Globally children and adolescents face cumulative crises and there is a need for policy and provision to understand the impact, prepare, prevent and protect. This study will examine the long term ramifications of caregiver death on child resilience and mental health. A group of children from South Africa (9-17 years of age) were recruited into a study examining COVID-19 orphanhood. 420 children were followed up at two time points. One group experienced a COVID-related loss and the second group were also exposed to COVID restrictions, but experienced no loss. Standardised validated measures of mental health, poverty, resilience, risk, family HIV and sociodemographic conditions were gathered. The analysis examines the level of impact, the change over time and then goes on to examine multiple crisis issues. Given the high background HIV rate in this context, the longer term data examines the change over time for the subgroup who were exposed to both COVID orphanhood and HIV in the family. Results document the high mental health impact, the change over time for the unaffected children, with a lingering mental health burden for those experiencing COVID related caregiver death and especially for those affected by multiple crises. The role of social support, good referral mechanisms, poverty alleviation (such as cash grant and social protection) were studied in relation to coping and adaptation. These data will be discussed in relation to multiple crisis and the implications for global action for children.