Fighting the COVID-19 pandemic: Refugees among the most vulnerable

“Not just science, kindness is going to help,” says Dr Mukesh Kapila

As the number of people tested positive for COVID-19 breaches the 165,000 mark across the world, it is important to work towards protecting refugees and other displaced populations. These people are not just at risk of losing their lives to persecution, conflict and climate emergencies but also are at particular risk of catching the coronavirus. Often, these populations who end up in the margins are forgotten about, especially in times of crises.

According to the office of the United Nations High Commissioner for Refugees, over 70 million people are forcibly displaced. Of those, over 20 million are refugees among whom 84% are hosted by low and middle-income countries that do not have the best water, sanitation and health facilities. In these testing times for global health security, and in the interest of reducing health inequities, refugees’ right to health is essential to a rights-based health system.

Dr Mukesh Kapila, who has held various high-level positions in the UK’s Department for International Development (DFID), the United Nations system and was also Director for Emergency Response at the WHO, told DH that access to quality healthcare is dependent on the country where a refugee is located. In some countries such as the UK, if registered as a refugee, they receive the same quality of healthcare as regular citizens whereas in others that may not be the case. Based on his visit to Cox’s Bazar in Bangladesh where many Rohingyas have sought refuge, he said that healthcare may in fact be better than the healthcare dispensed for the regular population in the country thanks to several international aid agencies. However, he added that for those unregistered, “it is a lottery” and for mobile groups of refugees they would be at the “bottom of the queue” as identification, diagnosis and treatment would become harder.

When asked about who would provide financial protection to these populations and who would pay for their healthcare, Dr Kapila said, “In a country with a strong public health system, in the interest of the country, they would have to look after everyone. In addition, international NGOs, medical charities and other organisations would have to take care of vulnerable populations.”

The stigma of having COVID-19 and isolating the people affected intersects with already prevalent layers of stigma and discrimination that is inherent to the status of a refugee and other forcibly displaced persons. Adding to these concerns is the risk of migrant populations carrying the coronavirus and putting the host population at risk, this may only inflate the discimination faced by displaced populations.

With borders being closed, travel being banned between many countries, there is a growing atmosphere of panic and fear. Measures taken by several countries may make the situation harder for healthcare workers to help displaced populations. The public health expert said that it is a “pandemic of fear”. He said based on past experience, “Closing down boundaries, banning travel, locking down countries won’t help. The virus doesn’t respect boundaries. These measures may in fact have a negative impact, damage will be caused economically and socially. Banning exports of supplies with neighbours, may make matters worse for workers helping refugees and displaced populations.”

In the past, several epidemics such as SARS, Ebola, influenza have wreaked havoc in many parts of the world. West Africa, the epicentre of the Ebola outbreak has faced many issues as a result of the crisis and still reels under the sombre shadows of history. Dr Kapila claimed that more people died of non-ebola causes than of Ebola due to panic, fear and draconian measures in West Africa. He further added that many countries were locked down and these economies have not recovered yet.

Lessons from the past can help overcome the coronavirus pandemic among refugee societies. “Firstly, honesty, openness and transparency is essential, we need the right facts and figures, secondly, education and information need to be given to vulnerable populations. Epidemics and pandemics start with communities and end at the community level, voluntary cooperation is necessary, closing schools, travel bans are not going to work, it is not going to work out in the long term.” said Dr Kapila.

“We need more labs, infrastructure, protective equipment and reporting systems. It doesn’t matter where the pandemic started, we need to follow basic methods of contact tracing, isolation and we must track everyone. Containment can’t work for very long. Everybody must have access to soap, water to practice good personal hygiene. Life must carry on.” he added.

Based on his experience at the UN, the WHO and other multilateral organisations, he said, “Not just science, kindness is going to help. How can we lock up the elderly just because they are vulnerable? The world is becoming increasingly intolerant and heavier restrictions on civil liberties will not help in such a situation.”