COVID-19 : Refugees-Migrants
COVID-19 does not discriminate; nor should our response
Statement by the United Nations Network on Migration
20 March 2020 [Editor’s text bolding]
As the world confronts the COVID-19 pandemic, the United Nations Network on Migration salutes the immense efforts to date to combat this crisis and urges that all – including migrants regardless of migratory status – are included in efforts to mitigate and roll back this illness’s impact. To that end, migrants must be seen as both potential victims and as an integral part of any effective public health response. It is particularly important that all authorities make every effort to confront xenophobia, including where migrants and others are subject to discrimination or violence linked to the origin and spreading of the pandemic. COVID-19 does not discriminate, and nor should our response, if it is to succeed.
A comprehensive approach to this crisis has implications for national and local public health, housing, and economic policies. Migrants and people on the move face the same health threats from COVID-19 as host populations but may face particular vulnerabilities due to the circumstances of their journey and the poor living and working conditions in which they can find themselves. Migrants too often face needless obstacles in accessing health care. Inaccessibility of services; language and cultural barriers; cost; a lack of migrant-inclusive health policies; legal, regulatory and practical barriers to health care all play a part in this, as does, in too many instances, prejudice. If a migrant fears deportation, family separation or detention, they may well be less willing to access health care or provide information on their health status.
Too often, millions – including migrants – are denied the right to an adequate standard of living, including housing, food, water and sanitation, and find little choice but to live in overcrowded, unhygienic conditions, with limited or no access to health services. This is a combination which increases communities’ and migrants’ vulnerability to disease, and massively hinders the ability of authorities to effectively put in place the early testing, diagnostics and care vital for effective comprehensive public health measures. It is crucial that government authorities at national and local levels take the measures necessary to protect the health of all those living in unsafe conditions and the most vulnerable regardless of status. Measures should include adequate prevention, testing, and treatment; continued and increased access to emergency shelters for homeless people without barriers related to immigration status; and suspensions of evictions.
While many countries have chosen to tighten controls at their borders in an effort to contain the spread of COVID-19, it is critical that such measures be implemented in a non-discriminatory manner, in line with international law, and prioritizing the protection of the most vulnerable. Enforcement policies and practices, including forced return and immigration detention, must be carried out in accordance with human rights obligations and may need to be adjusted to ensure they are compatible with effective public health strategies and maintain adequate conditions. In this regard, it is vital that any limitations on freedom of movement do not unduly affect human rights and the right to seek asylum, and that restrictions are applied in a proportionate and non-discriminatory way.
For our response to this pandemic to be effective, we must overcome the current barriers to adequate, affordable, truly universal, health coverage. The inclusion of all migrants and marginalized groups is necessary in all aspects of the response to COVID-19, whether we are looking at prevention, detection, or equitable access to treatment, care or containment measures, or safe conditions of work. Risk communication messages on how to protect everyone need to engage with all communities and be available in languages and media formats that are understandable and accessible by all.
Immigration detention centers are too often overcrowded and lack adequate healthcare and sanitation. In order to avoid a rapid spread of the virus, States should put in place the necessary measures to protect the health of migrants in these facilities and urgently establish non-custodial alternatives to detention as a measure to mitigate these risks.
Further, it is important that migrants are included in measures that are being introduced to mitigate the economic downturn caused by COVID-19. Migrants and their families are often part of marginalized and vulnerable groups that are already experiencing economic hardship as a result of containment measures. The impact of the closing down of activities due to the pandemic may particularly affect low-wage workers and those in the informal sector, including youth and women, who are often in precarious or temporary jobs and lack access to social protection, paid sick leave, or lost earnings support. Domestic workers may be more acutely affected by social distancing measures and isolation in employers` homes, and subject to discrimination.
Specific attention is needed for those workers many of whom are migrants, who continue ensuring indispensable services for people during the pandemic, such as those in the care economy and, the service industry and the gig economy, to ensure safeguards of their entitlements and fundamental rights at work. We welcome measures taken by Member States to extend working visas and other appropriate steps to alleviate constraints faced by migrant workers and their families due to the business closures, and to ensure the continuing protection of their international human rights, including their labour rights.
Only with an inclusive approach, truly leaving no-one behind, will we all be able to overcome this global crisis of unprecedented magnitude and proportions.
COVID-19 and refugee camps: the “perfect” storm
A COVID-19 outbreak in refugee camps would have catastrophic consequences. Prof. Karl Blanchet shares his growing concerns and calls for the creation of an academic taskforce to help governments apply the latest evidence on COVID-19 and make decisions using evidence-based information.
Karl Blanchet, CERAH Director; Professor, Faculty of Medicine, University of Geneva (UNIGE)
In February 2020, I was working in the refugee camps of Kakuma in Norther Kenya and Azrak, in Eastern Jordan. At that time, COVID-19 was still perceived as one of the many coronaviruses already known by the scientific community and was considered largely as a South East Asia outbreak. In March, just a month later, the World Health Organisation has declared a pandemic. COVID-19 has reached more than 30 countries with 125,000 cases confirmed and 4,600 deaths (as recorded on 12 March 2020).
While scientists and doctors worldwide are still studying this novel virus, it is a fact that containment situations increase the risk and pace of transmission. Refugee camps and slums are exactly the type of overcrowded environment where the virus would spread very rapidly. In such settings, people live in close proximity and do not have the option to follow preventive guidelines recommending to maintain “social distancing”. Additionally, hygienic conditions in formal and informal settlements are very poor, and too often people do not have access to clean water or soap, let alone protective masks and other sanitation products.
There are therefore serious concerns that refugee populations may be at very high risk, especially people already vulnerable and living in refugee camps such as in Jordan, Kenya, Cox’s Bazar or refugee camps in Greece. Urgent humanitarian action is needed.
To add an extra layer of complexity to an already challenging scenario, many refugee camps are located in countries with health systems that will struggle to screen, test and contain the epidemic. In Greece, for example, I anticipate that authorities and their international partners will experience great challenges in case an outbreak happened in a refugee camp. In fact, this may already be happening in Lesbos, where a case of COVID-19 on the island has been confirmed.
More importantly, I also have concerns that access for refugees to testing facilities and healthcare services will not be prioritized by governments. The latter will certainly give priority to host populations, especially in an environment of constrained resources. I am also worried that many governments, in particular the most populist ones, will exploit the situation to deter refugee populations or even force them out, even though it is proven that the infection does not come from refugees. Unjustified and arbitrary quarantine measures vis-à-vis refugee populations may be witnessed in the next few days and weeks. This will raise important ethical and equity issues.
Beyond this more political and ethical considerations, there are also crucial practical problems that need to be rapidly addressed to protect refugee populations. The disease surveillance system currently in use in refugee camps does not include any respiratory infections. This will need to be quickly added to the current protocols. It is also important that all national and international staff working inside camps respect the correct procedures in order not to infect refugees, and of course need support to ensure they maintain their own health status to continue delivering care to those in need. It is urgent to make sure that refugee populations are given the possibility to protect themselves from any infection.
There is no doubt that COVID-19 will mobilise a lot of resources, which might mean rechanneling some of the resources from humanitarian crises. Join me in calling upon policymakers and donors to ensure that countries have enough funding and resources to make sure that these populations at risk receive appropriate protection and care. I also would like to advocate for the creation of an academic taskforce to help governments apply the latest evidence on COVID-19 and apply this science for their decisions.
Forgetting “refugees” during COVID-19
COVID-19 has brought to the surface social inequalities for which “refugees” and the less advantaged are not morally responsible.
March 21, 2020
By Thalia Arawi, Founding Director, Salim El-Hoss Bioethics and Professionalism Program- American University of Beirut Faculty of Medicine and Medical Center
A few years back, I visited refugee camps in Sabra and Chatila, Mar Elias, and Ain el Helweh among others. I still recall climbing the stairs in one of the camps, looking at the people who were clustered there through no fault of their own.
The stench of sewage went straight through my nostrils and made its way to my lungs. Whether I felt dizzy because of my asthma or the mental shock at what I saw was unclear, but my forehead became cold as ice and I fainted for a few seconds.
I went to these camps because I wanted to start asking our medical students to visit these areas and foster an understanding of the social determinants of health and how the setting, environment, and living conditions play a role in healthcare. I also wanted them to help the very few doctors volunteering in these camps. Most importantly, I wanted them to see how those who are less fortunate than they live every day.
They are called refugees, a term I never made peace with –and perhaps never will. Nowadays, to add insult to injury, the term in people’s eyes denotes people who are less worthy than they.
When it was time to visit a few patients in their homes at the camp, I had to go through a damp, cramped, and mostly-destroyed hallway that smelled of sewage. The stench made the distance feel longer than it actually was.
I was welcomed into a humble house consisting of one room and a few jagged mats on the floor. I was asked to sit and offered tea. The eight-year-old boy had an infection in his eye, one he got from work. The other seven children were also around, dressed in rugged clothes.
There was poverty beyond imagination, no money, no cleanliness, no education. Just a day-to-day mechanism of survival, made lighter (or not) by lots of love and affection.
With the advent of the COVID-19 pandemic, stores around Lebanon are now closed. People are also practicing social distancing and purchasing, if not hoarding, huge amounts of disinfectants, gloves, and face masks.
The Ministry of Health issued guidelines on how to face the pandemic. So did the World Health Organization and many other official organizations hoping to contain the disease. Military forces are doing their work to ensure these COVID-19 measures are taken. But where is all this in refugee camps?
In refugee camps, people live en masse in small houses, rooms or tents. Forty people live in the same so-called home. It is impossible to observe social distancing when streets are flooded with individuals who live in less than humane conditions.
In refugee camps, there is no hot water and no soap to wash hands “for 20 seconds.” Attempting to buy a disinfectant might mean no food for one day or more. There are no hygiene kits that are distributed to a poverty stricken segment of society for free, no food and water delivered to their homes without cost to contain the virus from spreading, and definitely no electronic thermometer to check temperatures. There are no test kits.
“Refugees” are shunned to the margins of society and to the brims of life. The media proudly, and perhaps carefully, broadcast images and footage of empty streets in the country and yet are silent when it comes to refugee camps –as if shunning them away from the consciousness of the public would eliminate their existence altogether. Or worse: so-called refugee camps are totally disremembered. Whichever it is, the fact remains that a portion of humanity is forgotten in an apocalyptic Neverland they did not want to inhabit in the first place.
Unless authorities, the Ministry of Health, NGOs and others do their duty towards “refugees” and help them face the pandemic, the coronavirus will spread to the entire country with time. So, here comes a selfish bit of advice: Help them so as to help yourselves.
Some of us feel ashamed when we use disinfectants in abundance knowing that kids, elderly, young men and women, and pregnant wives somewhere in the Sabra neighborhood, Shatila camp, or Ain el Helweh have nothing to rely on and no one to resort to.
COVID-19 has brought to the surface social inequalities for which “refugees” and the less advantaged are not morally responsible. A social (and moral) catastrophe leading to grave health inequalities that decide who lives and who dies.
COVID-19 has revealed a unique ecology of sickness based on social determinants of health. If no measures are taken to counter this, we are heading towards a form of eugenics based on social endowments which are morally arbitrary.