Refugee and migrant health in the COVID-19 response

In a continued effort to curb the spread of coronavirus disease 2019 (COVID-19), countries have been tightening borders and putting travel restrictions in place. These actions have affected refugees and migrants worldwide. The International Organization for Migration and UNHCR announced on March 10, 2020, that resettlement travel for refugees will be temporarily suspended, although the agencies have appealed to states to ensure emergency cases are exempted.¹ The COVID-19 pandemic has prompted some countries to take steps towards further reducing population movement that affects humanitarian corridors around the world. At the same time, there could be cases of refoulement with asylum seekers being returned to their countries of origin, where they are at risk of persecution and in an apparent breach of international law. As of March 29, 2020, WHO reported 146 countries and territories with cases of COVID-19 from local transmission of severe acute respiratory syndrome coronavirus 2, many of which have large refugee populations.²

Search and rescue operations in the central Mediterranean, where more than 16 000 migrants have died since 2015,³ have been suspended due to logistical difficulties caused by COVID-19. The few search and rescue operations conducted before the COVID-19 nationwide lockdowns led to the immediate quarantine of migrants in reception centres. These measures were taken even though there was no confirmed case of COVID-19 in Africa at that time. In fact, some refugees and migrants are travelling from countries not yet substantially affected by COVID-19 and entering countries with increasing numbers of COVID-19 cases.

Measures to respond to the COVID-19 pandemic are a focus of communities in countries, but preparedness plans should consider refugees and migrants and their needs. Evidence shows that this vulnerable population has a low risk of transmitting communicable diseases to host populations in general.⁴ However, refugees and migrants are potentially at increased risk of contracting diseases, including COVID-19, because they typically live in overcrowded conditions without access to basic sanitation. The ability to access health-care services in humanitarian settings is usually compromised and exacerbated by shortages of medicines and lack of health-care facilities. Moreover, refugees typically face administrative, financial, legal, and language barriers to access the health system.⁴

Conditions in refugee camps are concerning. Many people who have been affected by humanitarian crises live in camps or camp-like settings in host countries. These camps usually provide inadequate and overcrowded living arrangements that present a severe health risk to inhabitants and host populations. The absence of basic amenities, such as clean running water and soap, insufficient medical personnel presence, and poor access to adequate health information are major problems in these settings.

Basic public health measures, such as social distancing, proper hand hygiene, and self-isolation are thus not possible or extremely difficult to implement in refugee camps. If no immediate measures to improve conditions are put in place, the concern about an outbreak of COVID-19 in the camps cannot be overstated. Site-specific epidemiological risk assessments must be done to determine the extent of the risk of COVID-19 introduction and transmission in such settlements, together with case management protocols and rapid deployment of outbreak response teams if needed.

Migrants and refugees are particularly vulnerable to the impact of COVID-19 in the wider community. They are over-represented among the homeless population in most member states—a growing trend in EU-15 and border and transit countries.⁵ Living conditions for homeless refugees and migrants can undermine the ability to follow public health advice, including basic hygiene measures, quarantine, or self-isolation, because many people are in close contact and gather in large groups. Furthermore, international migrant workers and refugees can be affected by income loss, health-care insecurity, and the ramifications that come with postponement of decisions on their legal status or reduction of employment, legal, and administrative services. There is also scarce culturally and linguistically accessible information about COVID-19 and how to protect oneself and others, which further increases risks to refugees and migrants as well as host populations.

© 2020 Alkis Konstantinidis/Reuters

Additionally, states of emergency and lockdowns to deal with the pandemic have affected refugee and migrant volunteer community service provision for this population group.

An inclusive approach to refugee and migrant health that leaves no one behind during the COVID-19 pandemic should guide our public health efforts. As governments tighten border controls and implement other measures in response to COVID-19, they need to consider the impacts on refugees and migrants and ensure that such actions do not prevent people from accessing safety, health-care services, and information.

There must be no forced returns and refoulement justified by or based on fears or suspicion of COVID-19 transmission, especially because there is estimated to be low risk of transmitting communicable disease from refugee and migrant populations to host populations in the WHO European region.⁴ Yet migrants and refugees are often stigmatised and unjustly discriminated against for spreading disease and such unacceptable attitudes further risk wider public health outcomes, including for host populations, since refugees and migrants could be fearful to seek treatment or disclose symptoms.⁶

Refugees and migrants must be included in national public health systems, with no risk of financial or legal consequences for them. This approach is of the utmost importance, as there can be no public health without refugee and migrant health.