian Response Plan (GHRP). The appeal is focusing in particular on countries assessed as high-risk and Niger is one of them. 

Niger is the lowest ranked country in the Human Development Index, with an extremely fragile health system, and currently hosting about half a million forcibly displaced.
Niger has made significant improvements in health care, but the situation is far from ideal. Challenges include affordability of health care, obsolete buildings and facilities, and issues to do with the quality of services provided (poor reception, availability of health workers, shortages of medicines and equipment). Communicable diseases are very common, and non-communicable diseases like diabetes, high blood pressure, and cardiovascular diseases are increasing. The country also faces severe food and nutrition crises. 
Hence, the best way to boost protection at 360 degrees must focus on supporting the Nigerien national health system,  through UNHCR strong experience in emergency management by ensuring that no one is left behind and that refugees are included in the national health system. 

The proposed intervention will focus on setting the mental health response in support to the healthcare public system. 
Stress and anxiety are common reactions amongst those facing events such as a global pandemic. People directly or indirectly affected by COVID-19 can experience fear, deterioration in social relations, stigmatization as survivors and as healthcare workers, feeling of aggression towards children and vulnerable people, and mistrust towards authority and official communications. 
While specific stress-related reactions come from real threats, some behaviors are the result of rumors, fake news, and lack of awareness. More specifically, stigmatization and discrimination against vulnerable and affected parts of the society (including refugees, COVID-19 survivors, healthcare professionals and their families) can turn into long-term issues hampering social recovery and integration of refugees in the local community.
In order to avoid this possible degradation of social relations, and with the purpose of supporting the emergency response of the public healthcare system, UNHCR is putting in place an extended set of activities, in coordination with Public Institutions, local partners and NGOs. The main goal is to create a team of mental care professionals that will ensure a coordinated response nation-wide, with the specific focus to train and follow-up on healthcare responders in the long term. 

Like in many other countries, the CODIV-19 pandemic in Niger is rapidly evolving from a health emergency into a full-blown economic crisis with risks of substantial long-lasting impact on national systems. 
The restriction on movement, a slowdown or even halt in economic activity will likely have a greater impact on refugees and the internally displaced people since the majority are involved in the informal sector which historically is one of the most affected during public health outbreaks.
Based on these considerations, UNHCR launched a pilot project where refugees will be in charge of the production of hygiene products and masks, with a double aim: on one hand to foster disease prevention and control of virus spread, on the other to promote income generating activities and refugees' economic inclusion.

This project, which received a grant from the Nando and Elsa Peretti Foundation aims to respond to the covid-19 Crisis with the goal of mitigating the social, health and educational emergencies related to the pandemic.

In Niger, UNHCR, in coordination with the United Nations System (SNU), is working to fight the pandemic within the framework of the Government of Niger's New Coronavirus Preparedness and Response Plan (COVID-19). This Plan has six main action points: 1. coordination; 2. epidemiological surveillance; 3. prevention and control of infection; and 4. Risk communication and socio-community involvement; 5. Capacity of health services; 6. Establishment of isolation sites.

Within this framework, this project aims at: 
A) reinforcing the Health and Socio-Psychological System (HSPS) by recruiting and training additional staff with a view to service the entire community, including refugees; and 
B) including refugees in the prevention response and in the fight against the spread of the virus within their hosting communities through the production of Personal Protection Material, thus supporting them with income generating activities. 

These objectives will be achieved through the implementation of the following activities: 
A) Mental Health and psycho-social response to COVID-19 Emergency
Based on the assessment done by the Mental Health and Psycho-Social Care Team put in place by UNHCR, in coordination with public institutions and its local partners and NGOs, a number of different activities aimed to respond to the mental health and psycho-social needs related to the COVID-19 emergency will be put in place.
The plan set by the team of professionals needs a primary reinforcement of the staff through temporary recruitment of healthcare responders (doctors, community liaison agents, health workers, MHPSS specialists, etc), These professionals will be locally recruited and based in all the refugees host areas of the country.
The second phase of the plan foresees several trainings specifically customized to reinforce capacities on the healthcare responders and provide them with an overall package of new skills to be used to face the emergency.
The activities are organized in several phases: 
1. Recruitment of additional staff: 
a. 4 additional doctors for a period of 3 months
b. 11 additional health workers for a period of 3 months
c. 12 MHPSS (mental health and psycho-social support) workers for a period of 3 months
d. 20 community liaison agents for a period of 3 months
e. 12 trainers to reinforce the national healthcare system 

2. Training of Staff: 
In partnership with local and international NGOs, UNHCR will provide trainings aimed at strengthening the experience of health care responders on sanitary and phyco-social matters.  

3. Reinforcement of Healthcare system 
In collaboration with local authorities and local/international NGOs, UNHCR will provide an overall and extended response to the mental health and psycho-social needs of the population and the refugees communities in the country.

B) Production of Hygiene products and masks 
With a view to have a truly sustainable impact, UNHCR aims at putting in place a steady supply chain mechanism to maintain a constant production of soap, bleach, and water containers in all refugee hosting areas. This will trigger positive spillover effects and boost economic production (and inclusion) in refugees’ and host population communities. 
UNHCR will support the scaling up of local production of hygienic products (antiseptic soap, liquid soap, and bleach) in refugee hosting areas, working with refugees and host communities. 
While the main objective is to contribute to the prevention of COVID-19, job opportunities will be created and social cohesion will be reinforced. In cooperation with the local NGO Forge Arts, UNHCR will continue to scale up production activities in Hamdallaye, Niamey, Ouallam, Abala, Agadez and Maradi 

The activities are organized in several phases: 
1. Purchase of raw materials: 
For the production of hygienic products, UNHCR will provide refugees with:
- bleach kits producing 50L each;
- antiseptic soap kits producing 30 tablets each;
- liquid soap kits producing 25L each;
- empty bottles – for distribution purposes.
For the masks production, UNHCR plans to provide: 
-  sewing machines and electric cables/multi-socket plugs;
- pedal sewing machines;
- Fabrics on local market, rubber bands, sewing materials. 

2. Training of beneficiaries: 
In each location, a team of trainers and of experienced couturiers will perform training sessions targeting refugees, will setup the chain of production and will be available to accompany beneficiaries while producing bleach, antiseptic soap tablets, liquid soap and masks and monitor the entire activity. 

3. Production of bleach, antiseptic soap, liquid soap and masks

4. Distribution of products to refugees and host populations
Products produced by refugees will be both distributed and will be available on the local market to refugees and hosting population under the supervision of UNHCR. 

An estimated total number of 846 refugees, hosting communities and locally recruited workers/trainers will be part of this project, plus an estimated number of 400 healthcare workers nationwide, with an immediate benefit response on thousands of persons. These activities will increase the capacity of the overall national healthcare system to respond to the sanitary, mental health and psycho-sociological care needs of tens of thousands of persons, including refugees, internally displaces and hosting communities. 
The output of these beneficiaries’ activities is going to have positive ‘indirect’ spillover effects to all refugees and host communities in regions where UNHCR is active and beyond.

In details, the expected outcomes of the project are:
• 346 refugees in Saram Forage Camp and Hamdallaye Transit Center will continue to to produce PPMs to be distributed and commercialized among the refugees and hosting communities, including local hospitals under COVID-19 mandate;
• 260 new refugees in other 4 sites will receive training, materials and daily cash for work (2500 FCFA/day) to start the production of PPMs to distribute among the local community of each site, reaching an estimated number of 15.000 persons who will receive PPMs;
• 190 refugees in 8 sites will receive training, materials and daily cash for work (2500 FCFA/day) to start the production of masks to be distributed and commercialized among refugees and local community of each site;
• 50 new recruited local staff trained to respond to the mental health and psycho-sociological care needs of the population;
• 12 trainers who will conduct up to 2 workshops per week reaching a number of 50 trained persons per each site, with an estimated number of 400 local healthcare workers trained to manage the mental health and psycho-sociological care needs of the entire population in the regions where UNHCR is active and beyond. 

Indeed, the proposed project fully responds to the COVID-19 emergency and, in parallel, it aims to have additional impacts and several outputs:
It will directly support the emergency response through production and availability on the market of (estimated) 200.000 economically affordable masks , 35000 L of bleach , 24000 antiseptic soap tablets and 17500 L of liquid soap, available for the refugees and the hosting local communities. The masks will be washable and reusable, they will be sewn with local fabrics and this will support local supply of raw materials at a time of limited economic activity. 
Given the supply of sewing machines, refugees will have the possibility, after the end of the emergency, to continue in the sewing business and sustain their livelihood. 
Finally, the prject will give POCs the unique opportunity to be a pro-active actor in the emergency response, while adding value by bringing skills of their traditional culture and boosting local economy.



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