COVID-19 could have more dire consequences in refugee camps than anywhere else in the world. The combination of a high density of people with limited access to water and sanitation and rudimentary healthcare provide the perfect conditions for transmission of any infectious disease.
Truelove et al, researchers at Johns Hopkins Bloomberg School of Public Health, modelled the likely scenario for a COVID-19 outbreak in the Kutupalong camp in Bangladesh, the world’s largest refugee camp and home to more than 600,000 Rohingya refugees from neighbouring Myanmar. (1)
Their findings were stark and predicted that a single infectious person could precipitate a large scale outbreak affecting up to 98% of people within the first year. (2)
The UNHCR (The United Nations High Commissioner for Refugees) has been warning for some time that with 26 million refugees around the world, and around 85 per cent of them in low income countries, host nations will not have the capacity to cope with COVID-19 outbreaks in the camps. Many of these nations are struggling to provide adequate healthcare to their indigenous populations.
However, it is not just outbreaks within camps that are of concern. Travel restrictions and lockdowns across countries has made it even harder for refugees to flee to places of safety. Since April 2020 Rohingya refugees have been stranded on boats in the Bay of Bengal unable to gain entry to countries in the region. Meanwhile some refugees wanting to return home to try and escape potential infection in the camps have likewise been unable to travel safely. The UNHCR reports that people in the camps are aware of how to try and avoid catching COVID-19 but the reality is measures such as social distancing, repeated hand washing and self-isolating are not possible. (3)
It is virtually impossible to find data for the true picture of COVID-19 in the camps. A lack of testing combined with a paucity of healthcare mean that the graphs and tables which are updated daily for countries worldwide simply don’t exist for the refugee camps. (4)
Various agencies and charities are actively working in refugee camps around the world and their reports are the main source of information.
ReliefWeb is a humanitarian information service provided by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). It collates information from more than 4,000 sources, including humanitarian agencies at the international and local levels, governments, think-tanks and research institutions, and the media. Its website has a dedicated COVID-19 hub with pieces on all 63 countries being helped by the Global Humanitarian Response Plan (GHRP) for COVID-19 which was launched on 25 March 2020. (5)
I would recommend their site if you wish to find out more about a country or camp not highlighted below. Click here for their latest COVID-19 updates.
Cox’s Bazaar Refugee Camps, Bangladesh
The UNHCR and WHO (World Health Organisation) have worked together training 1,400 Rohingya refugees to become community health workers. They go through the camps explaining about COVID-19 and are described as “the bridge” between the camp communities and health facilities. As fellow camp dwellers, they are able to gain people’s trust in a way outsiders wouldn’t. One worker will visit up to 150 families each week.
The first COVID-19 cases in the camps were diagnosed in May 2020. As of 21 July 2020 a total of 62 cases had been recorded. While at first glance a seemingly reassuringly low number the reality is that many are frightened to get tested fearing they will be attacked or sent away and separated from their families so the true number of cases is masked. Dispelling such fears is one of the prime goals of the community health workers.
The UNHCR and MSF (Médecins Sans Frontières) have built two isolation and treatment centres with 200 beds for the camp communities. The aim is to expand this to around 2000 beds. They are also co-ordinating the delivery of food and other essential items to families with symptoms of COVID-19 to enable them to isolate at home. (6) (7) (8)
Syria
MSF is active across the north eastern part of Syria where transmission rates of COVID-19 are high. As well as helping renovate isolation wards in various hospitals in the region, MSF are working in Al Hol Camp identifying those most at risk from COVID-19. The camp is home to 65,000 people, primarily women and children. Cases of COVID-19 have been confirmed in the camp. (9)
In addition, 5.5 million Syrian people are living as refugees in Egypt, Iraq, Jordan, Lebanon and Turkey. The UNHCR is attempting to offer financial support to these refugees but is hampered by a lack of funds, a situation made worse by the withdrawal of US funding. (10)
Palestinian Territories
There have been 7,800 confirmed cases and around 800 deaths among Palestinian refugees across the West Bank, Gaza, Syria, Lenanon and Jordan according to UNRWA (The United Nations Relief and Works Agency for Palestine Refugees in the Near East).
UNRWA’s commissioner-general Philippe Lazzarini said “These communities are economically vulnerable and politically and socially marginalised. Many live hand-to-mouth and are daily-paid workers. We now regularly hear from Palestine refugees that they would rather catch corona than die of hunger. Their vulnerability is very acute.” (11)
Greece
The first death from COVID-19 of a refugee in Greece was reported on 27 September 2020. The 61-year-old man lived in the refugee camp of Malakasa north of Athens and died in hospital in Athens. (12)
The largest camp in Greece, Moria camp on the island of Lesbos, had reported 17 confirmed cases amongst its 12,000 inhabitants in early September and was placed under quarantine. (13)
On 9 September 2020 the camp was destroyed by fire and the people left homeless. By this time there were 35 known COVID-19 cases. A new camp has been opened but many have refused to enter it fearing a continuation of dire living conditions. (14)
Tanzania
MSF is the only healthcare provider in Nduta refugee camp in the north-west of the country which hosts 75,000 refugees from neighbouring Burundi. MSF have built isolation areas within the camp and have ten beds with access to oxygen concentrators. (A machine that concentrates oxygen from the air, a more efficient and cost effective way to provide oxygen therapy than using oxygen cylinders.)
MSF is also working within the camp to educate the community on COVID-19 and ways to reduce infection risk. (8)
Sudan
Humanitarian workers in Sudan are reporting large numbers of unexplained deaths in the refugee camps of Darfur in the west of the country. Charities working within the camps say 10 to 15 people a week are dying compared to the normal death rate of 5 to 10 people a month.
The camps are home to 1.6 million people and healthcare workers are also describing patients presenting with fever, difficulty breathing and a loss of taste and smell, cardinal symptoms of COVID-19. With only two COVID-19 testing centres for the whole of the country it is impossible to carry out mass testing. (15)
In Conclusion
Refugees are the world’s most vulnerable population. At the beginning of the COVID-19 pandemic some described the virus as being an “equaliser” that would remove disparities between rich and poor as it swept around the world. In fact the opposite is true - the virus is pushing the world’s most vulnerable people into even greater levels of inequality, poverty and sickness. (16)
(2) Truelove S, Abrahim O, Altare C, Lauer SA, Grantz KH, Azman AS, et al. (2020) The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study. PLoS Med 17(6): e1003144. https://doi.org/10.1371/journal.pmed.1003144
(12) https://www.middleeastmonitor.com/20200928-greece-first-refugee-dies-of-covid-19-since-the-pandemic/
