“If we don’t get the prevention right, there isn’t the health system to take care of people. And there’s going to be death on an absolutely appalling scale.”eprived.”

– David Miliband, CEO and President of the International Rescue Committee

Crumbling infrastructure. Overcrowded living conditions. No access to healthcare. These are the conditions under which millions of refugees have been weathering the COVID-19 pandemic. 

More than 70 million people worldwide are refugees (Bruce-Lockhart, 2020). Of that, about 6 million live in refugee camps, which are temporary settlements made to assist and protect those who have fled their countries of origin due to violence, political persecution, or both (The UN Refugee Agency, 2021). Life in these camps is anything but comfortable – shelters are overcrowded, facilities are poorly maintained, and effective healthcare is almost impossible to obtain, making them a less-than-ideal place to be during a global health crisis. 

Refugees have long been a neglected group when it comes to global health, and COVID-19 has been no exception. In April of 2020, David Miliband, CEO and President of the International Rescue Committee, warned of “death on an appalling scale” in refugee camps if no action is taken to suppress the virus (Bruce-Lockhart, 2020). Not only would this be a humanitarian disaster of massive proportions – it could potentially put the entire global community at risk.

Why care about refugee health?

Refugee camps are primed to be COVID-19 hotspots. As previously mentioned, the living conditions in most camps are abysmal – many have population densities greater than that of New York City (Bruce-Lockhart, 2020) and healthcare services and health promotion initiatives are minimal. Under such circumstances, an outbreak of COVID-19 would run rampant through the population.

While this clearly puts refugees in a vulnerable position, it is also concerning for the health of other populations. When it comes to suppressing global infectious disease outbreaks, we are only as strong as our weakest link. An outbreak in one part of the world can eventually affect another and evade existing immunity, either through direct transmission of illness or the mutation of new, more contagious forms of the disease. 

To this end, refugee health is everyone’s concern. Without effective measures to prevent and control the spread of COVID-19 in refugee camps, the virus could spread out of control to other parts of the world, prolonging the pandemic and putting everyone’s health at continued risk.  

How do we protect refugees from COVID-19?

Refugee camps are much different from nation-states, and therefore require a different pandemic response. Given their high population densities and minimal financial resources, measures like social distancing and contact tracing – which have been the lynchpin of the COVID-19 response in other parts of the world – are not realistic.

Instead, preventative measures that stop the virus from entering refugee camps in the first place should be prioritized (Bruce-Lockhart, 2020). Basic measures like installing handwashing facilities and creating designated isolation units would help prevent contact with the virus before it has a chance to infect a new host. Greater access to medical resources would also help infected patients recover quickly and reduce the chance of significant spread. 

The most effective preventative measure currently at our disposal is COVID-19 vaccines. Vaccines are an incredibly important public health tool within refugee camps, as they prevent severe infection even if a person is exposed to the virus in a crowded setting. It is therefore imperative that vaccination is carried out among eligible refugees living shoulder-to-shoulder in camps as soon as possible to reduce the risk and severity of an outbreak.

What are some of the challenges to implementing these protective measures?

While we have solutions to address the problem of COVID-19 in refugee camps, implementation is another story. A lack of resources and political will, among other things, have created barriers to fighting COVID-19 in refugee camps.

Finances are, naturally, one of the most prominent struggles. In March 2020, the UN put out an urgent appeal for US$2 billion to combat COVID-19 in low-income countries and conflict zones (Bruce-Lockhart, 2020). But of that amount, just $100 million was allotted to NGOs – the main source of financial support for refugee camps. This is insufficient to compete with wealthy nations in the global marketplace for much-needed supplies like vaccines and ventilators.

But perhaps even more concerning than a lack of finances is a lack of human resources. Pre-pandemic, many NGOs and foreign countries had a strong volunteer presence in refugee camps around the world. But as COVID-19 began to pick up steam in March 2020, many of these workers retreated back to their countries of origin. This means fewer people are available to implement COVID-19 prevention strategies and tend to sick patients in refugee camps, a problem that cannot be solved simply by increasing financial resources. 

With all eyes turned towards COVID-19, and with both financial and human resources spread thin, another problem emerges: other infectious diseases. Outbreaks of infections like cholera, measles, and meningitis are relatively commonplace in refugee camps, but they are typically contained quickly thanks to years of research and robust outbreak response protocols. But as resources are shifted away from these illnesses and towards COVID-19, severe outbreaks become more likely. It is therefore necessary to strike a careful balance between treating the novel coronavirus while also preventing outbreaks of other well-known but equally concerning diseases.

The bottom line

Refugee populations living in camps are highly vulnerable during the COVID-19 pandemic – and yet, they have been consistently side-lined since the beginning of the crisis. Without proper prevention, containment, and treatment measures, refugee camps will become virus hotspots and threaten the safety of neighbouring countries and, indeed, the rest of the global population. 

Refugee health is human health. To overcome this pandemic, we must start paying attention to those living in refugee camps and supply them with the financial and human resources necessary to keep them healthy.

Written by: Claire Borgaonkar, BPAPM (c)