Hand-washing is a luxury in Yemen, where many communities lack access to soap & clean water. Photography: Oxfam/Pablo Tosco
In places such as refugee camps, where people are forced to live in overcrowded and unhygienic dwellings as part of a containment policy (with little to no access to sanitization like soap or clean water) the threat of Covid-19 is frighteningly real.
In Greece, the Ritsona refugee camp was placed under quarantine late last week after 20 of its residents were diagnosed with coronavirus, while camps across the Middle East are woefully unprepared for a global pandemic. Lebanon alone has the largest number of refugees per capita in the world, while Yemen and Syria are already beset by malnutrition, cholera and an insufficient supply of clean water and healthcare facilities. About 50% of internally displaced people in Yemen have no access to clean water, says the United Nations High Commissioner for Refugees (UNHCR). All of these countries were already struggling economically and have extremely weak health systems.
Elsewhere in the world it is arguably worse. The Rohingya refugee camp at Cox’s Bazar in Bangladesh, where the population density is 40,000 people per square kilometer, is plagued by dysentery, cholera, typhoid and malnutrition. In Gaza, where there are more than 5,000 people per square kilometer, and fewer than 70 intensive care beds for a population of two million, there are already 10 confirmed cases of Covid-19.
For displaced people living in camps or crowded urban areas, social distancing and washing your hands for 20 seconds is almost impossible
“The pandemic risks being catastrophic, not just in refugee camps, but also in host communities and in all countries across the region already beset by conflict, and could shatter already fragile health and protection systems and broken economies,” says Dr Hadeel Qazzaz, Oxfam’s regional gender co-ordinator for the Middle East and North Africa. “For refugees, and other displaced people living in camps or crowded urban areas with high population density and little basic infrastructure, lockdown, social distancing and washing your hands for 20 seconds is almost impossible. These conditions create a tinderbox for transmission to millions of already vulnerable people.”
Oxfam has distributed soap to 8,252 Syrian refugees in Lebanon, provided 200 beds to quarantine centers in Gaza, and is repairing and maintaining public water taps in the territory. In Jordan’s Zaatari refugee camp, which is home to 76,645 Syrian refugees, it has scaled up its hand-washing and hygiene awareness sessions to 2,000 children and is using social media to engage and connect with refugees under the country’s new curfew measures.
In Lebanon and Jordan, where an estimated three million Syrians live as refugees, the threat is not only to crowded camps, but to informal tented settlements and to some suburbs of Beirut and other big cities where large numbers of vulnerable communities live. “These people are at higher risk of being affected because of the crowded settings they live in, the weaker average health status and the increased number of barriers many face in accessing health care in Lebanon,” says Caline Rehayem, deputy medical coordinator for Médecins Sans Frontières’ (MSF) in Lebanon. “They are already living under harsh socioeconomic and poor infrastructural conditions. How can we ask people to protect themselves when they don’t have access to water or soap? Or to stay at home and self-isolate if they share a room with 10 other people?”
The highest concentrations of refugees in Bekaa is in the Zahle district, where the town of Bar Elias is located. A town of 30,000 Lebanese people and 32,000 registered Syrian refugees. At least 11,000 refugees live in informal tented settlements here.
In Iraq, where 1.5 million people remain internally displaced, the threat is also to hospitals, healthcare facilities and rehabilitation centers, the majority of which are chronically under resourced. As a result, the International Committee of the Red Cross (ICRC) has redirected funds to the Iraqi Red Crescent Society’s Covid-19 response and is also supporting 18 primary health care centers, 14 physical rehabilitation centers and two hospitals by providing soap and disinfectant, personal protective equipment and non-contact infrared thermometers. A further 27 places of detention, housing around 45,000 detainees, are also being supported with donations of preventive materials.
Refugees in Zaatari Camp line up to collect their bread amid the implementation of Covid-19 precaution measures. Marks on the ground have been made by community leaders to ensure that social distancing is adhered to.
“From my experience with Ebola, what is important is the involvement and the commitment of the community to follow the rules,” says Eve Charbonneau, health co-ordinator for the ICRC’s Iraq delegation. “Because if they do not, this is what makes it difficult to fight the disease. So we have to make sure that the population is well informed, the community’s involved, and that the discussion through the health authorities is clear and transparent and the measures are respected.”
“The battle to fight this virus requires that no one is left behind, including refugees. If anyone is excluded efforts to beat this vicious virus will fail
Yet none of this will be enough unless international assistance is forthcoming. Oxfam says it will need €100 million to fund its coronavirus response plan and has called for a package of nearly US$160 billion in immediate debt cancellation and aid for the world’s poorest countries. The UN has also issued a $2 billion appeal to fight coronavirus in the most vulnerable countries.
“The battle to fight this virus requires that no one is left behind, including refugees,” says Rula Amin, UNHCR’s senior communications advisor for the Middle East and North Africa. “If anyone is excluded, efforts to beat this vicious virus will fail as it will only rebound and spread again. The outbreak is a global challenge that must be addressed through international solidarity and cooperation. In order to effectively combat any public health emergency, everyone – including refugees, asylum-seekers and migrants – should be included in Covid-19 national preparedness and response plans, and be able to access health facilities and services in a non-discriminatory manner.”
A young boy is being attended to by doctors in Zaatari camp, during the Covid-19 crisis
In a bid to alleviate the threat posed to refugees and displaced people, Oxfam has called for “immediate ceasefires and the stopping of all forms of military aggression in Yemen, Iraq, Syria and the Occupied Palestinian Territory”, which Qazzaz says is “essential to ensure that these communities can survive the Corona crisis”. She continues, “We should all work together to support these communities and countries, to avoid a wave of the Covid-19 pandemic that would be devastating. Refugees and displaced people cannot face wars and pandemic simultaneously.”
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