Spatial Clusters: Covid in the Camps

In late March, UN Secretary-General Antonio Guterres issued an appeal for $2 billion to protect against COVID-19 and mitigate the spread of the virus to refugee camps. His plea reflects the fragility of public health systems in the settlements, where overcrowding, underlying health concerns, and a dearth of medical supplies, testing kits, heath care workers, and financial resources could present a doomsday scenario in the case of an outbreak. Should COVID-19 infiltrate the camps, communal water stations and World Food Program distribution centers for rations would become “spatial clusters,” transforming places where all refugees go to collect essential resources into "hotspots" where the spread of the virus is accelerated.

Guterres notably included a cris de cœur to armed groups to cease attacks that are at the root of the refugee crisis, and instead work together to fight the virus. His appeal has predictably fallen on deaf ears, as violence in Central America, Syria, Afghanistan, Myanmar, and South Sudan continues unabated. Hate, after all, never bows to reason.

A sombre truth we have learned about COVID-19 is that although the virus spreads indiscriminately, it is the poor, the hungry, the stateless, the homeless, the elderly, and the sick who are at greatest risk. Sadly, the characteristics that define the most vulnerable populations among us are the same characteristics that define the 70+ million refugees and internally-displaced peoples (IDPs) living in UN-administered camps and settlements across the globe.

In France and Belgium, where COVID-19 cases are spiking, emergency services workers in the Calais refugee camp reported that the number of infections rose from two to nine in a matter of days. Humanitarian organizations working in regions that have yet to experience widespread contagion are seeing the first signs of a coming wave.

“Confirmed cases of COVID-19 have been found in some refugee camps and communities with a large number of IDPs in Afghanistan, Iran, Gaza, and Greece,” says Dr. Paul Fean, Global Roving Youth Advisor with the Norwegian Refugee Council (NRC) based in Jordan. “Refugees and IDPs are often susceptible to COVID-19 due to high (internal) mobility, living in overcrowded conditions, and lack of clean water, sanitation and decent healthcare.”

Potential flash-points include Mediterranean entry points to Europe (Greece and Italy), Syrian civil war refugee host countries (Turkey and Jordan), relative safe havens from internal African conflict (Uganda, Ethiopia, Kenya), the borderlands of Afghanistan and Pakistan, the frontiers of Bangladesh and Myanmar, and the war zones of Yemen. Should COVID-19 reach these camps, the scope of tragedy would be incalculable.

In advance of the wave, Alight (formerly known as the American Refugee Committee) is providing refresher courses on hygiene to health care workers, ensuring that critical supplies are stocked and increasing the number of doctors and nurses on shift. They are developing lightweight portable hand washing stations that staff can carry and distribute around the camps. Daniel Wordsworth, CEO at Alight, says the volume of water that is needed as their biggest challenge. “We want them to be in as many locations as people are on a particular day: clinics, school, or water points.”

Richard Akim, a South Sudanese filmmaker and refugee living in Bidi Bidi, Uganda, the world’s second largest refugee settlement, says there have been no reported cases in the camp, but neither are there any testing locations. The Office of the Prime Minister and the UN High Commission on Refugees (UNHRC) are relying on isolation—which Bidi Bidi has in abundance—to combat the spread of the virus, issuing an order to cut off all roads leading to the camp and cease public transportation.

In lieu of help from the outside world, Akim says that refugees are taking matters into their own hands. “People in the camps are aware of the global COVID-19 crisis. They are socially distancing and staying home to keep themselves safe.” The most significant change to people’s daily lives, he says, is that World Food Program (WFP) rations have been decreased from 12 to 8kg per month.

Fear and isolation have given rise to a more perverse threat to public health in Bidi Bidi: the spread of misinformation. “A lot of refugees are getting news and updates from people who have access to the internet in the camps,” says Akim. But there is a dangerous rumor circulating that COVID-19 can be cured by “drinking tea without sugar and having sex,” which sadly calls to mind the tragic falsehoods spread in the wake of the AIDS epidemic.

The Norweigan Refugee Council is working with the UNHCR and other NGOs to disseminate guidance provided by the World Health Organization (WHO) and “conduct awareness campaigns to share information on hygiene practices.” But Dr. Fean explains it’s challenging to disseminate information effectively in cross-cultural settings because “refugee populations need adequate and correct information in their own mother tongue.”

Perhaps the most functional venue for mitigating the spread of misinformation is schools, where students receive critical information and guidance and pass it on to family members. From Dr. Fean’s experience, young refugees and IDPs tend to have strong networks and keen interest to support others. They are often the ones “sharing information about how to stay safe from COVID-19 through social media and with friends and family.” Unfortunately, the benefits of keeping schools open has thus far been outweighed by the potential risks.

“Most countries affected by COVID-19 have closed educational institutions, which means that refugees and IDPs are also out of school,” says Dr. Fean. “NRC’s country teams are adapting educational programs for children and youth so that learning can continue through remote teaching using the internet, radio, or self-learning. We are also considering how youth can have positive roles in their communities, such as through the involvement of youth participants in hygiene awareness campaigns.”

Another sombre truth, though, is that very little can be done to attenuate the spread of COVID-19 in the camps other than enhanced hygiene, hand washing, and social distancing, all of which feels feeble and woefully inadequate in the face of a growing pandemic.

The impending crisis is forcing humanitarian aid organizations to find creative, sometimes unprecedented, solutions. “In Jordan, for example,” says Dr. Fean, “NRC, in partnership with UNHCR, has completed cash distributions in Azraq camp so that Syrian refugees can purchase cooking gas, diapers, and sanitary items. NRC also contributed to distribution of hygiene kits to refugees residing in Azraq camp. A group of NRC staff are staying in Azraq camp so they can continue to support refugees while travel restrictions have been put in place across Jordan.”

Although heroic efforts are being undertaken by health care workers across the world, the pandemic has disproportionately affected wealthy countries, leading some to call COVID-19 "the great equalizer.” It is not. Wealth, access to medical care, and social security render no one immune to the virus. But those who walk the earth utterly defenseless, whose very survival requires another’s act of mercy, who have no home in which to sequester themselves or refrigerator to store their food, will suffer unimaginably should COVID-19 reach their tent cities.

Amid the fear there are glimmers of hope. Refugee health care workers from Venezuela, Iraq, and Syria are being called to the front lines to fight against the virus in their host countries—England, Colombia, Iran, and the US among them. Others are taking on the monumental task of educating and caring for the most at-risk populations within the camps. COVID-19 is not the great equalizer, but it may be the great moralizer. When all is said and done, we may learn that only by protecting the most vulnerable can we protect ourselves.