By Tala Al-Rousan
The links between human mobility, human rights and the spread of infection are unequivocally relevant when crafting a response to a pandemic. COVID-19 pandemic finds a world where there are 70 million people being born, live and die in refugee camps, as refugees, undocumented migrants, internally displaced persons, stateless persons or asylum seekers who are recognized under international law.
As the pandemic and its consequences unfold, its effects on displaced communities will be catastrophic. Currently, the reported number of confirmed coronavirus cases among the displaced is low, but this is most likely caused by the lack of testing besides the fact that the displaced are usually not a priority for hosting governments. These communities lack basic needs to fight this virus such as access to healthcare, medications, sanitation and healthy housing – while fearing deportation, discrimination or hate. Compounding their risks, are the high rates of the existing mental health trauma as well as other chronic health conditions.
Most of the world’s refugee burden is born by low and middle-income countries with limited resources like Jordan. While Jordan is taking one of the strictest lockdown measures in the world, the weight of the refugee crisis which the country is bearing is complicated when aspiring for a typical public health response to the pandemic. Only 15% of refugees in Jordan live in camps, while the majority are living in the community – hard to reach and suffer inadequate healthcare access and livelihood opportunities. Most refugees are either unemployed or survive on small businesses that will all be threatened by the economic and social consequences of this pandemic that are unfolding.
The global response thus far to the COVID-19 pandemic is telling. Countries such as Jordan, a small country with limited resources that is stressed from hosting refugees of 57 different nationalities (the majority of which are from Syria, Palestine, and Iraq) are heroically investing in pandemic control foremost among refugees through policies bringing refugees to the central response plan. Deployment of testing, protective equipment, and public health staff and scientist to camps was swiftly done and coordinated with the United Nations Higher Commission of Refugees to empower refugees living in camps to produce local “made in Zaatari” soap and be part of prevention and control. Refugees in the community are offered free healthcare coverage at times of crisis, targeted in awareness campaigns, with the King of Jordan himself appearing on national TV to address both Jordanians and refugees in a message of solidarity, compassion and equity. Portugal is setting an excellent example granting migrants provisional citizenship rights and full healthcare access during the outbreak while in contrast, Greece is credulously opting for locking-down migrant camps only, fueling the existing tension between refugees and migrants and the surrounding local communities. Maltese and Italian rescue zones have increased their non-assistance and deliberate delays on rescue ships of migrants crossing the sea causing more deaths both at sea and in Libya. In Bareilly, India, migrants returning home from cities were forced by the local administration to take an open bath in groups with disinfectant before being granted entry into the district. South Africa dispatched its police to raid churches in Cape Town and remove refugees, who have been protesting against xenophobia and maltreatment for months into shelters near Police Stations further spreading fear. It also started the construction of a 40-kilometer emergency barrier along its border with Zimbabwe, declaring ‘no undocumented or infected person is allowed to cross into the country’ (Zimbabwe has one of lowest rates of COVID-19 infections). Thousands of refugees and migrants confront detention in Bosnia in the newly built “unsuitable” forest camp adjacent to the border with Croatia. The government justified the moves as “urgent measures to prevent the onset of the disease caused by COVID-19.”
As an epidemiologist specializing in population science, I strongly rely on the power of data, modeling, biostatistics, and well-designed studies to draw scientific inferences. My research is focused on health disparities of marginalized communities such as natural disaster preparedness among older adults and the health of prisoners, people who live in trailers and mobile homes, and refugees. I discovered a consistent pattern that traverses the individual experiences of these communities; they all systematically suffer from health disparities, inadequate investment in precision public health (where interventions are made based on each community’s unique needs and situation), and a high prevalence of mental health and chronic stress which substantially compound their hardships. The end result is soberingly predictable – increase in mortality, the burden of chronic illnesses, intergenerational trauma, and social disengagement.
But research also promises effective health interventions if investments are made in gaining the trust of and providing vital support to community-based organizations and different agencies serving these communities. Not only such research provides evidence on the effect of improving sanitation, healthcare access (especially mental health), livelihood, housing and other basic necessities on health, but also fosters parallel collaborations that build the resilience to withstand catastrophes such as the current Epidemic. Now is the time to invest in capacity-building, tailored clinical and public health interventions, prevention and preparedness services, telehealth and effectively addressing social determinants of health in displaced communities. Most importantly, now is the time for a better understanding of the human condition that resulted in creating these pockets of marginalization and health disparities to begin with. Support for health equity research especially among difficult-to-access communities is urgently needed. The National Institute of Health and other significant scientific research agencies ought to redesign their grant review process to be inclusive of community stakeholders who have an eye for what works for their communities and can draw attention to relevant applications.
Human migration is a normal human state; forced displacement is not. Building fences and ceasing support to vital programs and organizations working with these communities will, at best, not prevent the spread of the disease, and, at worst, exacerbate it. Displacement itself is a neglected pandemic, which is continuously overlooked or manipulated by politics risking the lives of millions. This once-in-a-lifetime pandemic reveals unequivocally how chronic indifference to solving inequities (created by those who have been more fortunate), may have dire consequences to us all. Support for health disparities research, especially among difficult-to-access communities is urgently needed. The National Institute of Health and other significant scientific research agencies ought to redesign their grant review process to be inclusive of community stakeholders who have an eye for what works for their communities and can draw attention to relevant applications.
On a more personal level, Eudora Welty once said: “People are mostly layers of violence and tenderness wrapped like bulbs, and it is difficult to say what makes them onions or hyacinths.” This is the time when we pause to empathize, to put ourselves in other people’s shoes – the shoes of the forcibly displaced as they are faced by the only option which is to leave their homes and adapt to a new life. Often this is a life of scarcity, uncertainty, and nuances. All of which are feelings we all are most likely battling with now. This is the time to experiment with humanizing “others” including displaced communities—those who belong to races, religions, heritages or social classes that have long been neglected and vilified—to remember that no one is immune to the risk of losing everything.
At the end of the day, we are all fragile, a product of an interconnected ecosystem where our own actions and voice matter. May we all rise to the opportunity of being socially responsible, soul-searching, and proactive as we advocate for a new era of scientific discoveries, discoveries promoting human dignity, equity and inclusivity.