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 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 close to 900,000 refugees. The first case of COVID-19 was reported in the town of Cox’s Bazar on March 24th. As of today, no official cases have been identified in the camps. But authorities are sounding the alarm that an outbreak could be catastrophic. A study by Johns Hopkins predicts 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 kilometer, 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 hand washing. 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 small tents, forcing people to leave their homes 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 three million people.
A key concern is the lack of reliable information and limited communication channels. With Internet and phone access being widely unavailable in the camps, awareness-raising and information-sharing about the virus and prevention practices are difficult. This has fueled fear, anxiety, and misinformation, such as a pernicious rumor that symptomatic persons presenting at a health care facility will be killed. Health-seeking behaviors 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 host communities, aid agencies are setting up disinfection points, and awareness-raising efforts are expanding through the mobilization of community volunteers, radio programs, and tuk-tuks topped with megaphones.
Action needed across the entire Asia-Pacific region
However, much more needs to be done to minimize transmission and protect vulnerable refugee communities as well as host communities—not just in Cox’s Bazar, but in refugee settings throughout the Asia Pacific (and globally). The Afghan refugee population, for instance, constitutes the largest protracted situation in the world, with two million refugees living in Pakistan and Iran for over three decades. In addition, Asia, together with Africa, concentrates the highest numbers of urban refugee populations, be it in Kuala Lumpur, Kabul or Kathmandu.
Some key actions that donors, aid agencies, and national governments should undertake include:
Inclusive responses are key
In addition, 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 the elderly. 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 Ebola outbreaks, and donors must earmark funding and prioritize support for protection, particularly local women’s and LGBTIQ+ groups which are 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.
Dr. Sarah Chynoweth is the founder and director of the Sexual Violence Project at the Women’s Refugee Commission. She previously served as International Planned Parenthood Federation’s Emergency Response Advisor for the Asia Pacific and supported the capacity development of reproductive health providers across 28 countries in the region. She resides in Kuala Lumpur, Malaysia with her family.
The views expressed in this blog series are not necessarily those of FES.
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