The COVID-19 pandemic and its effects have now reached every country. There are two major impacts on low-and-middle-income countries. First, the direct health impact, with the peak of the disease in many of the most fragile countries expected at some point in the next 3 to 6 months. Second, the impact of the global economic recession and the domestic measures taken to contain the spread of the virus. This will cause rising unemployment and push more people into extreme poverty, may exacerbate fragility and violent conflict and is projected to cause a doubling in the number of people facing acute (life threatening) food insecurity. The impact of national measures to contain the spread of the virus and of the global recession may be larger than the direct impact of the disease in many countries.