It is a complex, global and long-lasting crisis that awaits us.

An interview with Alexandre Giraud, Managing Director of Solidarités International.

©Solidarités International.

Solidarités International specializes in access to water, hygiene and sanitation. How have you adapted your programs and set up specific projects to deal with the pandemic in the various situations?

Solidarités International’s action seeks to systematize integrated approaches to Water Hygiene Sanitation (WASH) and health in degraded contexts because the aim of WASH actions is mainly to reduce mortality linked to waterborne diseases. Within this framework, the global programme of Solidarités International (SI) for the prevention and fight against epidemics is organised around 4 operational axes: preparation and prevention, response, anticipation and continuous epidemiological monitoring.

In the specific case of our response within the framework of COVID 19, to date, the activities of our programmes carried out in our fields of intervention are still only slightly impacted. We mainly count on extended implementation delays due to supply problems (chlorine stock shortage currently in Southern Sudan, for example), border closures and problems of access to areas and populations.

However, from the very beginning of the crisis, in all our areas of intervention, we analyzed the risks linked to the epidemic and began to adapt our existing programs by changing certain methods: we no longer distribute or raise awareness on a mass scale, but instead focus on door-to-door distribution, the composition of hygiene kits has been changed to COVID kits to facilitate the application of barrier measures, awareness messages have been reinforced and adapted to barrier measures as well, etc.

The Rapid Response Mechanisms (RRM) in Mali and CAR have been adapted and extended to urban areas for the COVID response.

In general, the number of collective and individual handwashing points has been increased, hygiene kits have been distributed, and emphasis has been placed on mass sensitization via the media or door-to-door to avoid gatherings. In Yemen, we set up a one-off water trucking service to meet urgent needs for access to water.

In the DRC, WASH services were deployed in official health centres for “COVID-19 case management”.

We are now at the end of this first phase of emergency adaptation of all our programs aimed mainly at preventing the epidemic and protecting our teams. Many specific COVID projects are currently being developed for the next phase of response and anticipation of new epidemic waves.

Has your experience with waterborne diseases such as cholera or the Ebola epidemic been useful to you, as well as your proximity to communities affected by the coronavirus?

Our epidemic control programme has traditionally been active mainly in relation to diarrhoeal diseases such as cholera and haemorrhagic fevers such as Ebola.

We are working on Cholera epidemics in 8 Countries: DRC, Nigeria, Haiti, Yemen, ESS, Mali, Chad and Cameroon. SI’s operational strategy in the face of Cholera corresponds to a double approach “punch” (control) and “shield” (prevention). On the one hand, SI deploys rapid response teams to ensure a rapid response to cholera alerts. On the other hand, it works with communities to reduce their exposure to disease risks through improved access to safe drinking water, dissemination of prevention messages and management of human excreta. SI has previously been active also on the Ebola haemorrhagic fever outbreak of 2014 and 2015 in West Africa (response at the Ebola Treatment Centre in Sierra Leone) and on the outbreak in DRC in 2019 (community response).

The response to the current crisis and the adaptation of our programmes is obviously based on the experiences of response to previous epidemics, although the dynamics of COVID 19 are specific and the evolving knowledge of the virus itself has greatly complicated prevention and protection actions.

Operationally, in Haiti, for example, we have reactivated our mobile cholera response teams for the COVID response. Some currently active cholera responses are being expanded to include the COVID response. Our hygiene promotion teams, already well trained and familiar with the populations, have only had to strengthen and adapt the awareness materials and methods.

This experience in the fight against epidemics, our proximity to the population and our operational capacity in degraded areas are therefore real assets in the current crisis.

The countries in which you are working have so far been relatively unaffected by the pandemic, particularly in Africa. What has been the impact of this almost global pandemic on all your programmes and how do you see the coming months as the virus evolves differently from one continent to another and in the absence of a vaccine?

The impact on all of our programs is still difficult to assess, but the coming months will reinforce the challenges we face in responding to epidemics.

We will need to reinvent our interventions and adapt them to the diversity of contexts in which we are responding. This is why we are adapting our innovative OCTOPUS project to the current health crisis, developing the online platform for sharing experiences and facilitating collective learning for all AHE practitioners in relation to the COVID 19 epidemic.

In the field, containment measures and rumours related to the epidemic at times complicate access to the most vulnerable populations. This reduction in health coverage is, and will continue to be, conducive to the emergence, spread and resurgence of outbreaks of other diseases.

A major concern is the difficulty in getting equipment and expatriate teams into crisis theatres. Although the recent airlifts that have been put in place have only recently provided a response to the problem, we fear that we may face supply chain disruptions and gaps in our teams in the weeks and months to come.

Beyond the direct health impact of the virus, the immediate risk lies in a reduced response to pre-existing humanitarian needs due to these difficulties of access, supply and human reinforcement. In the medium term, the impact of the economic crisis in the making will have deleterious effects on food security and the livelihoods of populations, for example in the Lake Chad and Sahel sub-regions, as well as in Haiti.

©Alexandre Giraud at Malakal, South Soudan, Solidarités International.

Has this pandemic changed your relationship with national actors and with your international institutional partners?

The impact of the COVID crisis on our partnership approach has been multifaceted. Our feeling is that, in general, the place of local NGOs in the national response mechanism has had very little impact: unlike other epidemic situations (Ebola DRC, Cholera in Southern Sudan and Nigeria), the national and governmental response structures have been very closed, even opaque. This very strong level of centralisation of the management of the epidemic did not facilitate the involvement of civil society, which in many cases found itself covering peripheral or highly contextualised aspects. Generally speaking, and with the exception of the medical actors who were mobilised in their capacity as “clinical operators”, one may legitimately wonder whether it is not the humanitarian community as a whole that has not been relegated to the periphery of a response whose communication the States wanted to control, but this is a question that would require a more exhaustive lessons learned exercise.

Concerning SI, our relationship with our local partners has been very little affected by the crisis, except in terms of increased needs and therefore in terms of volume of coverage. We have not changed our partnership modus operandi.

However, the crisis has made us think a lot about the proximity that a non-medical actor such as SI, which is highly mobilized on public and environmental health through its water, hygiene, sanitation and food security programming, should have with the Ministries of Health and their decentralized agencies. Unlike MSF or MDM, we are often not perceived as a natural partner of these administrations, which is harmful because our community-based approach to preventing chains of transmission, our approaches to strengthening health systems (water points and waste management, community monitoring of prevalences) is essential to prevent an increase in morbidity rates. We hope that we will be able to build closer ties and collaboration with these ministries, in the same way that we have actively contributed over the past 4 years to greater proximity between the EHA Cluster and the Health Cluster.

On this subject, and in connection with international institutional partners, this crisis has at least allowed us to confirm within the WaSH Global cluster a priority for which SI has been fighting for years: the orientation of the WaSH (water, hygiene, sanitation) strategy around public health objectives, which we believe is essential to optimize the sector’s resources. We now need to generalize this approach and make it clear that health should not be the sole preserve of the health cluster. At the level of institutional donors, the response to the crisis has been rather heterogeneous, and at times quite contradictory between expectations and the means made available. The real question that will remain, however – beyond the emergency response to the crisis – will be the capacity of the latter to convince internally and to make people understand that in order to have a real net for mitigating epidemic risks, long-term investment in health infrastructures (health centres, but also access to water, access to social safety nets for contaminated people) in places with a high demographic concentration (city outskirts, community grouping areas) will be essential. As in the past, the commitments will be limited to grand declarations without any real intention, and this is what we will have to monitor closely.

And in conclusion.

This crisis calls on all of our humanitarian coping capacities, because we are facing a virus whose characteristics are not well known, and dealing with it requires humility, pragmatism and responsiveness. Moreover, our operational centres and the global movement of goods and people have also been simultaneously and massively affected by the constraints related to the fight against and prevention of the pandemic, which has drastically reduced our response capacities. Tomorrow it will be the impact of the economic crisis that will affect not only the countries in which we intervene but also donor countries and thus the means available to respond to crises.

It is therefore a complex, global and long-lasting crisis that awaits us, with so many variables that we will have to constantly adapt to the unpredictable changes to come. But it is clear that the ability to adapt is at the heart of the genetic code of humanitarians! We may therefore have lessons to teach on this subject to actors less accustomed to chaotic situations…

Alexandre Giraud

With a master’s degree in entrepreneurship and a DEA in media and multimedia, he began his career as an analyst in venture capital, assisting startups in their fundraising, before creating a media company and then joining a record company. In 2002, Alexandre Giraud discovered humanitarian work and decided to go to Haiti for two years to manage a rural development project… “I then discovered an environment where I could combine values, encounters and discoveries with professional commitment and a positive social impact”.

Until 2010, he held various positions in the field before joining Première Urgence’s headquarters as Head of the Middle East desk, then as Head of Missions and finally as Director of Operations.

After being appointed Director of Operations in 2015, Alexandre becomes Managing Director of SOLIDARITÉS INTERNATIONAL in October 2017.