Coronavirus: How humanitarian organisations are working to control the outbreak in refugee camps

On 25 March, in an open letter from the United Nations, the world’s most senior emergencies, health and development officials stated that help for the world’s weakest countries was ‘in everyone’s interest to stop the virus from spreading unchecked, destroying lives and economies, and continuing to circle around the world.’

The UN Secretary-General António Guterres, together with three senior officials, launched a global humanitarian response plan requiring US $2 billion dollars to fund the fight against Covid-19 in the world’s most vulnerable countries. The plan, coordinated by the UN Office for the Coordination of Humanitarian Affairs (OCHA), identified three key areas in which G-20 countries needed to take action:

1. As the first priority, G-20 leaders were urged to work with the World Health Organisation (WHO) to suppress the virus by banning tariffs, quotas or non-tariff measures; removing restrictions on cross border trade that affect the deployment of medical equipment; and waiving sanctions imposed on countries to ensure access to food, essential health supplies and Covid-19 medical support.

2. The Secretary-General called for the G-20 countries to offer critical support for developing countries that will feel the economic fallout of Covid-19 most acutely. A large-scale coordinated stimulus package of trillions of dollars was urged to target the direct provision of resources to businesses, workers and households in countries unable to do so alone.

3. ‘The current crisis is a stark reminder of humanity’s common fate and of the need for upfront investments to reduce the catastrophic downstream risks of the pandemic,’ said Guterres in an accompanying press release. With this reminder came the third pillar of the plan: that more inclusive and sustainable models of development are key to recovering from economic turmoil.

The measures outlined in the global humanitarian response plan will form the backbone of mitigation efforts to control the health and economic impacts of the disease. They will also aim to ensure that populations who rely on humanitarian aid can continue to access food, healthcare and other aid services. Nevertheless, grave concerns remain, chief among them the arrival of Covid-19 into migrant camps, or displacement sites, throughout the world. According to the Internal Displacement Monitoring Centre, 41.3 million people are currently internally displaced as a result of conflict, with 25.9 million refugees living in situations of displacement globally. The most vulnerable of these people often end up in camps, home to dense populations with strained healthcare systems and frail food security.

There were 33.4 million new displacements in 2019. Figure courtesy of the International Displacement Monitoring Centre (IDMC)

Internal displacement reached an all time high in 2019, with 33.4 million new internal displacements across 145 countries and territories. That year, Syria, the Democratic Republic of the Congo, Ethiopia, Burkina Faso and Afghanistan recorded the highest number of displacements due to conflict and violence.

Five countries with the most new displacements by conflict and violence in 2019. Figure courtesy of the Internal Displacement Monitoring Centre (IDMC)

Cases of Covid-19 have begun to emerge in countries that face a severe displacement crisis, such as Greece. Long before these reports emerged, the International Organization for Migration (IOM) reported concerns about the impact of Covid-19 on the health of people living and working in camps.

‘While much of the world’s population are urged to stay at home – millions of displaced people, forcibly displaced from their homes and habitual residences, live in crowded, unsanitary conditions in camps, informal settlements, or in peri-urban areas, with limited or very poor access to health services,’ said Cecilia Jimenez-Damary, the Special Rapporteur on the Human Rights of Internally Displaced People in a statement. ‘Recommendations to mitigate transmission of Covid-19, including social distancing and isolation measures, therefore remain challenging or even impossible for many displaced people, heightening the risk for Covid-19 to take root and spread among already extremely vulnerable communities,’ she added.

Two camps and one hotel sheltering migrants and refugees in Greece have seen their first confirmed cases of Covid-19. As of Friday 1 May, 202 migrants tested positive for Covid-19 in three sites managed by IOM across Greece. The first cases occurred in April in the Ritsona camp, where 2,700 migrants and refugees currently live.

‘Everyone is at risk. Migrants and refugees in Greece are susceptible to the virus as much as the Greek community. This development confirms the fact that this fast-moving virus does not discriminate and can affect both migrant and local communities,’ said Gianluca Rocco, chief of IOM’s Mission in Greece in a press release detailing the first 23 migrants who tested positive for Covid-19.

In response to the global outbreak, the IOM promptly issued operational guidance on how camp managers could control the outbreak in displacement camps. Improvement of hygiene facilities; training staff to screen for symptoms; securing and expanding living spaces; adapting migrant lifestyles to meet social distancing measures; and stocking of personal protective equipment (PPE) have formed the frontline of IOM’s response. ‘Based on decades of experience in camp management and migration health, we see the arrival of Covid-19 in camps as an inevitability, not a possibility, and have been preparing with this in mind,’ said IOM’s Director General, António Vitorino in March. IOM’s operational guidance should allow humanitarian aid workers to streamline funds from the UN’s global humanitarian response plan into action.

In Greece’s main camps, including the Ritsona and Malakasa camp, IOM staff have been distributing disinfectant products and educating people on transmission prevention techniques. Staff have also been provided with PPE. When cases emerge, camp residents are quickly put into quarantine while those infected are transferred to isolation spaces. IOM staff have also been providing food baskets and hygiene kits to residents. Remote telecommunication channels have also been opened, allowing residents to report incidents of gender-based violence, mental distress or other emergencies.

IOM staff prepare to distribute food baskets and core relief items to all refugees and migrants in Ritsona camp in Greece. Image courtesy of the International Organization for Migration (IOM). Photo: Muse Mohammed

IOM is attempting to coordinate responses with managed displacement camps across the world. Cox’s Bazar in Bangladesh houses more than 850,000 Rohingya refugees – the world’s most populous camp for displaced persons. Across April, IOM trained 600 staff to recognise the symptoms of Covid-19, while a parallel arm of 260 staff have been trained on managing suspected and confirmed cases. Two-hundred isolation and treatment centres are being built.

As of 4 May, 10,413 cases were confirmed in Bangladesh, and 21 cases were identified in Cox’s Bazar district, outside of the camps. Refugees within the camps themselves are threatened by overcrowding, limited sanitation facilities and an overburdened health system. According to the Humanitarian Action Working Group, low nutrition levels and limited access to health care may have had a damaging impact on the immunity levels of Rohingya refugees, making them more vulnerable to the virus. While action to tackle the pandemic is accelerating, residents are concerned. Rohingya refugee Saidul Hoque, speaking with the UN Refugee Agency, said ‘if Covid-19 arrives in the camp, it will be devastating.’ 

Elderly Rohingya refugees at Ali Khali camp, Teknaf in Cox’s Bazar being trained in hygienic standards to help prevent Covid-19. Image courtesy of the International Organization for Migration (IOM). Photo: Muse Mohammed

In the north-east of Nigeria, Borno state is the epicentre of a humanitarian crisis, where some 1.8 million people have been displaced, and 7.9 million are in need of humanitarian assistance. In coordination with health partners, IOM is constructing 90 quarantine shelters across the Borno, Adamawa and Yobe states to decrease the risk of Covid-19 spreading in densely populated camps.

There are concerns that the most serious effects of Covid-19 will trickle down from global restrictions on logistics. With restrictions in place across the world, the ability to deliver humanitarian assistance to those who rely on aid for their survival is strained.

The UN World Food Programme (WFP) is setting up a logistics backbone, but it claims that more funding is needed to establish the necessary transport hubs, charter vessels and provide aircraft for cargo, health workers and other essential staff. In an open letter released on 19 April, the UNOCHA placed an urgent call to fund the emergency supply system, requesting US $350 million dollars to enable rapid scale-up of logistics services to countries in-need.

As the virus’s grip continues to tighten around the crucial logistics channels that supply humanitarian aid to the world’s most vulnerable, the UN has called for unity in its global address: ‘Every human being, in every nation around the world, is facing the same mortal threat. Every step that speeds delivery, saves lives. The Covid-19 pandemic has presented all of humanity with a unique challenge, and only a uniquely global response can halt its forward march.’