COVID-19: perceptions of people in need in Iraq - Ground ...
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Round one: June 2020 COVID-19: perceptions of people in need in Iraq Government curfews were instituted across Iraq in mid-March, two weeks after the first case of COVID-19 was detected in Najaf city, south of Baghdad. By 12 June, there were 15,414 confirmed cases, and 426 people had died.¹ COVID-19 is compounding existing vulnerabilities for the country’s 250,000 refugees, 1.4 million internally displaced persons (IDPs), and the 4.6 million people who have returned to their areas of origin. Government and UN officials are concerned about the healthcare system’s capacity, weakened after decades of instability and conflict. Restrictions have impacted livelihoods, making it difficult to adhere to stay-at-home or social distancing policies. In April and May, as a service to responders and authorities, Ground Truth Solutions (GTS) – in partnership with the Iraq Information Centre (IIC) – conducted phone interviews in Arabic with 556 returnees, refugees, and IDPs across Anbar, Dahuk, Erbil, Ninewa, Salah al-Din, and Sulaymaniyah to gauge their perspectives on information needs and channels, behaviours, trust, and the economic impact of the virus. We found that: • It has become more difficult for people to meet their basic needs. • Most people (79% of respondents) feel informed about how to protect themselves and their families from COVID-19, but half of all respondents still say they need more information about the virus. Some feel unable to separate fact from rumour. • People find it difficult to shelter in place, wear facemasks, and practice social In partnership with: distancing. Supported by: H 2H Catalysts for Change 1 WHO, “Iraq: WHO coronavirus disease (COVID-19) dashboard,” https://covid19.who.int/region/ emro/country/iq. 1
Information The majority of survey respondents (79%) believe they are sufficiently informed about IDP (internally displaced person): refers how to protect themselves from COVID-19, thanks to health and humanitarian actors’ to someone who was displaced from their subdistrict between 2014 and 2017, and who rapid action. In parallel to routine communication and dissemination of key messages continues to reside in Iraq. through the IIC and implementing agencies, in April a UNICEF-led campaign reached nine million people across Federal Iraq and the Kurdistan Region (KRI) with Refugee: refers to someone who fled their mobile messaging on COVID-19 prevention.² A Facebook survey suggested this home and crossed an international border in campaign was working.³ order to seek protection in Iraq. All refugee However, when people are inundated with information, they may find it challenging respondents in this survey are Syrian nationals. to weed out rumours. Close to half (43%) of respondents say they are unable to distinguish between rumour and fact around the virus. Refugees and returnees find it Returnee: refers to a person who was more difficult than IDPs. People in Anbar and Erbil find it harder than those in other displaced between 2014 and 2017 but has governorates. We will be unpacking the reasons for this in our next survey. since returned to their sub-district in Iraq. Are you able to separate rumours from facts around the Coronavirus? (n=556) Status IDP in camp n=135 Note: in this report, error bars are included 21 58 21 representing the margin of error at the 95% IDP out of camp n=188 confidence level. A 95% confidence interval 19 66 14 is a representation of the spread of the data Refugee n=67 around the mean. A smaller confidence 31 How has your ability to meet your basic needs changed since the virus started spreading in the world? 55 13 interval If/when you experience coronavirusindicates less symptoms, what variance do you around think you would do? the Returnee n=166 Go to health provider mean. If repeated samples were drawn, 95% 57 Worsened 30 74 56 14 of those confidence intervals would include Who is your main source of information? // What source do you trust the most? Results in %provider Call health 26 News media the true population proportion. Social media No Yes Don’t know Health providers No change 17 Self−isolation 12 Don' t know People may feel informed, but not about everything. Around half (49%) of respondents National government Nothing 4 still want more information on how to identify symptoms, treatment options, and the UN/NGOs Local government Binary Survey Responses Improved 9 locations of current cases. Family/friends Employer Other 1 Binary Survey Responses Do you have enough information on how to protect Overall, do you believe the measures that have been introduced in your area will reduce the spread of the virus? Don' t want to answer 0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 What do you need more information on inPercent relation to the Coronavirus?* (n=556) Percent yourself from the virus? (n=556) None n = 556 n = 556 Religious groups Overall, do you believe the measures that have Dobeen introduced you have in information enough your area will to reduce protect the spread yourself of the from the virus? virus? What do you need more information on in relation to the coronavirus? Why are these measures difficult for you? Community leaders Community groups Nothing Nothing 49 AreDo youyou have able enough information to separate Fear to protect rumours from of missing yourself facts around thefrom aidvirus? the coronarvirus? 21 36 79 Other 50 40 30 20 10 0 10 20 30 40 50 Percent Don’t know Don' t know 15 Other −40 Are you able to separate rumours from facts around the coronarvirus? −20 26 0 20 40 60 80 n = 556 Percent What measures are most important? // What measures are most difficult? No YesNo Don't know Yes −40 −20 0 20 40 60 80 Identifying symptoms Identifying symptoms 11 Don' t know 13 Binary Survey Responses Percent Hygiene practices No Don't know Yes Staying indoors Treatment 8 11 Are you able to separate rumours from facts around Treatment Lack of enforcement Overall, do you believe the measures that have been introduced in your area will reduce the spread of the virus? Social distancing Wearing mask Access Access to information to information 7 Don' t want Do you have enough information 9 to yourself from the virus? to protect the Coronavirus? (n=556) Wearing gloves 0 10 20 30 40 50 0 10 20 30 40 Leaving home for critical tasks only Percent Percent Are you n= able 556to separate rumours from facts around the coronarvirus? 28 15 57 n = 556 Crisis-affected Whatpeople measures are are Don' t know relying most important? onmeasures // What news, social are most difficult?media, and health professionals Who is your main source of information? // What source do you trust the most? – their most trusted sources overall₄– to get their information on the virus. Females −40 −20 0 20 40 60 Those at risk staying indoors Percent Hygiene practices 49 6 News media 49 40 Other No Don’t know Yes appear to trust news media far more than other sources, while the trust gap between No Don't know Yes Don' t want to answer news media and health providers is narrower among males. 43 29 19 11 Staying indoors Social media 50 40 30 20 10 0 10 20 30 40 50 Percent n = 556 Social distancing Main information source* Who is your main source of information? // What source do you trust the most? 43 7 Trusted information source* Health providers 12 18 Wearing mask 33 10 Don' t know 5 9 News media News media 49 40 Wearing gloves 20 5 National government 3 6 Social media Social media 19 11 60 50 40 30 20 10 0 10 20 30 40 60 50 40 30 20 10 0 10 20 30 40 50 Percent Percent n = 556 n = 556 Health providers Health providers 12 18 News media Don' t know 5 9 National government National government 3 6 60 50 40 30 20 10 0 10 20 30 40 50 Percent n = 556 *Percentages do not total 100 because respondents 2 What measures are most important? // What measures are most difficult? could choose multiple options. UNICEF, “Iraq: COVID-19 situation report no. 2” (28 April–11 May 2020), https://www.unicef.org/ Hygiene practices iraq/media/1151/file/IRAQ%20Country%20Office%20COVID%20Sitrep%20Report%202.pdf. 49 6 3 Health Cluster Iraq, “Health cluster bulletin no. 4” (April 2020), https://www.humanitarianresponse. info/sites/www.humanitarianresponse.info/files/documents/files/iraq_hq_bulletin4_april_2020.pdf. Staying indoors 4 43 29 2 Ibid. Social distancing 43 7
What do you need more information on in relation to the coronavirus? Why are these measures difficult for you? Nothing 49 Fear of missing aid 36 Don' t know 15 Other 26 Behaviour What measures do you find most Identifying symptoms 11 Don' t know 13 important to protect yourself from the Respondents say8 better hygiene, staying indoors, social distancing, and wearing a Treatment Lack of enforcement 11 virus?* (n=556) facemask are the most important measures to prevent exposure to the virus, but they also find complying 7 with these measures difficult. Only 41% say they have no trouble Access to information following guidance around COVID-19. 0 10 20 30 40 50 Don' t want to 0 9 10 49% 20 Increased hygiene practices 30 40 Percent Percent n = 556 n = 556 Most important measures* Most difficult measures* What measures are most important? // What measures are most difficult? 43% Who is your main source of information? // What source do you trust the most? Staying indoors Hygiene practices Hygiene practices 49 6 News media 49 40 Staying indoors Staying indoors 43 29 Social media 43% 19 11 Social distancing Social distancing Social distancing 43 7 Health providers 12 18 Wearing mask Wearing mask 33 10 Don' t know 33% 5 9 Wearing mask Wearing gloves Wearing gloves 20 5 National government 3 6 ? If/when you experience coronavirus symptoms, what do you think you would you do? What measures do you find most difficult 60 50 40 30 20 10 0 10 20 30 40 60 50 40 30 20 10 0 10 20 30 40 50 49 Go to health provider Percent n = 556 55 to take to protect Percent yourself from the n = 556 virus?* (n=556) g in the world? Asked Call healthwhat If/when provider makes you experience compliance If/when you coronavirus experience coronavirus challenging, symptoms, what symptoms, doyouyou what do people think think 34 youdo? you would say wouldthey fear missing out on you do? 29 gender aid or services or going without work. They also say enforcement 49 is lacking. Among gender 41% Go to health provider Go to health provider 14 57 Female female Self−isolation respondents, missing9 out on aid is the primary impeding 55 factor, while male Female No difficulty Male Male 34 respondents Call health provider Nothing are more concerned about 2 Call health provider 29 losing access 26 to jobs. 5 gender These concerns Self−isolation Other 9 are 1 Self−isolation 14 unsurprising given delays in cash distributions and the suspension 12 Female 30% Staying indoors of some2 emergency 1 livelihoods activities due to movement ₅ Male 0 20 40 restrictions. Households 60 Nothing Nothing 4 across Iraq5 are experiencing widespread job Percent losses and challenges in meetingn =their basic1needs. Other ₆ Other 1 556 What precautionary measures do you find most difficult to do to protect yourself from the virus? (max 3) 10% Wearing mask 1 70 80 0 0 10 20 20 30 40 40 50 41 60 60 Why do you find these measures difficult?* None n = 556 Percent Percent (n=556) Why are these measures difficult for you? 28 n = 556 49 n = 556 7% Social distancing What precautionary Staying indoors measures do you find most difficult to do to protect yourself from the virus? (max 3) Fear of missing aidaid Fear of missing 36 33 gender gender 41 None Female Wearing mask 9 49 Female If/when you experience Coronavirus 5 Other** Male Other 8 26 28 Male symptoms, what do you think you would Staying indoors Don' t know Don’t know Don' t know 5 13 33 gender do? (n=556) 9 Wearing mask 10 Female Social distancing 5 3 Male Lack ofLack enforcement of enforcement 11 57% 8 0 20 40 Don' t know 5 Percent Go to health provider Don’t wantDon' to t want to 10 9 n = 556 Social distancing ? (max 3) 50 3 What source 0 do you trust 10 the most for20 information on30 how to protect40 yourself from the virus? 26% Percent n = 556 0 News media 20 Percent 40 33 n = 556 Call health provider Who is your main source of information? // What source do you trust the most? 44 WHO and Health Cluster messaging instructs 23 those who suspect they n = 556 are infected What source providersdo you trust the most for information on how to protect yourself from the virus? 12% Health gender to immediately self-isolate News media and 13 call the government hotline for further support. But 49 40 gender Self-isolation 33 News media close to 60% of respondents 8 tell us they would go to a health facility – contravening Female Social media Social media 44 19 11 Female 13 Male Health providers this advice – even though 10 the primary 23 barrier to health access among returnees Male andDon'IDPst know in the 201913 Multi-Cluster Health providers 8 Needs Assesment (MCNA) was the gender high cost 12 18 Social media of healthcare.₇ Only one-quarter 8 UN/NGOs 13 Don' t know 11 say they would call a health provider – possibly Female 5 9 6 Male because they0 do 10 not know10how. Fewer 20 still would self-isolate. 30 40 50 Don' t know National government 8 3 Percent 6 20 30 40 Why do you find 11 these measures difficult?* (n=556) 60 50 40 30 20 10 0 10 20 30 40 50 n = 556 “There is no doctor, no disinfectant in the UN/NGOs n = 556 6 Why are these measures difficult for you? Percent n = 556 area, there are no masks or gloves.” – Fear 0 Fearofofmissing missing aid aid 10 20 Percent 30 26 40 50 Male returnee in Salah al-Din 44 n = 556 31 Why are these Other** Other measures difficult for you? 19 gender gender Fear of missing aid 11 26 Impact of Ramadan Female Lack Lack of enforcement enforcement 44 Female 16 Male Male 31 13 Other Don’t know Don' t know 8 19 Data was collected during the month of gender Lack of enforcement 11 9 Female Ramadan, during which movement restrictions Don’t want Don' t to want to 16 6 Male were more relaxed. After observing an 0 13 20 40 Don' t know 8 Percent increase in daily confirmed cases, Gol and 9 n = 556 KRG reintroduced strict lockdown measures Don' t want to **Among people 6 who selected “other”, going without work was identified as the primary challenge in complying with measures. on 31 May.₈ This0 will be added as a closed answer option 20 in the next iteration of our survey. 40 Percent 5 n = 556 OCHA, “Iraq: COVID-19 situation report no. 14” (1 June 2020), https://reliefweb.int/sites/reliefweb. int/files/resources/20200601_COVID19_SitRep_No.14%20%281%29.pdf. 6 Ibid. 7 OCHA and REACH, “Iraq Multi-Cluster Needs Assessment (MCNA) VII” (December 2019), available at: *Percentages do not total 100 because respondents 3 https://www.reachresourcecentre.info/country/iraq/cycle/651/#cycle-651. could choose multiple options. 8 OCHA, “Iraq: COVID-19 situation report no. 14” (1 June 2020).
Economic impact COVID-19 has undoubtedly impacted livelihoods. The majority (74%) of respondents tell us that their ability to meet their basic needs has worsened. Curfews, lockdowns, and other measures have reduced economic activity and have particularly impacted vulnerable groups, including casual and low-income workers.₉ People fear losing “Markets are all open and people are their jobs.10 Of the 4,000+ calls the IIC handled between March and June 2020, the going without masks or gloves.” – Male primary COVID-related issue has been loss of employment opportunities.11 IDP in Ninewa How has your ability to meet your basic needs changed since the virus started spreading in the world? (n=556) How has your ability to meet your basic needs changed since the virus started spreading in the world? If/when you experience coronavirus symptoms, what do you think you would do? Go to health provider 57 Worsened Worsened 74 Call health provider 26 No change No change 17 Self−isolation 12 Nothing 4 ImprovedImproved 9 Other 1 0 10 20 30 40 50 60 70 80 0 10 20 30 40 50 60 Percent Percent n = 556 n = 556 What do you need more information on in relation to the coronavirus? Why are these measures difficult for you? Price increases for food and household items compound these worries. An ongoing assessment on market perspectives by the Cash Consortium of Iraq (CCI) reports Nothing 49 Fear of missing aid 36 price increases and shortages in basic food and hygiene items – including lentils, Don' t know 15 Other 26 rice, vegetable oil, and disinfectant – across five governorates.12 More than half of “The curfew affected our livelihood the households in the same study report having been unable to meet their basic needs Identifying symptoms 11 Don' t know 13 and restricted access to our daily, basic within the last week, with 73% saying they have been unable to work.13 Treatment 8 Lack of enforcement 11 needs.” – Female returnee in Anbar Trust Access to information 7 Don' t want to 9 0 10 20 30 40 50 0 10 20 30 40 According to our respondents (90%), preventative measures are working, even Percent n = 556 Percent n = 556 though Binary theyResponses Survey are difficult to follow. People in Salah al-Din feel notably more negatively What measures are most important? // What measures are most difficult? Who is your main source of information? // What source do you trust the most? on this indicator than those in other locations. The measures introduced there were Hygiene practices 49 6 News media 49 40 some of the most stringent, so this may be linked to resentment or discontent with the Staying indoors 43 29 Social media 19 11 obligation to comply, especially during Ramadan. Social distancing 43 7 Health providers 12 18 Overall, do you believe the measures that have been introduced in your area Binary Survey Responses will reduce the spread of the virus? (n=556) 33 10 5 9 Wearing mask Don' t know Wearing gloves 20 5 National government 3 6 10 60 50 40 30 20 90 10 0 10 20 30 40 60 50 40 30 20 10 0 10 20 30 40 50 Percent Percent n = 556 n = 556 −20 0 20 40 60 80 100 Percent No Yes No Don't know Yes Location Anbar n=48 10 90 −20 Dahuk 0 20 40 60 80 n=133 100 Percent 8 92 No Don't know Yes Erbil n=74 9 91 Ninewa n=168 13 87 Salah al-Din n=69 25 75 Sulaymaniyah n=30 3 97 Results in % 9 WFP, “Iraq market monitor report,” Issue 30 (April 2020), https://docs.wfp.org/api/documents/WFP- 0000115988/download/?_ga=2.68168340.440888833.1591881014-1575341897.1591881014 10 Ibid. 11 IIC, “COVID-19 dashboard,” https://app.powerbi.com/view?r=eyJrIjoiNzRmNDc5NjAtN- *Percentages do not total 100 because respondents 2QyMS00NmNlLWE4MDAtYTg0N2FiODM5YWVjIiwidCI6IjViNGExMjM3LWU1MjUtNDIwOS1iN- could choose multiple options. WIyLTY5ZTQ0ZWM4MTk5NiIsImMiOjEwfQ%3D%3D. CCI, “Beneficiary market perspectives – 8th round” (30 March–20 May 2020), https://www. 4 12 humanitarianresponse.info/sites/www.humanitarianresponse.info/files/assessments/19-may_bene- mark_eighth_round_brief.pdf. 13 Ibid.
Methodology Sampling We designed the sampling strategy using the most recent figures (9 April 2020) from the IOM This report presents highlights from the findings of Displacement Tracking Matrix (DTM) returnee and IDP master lists, as well as UNHCR refugee Ground Truth Solutions’ (GTS) telephone surveys with statistics, which provide the following population figures for Iraq: 1,399,170 IDPs, 4,660,404 323 IDPs, 67 refugees, and 166 returnees across six returnees, and 247,440 Syrian refugees. governorates in Iraq in April and May 2020. People in Need (PIN), as defined in the 2020 Humanitarian Response Plan (HRP), were divided Our quantitative citizen survey is conducted in into four strata across the six governorates: returnees, refugees, IDPs living in camps, and IDPs partnership with the Iraq Information Centre (IIC). outside of camps. Not all the strata were sampled in all five governorates. Strata amounting to 1% GTS will collect surveys of approximately 530 or less of the total PIN figures were not included. respondents per round for an initial duration of six The sample frame consisted only of people who recently contacted the IIC and is therefore not months and will target IDPs, refugees, and returnees representative of the Iraqi population in need in the selected governorates. Budget constraints across the six governorates with the highest numbers did not allow for the random approaches commonly used in phone surveys, such as random digit of People in Need (PIN): Anbar, Dahuk, Erbil dialling. Nonetheless, the sample includes different population types across each location. To Ninewa, Salah al-Din, and Sulaymaniyah. generate a more reliable sample, we used oversampling in regions and among population types with small numbers of people in the relevant population. GTS is sharing these findings with humanitarian actors to inform response planning and programme Survey questions adjustments. Over the coming months, we will Ground Truth Solutions designed the survey questions in consultation with the WHO Global Risk provide time-series data to track affected people’s Matrix14 and the Global Humanitarian COVID-19 response plan.15 We identified four metrics perspectives on the COVID-19 response in Iraq in to guide our questions: information, trust, behaviour, and economic impact. We reviewed other more detail. actors’ COVID-19-focused tools and surveys in order to avoid duplicating their efforts and to ensure that our data is useful and actionable. The IIC reviewed the questions and translations to Perception data ensure the survey is appropriate to country-specific realities. Ground Truth Solutions gathers feedback from Participants affected people, using their views, opinions, and perceptions to assess humanitarian responses. All participants were IDPs, returnees, or refugees over the age of 18. Of the total number of Gathering perception data from affected respondents, 37% were female and 63% were male. Respondents were selected from the IIC populations should be viewed as complementary database of recent callers and chosen at random by IIC Information Management (IM) within to other monitoring and performance data. the parameters set by the sample, aiming for a 50:50 gender split. Operators were instructed Collecting feedback is a vital first step in closing to obtain consent twice – first to enable IIC to use the stored contact information, and a second the accountability gap, empowering affected time for participation in the GTS survey. In total, 78 individuals did not give their consent to be populations to be part of the decisions that govern surveyed, and no interviews were conducted with them. All those who participated in our survey their lives, building relationships with communities, were given information on the government hotline and received key messages on COVID-19. and understanding local knowledge. Whenever possible, the process of collecting such feedback Weighting should be followed up with longer-term dialogue The overall mean values presented in this report were estimated based on strata means which between affected communities and aid agencies. Communicating the results of the surveys back to were weighted based on demographic information outlined in the 2020 HRP. For the multiple affected people and triangulating perception data choice questions, the maximum margin of error lies at (+/-) 8.5 percentage points, and between with other information sources is central to our (+/-) 3.76 and 5.94 for the binary questions. Margins of error for breakdowns by status, location, approach in Iraq. and gender are larger than for the overall weighted means. Data points that did not contain the respondent’s governorate or status (IDP, refugee, etc.) were not considered for the weighted analysis. Table 1: Sampling strategy, April 2020 with actual numbers* Governorate IDPs in IDPs out of Returnees Refugees Total camp camp Anbar 54/-1 54/-1 Dahuk 77 34/-1 29/-1 140/-2 Erbil 46/+1 38/+8 84/+9 Ninewa 58 45 71/+6 174/+6 Salah al-Din 31/+1 41/+11 72/+12 Sulaymaniyah 32/+2 32/+2 Total 135 188/+3 166/+16 67/+7 556/+26 14 WHO, “Survey tool and Guidance: rapid, simple, behavioural insights on COVID-19,” Table 1: *+/- represents number of surveys above or below Questionnaire – validation and value of variable and items included (2020), http://www.euro.who. original target sample. int/__data/assets/pdf_file/0007/436705/COVID-19-survey-tool-and-guidance.pdf?ua=1. 15 OCHA, “Global Humanitarian Response Plan COVID-19” (April–December 2020), https://www. 5 unocha.org/sites/unocha/files/Global-Humanitarian-Response-Plan-COVID-19.pdf.
Language of the survey Surveys were conducted in Arabic. Data collection Dates Data collection took place between 26 April and 15 May 2020. Data collection partner The Iraq Information Centre (IIC) is a central accountability mechanism for the humanitarian Author response in Iraq, implemented by UNOPS on behalf of the Humanitarian Country Team (HCT). A Cholpon Ramizova – Senior Programme Analyst team of 22 operators collected the data, with two IIC supervisors managing the process. Challenges and limitations Recommended citation Response rates: Surveys were conducted during the month of Ramadan, during which those Ground Truth Solutions, COVID-19: perceptions of observing the fast are less inclined to pick up their phones. Issues with network connectivity and people in need in Iraq, June 2020 phones being switched off also contributed to lower response rates. Gender balance: Women in the affected population commonly suppose that the male head of For more information about our work in household’s contact information must be provided in order to qualify for assistance. This presented Iraq, please contact Cholpon Ramizova challenges in targeting female respondents when sourcing information from the IIC database. (cholpon@groundtruthsolutions.org) or Meg Additionally, a male member of the household often answered the phone. To mitigate some of Sattler (meg@groundtruthsolutions.org). these challenges, only female operators were instructed to engage with female respondents. Where appropriate, female operators asked to speak to a female member of the household if the call was taken by someone else. 6
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