COVID-19 and refugee camps: the “perfect” storm

COVID-19 and refugee camps: the “perfect” storm
A woman carries her child as she crosses a wooden bridge in the refugee camp of Moria, on the island of Lesbos, November 26. Photo credit: AFP

2/03/20
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A COVID-19 outbreak in refugee camps would have catastrophic consequences. Prof. Karl Blanchet shares his growing concerns and calls for the creation of an academic taskforce to help governments apply the latest evidence on COVID-19 and make decisions using evidence-based information.

In February 2020, I was working in the refugee camps of Kakuma in Norther Kenya and Azrak, in Eastern Jordan. At that time, COVID-19 was still perceived as one of the many coronaviruses already known by the scientific community and was considered largely as a South East Asia outbreak. In March, just a month later, the World Health Organisation has declared a pandemic. COVID-19 has reached more than 30 countries with 125,000 cases confirmed and 4,600 deaths (as recorded on 12 March 2020). 

While scientists and doctors worldwide are still studying this novel virus, it is a fact that containment situations increase the risk and pace of transmission. Refugee camps and slums are exactly the type of overcrowded environment where the virus would spread very rapidly. In such settings, people live in close proximity and do not have the option to follow preventive guidelines recommending to maintain “social distancing”. Additionally, hygienic conditions in formal and informal settlements are very poor, and too often people do not have access to clean water or soap, let alone protective masks and other sanitation products.

There are therefore serious concerns that refugee populations may be at very high risk, especially people already vulnerable and living in refugee camps such as in Jordan, Kenya, Cox’s Bazar or refugee camps in Greece. Urgent humanitarian action is needed.

To add an extra layer of complexity to an already challenging scenario, many refugee camps are located in countries with health systems that will struggle to screen, test and contain the epidemic. In Greece, for example, I anticipate that authorities and their international partners will experience great challenges in case an outbreak happened in a refugee camp. In fact, this may already be happening in Lesbos, where a case of COVID-19 on the island has been confirmed. 

More importantly, I also have concerns that access for refugees to testing facilities and healthcare services will not be prioritized by governments. The latter will certainly give priority to host populations, especially in an environment of constrained resources. I am also worried that many governments, in particular the most populist ones, will exploit the situation to deter refugee populations or even force them out, even though it is proven that the infection does not come from refugees. Unjustified and arbitrary quarantine measures vis-à-vis refugee populations may be witnessed in the next few days and weeks. This will raise important ethical and equity issues.

Beyond this more political and ethical considerations, there are also crucial practical problems that need to be rapidly addressed to protect refugee populations. The disease surveillance system currently in use in refugee camps does not include any respiratory infections. This will need to be quickly added to the current protocols. It is also important that all national and international staff working inside camps respect the correct procedures in order not to infect refugees, and of course need support to ensure they maintain their own health status to continue delivering care to those in need. It is urgent to make sure that refugee populations are given the possibility to protect themselves from any infection.

There is no doubt that COVID-19 will mobilise a lot of resources, which might mean rechanneling some of the resources from humanitarian crises. Join me in calling upon policymakers and donors to ensure that countries have enough funding and resources to make sure that these populations at risk receive appropriate protection and care. I also would like to advocate for the creation of an academic taskforce to help governments apply the latest evidence on COVID-19 and apply this science for their decisions.