COVID-19 and refugee camps

Dear Editor,

COVID-19 emerges at a watershed period along with unprecedented global displacement and refugee crises that may worsen the global pandemic's course. Currently, there are 41.3 million internally displaced persons (IDPs) and 25.9 million refugees worldwide, mostly in low- and middle-income countries. Unfortunately, COVID-19 cases are now confirmed in dozens of refugee camps globally [1]. Besides, until September 2020, 7 COVID-19 deaths were recorded in Rohingya refugee camps in Bangladesh and one death was reported in an afghan refugee in the Malakasa camp in Greece. In the Middle-East, accumulating cases are progressively documented among Palestinian and Syrian refugees in neighboring host countries. As of October 12, there were 1479 and 146 cases as well as 40 and 2 COVID-19 deaths in Palestinian refugee camps in Lebanon and Jordan, respectively [2]. Likewise, 92 Syrian refugees living in urban areas in Lebanon and 120 others working for a local waste management company, tested positive until July, while 5 cases were recently reported in “Za'atari” and “Azraq” camps in Jordan. These data pose exacerbated fears that it will be only a matter of time before the virus devastates refugee settlements.

Three factors fuel the risk of catastrophic COVID-19 outbreaks among displaced populations. First is their dire living conditions in overcrowded shelters with inadequate water, sanitation, and hygiene (WASH) measures. These render physical distancing, self-isolation, and infection prevention and control practices almost impossible. Notably, overcrowding is related to greater and severe COVID-19 outbreaks as reported in close-contact settings during mass gatherings [3].

Second, severe COVID-19 cases needing intensive care unit (ICU) admission are predominantly people with non-communicable diseases (NCDs). Due to their precarious conditions, displaced populations are prone to this type of diseases. For example, a high burden of NCDs, mainly cardiovascular diseases, was documented in Syrian refugees in bordering countries [4]. These facts suggest that COVID-19 will be more challenging among displaced populations, especially given the limitation of oxygen supply and delivery systems in resource-limited settings, and their absence in refugee camps.

Third, international movement restrictions and lockdowns curtail the ability of aid workers to reach refugees [5], thus hindering the aid community's ability to address their needs. Moreover, suspension of refugee resettlement travel contributes to the accumulation of the most vulnerable refugees in highly overcrowded “hotspots” that form ideal COVID-19 breeding grounds [6].

In Lebanon, the situation may be worse than in other host countries. While the local health capabilities required to face the pandemic are sparing, the country is witnessing a rapid and sharp increase in COVID-19 cases. Currently, according to the ministry of health, more than 10% of the daily COVID-19 tests are positive, and ICU beds in public hospitals are near full capacity. Furthermore, several main hospitals and half of the clinics were severely damaged by the August 4 blast that devastated the Lebanese capital Beirut. To compound the dystopia, Lebanon is presently suffering from a catastrophic financial crisis that markedly weakens the country's health and socio-economic systems and undermines their capacity to provide the necessary services to citizens, and to a larger extent, refugees.

COVID-19 outbreaks in congested humanitarian settings will be hard to contain and might lead to panic once they start. Thus, rapid preparedness and response actions are urgently needed before the virus ravages refugee settlements. Governments, with local and international stakeholders, should therefore cover a range of interventions. The first step is to prioritize the refugees' access to accurate information on the virus, its transmission, and protective measures. The second is to sustain the provision of WASH services to settlements and enable aid workers to reach them. Third, increasing surveillance among IDPs and refugees on COVID-19 is needed to quickly identify cases and close contacts. Isolation centers for suspected or confirmed cases should be also established in camps. Fourth, there is a paramount need to ensure the availability of laboratory materials for affordable COVID-19 testing, ICU beds, and ventilators for IDPs and refugees. Fifth, successful implementation of large-scale COVID-19 vaccination can save millions of lives, especially among vulnerable populations. Consequently, refugees must be not left behind, and health authorities should ensure an equitable non-discriminatory provision of vaccinations for them. Finally, beyond health, COVID-19 is worsening the refugees’ economic, social, and educational circumstances. These matters must also be taken into account when planning interventions.

With movement restrictions, economic slowdown, funding reprogramming, and domestic consumption of resources, COVID-19 will deeply impact short- and long-term humanitarian programs. Furthermore, several factors may hinder anti-COVID-19 measures during interventions in refugee settings. These include language/cultural barriers, lack of cooperation for fear of stigmatization, and the high risk of contagion for frontline workers. However, this ongoing pandemic is threatening all humankind and the golden rule to win is to protect everyone. Uncontainable COVID-19 cases that can disseminate among IDPs and refugees are, therefore, a global threat requiring orchestrated international interventions.

Author contributions

MBI and MH conceptualized and designed the study. MBI, MO, RR, and FD undertook literature research and data collection and analysis. MBI, MO, and RR drafted the manuscript, and all authors reviewed and approved it.

Funding

None.

Declaration of competing interest

The authors declare that there are no conflicts of interest.