Blog Post: Refugees and the global response to Covid-19

There are currently, according to UNHCR figures (25.03.2020), a staggering 70.8 million forcibly displaced people worldwide of which 25.9 million, half of whom are under the age of 18, have crossed international borders and are therefore designated as refugees. The 1951 Refugee Convention theoretically safeguards the right to health for refugees that includes access to public health services and essential medicine equivalent to the level of citizens of host countries. Practically, this has often proven difficult – for multiscale socio-political reasons. Fundamentally, the international system is based on a system of exclusion, in which peoples of the world are organized into individual sovereign nation states whose political responsibility lies first with one’s own citizens. The moral and, under international law, legal duty to safeguard refugee populations, is all too often neglected. Mostly, ‘denizens’ or stateless peoples are partially or wholly excluded from public considerations, care and services. This is especially the case with hosting countries that are themselves under severe duress such as post-conflict and impoverished states including Sudan (1.1m refugees), Uganda (1.2m), Pakistan (1.4m). Together with Turkey (3.7m) and Germany (1.1.m), these states are currently the biggest hosts to refugees. Although international and nongovernmental organizations, with the UNHCR at the forefront, work to safeguard the rights and well-being of refugees, they still must operate in a world partitioned into sovereign nation-states. In times of crisis such as reemerging conflict and disaster situations including a pandemic, hosting governments are overwhelmed by national priorities that do not usually include refugee well-being.

Given the global political status-quo, many refugees in the world must live in health challenged circumstances, often in unsanitary and overcrowded conditions in which pathogens can easily proliferate. They have limited to no access to appropriate healthcare, including preventive care and vaccinations, thus making them also more susceptible to communicable diseases. The public health situation in refugee camps is regularly challenging. The majority of refugees live in camps in host countries neighboring their countries of origin. Countries hosting large numbers of refugees such as Jordan, Libya, Bangladesh and Turkey have weak health systems and limited to no resources to allocate to refugee camps – resources urgently required to sustain a minimum level of health of a physically and mentally vulnerable population. Refugees forced to live outside of official camps must oft also negotiate their existence in a situation of legal limbo without civil and human rights, hiding away in impoverished conditions, facing persecution and discrimination. 

A European tragedy. Consider the case of Libyan detention centers. Many African asylum-seekers currently trying to cross the Mediterranean into the European Union are detained or stranded in detention centers in post-conflict Libya after Libya’s deal with the EU to prevent further migrant passage. Detention center conditions have been described as hellish. Migrants lack food, sunlight and water. They are exposed, becoming victims of sexual exploitation and assault, of forced labor and torture, and of human trafficking. In these conditions, any kind of infection spreads quickly and relentlessly. A Covid-19 outbreak here, where diseased conditions prevail and basic healthcare is not given, and where organizations like UNHCR have already announced the suspension of some activities due to the ongoing pandemic, a humanitarian tragedy of a magnitude is almost certain. Consider also the case of the largest refugee camp in the world, Cox’s Bazar in Bangladesh, currently hosting a majority of ethnic Rohingya refugees fleeing from sustained violent conditions in neighboring Myanmar. Cox’s Bazaar reported its first case of Covid-19 this week. Here too, unsafe water, crowded and run-down living conditions, and where social distancing is an impossibility, provide the ideal breeding ground for outbreaks of infectious diseases to widen. Should a Covid-19 outbreak ensue in this camp, refugees would have to be referred to local hospitals, quickly overwhelming the Pakistani health system.

In the current Covid-19 pandemic situation, national governments are pressed to demonstrate their care for the health of their own citizens. Yet, with the health needs of refugees largely neglected, Covd-19 may well also spread largely unnoticed in refugee populations, in refugee camps and outside of camps where refugees live integrated in host urban spaces, widening the pandemic even further. Thus, there is an urgent need for an organized global Covid-19 response to protect not only refugees but the world as a whole.