Refugees and displaced highly vulnerable to COVID-19

The first confirmed case of COVID-19 on Lesbos last week sparked fears for the people stuck in Greek island camps where overcrowded conditions, lack of adequate sanitation and severely limited medical care create “the perfect storm” for an outbreak, warned Médicins Sans Frontières.

In the Middle East, where healthcare services are weak or stretched, there are similar fears of the virus spreading quickly through overcrowded refugee and IDP camps with poor sanitation facilities. 

To prevent the spread of COVID-19, refugee camps in Jordan were recently placed on lockdown, while in Iraqi Kurdistan stringent measures on camp re-entry were adopted. “Once you have contagion in camps, it’s going to get difficult,” says Karl Schembri, regional media advisor in the Middle East for the Norwegian Refugee Council (NRC).

The rapidly changing situation poses an enormous challenge for humanitarian workers, who face increasing restrictions to their movements every day. While necessary to limit exposure and prevent the spread of the virus, this makes the challenge of looking after the most vulnerable even greater, says Schembri.

Lebanon, Iraq, Jordan, Palestine and Turkey all have confirmed cases of COVID-19. But while all host large refugee and/or IDP populations, so far no cases have been confirmed in any of the region’s camps. The World Health Organization (WHO) ranks the risk of COVID-19 to Syria as “very high”, though the government insists there are no confirmed cases in the country. 

However, not a lot of testing is being done, so the number of undetected cases in host countries is likely much higher, says Rula Amin, senior communications advisor for the UN Refugee Agency’s (UNHCR) Middle East and North Africa bureau. 

“Once you have contagion in camps, it’s going to get difficult.” Karl Schembri

Across the region, the infrastructure of camps and their standards vary greatly, with some better equipped than others in water, hygiene and sanitation, says Schembri. “Of particular concern are the informal settlements in Lebanon, which have extremely poor conditions, and people have very limited access to medical and health services.”

In refugee and IDP camps, recommended measures to prevent the spread of COVID-19, such as self-isolation and social distancing, are impossible because of crowded living situations, says Abdul Rahman Bizri, an infectious disease specialist at the American University of Beirut, Lebanon. Furthermore, water access varies across camps and settlements, and for those with limited access, the basic preventative measure of frequent hand washing is a serious challenge.  

On the ground, UNHCR, NRC and WHO have ramped up the distribution of clean water, soap and hand sanitizer to camps in Jordan, Lebanon and Iraq, and are working to share prevention information. Wael Hatahit, emergency team lead at WHO’s Iraq Country Office, says WHO and the Iraqi health authorities have been active in trying to educate people about COVID-19 since the outbreak in Wuhan, and thinks most refugees and IDPs in the country have a fair understanding of how the virus is spread.

“The main issue is the limited capacity of the healthcare systems in the host countries.” Rula Amin. 

Awareness is especially critical for refugees and IDPs, as the circumstances they have had to endure and the conditions they live in make them particularly vulnerable to COVID-19. In addition to underlying health conditions, anything that affects the immune system, such as chronic stress, inadequate nutrition, lack of sleep, drinking and smoking, might have a serious outcome on the course of the disease, explains Hatahit.

While responsibility to care for refugees in times of a pandemic falls on the government of the host country, humanitarian workers are concerned about what might happen to refugees if hospitals become overwhelmed with their own citizens. “The main issue is the limited capacity of the healthcare systems in the host countries,” says Amin. “In situations like this, where doctors have to prioritise, will the refugees get prioritised as well? As we’ve seen in Italy…we will probably come to that point.”

Amin says UNHCR is pushing to ensure the full inclusion of refugees in national preparedness, prevention and response measures to the COVID-19 pandemic across the region.

A failure to step up services to help refugees and displaced persons would not only endanger their health, but could see them become further targets of discrimination by host communities. Humanitarian workers must strike a balance between advocating for the most vulnerable without whipping up the backlash against them, explains Amin. 

To prevent Iraq’s overstretched healthcare system from being overwhelmed, WHO is focusing on prevention, to try and limit the number of cases. 

UNHCR and NRC are also extremely concerned about the spread of the virus to active war zones in Syria and Yemen, where the healthcare systems and infrastructure have been decimated by the conflict, and would not be able to handle an outbreak. 

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