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Keeping distance, lacking space: COVID-19 in refugee camps and informal settlements
By: Sonja Rosina Ayeb-Karlsson
Last updated: Wednesday, 10 November 2021
The COVID-19 pandemic has turned our lives upside down over the last couple of weeks. Country after country has been knocked out and gone into lockdown. Nobody has been left untouched, while splitting families and loved ones Europe has been reminded of what it is like to experience war, uncertainty and crisis. As the most immediate shock of the drastic changes to our everyday life starts settling in we must look towards those who are not as fortunate. People who will face larger challenges than balancing children’s entertainment, home-schooling and getting work done – people who are lacking spaces to safely isolate themselves during the pandemic – those residing in refugee camps and informal settlements across the world.
I find myself returning to the field locations and the people who opened up their homes to our research sessions, those who shared their stories, and who refused to let us leave without having that tea. I worry about my family and friends overseas, but I feel terrified when I think about what could happen to my research informants.
In the upcoming months of the pandemic, who will protect the human rights and dignity of those already compromised – people on the move, those living in refugee camps and informal settlement?
The first case of COVID-19 was reported on Lesbos, Greece already on the 9th of March, and on the 24th of March we saw the first reported case near the Rohingya refugee camps in Cox’s Bazar, Bangladesh (Raju and Ayeb-Karlsson 2020; ACAPS 2020). Meanwhile, volunteers have been warning authorities about the fast spread of the virus through the Calais refugee camps in northern France. Moria camp in Lesbos has been described as overcrowded with 20,000 people living in a space built for 3,000, while lacking access to water and sanitation. In Cox’s Bazar, the refugees were already struggling to avoid infectious diseases due its dense population, and there is poor access to water and sanitation. The healthcare services there are generally provided by volunteers and NGOs (Carballo et al. 2017). Besides the inadequate living standards, misinformation and rumours are spreading at the speed of fire among the already conflict traumatised population, leading to hesitations to seek medical attention in fear of what may happen (Raju and Ayeb-Karlsson 2020; ACAPS 2020).
Roughly a billion people live in informal settlements across the world, including about 30-50% of the urban population in the Global South (Lilford et al. 2017). Most people here depend on casual work and cannot ‘work from home’. Similarly to the described living conditions in refugee camps, people live in overcrowded households, while lacking access to clean water, sanitation, waste management, and public health services. People often arrive here after rural-urban migration sometimes involving traumatic experiences. Many are left out of the health care systems, and social exclusion, stigma, forced evacuations and structural mistreatment trigger mistrust in the government, its law enforcement agencies, and civil authorities (Ezeh et al. 2017; Ayeb-Karlsson et al. 2020). The first COVID-19 case in a slum with 23,000 people in less than a square kilometre in Mumbai proved the unprecedented challenges around the general health risk and control guidelines. The infected woman lived with six others in a 250 square feet room, and shared a public bathroom with hundreds, potentially thousands, making contact tracing close to impossible (Raju and Ayeb-Karlsson 2020).
The WHO’s COVID-19 guidelines of social (physical) distancing and hand-washing will be far from enough to protect our ultra-vulnerable populations in the Global South (Hopman and Allegranzi 2020; Kluge et al. 2020; Corburn et al. 2020). Based on personal research experiences in vulnerable settings and the existing literature body (Raju and Ayeb-Karlsson 2020), we should ensure that we are:
- Providing immediate financial and social support to safeguard people who cannot work from home.
- Setting up free handwashing stations.
- Ensuring that trusted figures, such as religious and local leaders, NGO workers and volunteers, as well as social media groups, join in the efforts to emphasise how handwashing and physical distancing can help prevent spreading the virus.
- Urging for immediate global investments to improve access to clean water, sanitation, food and waste management.
- Setting up mobile clinics around vulnerable and overcrowded places to be able to provide immediate testing, isolation and treatment of people testing positive.
- Developing human rights-based disaster response plans, including non-traumatic temporary evacuations of settlements to safe areas close by to avoid family ruptures. This includes allowing people to move and isolate with their loved ones, bring valuables and safely return home after the outbreak.
- Making good use of existing health recommendations and best practices from diverse case study contexts in regards to other infectious diseases in similar environments. For example, some of the settlements have health response protocols around pneumonia and tuberculosis that could help reduce the spread of COVID-19.
- Working towards global efforts, including ‘vulnerable settings preparedness plans’, and increased capacity and resources of existing health services, global science and medical collaborations, such as open science, sharing testing, laboratory and medical advances, and closer collaboration between public and private healthcare sectors. Global pandemics require global solutions.
The COVID-19 pandemic is revealing and exaggerating existing social inequalities within our societies across the world. A sustainable way forward must include protection, investment in and safeguarding of our ultra-vulnerable populations through a human rights and dignity-based approach. All human beings have the right to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses - people should already be living in conditions where they are assured clean, available, acceptable, accessible, and affordable water and sanitation, and if they do not, that is the problem right there.
Written by Dr Sonja Ayeb-Karlsson who researches (im)mobility, migration, health and wellbeing in the context of climate change. She is a Senior Researcher at UNU-EHS, part of Lancet Countdown's WG1 and WG2, and a BSMS and University of Sussex Co-Invesitgator on the Sussex Sustainability Research Programme (SSRP) project "DROught, Poverty and HIV drug RESISTance (DROP-RESIST)".
This blog is based on the article "COVID-19: How do you self-isolate in a refugee camp?" published in the International Journal of Public Health.
ACAPS, COVID-19 Rohingya Response. Geneva (2020). Available at: https://www.acaps.org/sites/acaps/files/products/files/20200319_acaps_covid19_risk_report_rohingya_response.pdf
Ayeb-Karlsson S, Kniveton D, Cannon T, Trapped in the prison of the mind : Notions of climate-induced (im)mobility decision-making and wellbeing from an urban informal settlement in Bangladesh. Palgrave Commun 62:6, 1-15 (2020). https://doi.org/10.1057/s41599-020-0443-2
Carballo M, Hargreaves S, Gudumac I, Maclean EC, Evolving migrant crisis in Europe: implications for health systems. Lancet Glob Heal 5, e252–e253 (2017). https://doi.org/10.1016/S2214-109X(17)30040-2
Corburn, J., Vlahov, D., Mberu, B. et al. Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health (2020). https://doi.org/10.1007/s11524-020-00438-6
Ezeh A, Oyebode O, Satterthwaite D, et al The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet 389, 547–558 (2017). https://doi.org/10.1016/S0140-6736(16)31650-6
Hopman J, Allegranzi B, Managing COVID-19 in Low- and Middle-Income Countries. JAMA (2020). https://doi.org/doi:10.1001/jama.2020.4169
Kluge HHP, Jakab Z, Bartovic J, et al, Comment Refugee and migrant health in the COVID-19 response. Lancet 2019, 2019–2020 (2020). https://doi.org/10.1016/S0140-6736(20)30791-1
Lilford RJ, Oyebode O, Satterthwaite D, et al, Improving the health and welfare of people who live in slums. Lancet 389, 559–570 (2017). https://doi.org/10.1016/S0140-6736(16)31848-7
Raju E, Ayeb-Karlsson S, COVID-19: How do you self-isolate in a refugee camp? Int J Public Health (2020). https://doi.org/10.1007/s00038-020-01381-8
This blog is part of the
SSRP Forum: the Pandemic and Sustainability
This forum aims to contribute to the analysis of the impact of the pandemic on sustainability and the Sustainable Development Goals (SDGs), and to offer policy recommendations on how to respond to this unprecedented challenge.
The spread of coronavirus (COVID-19) presents us with an unprecedented challenge. We see losses of human life around the world, while one can hardly think what will happen if and when the pandemic reaches poorer countries with weaker economic and health structures. We see countries shutting down their economies to avoid the spread of the virus, as well as employing unprecedented measures of social distancing and population lockdown. We see whole economic sectors and households entering the intensive care of public financial support. In less than a month, the pandemic has redefined the priorities, parameters and boundaries of ‘what is possible’ in much of the world that we constructed since the Second World War.
The most urgent question is how to deal with the humanitarian crisis currently evolving and prevent it from getting out of control at a global scale. But a question we must also face is how the currently unprecedented mobilisation of public resources will be used to support our transition to a sustainable future, rather than a return to a socio-environmentally unsustainable past. One can hardly overstate the urgency of both these tasks. We in the Sussex Sustainability Research Programme (SSRP) community aim to contribute to this ‘mobilisation’ effort by setting up this Forum which aims to bring together experience, knowledge, ideas and recommendations to inform public responses to the pandemic and the implementation of Sustainable Development Goals (SDGs) at both local and global levels.