The hidden damage of COVID-19: The impact of the pandemic on migrants and ethnic minorities

Europe has been particularly affected by the refugee crisis and the Coronavirus Disease 2019 (COVID19) pandemic. Since 2015, over 1.88 million refugees have reached Europe through Mediterranean routes, 25,000 only in 2020 [1].

With the emergence of the COVID-19 pandemic and resulting control measures taken by nearly every government, it promptly became clear that the health of migrants and ethnic minorities was highly threatened [2]. Migrants, refugees, and asylum seekers have been recognized as a vulnerable population during the COVID-19 pandemic due to the precarious conditions they face. For instance, racialized populations are likely to have less access to testing, greater rates of severe disease, higher mortality rates and worse sequelae when they survive the infection[3]. Despite this, except for the UK, European countries do not report COVID-19 statistics according to migrant status or ethnicity. In France, immigrants constitute 10% of the population, most commonly originating from Africa (47%). Statistics show that foreign-born persons had on average double the rates of all-cause mortality between March and April 2020, when contrasted with the native population. Some of these numbers were due to COVID-19, however, the exact percentage is still unknown[3].

The report of elevated rates of health problems, particularly infectious diseases, among migrant or racialized populations involves some risks, the largest likely to be that of stigmatization. Lack of contextualization can lead to the racialized portrayal of behaviour instead of envisioning and perceiving the structural and economic inequities and the structural racism of society and of health systems that are the cornerstone of those disparities. Changes must start from the upstream discrepancies in exposure and processes contributing to susceptibility, which include social determining factors of health and disease, rather than focusing only on assessing elements late in the pathways of disease, morbidity, and mortality[3].

The Global Society on Migration, Ethnicity, Race and Health conducted, in connection with the European Public Health Association, an online conference on October 12, 2020, to examine the impact of the COVID-19 pandemic on migrants and ethnic minorities, as well as the role of racism[2]. The main conclusions were that (1) the pandemic exacerbated pre-existing structural challenges facing migrants across the world; (2) in many countries, migrants were omitted from public health responses; (3) migrants frequently experience crowded and unhealthy living environments; (4) there was an exacerbation of previously existing xenophobic and racist behaviours; (5) there was a disproportionate impact of COVID-19 among ethnic minorities; (6) a high age-adjusted COVID-19 mortality rate among ethnic/racial minorities was described, being at least three times higher than Whites among African Americans, Latinos and Indigenous American; (7) it has been reported exceptionally high levels of inequalities, by almost every indicator, in Latin America in general, and in Brazil in particular[2].

The epitome of the prejudice seen among migrants was witnessed in Greece's Eastern Aegean Islands, where by September 2020, a fire largely destroyed the Moria camp on Lesvos, leaving 13,000 people homeless. This led to the construction of a new camp where most people were rehoused (often unwillingly) in overcrowded conditions, with inadequate sanitation and limited access to healthcare, and the number of cases of COVID-19 continued to rise. Regarding Portugal, there were, since the beginning of the pandemics, at least six COVID-19 outbreaks among immigrant communities. Despite the description of inhuman housing conditions, the lack of sensitivity with which the media communicated this information resulted in the increase of the stigmatization of these populations, inclusively with the report of actively discriminatory behaviours. Moreover, little interest was deposited in the study of the vulnerability factors or the strategies to improve the health care of immigrants.

Recently published guidelines from the United Nations Refugee Agency (UNHCR) aim to raise awareness on mental health and psychosocial support activities in refugees, asylum seekers, and migrants. In the light of the COVID-19 pandemic, the UNHCR has aimed to address these emerging psychosocial and mental factors, as well as to ensure these fragile populations receive appropriate care. Implementation of telemental health care services, helplines in different languages, capacity building of front-line workers in Psychological First Aid, and raising awareness and sensitization form the core of their community-based approach[1,4].

It has been recommended that (1) interventions in these populations should be socially, culturally, religiously, and linguistically appropriate when designing promotion, awareness, and information platforms (taking into account the diverse background of cultures, religions, and languages may help increase access to these interventions and promotion programmes); (2) low digital literacy and reduced access to technological means should be considered a top-barrier to overcome when designing telemental health care services; (3) besides being provided with multiple languages, helplines should be proactive when aiming to provide psychological relief to these populations; and (4) governments and institutions should proactively address these population’ working, regulatory, migratory, health, and economic conditions to reduce the psychosocial burden these may represent on them[4].

The COVID-19 pandemic may be an opportunity for a renewed public discussion about the relevance of collecting and analysing data on migrant status, ethnicity, and health in Europe, and a time to move forward regarding politically and socially acceptable indicators to be used in public health research and surveillance. The impact of the conditions where migrants live must be - now, more than ever - addressed and measures must be implemented to ensure the physical and mental health of these persons.