By Leena Fraihat, The University of Virginia (previously at Doha British School)

Citation

Fraihat, L. (2022) The role of a refugee camp in a global pandemic. Routes 2(3): 136-143

Abstract

The COVID-19 global pandemic has affected millions worldwide. This article explores the impact on refugees in Syria, and why they are in a particularly vulnerable situation. The article also suggests multiple ways in which we can tackle the complications faced by refugees as a result of coronavirus to better manage the damage and direct impact it has had on these communities including but not limited to poorer health and destruction of medical infrastructure.

1. Introduction

As I watched the continuous headlines on the damage the current global pandemic has done, a thought sparked my mind; what about those who were already dealing with difficult situations? The people in the parts of the world where conflict was already engulfing their lives like the Syrian refugees. While people turned to their local, national and international leaders in hopes for some guidance, who did they have to turn to? How were they expected to cope? Weakened by displacement, Syrian refugees found themselves caught up in a double crisis, the conditions of displacement and fighting the COVID-19 pandemic. I intend to identify the impact this vulnerable group has endured and the measures that are being taken in order to tackle this issue.

Since 2011, conflict in Syria has left 6.7 million people displaced within the country and a total of 6.6 million Syrian refugees fleeing elsewhere, seeking safety¹. According to Physicians for Human Rights, a Non Governmental Organization, they have confirmed 566 attacks on 348 medical facilities in Syria from March 2011 to May 2019. Almost 900 medical workers are reported to have lost their lives as a result of these attacks. This verifies the already apparent lack of stability in the medical infrastructure as a result of this conflict². Alongside their poor conditions, they are put in an extremely vulnerable position as a community, classifying the coronavirus as a top concern for health workers in the area.

Refugee camps in the region are known to be extremely crowded. The Za’atari refugee camp for example, holds up to 80,000 Syrian refugees with over half of them being children⁴. This many refugees in one place leaves them elbow to elbow, crammed into extremely tight spaces; making social distancing, the main coping mechanism against COVID-19, impossible. The overpopulation of the Za’atari refugee camp means that every single individual within the camp is always in close contact with multiple other individuals. Therefore no matter their attempts, they will not be socially distant. Especially not to the extent of which is required of them in this situation. Not only does this restrict their precautions towards preventing the virus, but it also allows it to spread vigorously between them. A pandemic that has already killed thousands has the potential to aggressively demolish this community at a disastrous rate. The unsettling part is the fact that this many people in one camp is not only common but is the norm for millions of Syrians in the region. However, the issue does not end here.

This article will firstly highlight the severity of the issue at hand and why the global pandemic puts the Syrian refugees, as well as all refugees globally, in a particularly vulnerable position. Secondly, the article will explain findings throughout this research process specifically relevant to the risk that refugees face in the region. The article will then underline the way forward and specific solutions communities can adopt in order to assist refugees that face this risk.

2. Methods

Research was collected on both a primary and secondary basis through a variety of techniques. Firstly, primary information came from a total of 3 semi-structured interviews and was conducted through snowball sampling – after speaking with someone in particular they would then refer me to another expert in the field. These interviews were conducted during May 2020, completely over the phone. Through this process I was able to find a large range of perspectives on the conditions of refugee camps during the time of a global pandemic. Common themes brought up during these conversations was the position and responsibility of the refugee camp in mitigating the impact of the virus and the difference in the access to medical supplies within a refugee camp compared to other communities. 

Ethical implications included staying completely neutral throughout the interview process and ensuring that all credit was given where it was due throughout this article. Throughout the interview process, difficult ethical questions were navigated by ensuring the questions being asked were in a respectful manner. Interviewees were also reminded to share what in particular they were comfortable with – no more, no less. Secondary sources came from academic literature that provided information from academics in the field on the history and reasoning behind the harsh realities of refugee camps in a time as severe as COVID-19. All interviewees also consented to being quoted as well as having their names revealed throughout research. They were aware that there was a possibility that their answers would be published online and as experts in the field, they were comfortable with this. Answers from interviewees including Medical Doctor Mossab Breij, along with other experts in conflict were incorporated throughout especially within findings and the way forward and allowed me to gain a deeper understanding of why it is that refugees are considered so vulnerable in this situation.  

Throughout this perspective piece, Doctor Breij’s testimony is focused on because of the powerful perspective he offered throughout this research. Due to his geographical location in north-west Syria and position as a medical doctor, he has close contact with the community the research focuses on. Doctor Breij was therefore able to offer first hand experience when explaining how it is that his opinion was formed. His unique position caused this essay to focus on his input compared to the others.

There are limitations to only interviewing three people and this was found throughout the research. For example, some of the information given was repeated multiple times by different people. This limited the diversity in perspective offered. In order to prevent this, analysis of academic research was incorporated as a secondary source of information.

3. Findings

After speaking with a medical doctor that works in the north-west Syria area, Mossab Breij, he pointed out an extremely important factor required when tackling the issue of COVID-19 in refugee camps; the lack of testing. Their highly limited medical resources leaves them in a limited position when finding those that show signs of the virus. Breij stated that, “the problem is the capacity of the tests that can be done on a daily basis.” This also results in misleading numbers as to who is and is not infected, as well as an inaccurate representation of what stage of the pandemic they fall under. 

The lack of awareness within these camps does not enable them to fully understand how serious COVID-19 is, rather leaving them to compare it to what they are already used to. These factors have collectively allowed the medical infrastructure to “collapse” in Doctor Breij’s words. We must also remember the damage that has already been done to the medical industry of the region as a result of the conflict. As an expert in the field and a health worker himself, Doctor Breij’s perspective is essential in tackling the root of the problem at hand. Especially considering his close contact with this very region. He says, “with the low capacity of the intensive care units in northwest Syria, in these very crowded communities, everyone is expecting that the toll of COVID affected individuals to increase dramatically.” Once again, highlighting the issues associated with having high population refugee camps.

Expanding on these difficulties, according to Doctor Breij, depending on what area in particular they reside in, heavily impacts their access to healthcare. With certain parts of northwest Syria being under Turkish rule, they have shown slightly better results compared to those who are not. Currently, they have set up 3 hospitals in isolated areas designed strictly for COVID-19 cases in north-west Syria in which anyone who shows symptoms of infection is taken immediately. However, with all the additional issues associated with the area, these hospitals do and continue to struggle. Especially considering their extreme deficit in medical supplies. These difficulties re-emphasise the vulnerability of refugee camps during COVID-19, highlighting the importance in recognizing this.

This however, is not just the reality for Syrian refugees but refugees from every corner of the world, as they are left unsure and unaware of their future situations. At 168 million inhabitants, Bangladesh is one of the most densely populated countries in the world. Bangladesh has seen COVID-19 spread quickly within the country, but another large factor they are forced to consider is the overcrowded conditions of what has been described as the world’s largest refugee camp, located in Cox’s Bazar, (Vince, 2020) home to over Rohingya 745,000 refugees⁶. The Rohingya refugees have been forcibly displaced from a neighboring country, Myanmar, causing Bangladesh to accommodate these new populations in the process of managing COVID-19 as it is. 

Similar to Za’atari, the camp lacks testing with the closest testing facility being in Dhaka, 400km away. Among this, health workers in the area have also had to actively debunk controversies to do with the virus. Rohingya refugees showing symptoms have avoided testing because of the stigma created by fear, preventing people from receiving treatment (Islam and Yunus, 2020). Structural mistreatment has also caused a mistrust in the government (Raju and Ayeb-Karlsson, 2020). These reasons highlight the difficulty of following WHO advised protection measures within refugee camps and the struggle medical professionals face on a day to day basis. If cases of COVID-19 increase within refugee camps, the Bangladesh government plans to send some to Bhasan Char, an island off the coast of Bangladesh, in order to reduce pressure on these camps (Islam and Yunus, 2020). 

4. The way forward

It is important to recognize why refugee camps are in such vulnerable positions and direct solutions that could be considered in managing this risk. I will elaborate on ways of which this can be done within these populations, clarifying the role of the refugee camp in the time of a global pandemic.

The first solution that should be considered is an increase in testing. This can be done by increasing the capacity of intensive care units in these areas- north-west Syria as well south Bangladesh. The obvious conclusion highlights how in order to reduce the cases, we must firstly locate specific individuals who carry it and this can be done by testing more often. As a result this will allow medical professionals to target these individuals and better contain the virus. An increase in testing will also allow specialists to better gather statistics on the amount of cases in the area making it easier to implement protection strategies accordingly. This will also allow them to forecast the amount of cases within the refugee camp based on previous trends as well as in comparison to the rest of the country, and therefore meaning they can plan accordingly. 

 Awareness must also be raised to the Syrian refugees so that we ensure they fully understand the severity of the pandemic and what it means if safety precautions are ignored. This will debunk the controversies that have arisen within refugee camps, hopefully creating a more proactive community. This will also work as a catalyst to prevent the spread of the virus as well as, ensure the safety of all individuals in the area. Unfortunately, with limited access to education within these refugee camps, it is likely the full capacity of the issue is misunderstood. This causes them to disregard the pandemic as a major concern, making it unlikely for them to adhere to the process implemented in order to prevent the spread of the virus. It is also important to remember the language barriers faced by refugees in new destination countries as well. Further emphasizing the importance of designing education systems that cater specifically to these populations. 

The World Health Organization as well as medical specialists from every corner of the world have constantly advised that we stay at home to limit social interactions⁷. However, we cannot expect refugees to comply with this considering the extremely weak state of the refugee camps. In order to tackle this, better infrastructure should be implemented within these refugee camps, instead of the current tin shed that they currently live under, to allow them to have a place where they could actually stay while limiting contact (Raju and Ayeb-Karlsson, 2020). This, like other effective solutions, will allow refugees to prevent the spread of the virus. Additionally, these processes will also protect this vulnerable population from future COVID-19 related issues, such as the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), placing further strain on these already vulnerable populations (Kentikelenis et al., 2020).

Lastly, the obvious solution to this crisis is to immediately improve the standards of these refugee camps. The reality is that the living situation in camps around the world be it in south Bangladesh or north-west Syria are extremely poor. They lack basic sanitary supplies such as soap, sanitizers and even clean usable water. It is unrealistic to expect refugees within these situations to wash multiple times a day or continue to sanitize their belongings when they simply do not have the resources to do so. In this situation, the solution to this is to supply refugee camps with these basic resources in order to then give them the freedom to then implement cleaning systems allowing them to further sanitize their spaces. Therefore, reducing the spread of the coronavirus and decreasing the number of positive cases on a daily basis.

5. Conclusion

The consideration of refugees’ rights in this situation is simply a matter of human rights and it can not be ignored. This issue has become an international responsibility and it is in no way acceptable that we neglect the urgency of ensuring refugee populations have access to safe and effective medical resources to protect them. It is then that refugee camps globally can effectively uphold responsibilities in protection from the virus. It is time to ensure access to high quality health care for this community as they already face unequal medical treatment opportunities (Brandenberger et al., 2019). COVID-19 has proven to be a nightmare for many, it is essential that we consider all communities, because in a time like this, we do not have the luxury of forgetting anyone.

6. Acknowledgements

My incredible parents and siblings for their constant support in my academic career. I am extremely thankful for them and don’t think I’d be where I am today without them. I’d also like to thank my remarkable geography teacher, Miss Butler, for her continuous support in guidance making me the geographer I am today. I’d also like to think Routes for giving me this opportunity.

7. Endnotes

1. Unrefugees.org. 2020. Syrian Refugee Crisis: Aid, Statistics And News | USA For UNHCR. [online] Available at: <https://www.unrefugees.org/emergencies/syria/>  [Accessed 7 August 2021].

2. Lund,  A., 2020. The UN Made A List Of Hospitals In Syria. Now They’re Being Bombed.. [online] Available at: <https://tcf.org/content/report/un-made-list-hospitals-syria-now-theyre-bombed/?agreed=1>
3. ReliefWeb. 2014. Syrian refugees in the region (as at 7 January 2014) – Lebanon. [online] Available at: <https://reliefweb.int/map/lebanon/syrian-refugees-region-7-january-2014> [Accessed 18 April 2021].
4. Oxfam International. 2020. Life In Za’Atari, The Largest Syrian Refugee Camp In The World | Oxfam International. [online] Available at: <https://www.oxfam.org/en/life-zaatari-largest-syrian-refugee-camp-world> 
5. ReliefWeb. 2020. Snapshot | IDPs in North West Syria – 01/03/2020 – Syrian Arab Republic. [online] Available at: <https://reliefweb.int/report/syrian-arab-republic/snapshot-idps-north-west-syria-01032020>  [Accessed 18 April 2021]
6. OCHA. 2021. Rohingya Refugee Crisis. [online] Available at: <https://www.unocha.org/rohingya-refugee-crisis#:~:text=Yet%20it%20was%20August%202017,have%20fled%20into%20Cox%27s%20Bazar.>
7. Who.int. 2021. COVID-19 transmission and protective measures| WHO Western Pacific. [online] Available at: <https://www.who.int/westernpacific/emergencies/covid-19/information/transmission-protective-measures>[Accessed 7 August 2021].

8. References

Brandenberger, J., Tylleskär, T., Sontag, K., Peterhans, B. and Ritz, N. (2019) A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries – the 3C model. BMC Public Health, [online] 19(1). Available at: <https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7049-x>

Islam, M. and Yunus, M. (2020) Rohingya refugees at high risk of COVID-19 in Bangladesh. The Lancet, [online] 8(8). Available at: <https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30282-5/fulltext> 

Kentikelenis, A., Stuckler, D., Kaasch, A., Saint, V. and Bozorgmehr, K. (2020) COVID and the convergence of three crises in Europe. The Lancet, [online] 5(5). Available at: <https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30078-5/fulltext> 

Raju, E. and Ayeb-Karlsson, S. (2020) COVID-19: How do you self-isolate in a refugee camp?. International Journal of Public Health, [online] 65(5), pp.515-517. Available at: <https://link.springer.com/article/10.1007/s00038-020-01381-8> 

Vince, G. (2020) The world’s largest refugee camp prepares for covid-19. BMJ, [online] p.m1205. Available at: <https://www.bmj.com/content/368/bmj.m1205>. 

 

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