This piece was originally written by Rebecca Root and published in Devex on April 3, 2020.
BELFAST, Northern Ireland — As the COVID-19 pandemic continues to spread across communities, nowhere is immune from its reach. On April 2, Greece became the first country forced to quarantine a refugee camp after 20 residents there tested positive for the virus — raising questions about how the world’s overcrowded, underresourced displacement camps can or should be preparing for an outbreak.
COVID-19 will disproportionately impact refugees and displaced people, said Bob Kitchen, International Rescue Committee’s vice president for emergencies and humanitarian action. The health systems available to these groups — if they exist — would be overwhelmed immediately in the event of an outbreak and fatality rates could surge to the highest seen, he said.
According to The UN Refugee Agency, there are currently 70.8 million people forcibly displaced around the world. Of the 100 countries that had reported cases of the coronavirus as of March 10, 34 had refugee populations of over 20,000 people.
But with social distancing and frequent hand-washing almost impossible to do in camp settings, the aid community is struggling to identify solutions, Kitchen said.
“You can’t close [the camps] off, you can’t stop people coming, and many refugees living in the camps are reliant on leaving the camps to farm and to work to sustain themselves and their families,” he explained. “Movement is turbo-charged in a camp setting where no one has any space.”
Despite the challenges, aid groups around the world are taking steps to prepare camps for a potential outbreak as best they can.
So what does the COVID-19 response look like in a refugee camp?
Social distancing and isolation
A report from Refugees International recommends that, just like elsewhere, donors, host governments, and international aid groups prioritize decongestion and the building of isolation and quarantine capabilities.
Camps need to be following the same procedures as those in urban areas in terms of self-isolation and taking personal protective measures, said Amy Slaughter, chief strategy officer at RefugePoint.
While the confined and often cramped nature of camps can make that more of a challenge, it’s not impossible. Services that attract crowds — such as food distribution and education — could be restructured, while rules on mobility could be implemented. For example, in Jordan’s refugee camps, stipulations on when people can go to the shops, leave their homes, and leave the camp have already been put in place.
“When refugees go and pick up their bread in the morning, they have drawn marks on the ground themselves to define the two-meter mark when they’re queuing,” said Lilly Carlisle, communications specialist at UNHCR Jordan, adding that in the large Azraq and Zaatari camps, UNHCR has already erected designated quarantine and self-isolation shelters.
Health care services
Alongside the physical spaces needed for isolation, “we have to introduce robust infection prevention control mechanisms to triage and isolate suspected cases,” Kitchen said.
Medical staff won’t be able to treat patients in a camp without the right equipment, and now would be the time — before the outbreak takes hold in the camps — to prepare. Maxime Michel, head of humanitarian programs at CARE Canada, explained that CARE is currently working to procure personal protective equipment and hand sanitizer for health care workers and community outreach workers and will get these stocks into camps as soon as possible to prepare for potential market shortages and travel limitations.
“It is imperative that we ensure that these items are available to the most vulnerable communities globally, in order to reduce further risk of COVID-19,” she said.
Staff must also be adequately trained and prepared for how to handle COVID-19. Daniel Wordsworth, CEO at Alight — formerly known as the American Refugee Committee — said it was giving refresher training to health care workers across the 19 countries it operates in on how to deal with highly infectious diseases, as well as ensuring medications and supplies are stocked, and increasing the number of doctors and nurses available for every shift.
Identifying vulnerable populations within the camps prior to the virus hitting could also help to prepare and mitigate the spread.
Access to water, sanitation, hygiene facilities
Hand-washing is one of the key weapons in the fight against COVID-19. As a result, many of the organizations Devex spoke to are focused on ensuring everyone in the camps has access to water, soap, and sanitizer. But one barrier to this is reliable access to clean water.
Michel said that CARE, where feasible, is looking to scale up water supply activities. “This could mean increasing the frequency of water trucking or providing mobile cash or vouchers for the most vulnerable to access private water and other supplies,” she said.
So far, it has purchased water and soap for eight health and stabilization centers — facilities offering last resort nutrition support for babies and toddlers and designed to alleviate pressure on traditional health clinics — in Darfur, Sudan, to ensure that staff, patients, and visitors are able to wash their hands.
Alight has also set up small, portable hand-washing stations that staff can carry and distribute throughout settlements. “We want them to be in as many locations as people are on a particular day: clinics, school, or water points. The challenge really is the volume of water that is needed,” Wordsworth said.
Once there are more hand-washing facilities — both on the perimeters of and within camps — next should come awareness-raising on the importance of hygiene and social distancing, Kitchen said.
Other measures that organizations could take include taking the temperature of staff before they enter a camp, sterilizing vehicles, and disinfecting every facility that delivers services within a camp.
“Particularly with this pandemic, it’s absolutely vital governments, humanitarian organizations, and local officials take special measures to communicate effectively with displaced populations,” said Devon Cone, senior advocate for women and girls at Refugees International.
“We’re having a challenge ourselves in the United States with accurate information. You can only imagine what kind of information the displaced, marginalized communities are getting,” Cone said.
In Nairobi, Slaughter said there had been rumors circulating among the refugee population that the virus was nothing to worry about. Such misinformation has the potential to exacerbate the situation.
According to a Refugees International report, governments must first lift any phone and internet restrictions that are sometimes imposed on camps and can limit communication. Along with aid groups, governments should then create information campaigns that cater to displaced communities and ensure they have up-to-date information. The report recommends working with local civil society and displaced persons groups to ensure messages are communicated in a way that is most likely to resonate.
For RefugePoint, while not enough by itself, using an SMS system to send texts in local languages has been an effective way of sharing information, with feedback from beneficiaries that it had improved awareness of the health messages they contained.
Wordsworth said Alight was monitoring places where people typically gather — like water points and clinics — and going there to provide information on social distancing and hygiene practices.
“We’re using children as the kind of change agents in this setting. So we use songs and we use pamphlets that the kids like — cartoons,” he said, explaining that children then share information with their siblings and parents.
Continuing traditional programs
While pivoting efforts to prevent and treat the disease in refugee settings is important, organizations shouldn’t forget their usual work, Kitchen said. “[COVID-19’s] impact will only be more severe when you overlay it … with conflict, violence, food insecurity, and the vulnerability that comes along with that,” he said.
In Greece, Cone said asylum services had closed, meaning that no new arrivals can seek asylum and ongoing cases can’t be processed.
“All the same needs and issues displaced people face remain and their rights should not be restricted because of the pandemic,” she said.
Digitization could help in offering some services. Carlisle explained that while UNHCR Jordan has had to close its registration and community centers because of the high footfall, it is offering limited services using technology. “We’re trying our best to conduct interviews over the phone and counsel with refugees digitally and virtually,” she said.
But for some organizations, there is a worry that doing both tasks — their usual programming and new preparations for COVID-19 — isn’t feasible.
Ole Solvang, director of partnerships and policy at the Norwegian Refugee Council, said he was concerned about the group’s ability to continue its regular programs to support refugees, especially given restrictions on movement. Wordsworth said Alight was already struggling with the lack of budget.
“We were not set up for this kind of scale-up. And I think the donor community is responding quite slowly to all of this,” he said. While the organization is used to responding to a disaster, Wordsworth explained that never before has one hit all 19 countries it operates in.
Playing a big part in any organization’s ability to ride the wave of COVID-19 and provide support to refugee populations is access to more funding and the inclusion of refugees in government response plans.
Appointing COVID-19 focal points within country programs to coordinate with national health ministries — something CARE is doing — could help ensure refugees and displaced people aren’t left behind in government plans.
Feeding into the United Nations’ global call for $2 billion of funding for the COVID-19 response, UNHCR is also appealing to member states for $255 million to “curb the risk and lessen the impact of COVID-19” on such communities.
While $100 million of the $2 billion is also slated to be put aside for NGOs, Kitchen called the amount “short-sighted and inadequate for what is going to be a frontline NGO-led response in so many of these countries.”
He called upon other donors to allow for flexibility in the way NGOs are working to deliver their projects and protect populations from the virus.
“Keeping the funding flowing to meet the existing huge level of humanitarian need is critical, otherwise we’re just going to be accentuating the impact of the COVID crisis as it spreads,” he said.
Additional reporting by Sara Jerving