When Covid-19 began shutting down Nilda López’s vital organs, doctors decided that the best chance of saving her and her unborn baby was to put her into a coma.
Six months pregnant, López feared she would not wake up, or that if she did, her baby would not be there.
Her partner had already died of the virus, and doctors predicted that López would too.
But whether due to the expertise of the intensive-care unit’s medical team, López’s will to cling to life for her children – or, as she sees it, divine intervention – doctors were able to save the mother and the baby, María Belén, who was three months premature, with an emergency caesarean.
“It really is a miracle of God,” says López, who lives in a settlement of ramshackle wooden and concrete-block houses in the dusty mountains skirting the northern edge of Lima. “Maybe he didn’t want me to die for my kids, so I could continue fighting for them. They are the ones that really need me.”
The scars remain for López. She has not yet processed the loss of her partner and has to provide for her three children – including 12-year-old twins from a previous marriage – while Covid-19 has impaired her ability to walk.
María Belén, now six months old, is one of an estimated 99,000 children in Peru and 1.6 million globally who have lost a caregiver to Covid-19, according to a study published in the Lancet in July.
Covid-19 orphanhood is a “hidden pandemic”, say researchers. Obscured by the more visible tumult of the pandemic, it is damaging the mental and physical health and economic future of the next generation.
Peru faces a particularly severe crisis. High levels of informal labour, intergenerational housing and poverty have made it fertile ground for the coronavirus. It has recorded 197,000 Covid-19 deaths – the highest number in the world per capita.
By the end of April this year, almost 93,000 Peruvian children – more than one in 100 – had lost a parent, according to the Lancet study.
Experts believe the impact of the pandemic on children has been overlooked as they are usually less badly affected than adults by the illness itself, even though more than 1,000 Peruvian children have died from Covid-19.
Yuri Cutipé, executive director of mental health at Peru’s ministry of health, says: “If we add the loss of a parent or caregiver to the mental health impact of the pandemic in the context of weakening family and community networks and economic shortcomings, mental health throughout the life of this population is likely to be marked by various breakdowns and some complex difficulties.”
Lengthy lockdowns have caused a sharp increase in domestic violence as well as anxiety and depression in children. A third of children in Lima “show a high burden of mental health risk”, according to a study by Peru’s health ministry and Unicef.
Roxana Pingo, coordinator of Save the Children Peru’s (SCP) Covid response programme, says: “Even before you take into account that more than 1,000 children have died from Covid-19 in Peru, they have been extremely affected by depression and anxiety.”
Latin America and the Caribbean had the largest number of children missing school in the world, according to Unicef’s estimates in March. The educational hiatus is accentuating existing chasms in inequality and setting back life prospects for a generation, the UN agency says.
The pandemic has plunged families who have lost a breadwinner into deeper poverty. López’s partner, a taxi driver, brought in the main wage and she cannot continue her job cleaning at a local college due to her difficulties walking. “We don’t know what to do,” she says. “I don’t see any economic opportunities.”
So many Peruvian families have lost a caregiver that the government approved an “orphan pension” in March. It pays caregivers of children who have lost one or both parents 200 Peruvian soles (£35) a month until the child is 18 years old. “It’s a lifeline,” says López.
But the delivery of pension payments has been slow. For now, López is relying solely on the goodwill of strangers and donations from SCP for food, milk and nappies.
It could take up to six months for a child who has lost a parent to start receiving payments and longer for those who have lost both parents, says Pingo. There are also insufficient funds to cover the programme, so children under five are prioritised.
The sluggish, fragmented response is typical of Peru, says Nelly Claux, SCP’s director of programme impact. The country became a model for child rights in Latin America during the 1990s, thanks to its progressive legislation. But the government often struggles to bring ideas conceived in Lima into reality in the sprawling slums on its periphery or the towns and villages dotted across the Andes.
“We have no lack of legal framework. It’s world-leading,” Claux says. “What we don’t have is cooperation, officials who know what they are doing, and funds.”
An official at a Child Defence Centre (Defensoría Municipal del Niño y el Adolescente or Demuna) told López that many parents and caregivers did not know that they were entitled to the pension. Demuna, a state-funded office that supports children’s rights at a local level, has been distributing flyers at its centres, posting notices on Facebook and going from door to door to raise awareness.
By the end of July, more than 11,000 families were receiving the payment, according to Peru’s ministry for women.
The government estimates that 35,000 children are eligible, which is below the Lancet study’s findings of 99,000. Terre des Hommes, a child development agency, puts that number at 70,000.
Children who lose a caregiver are more likely to be institutionalised in an orphanage or care home, and experience broader short- and long-term adverse effects on their health, safety and wellbeing, say experts.
Girls become more vulnerable to sexual exploitation and boys to illegal mine work. “The Peruvian response must be comprehensive, protecting against damage to mental health, education, exploitation and crime,” says Pingo.
“We know that they are out there and that the quicker we get to them, the more we can help. But we just don’t know where they are. We’ve got to find them.”
Early intervention minimises the impact. But first, they have to find the children. All the while, the list keeps growing. In the week to 10 August, more than 500 Covid deaths were recorded, meaning hundreds more children have likely lost a parent or caregiver.