The International Rescue Committee was founded in 1933, to support the resettlement of refugees from Nazi Germany. After the Second World War, the organization expanded to offer humanitarian assistance to refugees worldwide, from Haitians fleeing the Duvalier regime, in the nineteen-sixties, to Iraqis displaced by the long aftermath of the American invasion. On April 1st, the I.R.C. released a report on how the coronavirus pandemic could affect refugees. Focussing on displaced populations in Syria, Greece, and Bangladesh, the I.R.C. found that refugees will likely face extreme risk when the virus begins to spread. “The rapid spread of COVID-19 on the Diamond Princess”—the cruise ship that was quarantined in the port of Yokohama, Japan—“showed how the virus thrives in confined spaces,” Marcus Skinner, a senior policy adviser at I.R.C., wrote, but the conditions of millions of displaced people “are far more cramped and poorly serviced, and the risks are far deadlier.”

I recently spoke by phone with David Miliband, the president and C.E.O. of the I.R.C. He was formerly a Labour Member of Parliament and the United Kingdom’s Foreign Secretary. During our conversation, which has been edited for length and clarity, we discussed what can be done to prevent vulnerable populations from contracting the coronavirus, how the I.R.C. is protecting its own staff, and why a pandemic makes international coöperation all the more necessary.

What was your biggest takeaway from the analysis your organization released?

We know that COVID-19 is wreaking havoc in the most advanced industrialized countries in the world, with the most developed health systems. The people that we’re helping, in war zones and refugee-hosting states in the world, are living with some of the weakest health systems and some of the most dangerous public-health conditions. We know from New York how important population density is, and that the population density of New York City, across the five boroughs, is about twenty-five thousand people per square mile, or about ten thousand people per square kilometre. We know that Wuhan was about six thousand people per square kilometre. And we know that in the places where we work, like Cox’s Bazar, in Bangladesh, where there are about a million Rohingya Muslims who fled from Myanmar, the density is between forty thousand and seventy thousand people per square kilometre. And for the poor people, the benighted people in the camps on the Greek islands, it’s even up to two hundred thousand people [per square kilometre].

And so the point of the report is very simple. If the coronavirus is wreaking havoc in countries with the most advanced systems, then we have to beware carnage in those places where there are the weakest health systems. And our plea to the world is to use the time that we seem to have, before the virus becomes fully rampant, to take some of the most basic protection measures, like getting hand-washing stations set up, getting the triaging set up, getting some isolation space set up. It would be folly to talk about “social distancing” in the midst of a humanitarian emergency. But we can take basic measures and try to protect life in the time that we’ve got, before the virus becomes fully invasive in the places where we work.

What has been the I.R.C.’s experience working on health-care issues in refugee camps, and what lessons does it offer?

The International Rescue Committee was founded by Albert Einstein, to bring people to America, and has become, since the nineteen-thirties, not just a refugee-resettlement agency in America but a global humanitarian agency. We work in two hundred field sites around the world, including many refugee camps. However, it’s important to say a couple of things. First, most refugees don’t live in refugee camps. Of the twenty-five million refugees and four and a half million asylum seekers around the world, about four million are in formal refugee camps. About sixty per cent are in urban areas. So the first piece is about understanding where we work. We do work in refugee camps, but we also work in what are called “informal settlements,” or in rural areas. So it’s not just about camps.

Second, issues of ill health are very important for displaced populations, not just those who are suffering the wounds of war. We have more than thirty thousand staff around the world—fourteen thousand employees and seventeen thousand auxiliary workers. About forty per cent of our programs are health-related— maternal health, public health, mental health, environmental health. And so we know a lot about both communicable disease and noncommunicable disease. And we know that infection prevention and control, which is the major issue raised by the COVID-19 pandemic, depends on trust. Ebola has been a very important learning experience in this. The first ingredient of effective health response is not a health facility. It’s trust. And, if there’s no trust among the local population about the messages that are being given about how to stay well, then your health facilities are going to get overwhelmed. And so that’s why we employ local staff. Ninety-five per cent of our staff are locally hired. We’ve got eight hundred staffers in Syria today, and they’re all Syrians, because that’s how you get local trust.

And there’s one other point I would raise to you, specifically in respect to the camps. We know that camp health care may be basic, but at least it’s there. And often, especially for the camps that are in the most remote areas, health care inside the camp can be better than health care outside the camp. And so we make it a very important principle that our health-care services are available both to camp residents and to non-camp residents. If you visit our health center in northern Jordan, in Mafraq, which is a town in northern Jordan, you’ll see that our health center is open for Syrian refugees, but it’s also open for the Jordanian population. And that’s very important to try to insure that there isn’t excess tension with a local population which sees services that are being denied to it.

Yes, I was going to ask how concerned you were about a less welcoming atmosphere from populations hosting refugees and shutting borders. This has been happening the last few years for various political reasons, and now the past few weeks for health reasons. Do you have long-term concerns about what this will mean for refugees or people who are stateless?

Well, I have a concern about people putting up borders, although I don’t believe in a borderless world. And so the health reasons that you refer to are serious. In 1990, after the Berlin Wall fell, there were eleven walls around the world. And now, according to an article in Foreign Affairs magazine, there are seventy walls around the world. So this is a pre-COVID-19 threat. Now, COVID-19 gives an added dimension to this, and in the wrong hands it becomes an excuse. For pregnant women trying to flee Venezuela at the moment, where the health system is in a state of implosion, the closure of the border to Colombia is devastating. And, to my mind, COVID-19 is a disease of the connected world, where all of us are only as strong as the weakest link in the chain, where the only solution has got to be a universal solution. Now, the lesson of COVID-19 is not that you should have open borders but that you need to provide for people across borders. And, for those who need to flee, it’s very important to sustain the legal, as well as moral, rights that they have. The legal rights go back to the post–Second World War period, and the moral rights go back longer.