Right now, there are more than 70 million people around the world who have been forcibly displaced – and they are some of the most vulnerable in a global pandemic.
So how are refugees and other displaced people being impacted by, and enduring, the novel coronavirus (COVID-19), and how is Médecins Sans Frontières/Doctors Without Borders (MSF) responding in these communities?
How is coronavirus affecting refugees and other displaced people?
The public health advice we’ve heeded during coronavirus in Australia and New Zealand – to stay at home, physically distance and wash and sanitise our hands and belongings – is near impossible to follow in a refugee camp.
As a refugee, asylum seeker or internally displaced person, you’re often living in a shelter with multiple other families, with little access to running water or soap, let alone to medical care when you get sick.
The conditions for people living in displacement camps are typically overcrowded and unsanitary: an ideal environment for infectious disease to spread very quickly. People who have fled war, violence, disaster or precarious situations have also often faced barriers to getting medical care while on the move and again in the country where they are seeking safety.
This means they may have other inadequately treated health conditions like diabetes or HIV, which can put them at greater risk of developing serious illness or dying if they contract coronavirus.MSF is beginning to treat COVID-19 patients in the Rohingya refugee camps in Bangladesh, while in Al Hol camp in northeast Syria, where there are no cases yet, our staff are bracing for the pandemic to spread.
Yet even as the virus is causing fear and devastation in communities across continents, displaced people are enduring and coping better than we might think. In a Greek island refugee camp, Frederic* told MSF teams how he has applied lessons learnt from his recovery from experiencing torture to help him cope with lockdown and fear of the virus; and in West Africa, a region used to outbreaks of diseases like Lassa fever and Ebola, communities are turning to skills, knowledge and resilience developed from past epidemic responses.
How is MSF responding to coronavirus in refugee and displacement camps?
Let’s take a look at MSF’s coronavirus response and preparations for displaced people in five countries: Bangladesh, Greece, Syria, Iraq, and Tanzania.
In Bangladesh, MSF works in the Cox’s Bazar refugee camps, where nearly one million Rohingya refugees live in densely-packed and unsanitary conditions. Coronavirus has reached the camps and our staff are treating a number of patients with the virus in dedicated isolation wards within our health facilities.
We are also monitoring people who are thought to have COVID-19 and have set up separate waiting areas for patients with symptoms of coronavirus in our clinics.
From MSF’s experience in other infectious disease outbreaks, we know it is essential to reduce people’s fear and prevent rumours by giving people access to correct information. Our outreach teams in Cox’s Bazar are going door-to-door to educate people about COVID-19 and preventing its spread, as well as connecting with local community leaders to share information and build trust.
In the Greek islands, more than 33,000 people live in squalid conditions in tents or containers. To date there have been no reported cases of COVID-19 within any of these centres, but with overcrowding, little clean water and scarce sanitation, our teams are concerned the pandemic would spread quickly in these camps, and are making preparations should cases arise.
In Lesbos MSF is operating an inpatient medical unit outside of Moria camp, where we are testing patients showing symptoms of COVID-19 to provide early detection and isolation of people thought to have the virus, as well as treatment for anyone with mild symptoms. No one has yet tested positive. We have adapted our facilities to ensure protection for our patients and staff, including supporting health workers with correct triage of patients.
In both Samos and Lesbos, we’re scaling up our activities to deliver water and sanitation services in the camps, and we’ve recruited extra staff to increase both medical care and support work. In Samos, this includes an emergency preparedness team working on primary healthcare and screening.
Around 65,400 people—more than 90 per cent of whom are women and children—live in Al-Hol camp, the largest camp for displaced people in northeast Syria. Most of these people were displaced during the nine-year conflict which has devastated the country’s health system. Al-Hol is a closed camp, surrounded by barbed-wire fencing and with heavily-guarded entrances preventing people from coming in or out of the camp. With an average of seven people squeezed into each tent, the camp is very overcrowded.
As the coronavirus spread across the Middle East region, MSF continued to run our inpatient therapeutic feeding centre, wound care program and water and sanitation services in the camp until restrictions were implemented. Of the 24 primary healthcare clinics in the camp, only five are currently operational due to the pandemic restrictions. The consequences of this lack of healthcare are devastating—in just one week in August, seven children under the age of five died.
Since late July, when MSF clinics were allowed to reopen, we have seen more than 1,000 patients. Thankfully some limited services have been able to restart, but it is unclear how long this can be sustained.
“We have just heard about the first confirmed case of COVID-19 among Al-Hol residents,” says Will Turner, MSF Emergency Manager for Syria. “Al-Hol camp is not well prepared for an outbreak of COVID-19. We are worried about what will happen next.”
MSF has been working to provide targeted health awareness messages on how to stop COVID-19 from spreading, but with people living so close to one another some measures, like physical distancing, are impossible to implement.
Our teams have identified 1,900 people across Al-Hol camp who will be particularly vulnerable to COVID-19, many of whom have non-communicable diseases, such as diabetes, hypertension, asthma or heart conditions. We are providing these people with the medicines they need, as well as with soap and other essential items that they can’t go out to buy for themselves.
More than 1.3 million of the Iraqi people who fled their homes due to war—a war that officially ended in 2018—are still displaced, with more than 300,000 living in camps across the country. During the ongoing COVID-19 pandemic, camp residents are among the most vulnerable to the disease, as their living conditions are likely to accelerate the spread of the virus. Those with underlying health conditions still need guaranteed access to healthcare services related to their conditions while being protected from COVID-19 infection.
In Laylan camp, MSF teams have established a triage centre in our existing clinic where patients are screened for any signs or symptoms of COVID-19 and reviewed for any contact with known cases. Where possible, we give patients a three-month supply of their chronic disease medications or family planning treatments to reduce the frequency of their visits to the clinic. We’ve increased our health promotion sessions to the camp residents focusing on COVID-19 awareness, encouraging them to maintain social distancing as much as possible in the crowded surroundings.
Our medical team has put in place measures to continue care in the event that we are not able to be in the camp in person, allowing our staff within the camp to provide medicines under the remote supervision of medical team members.
Nduta camp in western Tanzania is home to 75,000 Burundian refugees who have fled their homes due to violence, and who are the most underfunded refugee group in the world according to the UN Refugee Agency. MSF is the main provider of healthcare in the camp, which has ballooned to double its intended capacity.
People living in Nduta exist with only basic shelter and limited access to water and sanitation, and face regular outbreaks of diseases like malaria that spread rapidly in the overcrowded and unhygienic conditions. As our teams prepare for coronavirus, we are educating the community on hygiene and health practices to bolster their protection.
In the camp, MSF has built triage and isolation areas in each of our four health clinics. More than 250 MSF staff have been trained for the COVID-19 response, including in screening and triaging patients, safe isolation and transportation of people thought to have the virus to the nearby MSF hospital for testing, and use of personal protective equipment. In April, seven patients with suspected coronavirus were admitted to our isolation facilities, and all tested negative for the virus.
What more can be done?
In many places where MSF works, the coronavirus pandemic is being used as an excuse to further marginalise and punish people who are displaced. Many states are preventing people on the move from crossing borders to seek safety, or trapping them in dangerous overcrowded and unhygienic camps.
In the Greek island reception centres, MSF is calling for the most vulnerable people to be immediately evacuated, and for these sites to be decongested. In other regions, we are continuing to advocate for an urgent increase in medical and humanitarian supplies for displaced people, and for states to safeguard the entry of these supplies and staff into countries so that lives can be saved.
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