You Can’t Practice Social Distancing if You’re a Refugee

BEIRUT—To Khaled Abdul Razaq al-Dasher, the call for “social distancing” amid the coronavirus pandemic is a cruel joke.

Dasher shares a tent in Lebanon’s Bekaa Valley with nine family members, all of them refugees from the Syrian civil war. Around 500 people live in the informal camp. The next tent over is just 5 feet away, a foot or so short of what’s recommended by public health experts. They have sheets of tarpaulin and plastic that make the walls between them, but so much as stepping out of the tent puts them at unadvisable risk. The drum that feeds their tents running water is shared with a neighboring family, and sometimes it runs out. Instead of the frequent hand-washing being recommended globally, Dasher and his family are wiping their hands with alcohol and cleaning with chlorine.

“But supplies are running a little low,” he said.

And the coronavirus pandemic is drawing nearer. “Social distancing is a privilege,” said Sahar Tawfeeq, a spokesperson for the International Committee of the Red Cross in Iraq. “There is a hashtag trending: #StayHome. They can’t do that. They don’t have a home to stay in.”

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The United Nations and aid organizations are now faced with the task of trying to protect the world’s 70 million displaced people from a virus that has devastated some of the world’s best health care systems. In the Middle East, millions of people forced to flee due to the war in Syria, the fight against the Islamic State, and other conflicts remain displaced in camps, informal settlements, and overcrowded or unfinished buildings.

“All the basic things you need to prevent an outbreak are missing,” said Misty Buswell, the Middle East policy director for the International Rescue Committee. Often, it’s not that camps have weak health systems—which experts warn will be overrun by the coronavirus—but that they have no health system at all.

Dasher’s home in the suburbs of Aleppo, which his family fled in 2011, had a proper bathroom and running water and would provide much better protection from the invisible virus that now threatens his family. But it’s still not safe to return. He said he’s not scared for himself but worries about his elderly parents who live in a neighboring tent with siblings. The two tents share one bathroom.

“People think refugees are stupid, but we aren’t hicks,” said Dasher, who trained as a nurse in Syria, “It’s just our resources are scarce.”

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Across the region, aid groups are stepping up distribution of soap, water, and information about the virus. In Iraq, where 1.5 million people remain displaced, camps are being sprayed with disinfectant. Some tents hold more than 15 family members. Iraqis in camps are doing the best they can to follow the health guidelines, and the International Committee of the Red Cross has distributed extra food and hygiene kits to some of the camps this week. But, Tawfeeq said, “You can’t tell someone to use soap and clean if they don’t have any.”

Camps in the Kurdish region in the north have been mostly sealed off. Jordan took a similar measure this week. And those living in camps and informal settlements are becoming fearful of outsiders entering, knowing that they could be bringing the virus.

“If there was one case in a camp, there it’s a huge problem,” Tawfeeq said.

Dasher has stopped visiting other tents and said, with the exception of emergencies, they are not allowed to leave. “They told us we should wear gloves and masks if we go out but have not provided us with any yet,” said Dasher, who spoke by phone because a journalist entering would put the community at unnecessary risk.

So far there are no confirmed cases of the virus in any of the Middle East’s hundreds of camps and informal settlements, but that doesn’t mean it’s not there. All the refugee-hosting countries have rising numbers of infections, but testing in the camps has been scarce. Dasher said he hasn’t seen any testing where he lives. In a camp in Iraq, a handful of suspected cases were tested last week and came back negative.

“It could create a false and dangerous sense of comfort,” said Muhammad Hamid Zaman, a professor of biomedical engineering and international health at Boston University who has worked in camps across the Middle East. “Just because we don’t have data doesn’t mean the problem doesn’t exist.”

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There is little information, added Zaman, even on how many tests have been carried out among displaced populations, and with COVID-19, ignorance is surely not bliss. He said many refugees and internally displaced people are already vulnerable after years—or even decades—of poor nutrition and health care.

In the region’s dozens of Palestinian camps, refugees live in permanent structures, but they are still densely populated, with only dark narrow alleys between apartments and often several generations sharing a living space.

Meanwhile in Idlib, Syria, 2 million displaced civilians face the virus under a shaky cease-fire brokered by Turkey and Russia earlier this month. Hundreds of thousands of people there live in camps, sometimes with several families sharing a single tent. A return to conflict could mean thousands of people on the move, and Buswell said in that scenario it would be almost impossible to assist them.

People who work in the opposition’s health directorate in Idlib say they are preparing the best they can considering so many health facilities have been destroyed by bombings, and they are trying to raise awareness among Idlib’s population.

“People are very indifferent due to the concerns of life, displacement, and bombing,” said Waseem Zakaria, a doctor who is part of the directorate.

Syria is claiming to have no cases of the virus, but reports have called that into question.

Aid organizations have faced tough decisions. Most have canceled all nonessential programming, only continuing work related to health, hygiene, and food, with the goal of limiting the number of people entering the camps.

There is a risk that well-intentioned humanitarians could bring the virus to vulnerable populations, especially considering the alarming rates of asymptotic transmission.

The U.N. and aid agencies are now training staff on safety and prevention for the coronavirus, but last week one aid worker who had visited the refugees in Lebanon’s Bekaa Valley tested positive for the virus, raising concern.

The U.N.’s World Food Program—inconveniently headquartered in Rome, where the coronavirus has run rampant—put out new guidelines for food distribution this week that include noncontact rules, mandatory temperature checks, and instructions for making a hand-washing solution with 0.5 percent bleach for use by aid recipients.

In countries like Lebanon, rather than handing out bags of rice and jugs of oil, U.N. agencies and nongovernmental organizations have long transferred cash to refugees to buy food and other essentials, but it’s not enough for stocking up—and news of people panic-buying food or disinfectant must seem like another cruel joke.

The U.N.’s refugee agency has launched an $33 million appeal to deal with the crisis, but so many states that might usually donate are struggling to contain their own outbreaks. Refugees will face an unprecedented competition for emergency medical resources, as organizations like Doctors Without Borders, which usually assists the world’s most vulnerable, send teams to places like Italy. In that competition for global health resources, refugees are likely to lose.

“Everyone is very focused on what’s happening in their own country,” Buswell said. “But this virus doesn’t respect borders.”

Even with aid and medical supplies donated to some countries, it’s not clear how much will trickle down to refugees. Zaman, the Boston University professor, said that on top of the physical vulnerability of being unable to self-isolate and lack of health and hygiene facilities, refugees also face an incredible stigma, often scapegoats amid crisis. If the virus spreads rapidly in the camp, local populations may forget that it entered the country on commercial airliners. Borders are closing at an unprecedented rate, and resettlement, the miracle granted to just 1 percent of refugees that gives hope to millions, has been temporarily halted.

“A Syrian is already in a precarious position,” said Dasher, “so they are concerned about what happens if they get ill.”

Some Syrian refugees in Lebanon worry that they will not be treated in the country’s hospitals if they do catch the virus. There is no indication that is true, but as health systems struggle to treat their own populations, it’s very possible refugees could be deprioritized.

“On a certain level, looking after your own is natural, but if that’s all you do, it’s problematic,” Zaman said.