By Nadine Voelkner, IRIO & Groningen Centre for Health and Humanities, n.m.t.voelkner@rug.nl

According to UNHCR figures (25.03.2020), there are currently a staggering 70.8 million forcibly displaced people worldwide. Among them, 25.9 million, half of whom are under the age of 18, have crossed international borders and are, therefore, designated as refugees. The 1951 Refugee Convention theoretically safeguards the right to health for refugees, which includes access to public health services and essential medicine equivalent to the level of citizens of host countries. Practically, this has often proven difficult due to multiscale socio-political reasons. Fundamentally, the international system is based on a system of exclusion, in which peoples of the world are organized into individual sovereign nation states whose political responsibility lies first with one’s own citizens. The moral and, under international law, legal duty to safeguard refugee populations is all too often neglected. Mostly, ‘denizens’ or stateless people are partially or wholly excluded from public considerations, care and services. This is especially the case with hosting countries that are themselves under severe duress, such as post-conflict and impoverished states including Sudan (1.1m refugees), Uganda (1.2m), Pakistan (1.4m). Together with Turkey (3.7m) and Germany (1.1.m), these states are currently the ones hosting the greatest amount of refugees. Although international and nongovernmental organizations, with the UNHCR at the forefront, work to safeguard the rights and well-being of refugees, they still must operate in a world partitioned into sovereign nation-states. In times of crisis, such as reemerging conflict and disaster situations including a pandemic, hosting governments are overwhelmed by national priorities that do not usually include refugee well-being.

Given the global political status-quo, many refugees in the world must live in challenging health circumstances, often in unsanitary and overcrowded conditions in which pathogens can easily proliferate. They have limited to no access to appropriate healthcare, including preventive care and vaccinations, thus, making them more susceptible to communicable diseases. The public health situation in refugee camps is regularly challenging. The majority of refugees live in camps situated in host countries neighboring their countries of origin. Countries hosting large numbers of refugees, such as Jordan, Libya, Bangladesh and Turkey, have weak health systems and limited to no resources to allocate to refugee camps – these resources are urgently required to sustain a minimum level of health of a physically and mentally vulnerable population. Refugees forced to live outside of official camps must also negotiate their existence in a situation of legal limbo without guaranteed civil and human rights, hiding away in impoverished conditions, facing persecution and discrimination.

A European tragedy. Consider the case of Libyan detention centers. Many African asylum-seekers currently trying to cross the Mediterranean into the European Union are being detained or stranded in detention centers in post-conflict Libya, after the country’s deal with the EU to prevent further migrant passage. Conditions within these detention centers have been described as hellish; migrants lack food, sunlight and water. They are exposed, becoming victims of sexual exploitation and assault, of forced labor and torture, and of human trafficking. A Covid-19 outbreak here, where diseased conditions prevail and basic healthcare is not given, will allow for the virus to spread quickly and relentlessly. Organizations like UNHCR have already announced the suspension of some activities due to the ongoing pandemic. A humanitarian tragedy of significant magnitude is all but certain. Consider also the case of the largest refugee camp in the world: Cox’s Bazar. Located in Bangladesh, Cox’s Bazar is currently hosting a majority of ethnic Rohingya refugees fleeing from sustained violent conditions in neighboring Myanmar. Cox’s Bazar has reported its first case of Covid-19 this week. Here, too, unsafe water, overcrowding, troubling living conditions, and the impossibility to enforce social distancing,  provide the ideal breeding ground for outbreaks of infectious diseases to spread. Should a Covid-19 outbreak ensue in this camp, refugees would have to be referred to local hospitals, quickly overwhelming the Pakistani health system.

In the current Covid-19 pandemic situation, national governments are pressed to demonstrate their care for the health of their own citizens. Yet, with the health needs of refugees largely neglected, Covid-19 may as well spread largely unnoticed among refugee populations. This might happen both in refugee camps and outside of camps where refugees live integrated in host urban spaces, widening the pandemic even further. Thus, there is an urgent need for an organized global Covid-19 response to protect not only refugees, but the world as a whole.