COVID-19 and refugees in Asia: A crisis waiting to happen

Around 3.5 million refugees reside across the Asia-Pacific region, having fled conflict and persecution in their home countries. The largest refugee populations in Asia are Afghan refugees residing in neighbouring Iran and Pakistan and the Rohingya refugees from Myanmar in Bangladesh. Refugees are particularly vulnerable to COVID-19: They often have limited access to medical care and hygiene supplies, reside in high-density settings where social distancing is not an option and struggle with pre-existing health conditions that put them at higher risk of mortality and morbidity.

A potential hotspot: Rohingya refugee camps in Cox’s Bazar

Nowhere better encapsulates this vulnerability like the Rohingya refugee camps in Cox’s Bazar District, Bangladesh—one of the largest camps in the world, with nearly 900,000 refugees. The first case of COVID-19 was reported in the town of Cox’s Bazar on 24 March. As of today, no case has been found in the camps. But authorities are sounding the alarm that an outbreak could be catastrophic. A study by researchers from Johns Hopkins Bloomberg School of Public Health led to their prediction of around 500,000 cases within the first 12 months in the Rohingya camps, with hospitalization capacity being eclipsed within two to five months.

The setting is ripe for transmission. Around 40,000 people reside per square kilometre, more than 40 times the average density of Bangladesh. More than half of households do not have enough water to meet their basic needs, such as handwashing. Around 175,000 cases of acute respiratory infection have been recorded since the beginning of the year, highlighting the ease of communicable disease transmission in the camps. More than 31,500 Rohingya are older than 60 and are particularly at risk of COVID-19-related mortality. Traditional burial practices, which involve close social contact, can also facilitate the spread of the virus. Food storage is impossible in the small huts, forcing people to leave their home on a daily basis to secure food. These challenges are compounded by a dearth of ICU beds and zero ventilators in the entire Cox’s Bazar District of 3 million people.

A major concern is the lack of reliable information and limited communication channels. With Internet and phone access widely unavailable in the camps, awareness-raising and information-sharing about the virus and prevention practices are difficult. This has fuelled fear, anxiety and misinformation, such as a pernicious rumour that symptomatic persons presenting at a health care facility will be killed. Health-seeking behaviours among the Rohingya as well as trust in service providers were already low before the pandemic and appear to be eroding further.

The good news is that government actors and humanitarian agencies are preparing to respond. For example, UNHCR and partners are working to add 1,900 beds to serve both refugees and the host communities, aid agencies are setting up disinfection points, and awareness-raising efforts are expanding through the mobilization of community volunteers, radio programmes and tuk-tuks topped with megaphones.

Action needed across the entire Asia-Pacific region

Much more needs to be done to minimize transmission and protect vulnerable refugee communities as well as the host communities—not just in Cox’s Bazar but in refugee settings throughout the Asia-Pacific region (and globally). The Afghan refugee population, for instance, constitutes the largest protracted situation in the world, with 2 million refugees having lived in Pakistan and Iran for more than three decades. In addition, Asia, together with Africa, has the largest numbers of urban refugee populations, be it in Kuala Lumpur, Kabul or Kathmandu. 

Some critical actions that donors, aid agencies and national governments should undertake include:

-  Sufficiently funding COVID-19 appeals and broader humanitarian response plans (the 2020 Joint Response Plan for the Rohingya Humanitarian Crisis is currently only funded at 17 per cent).

-  Widespread testing that includes both refugee and host populations.

-  Large-scale procurement and distribution of personal protective equipment. 

-  Inclusion of refugees, internally displaced persons and stateless persons in national COVID-19 response plans.

-  Partnering with refugee communities to develop effective awareness-raising and trust-building efforts between authorities, health providers and refugees.

Inclusive responses are key

It is critical that response efforts are inclusive and address the unique needs of vulnerable groups, particularly women and girls, LGBTIQ+ persons, disabled persons and older persons. These groups are especially at risk, given, among other reasons, their traditionally limited access to information and services, which can shrink even further during crises. For women and girls, their lives are at risk not only from COVID-19 but violence in the home: the UN is warning of a “shadow pandemic” as reports of domestic violence have skyrocketed globally. Aid agencies should learn from the gendered impacts of the Ebola outbreaks, and donors must earmark funding and prioritize support for protection, particularly local women’s and LGBTIQ+ groups that are at the forefront of providing violence-related services.

Time is of the essence. Governments, funders and humanitarian agencies must act now to save lives and mitigate the potentially catastrophic impacts of COVID-19 on refugee and host communities throughout the Asia-Pacific region.