nlp-thedeep/humsetbias huggingface dataset:
Specific elements to consider in CVA feasibility studies and market assessment in this pandemic context: ➢ In order to ensure that your assistance modality is still the most appropriate one, make sure you have considered and rapidly assessed the 3 key components of a CVA feasibility study: Community, Markets and Service Providers/FSP. ➢ Pay particular attention to: * the prices, stocks, supply chains of key commodities and services  ( in countries already affected by chronic inflation such as Venezuela, Libya, South Sudan and Yemen, such market monitoring is critical ) . * physical access to marketplaces  ( containment measures, self isolation and fear or public places )  * levels of liquidities and circulation of cash in a local economy. There are increasing evidence that banknotes are a vector for viruses: some countries such as Yemen and Kenya have started limiting the use of physical currency to prevent the spread of COVID 19. ➢ Consider the scale of our intervention: is there any risk that our assistance will negatively impact non  participants, due to constraints in supply and limited availability of certain goods? ➢ Increase the frequency of price monitoring  ( with existing secondary data and primary data if needed )  focusing on basic goods included in your Minimum Expenditure Basket  ( MEB ) . You may need to adjust your transfer values if there is significant and consistent price change. ➢ If markets become inaccessible, you will need to consider other modalities. ➢ Before switching from an assistance modality to another one  ( eg: from in kind to value vouchers ) , make sure the potential new modality is also accepted by the government and local authorities. ➢ Map/update the capacities and intervention of other actors in CVA, including government' safety nets. ➢ Service providers we work with: ensure consistent messaging is being provided to participants they may directly interact with and consider developing messaging to share or put on display in their shops; assess their availability, network, cash out points, flexibility and willingness to continue or open services in affected areas; discuss their mitigation measures. ➢Market support interventions  ( eg: preventing the shortage of life saving commodities )  should be considered as they can contribute to limiting the spread of COVID 19, and at a later stage, cushion the impact of the pandemic on affected households and systems.
Oppression: Media reported that some medical staff, journalists, and academics questioning government figures of the COVID 19 caseload and criticising lack of preparedness and medical capacities have been threatened and detained  ( Semana 07/05/2020; BBC 28/04/2020; CNN 14/05/2020 ) . This is likely to discourage independent reporting of cases.
High vulnerability due to pre existing humanitarian needs The humanitarian crisis in Venezuela precedes the onset of the COVID 19 crisis.
Information gaps: Significant information gaps on humanitarian needs, vulnerable population groups, and geographical areas with high needs are reducing the ability of humanitarian organisations response.
Women do the bulk of unpaid care work. Globally, women on average do three times as much unpaid care and domestic work as men – a workload that intensifies with school closures and when health systems are overloaded. Widespread job losses will have long term impacts for women's economic independence and security. With 740 million women globally informal employment and a majority employed in services, in the crisis. women are particularly hard hit by Lockdowns and restrictions adversely affect women's access their vulnerability. Emerging data shows that since the outbreak, violence against women and girls has intensified, resulting in a shadow pandemic.
High levels of food insecurity, existing malnutrition, as well as prevalent diseases, increase the population's vulnerability to COVID 19 and the containment measures.
Points of entry are operating at reduced capacity, which could lead to delays in processing shipments of critical medical supplies  ( OCHA 10/04/2020 ) .
The Livelihoods sector is a priority in the region; however, National Societies need to increase their operational capacity by having operational plans that include this type of programme, personnel responsible for Livelihoods and by participating in coordination spaces. There is greater experience in rural than in urban contexts, especially with projects centred on self employment and/or small  scale businesses and agriculture. There is no experience, tools or specialized technical training to address these new challenges, work on livelihoods in the long term and support National Societies with programming and implementation of interventions that strengthen medium  and long term resilience. There are still many needs in the region in this regard, especially in terms of financing, resource mobilization, technical support and capacity building.
In the last ten years, livelihoods have taken on significantly increased importance and relevance. The International Federation of Red Cross and Red Crescent Societies  ( IFRC )  2020 Strategy puts a special emphasis on protecting livelihoods, enabling a safe life and promoting social inclusion. As of the inclusion of livelihoods in the 2020 Strategy, several Movement strategies and framework documents now take this sector into account. The IFRC Recovery Programming guidance; the IFRC's 2016 2020 Plan and Budget, which includes livelihoods as a programmatic area; the IFRC Framework for Community Resilience; IFRC's Road to Increased and Improved Cash Transfer Programming; and more recently, the Buenos Aires Commitment, include the sustainable livelihoods approach as an intervention sector that contributes to strengthening resilience within a community or household.
Community coping mechanisms In countries where containment measures may be preventing people from accessing their regular source of income there is a concern that more people will pursue illegal and more dangerous lines of work, out of sight of the authorities. This might include sex work, organ sales, or other illicit trade networks  ( ACAPS, 21/04/2020 ) .
Insecurity, related to the presence of armed groups in some areas, further compounds access challenges.  ( OCHA 06/02/2020 ) .
This context requires Red Cross Societies in the region to work hand in hand, as the general outlook is one of many implications, challenges and opportunities. The challenges in the region have been prioritized in the Buenos Aires Commitment signed within the framework of the 21st Inter American Conference by the leaders of Red Cross National Societies in the Americas region. National Societies have addressed these challenges. Of the more than 100 operations in the region over the last five years, at least 42 have included livelihoods actions benefitting a total of 18 Housing and improving precarious settlements. International Federation of Red Cross and Red Crescent SocietiesLivelihoods Regional Roadmap – Latin American and the Caribbean 270,234 people, and at least 23 have delivered assistance in the form of cash or vouchers. As shown in Figure 1, at least 17 National Societies have implemented livelihoods actions to respond to emergencies involving floods  ( 17 ) , drought  ( 7 ) , human mobility  ( 5 ) , hurricanes  ( 5 ) , etc.
Water shortages in many areas are an obstacle to adequate hygiene practices.
Medical staff who rely on fuel to reach their places of work are impacted as well, with some reporting being unable to obtain fuel despite the government's announcement that medical staff would have preferential access at stations  ( Reuters 07/04/2020; Al Jazeera 08/04/2020 ) .
By the time it becomes apparent that COVID 19 cases have increased significantly the disease will already have spread widely and the following can be expected: • A high number of infections among medical workers and consequent decrease in the health system's capacity due to shortages of protective equipment.
Rural livelihoods Agriculture production. Seasonality of production cycle: due to movement restrictions and markets closure 1 )  planting season may be disrupted limit farms access to essential inputs such as seeds, fertilizers or pesticides; 2 )  seasonal workers may lose job opportunities and so incomes for their families. Health impact on households capacity to maintain their activities: planting, maintain the crops, harvest Incomes losses farmers at risk of losing their main incomes source as they cannot sell their products and have no capacity to storage or process production into new products.
Significantly above average mortality and morbidity rates, from both COVID 19 and other causes due to insufficient treatment and medical equipment available in hospitals. Many deaths will likely not be registered as COVID 19 related due to lack of testing, leading to inaccurate mortality rates.
Borders with Colombia and Brazil are closed; however, corridors are opened for returning Venezuelans and medical emergencies  ( La Opinión 07/05/2020 ) . Evidence indicates that people continue to use irregular border crossing points at the border with Colombia  ( Crónica Uno 08/05/2020 ) .
Access to other health services, such as reproductive and sexual health services, is likely to be severely limited due to the health system's focus on responding to the COVID 19 outbreak  ( OCHA 10/04/2020 ) .
Tenga en cuenta lo siguiente al evaluar la funcionalidad y el acceso al mercado: ● Los mercados de bienes básicos pueden verse presionados. Evalúen el funcionamiento de la cadena de suministro. ● En cuanto a cadenas de suministro para mercados o servicios  ( por ejemplo, alimentos, medicamentos, etc. ) : ¿existe una dependencia de los suministros de los países en los que se detiene la producción debido a la pandemia? ¿Dejarán de funcionar las empresas de logística? ¿A los comerciantes, trabajadores de salud y otros trabajadores clave se les impedirá trabajar, o dejarán de asistir a trabajar? ● Acceso de personas a mercados y servicios: las personas pueden estar menos dispuestas o tener menor capacidad de llegar a mercados abarrotados en situaciones de pandemia. Asegúrese de que los programas de PTM no contribuyan a incrementar la transmisión al requerir que los destinatarios acudir a mercados abarrotados. ● En caso de que exista limitación total de movimiento, sin acceso a los mercados, evalúe si están surgiendo sistemas alternativos  ( por ejemplo, entregas a domicilio, grupos de compras comunitarias ) . ● El acceso y las necesidades de acceso deben evaluarse de cerca, y pueden cambiar con el tiempo. Por ejemplo, a medida que más países se decretan cierre por emergencia, van limitando el movimiento y las personas entran en cuarentena. ● Tener claro si se crean líneas de suministro alternativas, por ejemplo, por el gobierno. ● Evaluar si el mercado informal o los servicios están más o menos afectados por la crisis  ( por ejemplo, si el mercado formal o los servicios cierran ) . ● Refiérase a “Zonas urbanas vs rurales. Niveles de liquidez en ubicaciones remotas y monetización de la economía local "12 “Impacto y causas del impacto de las epidemias en los sistemas de mercado  ( precio y acceso a los mercados )  y medios de vida'. 13
Mientras los ciudadanos más ricos tendrán acceso a servicios de salud de alta calidad, quienes utilicen el sistema público se enfrentarán con obstáculos para la protección y el tratamiento, por lo que podrían incrementar el riesgo de una propagación acelerada de la pandemia.
Despite borders being formally closed, it is likely that a deterioration of the situation in Venezuela would lead to some spill over into Colombia, Brazil, and possibly Guyana, as people try to access healthcare in those countries. The fluidity of land and river borders prevents complete control over entries. Many people would likely use irregular border crossings, which are controlled by armed groups, implying protection risks.
We see a similar trend within LICs and LMICs: there is a higher proportion of inter generational households in the poorer wealth quintiles  ( Figure 3C ) . In both cases, this higher contact between younger individuals and the elderly  ( the most at risk from COVID 19 )  will limit the effectiveness of strategies aimed at shielding this vulnerable demographic in the home.
Having clean hands, washed with soap and water, remains a key component in the control of infection and transmission of SARS CoV 2  ( 4 )  supported by recent data from the UK and elsewhere demonstrating that handwashing can reduce the carriage of coronaviruses  ( 5 ) . However, many people residing in LICs and LMICs do not have access to soap and clean water in their home, limiting their access to basic infection prevention measures.
Individuals from disadvantaged populations face significant barriers to the timely access of healthcare upon falling ill. Hospitalisation rates for COVID 19 are high  ( 10 )  and in many LICs and LMICs large sections of the population live far away from the nearest hospital  ( Figure 2C )   ( 11–13 ) . Furthermore, access to a hospital decreases as poverty increases  ( Figure 2 C, D )   ( 7 ) , with the median distance to the nearest hospital 4km for the wealthiest category considered here and 30km for the poorest.
Populations in these circumstances  ( such as refugees and internally displaced people )  are especially vulnerable to the impacts of COVID 19 and associated non pharmaceutical interventions  ( NPIs )  that aim to reduce contact rates in the population. These include those who are displaced  ( 24,25 )  and those who are affected by conflict.
In Venezuela, the first cases of COVID 19 were confirmed on 13 March 2020 and containment measures were introduced over the following weeks. An increase in cases is likely, due to an inconsistent adherence to the lockdown, limited PCR testing, and limitations on regular access to hygiene related to water shortages.
Los factores que pueden aumentar esta situación de vulnerabilidad son, entre otros, los obstáculos de acceso a la salud pública, la mayor prevalencia de las enfermedades crónicas, el menor acceso a las redes de seguridad social, la desconfianza generada por antecedentes de racismo y la alta informalidad laboral en estos grupos.
 Some National Societies will determine that they have a role to play in supporting community recovery from the secondary impacts – if they can identify specific vulnerable groups who are likely to be excluded from wider Government assistance and will find it difficult to recover. Focus should be on: o FSL recovery  ( especially using CVA )  o Engagement and communication with communities which rebuilds social cohesion and continues to provide PSS. o Specific shelter & settlements needs in urban informal settlements.
Es importante tener en cuenta que el racismo estructural y la discriminación histórica de los que estas poblaciones han sido y continúan siendo objeto generan una situación de vulnerabilidad a los efectos de la pandemia con relación a la población general.
A pesar de la falta de datos exactos, la información disponible muestra la coexistencia de una variedad de condiciones y factores relacionados con la vulnerabilidad de ciertos grupos sociales y territorios, incluidos los pueblos indígenas y la población afrodescendiente, que afrontan retos únicos, como niveles más altos de pobreza y falta de acceso a algunos servicios básicos, como agua y saneamiento, así como niveles más bajos de alfabetización.
Asymptomatic cases It is known that a proportion of people with COVID 19 are asymptomatic. However the proportion of people who remain asymptomatic is not clear. It is also not clear to what extent asymptomatic carriers of the virus contribute to transmission. It is speculated that the level of contagion does not differ significantly between people who do and do not display symptoms, however more research is needed to confirm whether this is the case.
El componente comunicacional adquiere especial importancia al abordar la COVID 19 en los grupos étnicos, tomando medidas específicas para que estas poblaciones tengan acceso a la información sobre prácticas de prevención y manejo de la COVID 19 en sus comunidades, incluidas las prácticas familiares. Es necesario una articulación directa con los servicios de salud y con los responsables del manejo de la información de salud pública que se genera durante la pandemia de la COVID 19.
There are also unknowns regarding how at risk children are or how much they contribute to the spread of the virus. While cases have been reported among children, the overall proportion of children having been affected is either very low or most cases among children are asymptomatic  ( ACAPS HEN, 04/2020 ) .
Las personas indígenas, afrodescendientes y pertenecientes a otros grupos étnicos pueden correr un riesgo mayor de contraer la COVID 19 debido a distintas causas, que incluyen las siguientes: Obstáculos para emplear algunas medidas básicas de higiene, como el lavado de las manos  ( por ejemplo, si no se cuenta con agua o jabón ) . Dificultades para mantener el distanciamiento físico debido a sus formas de vida, porque deben ser culturalmente aceptadas o porque vienen impuestas por las condiciones socioeconómicas en las que viven o, incluso, una combinación de ambas puesto que existe una relación positiva entre la incidencia de la COVID 19 y la densidad poblacional.
Además, las adaptaciones culturales que promueva el personal de salud deben expandirse a todo lo concerniente a la toma de pruebas diagnósticas y al tratamiento, así como a las medidas de aislamiento y cuarenta, tomando en cuenta los modos de vida. Es importante contar con un directorio  ( telefónico u otro medio )  que contenga información de contacto sobre los jefes y líderes de las comunidades indígenas y afrodescendientes, para que pueda establecerse una relación fluida durante la pandemia. De esta manera, los servicios de salud responsables de la cobertura en estas comunidades tendrán un panorama claro sobre su situación y necesidades.
Three main variables are considered to have primary influence over the way the global humanitarian situation will develop in the coming six months: government containment measures, national capacity to provide essential services, and the mortality rate of COVID 19.
In the UK for example, data shows that people from minority ethnic groups have been disproportionately affected by both the primary and secondary impacts of the virus. Analysis of this issue has taken in to account pre existing characteristics of different communities including wealth, health, living standards and education. Socioeconomic disadvantage and health status does impact how vulnerable a particular ethnic group might be to the impact of the virus; however, research shows that this alone does not account for the disparity and there are other issues at play that are not yet fully understood  ( IFS, 01/05/2020; The Guardian, 07/05/2020 ) .
There are speculations that age may not be the most dominant factor in increased vulnerability to severe infection. Research is investigating the link between the virus and pre existing health issues such as diabetes, obesity, and heart disease. There are also unknowns around the potential link between vulnerability to the virus and smoking, as well as whether or not blood type and genotypes are significant  ( Live Science, 05/05/2020 ) .
Seasonal/climate impact: There are speculations that warmer temperatures will help to limit the spread of the virus, as is the case during an influenza outbreak. However, it is too soon to tell whether this is the case with COVID 19. Brazil, Peru, and Indonesia are all warmer climates and have experienced significant spread of the virus  ( New York Times, 03/05/2020 ) .
Humanitarian response capacities are further impacted by access restrictions.
The containment measures have rendered many services inaccessible or only partly operational as they are deemed non essential, or movement restrictions inhibit use. This has affected family planning services and maternal care, psychosocial support services, nutrition services, among others. Treatment for other widespread diseases is also at risk of being interrupted including malaria, TB, and HIV. The extent to which other health services remain open is not always clear across countries  ( Nature, 02/04/2020 ) .
As reported in parts of Europe, there is a risk that many people in need of healthcare for a range of issues, will actively avoid health services for fear of catching COVID 19. It is not clear to what extent this is happening and whether the avoidance of healthcare is resulting in increased suffering due to choosing to forgo treatment for other illnesses.
While this is a universal concern, there is currently limited information to allow for a more granular understanding of how domestic violence is impacting different people in different communities and countries  ( UNFPA, 27/04/2020 ) .
Risk factors Limited medical capacities Venezuelan hospitals are not equipped to deal with a large scale outbreak. The Venezuelan health system has been crippled for years by an exodus of medical personnel, lack of medical supplies including pharmaceuticals and basic supplies such as face masks and disinfectants, and the weak state of the water and electricity infrastructure.
Changes in levels of food security and malnutrition Countries or regions most vulnerable to food insecurity include those affected by conflict, those which are particularly prone to climatic shocks, as well as areas with high refugee or IDP populations. Urban areas will be particularly affected due to higher reliance on the functioning of markets   which in many cases are no longer functioning. While pre  existing characteristics of a region give an indication of how vulnerable an area is to further shocks to the food supply, the extent to which COVID 19 is already exacerbating food insecurity and malnutrition in particular areas is not yet clear  ( TNH, 14/04/2020 ) .
In countries around the world aid agencies have been prevented from delivering essential food supplies and children often depend on school feeding schemes but widespread school closures have rendered this service unavailable  ( World Bank, 04/05/2020; WFP, accessed 15/05/2020 ) .
Existing and previously projected food insecurity and malnutrition are likely to worsen over the next months; particular attention must be paid to contingency planning in areas and among populations that are vulnerable to sudden shocks as a compounding crisis could tip a population over the edge.
In many instances international humanitarian agencies have been forced to suspend their programmes due to government restrictions. Many aid workers are under lockdown in country, or have been evacuated and the redeployment of staff is limited. It is not known how long this shortage of humanitarian personnel will continue  ( The Guardian, 25/03/2020; TNH, 14/04/2020, NRC/EGMONT Webinar, 07/05/2020 ) .
Containment measures The national government under President Nicolás Maduro has implemented several containment measures to reduce the spread of COVID 19. A state of emergency was declared on 12 March 2020. A ‘social quarantine' was declared on 16 March 2020, stipulating strict movement restrictions, temporary closure of non essential businesses, as well as suspension of most work activities and all classes nationwide  ( Gaceta Oficial N°6.519; Efecto Cocuyo 07/04/2020 ) .
Questions are also being raised around whether certain environmental or demographic factors play a role in exacerbating the spread of the virus. Numerous studies are underway that explore the way different factors may interplay and shape the trajectory of the pandemic in different cities, countries and regions  ( New York Times, 03/05/2020; USA Today, 07/05/2020 ) .
Population Density: this is a known variable in the spread of COVID 19 but cannot be considered as a stand alone factor. The interaction of population density with other variables such as service availability and success of containment measures will determine the trajectory of the virus. A number of studies reveal how higher population density can go hand in hand with better access to health services as well as higher financial capacity to provide the resources needed to manage the spread. Differences in affluence of densely populated areas has also been observed as a potential factor. For this reason it should not be assumed that population density immediately results in faster disease spread and should be analysed according to each specific context and the other variables at play  ( World Bank, 20/04/2020 ) .
Air pollution: It remains unknown as to whether air pollution exacerbates the spread of COVID 19. Previous studies of other viruses have found a link between pollution levels and spread of disease, and there are speculations that particularly high levels of pollution in northern Italy may have exacerbated the spread of COVID 19 in the region. While COVID 19 has been detected in pollution particles in the air, more research is required to determine if this means that the virus can be carried over longer distances and increase the number of people infected  ( The Guardian, 24/04/2020; SIMA, accessed 11/05/2020 ) .
Impact on co morbidities is not clear. How the virus interacts with malnutrition or endemic diseases such as malaria or dengue are unknown and should be carefully monitored.
The most commonly used test  ( Polymerase Chain Reaction – PCR )  assesses the presence of the virus in the body. Often there are significant time lags between being tested for the virus and receiving the result. It is therefore not always possible to know if a sudden spike in cases is due to an actual rise, or due to testing results long after samples were collected. This is likely to be of greater concern in countries with lower laboratory capacity.
The population in many poor communities is not adhering to lockdown rules out of economic necessity  ( El Nacional 17/05/2020; Efecto Cocuyo 14/04/2020; LaFM 13/04/2020 ) .
Most countries only report COVID 19 deaths that occur in hospitals. Deaths in the community are largely unaccounted for. Reporting of deaths is not timely. Daily figures refer to deaths reported on that day, rather than deaths that occurred on that day. There is usually a lag between time of death and when that death is reported. Some countries have now only begun to report deaths once the death certificate has been issued. This is a more reliable indicator than the daily hospital figures released  ( Oxford University, 01/05/2020; The Economist, 16/04/2020 ) .
The spread of the virus risks overwhelming health systems due to a rise in COVID 19 patients, hindering the capacity to deliver services beyond treatment for the virus.
Shortages of medical staff: The political and socioeconomic crisis in Venezuela has led to the emigration of thousands of Venezuelan doctors. In 2018, the Venezuelan Medical Federation estimated that some 26,000 medical professionals had left the country in the previous years  ( ABC 30/10/2018 ) .
Medical supplies: Venezuela's hospitals experience a chronic shortage of medical supplies, including protective gear and pharmaceuticals. Anecdotal reports indicate shortages of supplies crucial for medical care of COVID 19 patients, such as face masks, gloves, and disinfectant  ( El País 22/03/2020 ) . Reportedly, patients often have to buy and bring in their own supplies in order to get treatment, which are often purchased on the black market at inflated prices  ( HRW 24/10/2016; Guardian 05/04/2018 ) .
Limited epidemiological information The government, responsible for updating on case figures under International Health Regulation norms, information. Independent releases of estimates of case figures and reporting on conditions in the health system are suppressed. In addition to a low PCR testing rate, this likely leads to underreporting of cases. Consequently, the detection of a major outbreak of COVID 19 would likely be delayed, with reported cases not reflecting the actual situation.
According to WFP, 2.3 million people in Venezuela  ( 7.9% of the population )  are severely food insecure, with an additional 7 million  ( 24.4% of the population )  moderately food insecure and 17 million marginally food insecure. The states with the highest prevalence of severe food insecurity are Delta Amacuro, Amazonas, Zulia, and Falcón  ( WFP 23/02/2020 ) . In the context of COVID 19, the vulnerability of food insecure households is heightened.
Access to water and hygiene: Water shortages are interrupting people's access to water. According to the WFP assessment, 40% of surveyed households reported experiencing daily interruptions in water supply  ( WFP 23/02/2020 ) . This affects access to potable water for consumption as well as for hygiene and cleaning purposes. People with likely unable to follow hygiene recommendations to reduce transmission of the Coronavirus.
High incidence of malaria and dengue, especially in the “Arco Minero' mining states, increase the vulnerability of the population. Bolívar and Amazonas states are of particular concern  ( OCHA 10/04/2020 ) .
Underlying and compounding factors Political conflict Venezuela is dominated by a highly polarized political environment. The political conflict over national power between the government of Nicolás Maduro and the opposition, led by the administration of Juan Guaidó, president of the National Assembly, poses an obstacle to concerted, joint action by political actors during the epidemic. Any information about the evolution of the crisis is likely to be used for political purposes.
The government has reportedly received some medical support from allies such as China and Russia  ( Government of Venezuela 12/04/2020; OCHA 23/04/2020 ) . UN agencies such as WHO/PAHO and UNICEF have delivered medical supplies, including personal protection equipment  ( PPE )  for medical workers, oxygen concentrators, and hygiene kits  ( OCHA 23/04/2020 ) .
The population in many poor communities does not adhere to lockdown rules out of economic necessity  ( Efecto Cocuyo 14/04/2020; LaFM 13/04/2020; TalCual 14/04/2020 ) . Furthermore, media reports indicate that since until recently, the national government reported low case figures and was giving off the impression that the crisis is under control, people feel that the quarantine is overly strict  ( France24 20/04/2020 ) .
Las mujeres tienen, con frecuencia, la responsabilidad de los gastos en este tipo de productos relativos a la salud y por lo tanto pueden estar más afectadas por el incremento de sus costos. Esto puede conducir a exacerbar la pobreza.
Mujeres viviendo en áreas alejadas a los centros urbanos, trabajadoras informales sin relación de dependencia o precarizadas, mujeres inmigrantes, refugiadas, tienen mayores dificultades de afrontar una crisis económica.
En la región latinoamericana, 26 millones de mujeres dependen del trabajo informal5. En el Ecuador y a marzo de 2019, el 65,24% de la población ecuatoriana pertenece al sector informal de la economía, 45,14% son mujeres en condición de empleo no pleno  ( ENEMDU, 2019 ) .
La cuarentena influye en la calidad de vida de las mujeres, esto podría incrementar el estrés, el cansancio y el deterioro de su salud mental y física.
Los costos de transporte probablemente suponen una carga considerable para quienes necesitan viajar largas distancias para acceder a la atención hospitalaria. Además, las mujeres son menos propensas que los hombres a tener acceso a un propio transporte, por lo que en este ámbito hay importantes implicancias de género a tener en cuenta.
Violencia por razón de género.A nivel nacional 20 de cada 100 mujeres han experimentado algún tipo de violencia en el ámbito familiar  ( ENVIGMU , 2019 )   [ 6 ] . Además, en 2019 y a nivel nacional, el 56,92 % de las mujeres reportaron haber vivido violencia psicológica en los últimos meses  ( ENVIGMU, 2019 ) . La violencia por razón de género en situaciones de emergencia y desastres profundiza las desigualdades entre hombres y mujeres y pone en riesgo la integridad física, psicológica y sexual de las mujeres, niñas, adolescentes, jóvenes y adultas mayores [ 7 ] .
Al menos 3.529 mujeres fueron asesinadas en 2018 por razones de género en 25 países de América Latina y el Caribe 5 . Si las víctimas están pasando la cuarentena con sus abusadores, es difícil encontrar una salida. En situación de confinamiento, los números de abusos pueden incrementar exponencialmente.
Sin embargo, en la mayoría de los países latinoamericanos, el gasto de bolsillo en salud sigue siendo elevado. Esto indica claras deficiencias de los sistemas de aseguramiento para proveer protección financiera y acceso oportuno a servicios de salud de calidad, que son el núcleo de la CUS.
A largo plazo, el fortalecimiento de los sistemas de salud debe ser una prioridad para ayudar a los países a cumplir sus objetivos de cobertura universal de salud.
La epidemia también muestra la crítica necesidad de tener sistemas de salud pública sólidos, con recursos financieros y humanos adecuados que permitan una respuesta eficiente y equitativa, y estados fuertes que protejan a la ciudadanía contra las múltiples crisis que enfrentarán luego que pase la epidemia.
There is an apparent trilemma that needs to and can be confronted. You can have an epidemiological strategy of social distancing and quarantine, but without a social protection floor, you will either not be able to sustain it  ( because people will move to earn a living )  or if you do it will be with inmense social costs. Thus you will have to deal with increasing political pressures that will either lead to authoritarian solutions or to political chaos.
We need to put swiftly in place basic income guarantees and define a strategy for continued access to basic utilities. These are the two critical ingredients to avoid a humanitarian crisis in Latin America as it deals with COVID19 and as it develops the epidemiological strategies to flatten the curve and contain the spread of the virus.
There is a huge asymmetry in how people from different social strata can cope with such radical distortions to life, markets and families. As the pandemic finds its exponential phase in the global south it becomes also clear that different countries in the world have very different tools available to both enact an effective epidemiological strategy and to deal with the socioeconomic disruptions the strategy brings with it.
In Venezuela, the Nicolás Maduro government grounded flights and sent the country into lockdown early on. The desperate economic situation and deteriorated healthcare system leave the country ill prepared to face the crisis, and the collapse of the world market price for oil only adds to the bleak perspective for Venezuela.
Asegurar el acceso de las trabajadoras en los servicios de salud, mujeres de los servicios esenciales la Defensoría y de las comisarías a equipos de protección personal y promover el adecuado descanso.
Además, los esfuerzos necesarios de conten  ción a menudo desvían recursos de servicios esenciales de salud, como la salud sexual y reproductiva, incluida la atención prenatal y postnatal, la atención a casos de violencia hacia mujeres y niñas y el acceso a métodos anticon  ceptivos.
Where populist presidents from the right  ( Brazil )  or left  ( Mexico )  deny the ser iousness of the pandemic, subnational and other authorities seek to fill the leadership vacuum – but policy implementation is harmed. The heaviest price will be paid by the most vulnerable.
The potential abuse of extraordinary powers raises concerns for the medium run. In Chile and Bolivia, governments struggling with legitimacy after last year's massive protests have had to postpone a constitutional convention vote in the former and presidential elections in the latter.
The charismatic president of El Salvador, Nayib Bukele, has also gained respect by getting in front of the pandemic; he early on announced a comprehensive emer  gency plan to address COVID 19. In a country racked with high levels of violence, corruption, and a weak economy, he not only decreed a complete quarantine for one month but also put forwards an ambitious plan of social assistance to the majority of Salvadorans who work in the informal sector.
Notwithstanding Cuba's assistance to other countries, the COVID 19 pandemic has also put its own domestic health system to a severe test. After many years of crisis, the quality of Cuban hospital care is no longer what it used to be. Doctors are extremely low paid  ( one reason why the much better paid work on missions abroad is so attractive ) , many medical materials are in short supply or cannot be come by, and sanitary conditions have become precarious for broad segments of the popula  tion – with chronic deficiencies in the supply of tap water or body soap.
Las medidas de restricción de movili  dad también pueden presentar barreras de acceso a salud para mujeres en zonas rurales, en espacios de reintegración y/o donde los servicios de salud ya son insuﬁcientes.
El aislamiento produce tensiones en el hogar, debido al manejo de nuevas situaciones estresantes, algunas de estas relacionadas con pérdida de fuentes de ingreso, así como la limitación en las posibilidades de contacto social, y aumento en la carga de trabajo en la casa.
Las mujeres siguen siendo las más afectadas al asumir desproporcionadamente el cuidado no remunerado, carga que se incrementa ante el cierre de escuelas, el aislamiento preventivo en los hogares y la necesidad de contención emo  cional de los demás miembros de la familia ante a la incertidumbre producida por la pan  demia.
En Colombia cerca de 3 de cada 10 mujeres reporta haber sido víctima de violencia física por parte de su pareja o su expareja, de acuerdo a la Encuesta Nacional de Demografía y Salud  ( ENDS; 2015 ) .
Las mujeres desempeñan un papel imprescindible en la lucha contra la pandemia de COVID 19: como principales cuidadoras en los hogares, en las redes familiares extensas y los espacios comunitarios, trabajadoras y profesionales en el sector de la salud, lideresas y defensoras comunitarias, sobrerrepresentadas en los servicios de limpieza, trabajadoras domésticas y en servicios básicos  ( como supermercados y farmacias ) .
En América Latina las mujeres son el 74% de las personas empleadas en el sector sanitario y social1, pero, están excluidas de las funciones de liderazgo.
Estos riesgos se ven agravados debido a la potencial ralentización de los servicios judiciales y jurídicos, el acceso limitado a servicios de la institucionalidad durante la crisis, la desactualización de rutas en VBG ante la coyuntura, y la menor presencia de actores humanitarios en territorios.
Considerar de manera diferenciada las necesi  dades y capacidades de mujeres, hombres, niñas y niños, en su diversidad étnica, racial, por situación de discapacidad o dependencia, y ciclo vital, incluyendo las mujeres expuestas a contextos especíﬁcos de vulnerabilidad: mujeres víctimas del conﬂicto armado y rein  corporadas, refugiadas y migrantes.
Implicar a las mujeres en todas las fases de la respuesta y en la toma de decisiones naciona  les y locales; Asegurar la dimensión de género en la respuesta con la participación directa de las organizaciones de mujeres, lideresas y defensoras;
Adecuación y activación de rutas de atención para casos de violencias contra las mujeres y las niñas con intervención inmediata de las autoridades, garantizar la continuidad de los servicios y rutas de atención y protección para sobrevivientes de violencia asegurando el reforzamiento y el cumplimiento de medi  das de protección;
Given that the key to tackling COVID 19 is not to focus on preventing its inevitable arrival but rather to prepare to restrict its spread appropriately, an adequate response involves having sufficient resources available: strengthening surveillance, training the health services, the prevention of propagation and the maintenance of essential services to slow down the transmission and save lives. It is in these areas where the Latin American health situation, which is very uneven and heterogeneous from country to country, suffers its main weaknesses.
All its health systems aspire to universal coverage, but in practice most offer only partial coverage, as a 2019 report from the London School of Economics makes clear. Only Costa Rica and Uruguay meet the WHO recommendation that medium and medium high income countries invest 6% of their GDP on healthcare.
And while some countries have lengthy and first hand experience of combating infectious diseases such as chikungunya, zika, dengue fever and, in the case of Mexico, influenza A  ( H1N1 ) , which has forced them to improve their public health surveillance systems, most have few laboratories with the ability to test samples to detect cases in under 24 hours, or centres or institutes for conducting field research into those infected with the virus, which would provide them with the autonomy for detecting it and acting accordingly.
Aside from a brief interruption in 2016, the Venezuelan government has not published epidemiological data for several years. The healthcare system has all but collapsed. The once impressive laboratory system has been looted.
Groups that are likely to experience disproportionate mental health effects from COVID 19 include those with a mental disorder, health professionals and carers, offenders, refugees, and older people, including those in care homes.8
Public mental health interventions can be divided into mental disorder prevention and mental wellbeing promotion. Such interventions need to be proportionately targeted to groups at a higher risk of mental disorder and poor mental wellbeing than the general population.
The COVID 19 pandemic presents a triple global public mental health challenge:  ( 1 )  to prevent an associated increase in mental disorders and a reduction in mental wellbeing across populations;  ( 2 )  to protect people with a mental disorder from COVID 19, and the asso ciated consequences, given their increased vulnerability; and  ( 3 )  to provide appropriate public mental health interventions to health professionals and carers.
Evidence suggests that pandemics, including COVID 19, are associated with an increased risk of developing mental disorder and poor mental wellbeing.1,2 This increase in risk is likely to be mediated by the effects of the pandemic on risk factors, including socioeconomic inequalities, poverty, debt, unemployment,1,2,7 food insecurity, social factors,2 quarantine,5 physical distancing, and physical inactivity,
Mental disorder prevention Mental disorder prevention can occur at primary, secondary, or tertiary levels. Primary prevention Addresses risk factors exacerbated by COVID 19, including socioeconomic inequalities, poverty, debt, unemployment,2,7 food insecurity, parental mental disorder, child adversity, stress at work  ( including in health professionals ) , physical ill health, physical inactivity, and social isolation  ( including from quarantine5 ) . Secondary prevention Early intervention for mental disorders and their associated effects, including those related to COVID 19. Tertiary prevention Intervention for individuals with an established mental disorder to prevent the associated consequences and disability through treatment, patient education, and addressing health risk behaviour, physical illness  ( including from COVID 19 ) , socioeconomic issues, social isolation, stigma, and discrimination.
Population access to public mental health inter ven  tions, including during pandemics, can be improved in several ways.1,3 Training of health and allied professionals improves knowledge about public mental health and COVID 19, while improving population knowledge about mental health, in general and in relation to COVID 19, is important. Digital technology can deliver public mental health interventions,3 support the mental health of carers and health professionals, reduce social isolation, deliver public mental health training,10 and facilitate contact tracing. However, risks of excessive screen time need to be mitigated,3 while also considering the needs of those without such technology. Setting and group approaches enable public mental health interventions to be implemented in large sections of a population, such as schools and workplaces, including through digital means during lockdown or quarantine. Existing resources can be maximised through self help and the shifting of tasks  ( eg, treatment )  to less trained individuals.
A nivel comunitario, existen riesgos generales para la protección, que se acentúan debido a la amenaza de contagio del coronavirus. Entre los principales riesgos identificados a partir del análisis del sector, se encuentran el riesgo de desinformación  ( pánico colectivo o de miedo infundado ) , riesgo de desabastecimiento de servicios y productos esenciales  ( agua, productos de higiene, productos de la canasta básica, subida de precios en la canasta básica e incapacidad de compra ) , riesgo de no poder movilizarse  ( detención ilegal, riesgo de ausencia de movilización comunitaria para realizar actividades de prevención e información, riesgo de aislamiento de personas no acompañadas, riesgo de no acceder a procedimientos de asilo en territorio y frontera ) , riesgos de salud  ( falta de acceso a consultas y tratamientos médicos para pacientes con otras patologías que no sean las del virus COVID 19, riesgo de aumento de casos de violencia sexual basada en género, riesgo de alta transmisión del virus COVID  19 )  y otros riesgos asociados al rol de “autoridad' de los grupos criminales llamados “pandillas'. Adicionalmente, existen riesgos asociados con la actuación del crimen organizado, que continúa cometiendo delitos como el homicidio, la desaparición de personas, la extorsión, el tráfico de drogas y otros que afectan a las comunidades, mientras la capacidad institucional se ha reducido en respuesta a la emergencia. Por su naturaleza, las estructuras criminales se adaptan a las nuevas circunstancias para obtener provecho de estas y diversificar sus actividades delictivas, por lo cual existen riesgos adicionales en el ámbito del ciberdelito, el lavado de dinero y activos, el aumento de la violencia sexual y otros delitos.
IMPACTO DE LA COVID 19 ha impulsado la necesidad de iniciar un proceso de continuidad educativa desde plataformas virtuales, que a su vez deja en evidencia las limitaciones como: limitada capacidad de adaptación inmediata a sistemas o esquemas de educación virtual/en línea, formación de docentes, preparación curricular, acceso a plataformas virtuales y/o dispositivos digitales que garanticen la educación virtual  ( solo el 61 por ciento de los estudiantes tienen acceso ) . El impacto en sus aprendizajes dependerá de cuánto puedan apoyarse en otras herramientas para aprender, como, por ejemplo: guías impresas, disponibilidad de programas de televisión o radio educativa.
Al 6 de mayo, según datos oficiales, un total de 12.399 personas, entre las cuales 11.145 personas adultas y 239 niñas y niños no acompañados, habían sido retornados desde Estados Unidos vía aérea. Para los retornos vía terrestre desde México al momento solo hay datos disponibles hasta marzo, con 9.683 personas retornadas  ( entre ellas 1.960 niños y niñas ) , un aumento del 30 por ciento respecto al mismo periodo del año anterior
En el caso de las niñas y adolescentes, especial efecto puede producir el paro de labores en el sector educación, ya que, al estar fuera de la escuela, la pierden como medio de protección y se exponen a situaciones de cuarentena o encierro se exponen a violencia basada en género, embarazos forzados, abuso y violencia sexual.
Pese al cierre de fronteras, el flujo de personas en tránsito por Guatemala no se detiene, quienes huyen de sus países por la violencia de maras, crimen organizado, violencia basada en género y contra población LGBTIQ+, además de la pobreza. Al no contar con mecanismos de protección en frontera y tránsito regular, muchas se ven obligadas a acudir a redes de tráfico ilícito de migrantes. Preocupa la falta de atención especializada en salud y protección, e información accesible, para las personas con discapacidad, en particular la situación en el Hospital de Salud Mental “Federico Mora', y la situación de las personas privadas de libertad, con énfasis en adolescentes y madres, por el hacinamiento en los centros de detención y las barreras al pleno acceso sin discriminación a información y derecho a la salud.