Refugees at the Kara Tepe camp on the Greek island of Lesbos
As a result of almost two decades of war in the Middle East, millions in the region have fled their homes; either displaced in their own countries or living in camps or makeshift accommodation in neighbouring states. There are 70 million displaced people in the world, and over 80% of the world’s refugees have limited or no access to healthcare and sanitation systems. The war in Syria alone has resulted in over six million Syrians living as refugees in Turkey, Lebanon and Jordon and a further six million displaced within Syria itself.
The impact of coronavirus on those fleeing war and persecution is likely to be catastrophic. Often already malnourished, displaced people find themselves living in the perfect conditions for a virus such as Covid-19 to thrive. Those who currently have access to medical facilities are fearful that if the virus hits they will be the first to be denied treatment as resources become scarce. Hospitals, it is feared, will prioritise citizens over refugees. But for many refugees there is no access to healthcare to begin with.
During the last month aid groups have tried relentlessly to increase the distribution of soap and water to camps, but there is never enough. In Iraq, there are over 1.5 million displaced people and in some camps it is common for tents to hold over 15 people.
Extra hygiene kits are being distributed, but there are too many people and too few kits. Sahar Tawfeeq, a spokesperson for the International Committee of the Red Cross in Iraq, despaired last week that he is asking people without soap or access to water to wash their hands. He commented that the prospect of social distancing is an unimaginable luxury for most: “Social distancing is a privilege,” he said, “there is a hashtag trending: #StayHome. They can’t do that. They don’t have a home to stay in.”
Global restrictions on freedom of movement to contain the virus are currently hampering aid and preventing aid workers from reaching refugees. Most aid agencies have cancelled all but essential programmes as many fear that aid workers themselves could transmit the virus into camps. But essential provisions are still required to reduce the spread of the virus. Supplies such as food, soap, clean water and hygiene kits are now urgently needed. Unless action is taken immediately by the international community vital supplies will run out and displaced people will have nowhere to turn.
To date there have been no reported cases of coronavirus in the camps of Iraq and Syria, but this does not mean that the virus is not already there. All refugee host countries are reporting infections and borders between conflict areas are often extremely porous. Some camps (notably those in the Kurdish area of Iraq and in Jordan) have been sealed off in an attempt to stop the contagion from entering. Although the WHO has managed to send some testing kits to camps in northern Syria, it is unlikely that significant testing will be carried out. A UN spokesperson suggested that it will not be until we hear of thousands upon thousands of deaths that the presence of coronavirus in the camps will be known.
The BBC recently reported that in the areas around Idlib there have been “stark warnings” from doctors, aid workers and the UN “that camps for the displaced in North Western Syria could be devastated by an outbreak of coronavirus.” There is also concern that if the current precarious ceasefire fails to hold, thousands will once again be on the move. In a recent statement the head of the Norwegian Refugee Council, Jan Egeland, commented that without urgent action “there will be carnage when the virus reaches parts of Syria [and] Yemen …. where hospitals have been demolished and health systems have collapsed.”
It is clear that a background of continuous conflict, proxy wars, sanctions and lack of international cooperation make any assistance incredibly difficult. Even if ceasefires hold, the weakness of many states and the lack of infrastructure following years of war, make dealing with a pandemic almost impossible. If refugees and displaced persons are to survive a massive international effort is urgently needed.
Persuading governments to help refugees when they are so preoccupied with the crisis unfolding at home will not be easy. Competition for medical resources is great and some international agencies, such as MSF, are now providing assistance in European countries.
Meanwhile, right-wing politicians (Salvini in Italy and Orbán in Hungary) have already blamed refugees from the Middle East and North Africa for bringing the virus to Europe. Although this is blatant scapegoating, a failure to counter the spread of the virus among the large refugee communities in or near the borders of Europe could result in undermining any success in containing the outbreak. Dr. Hilde Vochten, medical coordinator in Greece for Doctors Without Borders has said, “To this day, we have not seen a credible emergency plan to protect and treat people living [in camps] there in case of an outbreak.”
It is imperative that governments include refugees and displaced persons in their epidemic planning. Refugees must have access to mitigation techniques and information as well as medical treatment. If the international community fails to respond hundreds of thousands will die needlessly and the virus will continue to spread.