Unlike humans, the virus doesn’t discriminate: nobody is protected until everybody is.

COVID-19, refugee population and mental health. Most of us might be aware of the severe coronavirus (COVID-19) impact on New York City and how it became a hotspot for rising cases in the United States of America. Manhattan hosts approximately 1.6 million people and is known as the county with the highest population density in the United States with many people crowding a very small island. Now imagine double the population density of Manhattan set in a low-income country with a weaker health system. This is not it yet, imagine 7 family members sharing an 8 x 10-foot shelter packed next to many thousands of such similar shelters. This is the sad reality of the Rohingya refugee camp in Cox’s Bazar in Bangladesh, home to 900,000 refugees. The Rohingya refugees are amongst the most high-risk populations during this pandemic. They face not only deteriorating climatic conditions, malnutrition, violence, but the broader health and social challenges resulting from a serious humanitarian crisis.

71 million people are forcibly displaced around the world and refugees living in camps and close quarters are highly susceptible to COVID-19. Currently, 134 refugee-hosting countries report community transmission of Sars-Cov-2; posing a huge public health concern for these countries. This is indeed not just a problem for the refugee-hosting countries or the vulnerable refugee populations themselves, it is a serious global concern for each one of us as no one is safe from the virus till everybody is safe from the virus.

The United Nations High Commissioner for Refugees (UNHCR) has scaled up its work to safeguard refugees and internally displaced people by providing life-saving support to various countries. They also closely monitor the outbreak and take timely action to prevent and delay the spread of the virus amongst vulnerable populations. Due to poor access to credible information at refugee camps, UNHCR has been working to support communications to improve awareness on COVID-19. They have partnered with several local community networks to ensure access to accurate and timely information on handwashing, social distancing, isolation from infected people and where to access health services. In Angola, refugee journalists have been trained to run a mobile radio campaign on COVID-19 prevention while in Ecuador a WhatsApp information line was launched to support cases and communities.

While essential life-saving kits for water, nutrition and hygiene are getting distributed, UNHCR has also focused on providing mental health and psychosocial support for refugees during this pandemic. Refugees suffer many risk factors that are common to COVID-19 and mental illness. The factors range from overcrowding and poor hygiene to lack of nutrition and shortage of health care services. When these factors are coupled with the uncertainty of COVID-19, refugee camps around the world can potentially struggle severe mental distress and a rise in COVID-19 infections. The duality of infectious disease and mental health is not uncommon. More recently several West African countries have seen a steep surge in the cases of mental illness post-Ebola, and still continue to deal with a high mental health treatment gap due to the long-lasting consequences of Ebola. Therefore, there is no doubt that this current COVID-19 pandemic is going to take a huge toll on people’s mental health for years to come, but this public health emergency could disproportionately affect vulnerable groups, such as displaced persons.

The mental health impact on refugee populations can result from a wide range of factors affecting them. Lack of quality information and language discrepancies in published information is one of the major reasons addressed in a recent review that discusses ‘A crisis within a crisis’ (Junior, 2020). Additionally, factors such as intimate human contact and shortage of human resources in local health care services also contribute to poor mental health outcomes. To combat these challenges that have emerged from COVID-19 prevention measures, international agencies, such as UNHCR have been working towards capacity building within refugee populations to make them more self-reliant. They have also partnered with and fostered community networks to bridge the information gap in a culturally nuanced and effective manner. Finally, the UNHCR has mobilized remote operations to withstand the on-site shortage of resources and services, allowing people worldwide to connect electronically in an attempt to solve field problems and stand by the refugees in these unprecedented times.

Humanitarian agencies and government actors have partnered and prepared for isolation and treatment centers at the Rohingya refugee camp in Cox’s Bazar Bangladesh. They have established disinfection points and expanded their awareness and communication channels. Despite all the global efforts to prevent the virus from entering the camp, the world’s largest refugee camps were faced with their first 29 cases around late May 2020 and are continuing to prepare for the worst. While controlling the virus from spreading within the camp may be inevitable now, efforts can be channelized into curbing the spread to prevent health services from getting overwhelmed. At the same time, ensuring the capacity building continues to allow essential services to run, especially mental health service provision to alleviate the potential grim aftermath of the pandemic.

Looking ahead at the coming months, with protocols in place to tackle the physical health challenges arising from COVID-19, it will be of strategic importance to prioritize and safeguard the mental health and well-being of vulnerable populations across the globe. Apace with efforts directed towards refugees and displaced persons, children and women who are particularly more vulnerable within these groups, may require closer attention and tailored interventions. Volunteers, community workers and field staff at the frontline of battling the pandemic, in often overcrowded and poorly managed refugee camps must be protected and equipped with better healthcare and resources, including mental health and psychosocial support. This current combat against the coronavirus calls for global solidarity, and countries with weaker health systems and vulnerable population groups must feel confident enough to lean on the rest of the world as they need humanitarian support more than ever today. Shreya Agoramurthy

Young Leaders for Health

References: Euro.who.int. 2020. COVID-19: Ensuring Refugees And Migrants Are Not Left Behind. Available at: https://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/news/news/2020/4/covid-19-ensuring-refugees-and-migrants-are-not-left-behind [Accessed 21 June 2020].

Fes-asia.org. 2020. COVID-19 And Refugees In Asia: A Crisis Waiting To Happen. Available at: https://www.fes-asia.org/news/covid-19-and-refugees-in-asia-a-crisis-waiting-to-happen/ [Accessed 21 June 2020].

Júnior, J., de Sales, J., Moreira, M., Pinheiro, W., Lima, C. and Neto, M., 2020. A crisis within the crisis: The mental health situation of refugees in the world during the 2019 coronavirus (2019-nCoV) outbreak. Psychiatry Research, 288, p.113000.

Nations, U., 2020. UN Scaling Up COVID-19 Response To Protect Refugees And Migrants | United Nations. Available at: https://www.un.org/en/un-coronavirus-communications-team/un-scaling-covid-19-response-protect-refugees-and-migrants [Accessed 21 June 2020].

Refugees, U., 2020. Public Health During COVID-19. UNHCR. Available at: https://www.unhcr.org/health-covid-19.html [Accessed 21 June 2020].