The COVID-19 virus that appeared in China in December has caused some of the greatest social and economic disruption ever seen in developed countries outside of wartime. It poses a severe public health risk. As of today, 11,000 people have died, and this number is increasing quickly as the virus spreads exponentially and health systems become overwhelmed with patients. Quarantine and “social distancing” measures have been introduced in most developed countries to slow the spread of COVID-19, forcing people to put their lives on hold.
I am writing this from my flat in Paris, which I am not allowed to leave except to buy food or do brief exercise. I don’t know when it will next be possible to see my family. I am lonely, bored and anxious about the future. But I am also immensely privileged. Here are a few ways. I am living alone in a reasonably spacious flat. I have access to clean water and soap any time I want. That means I can easily follow the WHO advice to avoid social contact and wash my hands frequently. I have access to reliable and regularly updated news media in my own language, so I know how COVID-19 is spreading, what measures are being taken, and what I personally should do. If I need to see a doctor, I can. If I contract COVID-19 and need intensive care, I am likely to get it. Most readers of this article will be in a similar situation.
Living through the pandemic is scary, frustrating and depressing. Many of us will face personal tragedies, lose our jobs or have our education disrupted. But all of us who are following public health advice and waiting in relative physical comfort for it all to be over should remember how many people are in very different circumstances.
There are currently 70.8 million forcibly displaced persons in the world: a record number, more than the entire population of the UK. Many live in crowded camps or inadequate accommodation where it is impossible to self-isolate or to track the spread of the virus. They have limited or no running water to wash their hands, and medical care is severely limited. They are intensely vulnerable to the direct and indirect effects of the COVID-19 pandemic.
The Middle East and Turkey have particularly large populations of refugees and internally displaced persons (IDPs). Host countries’ health systems are threadbare and already overstretched. In the most extreme case, months of bombing have left Idlib – the last rebel-held region of Syria – with 60 hospital beds for 3 million people. For Europeans, this problem also exists close to home. Conditions at our borders are appalling. More than 40,000 asylum seekers are living in camps on the Greek islands. 2,000 more are camping on the Greek/Turkish border, and 7,000 in Bosnia, without electricity or clean water. The notorious Moria camp in Greece, built for 2,200 people, now holds 18,000. Closer still, in northern France, there are also thousands of people living in camps with no way to self-isolate and no access to basic sanitation. It’s shameful that we ever thought this was an acceptable state of affairs, virus or no virus. Will this pandemic change anything?
How will coronavirus affect refugee and IDP camps?
In an online panel discussing coronavirus in crisis zones organised on Thursday by The New Humanitarian, Jeremy Konyndyk of the Center for Global Development stated, “You would have a hard time designing a more dangerous setting for the spread of this disease than an informal IDP settlement.” He highlighted the crowding, the lack of sanitation and the impossibility of effective disease surveillance (case reporting, contact tracing, etc). Other panellists noted the lack of clear public health advice about the measures people can take to avoid infection (e.g. handwashing where possible, avoiding large gatherings) and what the WHO has called an “infodemic” of dangerous misinformation.
In addition to the direct impacts of the virus, displaced persons will be threatened by the disruption of other essential services due to travel bans and staff shortages, and from other infectious diseases which could spread more easily during the crisis (an outbreak of H1N1, or swine flu, is currently ongoing in northern Syria). Many refugees – for example, the large Syrian community in Lebanon – already face significant hostility from host populations. This is being exacerbated by the COVID-19 pandemic and makes it even more difficult for them to access medical care. In Greece, camp residents are completely excluded from the mainstream health system and medical care is provided solely by NGOs. In some cases, violence from locals has forced them to suspend operations.
Yet so far, developed countries have been preoccupied with protecting their own citizens, and have paid little attention to the impact of coronavirus on displaced persons. If their existence is remembered at all, it’s often to speciously blame them from spreading the virus, as far-right leaders Matteo Salvini and Viktor Orbán have tried. For example, the main measure taken in Greece has been to restrict movement in and out of camps for both migrants and visitors, while doing little to address the extremely dangerous conditions inside them. It seems we are pinning our hopes on stopping COVID-19 from spreading there in the first place, knowing how impossible it would be to deal with if it did. This strategy is optimistic beyond belief.
During the panel, Konyndyk said he had already heard rumours of cases in Cox’s Bazar, the group of refugee camps in Bangladesh home to over 800,000 people, and in IDP camps in Iraq. Given the lack of testing capacity, it is likely that there are already more cases than we know about. The exponential spread of coronavirus caught Europe by surprise in the last weeks, but in crowded and dangerous camps it’s likely to be faster still. It is inevitable that coronavirus will spread to the camps and no Western government has yet provided an answer to how they will deal with it.
This will be an immense human tragedy.
This will be an immense human tragedy. Without ICU facilities or even basic medical care, death rates will be much higher than those so far seen in developed countries. Terje Andreas Eikemo, the head of Norway’s Centre for Global Health Inequalities Research, has recently completed a study on health problems in the Greek camps. He suggests that because so many people are already in poor health and suffer from weakened immune systems, we should expect to see a lot more children and young people dying from coronavirus. If that still sounds like something we can afford to forget about while we deal with our own crisis, we should keep in mind that if coronavirus is spreading uncontrollably in refugee camps, it could return to developed countries and wipe out any progress made here. According to UNHCR spokesperson Andrej Mahecic, we know from the 2014 Ebola outbreak and other epidemics that public health measures need to include displaced persons to be effective.
What can we do?
We should be under no illusions: things are likely to get very bad. But that doesn’t mean the situation is hopeless. Humanitarian organisations around the world are still working to disinfect camps, build field hospitals, disseminate public health advice, and help displaced persons access medical services. If we can meet the logistical challenge of increasing testing capacity, it will make a big difference in stopping the spread of the virus. This is particularly important where access to treatment is limited. Another, more hopeful message from the New Humanitarian panel is that the international humanitarian community learned a lot from Ebola about controlling infectious diseases, including in contexts where only low-tech medical equipment is available. It also improved its operational infrastructure following the Ebola crisis. We should be immensely grateful to the staff (most of them local, especially following travel bans) who are doing this difficult and gruelling work, often in dangerous settings. Those of us who can afford to should give them our financial support.
Western governments have spent the last week waving through record-breaking economic rescue packages for businesses. They should also ensure that humanitarian organisations have whatever resources they need to deal with the pandemic.
Western governments have spent the last week waving through record-breaking economic rescue packages for businesses. They should also ensure that humanitarian organisations have whatever resources they need to deal with the pandemic. For context, France announced a €45 billion rescue package for businesses on Tuesday, and an additional €300 billion of loans; the UNHCR is initially appealing for US $33 million for basic supplies to fight coronavirus in refugee camps. But more action is needed. Eikemo is calling for an immediate evacuation of the Greek camps, as are many NGOs, since there is no other way to enable self-isolation and hygiene measures. This is not practically possible in larger refugee camps in the developing world, where humanitarian workers will have to do their best to provide field hospitals and isolation and hygiene facilities within the camps. In Europe, however, residents should be evacuated to safe facilities immediately. Empty hotels in France are already being requisitioned to house homeless people: this approach could also be used more widely.
It is also paramount that refugees – wherever they are living – are not stigmatised, and that our coronavirus response guarantees them equal health provision to the native population. As the Norwegian Refugee Council points out, this is for everyone’s safety, not just theirs: “When we stigmatise migrants or certain people, it risks them hiding symptoms or failing to present for treatment, putting their and everyone else’s health at risk.” This affects refugees and undocumented migrants living in our communities, not only in camps. Many of us living under quarantine are taking part in mutual aid initiatives, such as offering to help self-isolating and vulnerable neighbours with errands: we should explicitly consider how we can extend this support to refugees, undocumented migrants and other marginalised people. The German Quarantäne Helden initiative is setting a good example by making its info and sign-up sheets available in 20 languages.
Ben Parker, host of the New Humanitarian panel, pointed out that Western countries are now experiencing some of the same things people in crisis zones have dealt with for years: fear for one’s life, resource shortages, inadequate healthcare capacity. Unfortunately, that may not give us any more empathy for them. As the crisis leads us to think first and foremost to our own safety and economic security, they may be ignored even more, just as they are in acute danger. Western politicians face intense media scrutiny in their response to the pandemic, and immense public pressure to reassure people and keep them safe. It’s up to us to make it clear to them that we care about the safety of vulnerable displaced persons as well as our own.
The author suggests donating to a reputable humanitarian organisation providing medical and public health programmes to forcibly displaced persons, such as the UNHCR: https://donate.unhcr.org/int/coronavirus-emergency/~my-donation. You could also consider contacting your elected representative to ask them to do whatever they can to ensure your government provides adequate support to displaced persons during the pandemic.