As the majority of Covid-19 deaths occur in older populations, most of the world’s attention has been focussed on adults. However, as this new study in The Lancet points out, the tragic result of high adult morbidity is that many children have lost their parents, grandparents or primary caregivers to Covid-19.
Around the world, a total of 1.5 million children lost either a parent, a grandparent who helped care for them or some other relative responsible for their care since March 2021. Of these children, over a million were orphaned of their parents.
"Orphanhood and caregiver deaths are a hidden pandemic resulting from Covid-19-associated deaths. Globally, from March 1, 2020, to April 30, 2021, we estimate 1,134,000 children experienced the death of primary caregivers, including at least one parent or custodial grandparent," says the research team in The Lancet.
"1,562,000 children experienced the death of at least one primary or secondary caregiver. These children are the tragic overlooked consequence of the more than 3 million Covid-19-associated deaths by April 30, 2021,” says the report.
The researchers explain how public health responses to the pandemic, such as lockdowns and school closures, have also severely reduced the capacity of established child protection systems and services to provide much-needed child safety interventions and support. In poorer countries, it can even be difficult to establish a child has been orphaned.
‘For every two Covid deaths, one child loses a carer’
The team included researchers from the US Centers for Disease Control (CDC), USAID, the World Bank and University College London. They counted deaths in 21 countries that accounted for more than 76 percent of all Covid-19 cases. They used the same methods that were developed and validated to estimate the number of children globally who would have been orphaned by AIDS to forecast the number of Covid-19 orphans. According to UNICEF, an orphan is a child (anyone under the age of 18) who has lost one or both parents due to any cause of death.
"For every two Covid-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver," said CDC’s Susan Hillis, who led the study. “The number of Covid-19 orphans will increase as the pandemic progresses. There is an urgent need to prioritise these children and support them for many years into the future.”
"We need to respond fast because every 12 seconds a child loses their caregiver to Covid-19,” added study co-author Lucie Cluver of Oxford University.
The immediate global and local responses to the pandemic have been to focus on public health necessities: preventing infections, advancing treatment, reducing mortality, and developing and distributing vaccines.
“This overlooks one of its most urgent and tragic consequences: the multitude of children bereaved through the abrupt death of a parent or grandparent who lived with and cared for them,” says a CDC report ‘Children: The Hidden Pandemic 2021 – A joint report of Covid-19 associated orphanhood and a strategy for action’.
This report says that a conservative estimate is that over 4 million more children may suffer the death of parents and caregivers, through Covid-19, in the coming years.
Grandparents often play a key role in extended family homes across the world, often providing psychosocial, practical or financial support for their grandchildren.
In the USA, 40 percent of grandparents living with grandchildren serve as their primary caregivers. In the UK, 40 percent of grandparents provide regular care for grandchildren. In Africa and Latin America, custodial grandparents customarily act as guardians, caring for grandchildren whose parents migrated for work, died of AIDS or other causes, or are separated by conflict or war.
"We cannot allow any more victims, even if indirect, of this pandemic. If we do not protect this generation, they run the risk of being left behind. As children lose one or even two parents, families are often pushed further into poverty, which can mean children will drop out of school and work, to help with the family income. These children will not return to school, and will likely be trapped in a cycle of poverty”, said Bidisha Pillai, Global Policy, Advocacy & Campaigns Director for Save the Children.
The impact of the coronavirus has already worsened the living conditions of children around the world, said Save the Children. It has pushed back decades of progress made to safeguard the most vulnerable, severely affecting their future. Already weak health systems and child protection systems have collapsed and, where many families have plunged into poverty, child malnutrition rates have increased as families have lost their sources of income and sometimes their livelihoods.
“Without caregivers, children are particularly vulnerable,” added Pillai. “The pandemic undermined the education of hundreds of millions of children, and the loss of school days exposed girls, boys and adolescents to the risk of child labour, early marriage and pregnancy, and permanently dropping out of school.”
Save the Children called on institutions and governments around the world to pay urgent attention to the situation of orphaned children who have lost parents and caregivers, and ensure they are cared for. They say governments "need to look at strengthening family-based care systems. So children who have lost one or both parents can be kept safe in family settings, instead of being sent to an institution".
Responses must be family-based, according to the CDC report. Children benefit by being in a family structure, and families need support to care for children. Resources need to be directed to ensuring that each affected child has a supported, safe and nurturing family, and to make sure that children do not fall through the gap and end up in institutional residential care.
CDC believes this can be achieved through a ‘cash plus care’ approach that combines income and parenting support for families caring for children who have experienced orphanhood, drawing on evidence and good practice.
Lasting damage
UNICEF believes there are steps that governments and international aid communities need to take now to ensure families have continued access to social protection, counselling and health care. Child protection services must be strengthened, including the social service workforce, for vulnerable children and families. Schools and other children’s services must be kept open and accessible.
They say a system must be developed whereby children deprived of parental care can be looked after by extended family members and not placed in unsuitable alternative care.
“The immediate and long-term damage caused by family separation and unsuitable alternative care, particularly in institutions, is well documented. Institutions are often characterised by inherently harmful living arrangements,” said UNICEF’s executive director Henrietta Fore in a statement released this week. “Children may experience forced cohabitation and fixed routines not tailored to their individual needs. They are frequently deprived of the ability to make choices that suit their best interests.”
“What’s more, children in alternative care are regularly isolated from their families and local communities,” added Fore. “Deprived of parental care, they can endure physical, psychological, emotional and social harm, with consequences that last a lifetime. These children are also more likely to experience violence, abuse, neglect and exploitation.”
“As Covid-19 continues to devastate families and communities, we must protect every child’s right to live and grow up in an environment that supports their physical, psychological, social and emotional development,” said Fore.