Crowding, lack of water spell COVID-19 nightmare for world’s 71 million refugees

For the 70.8 million forcibly displaced people worldwide — 2.6 million of them trapped in overcrowded camps without proper sanitation — basic preventative measures against COVID-19 such as social distancing and frequent hand washing are almost impossible.

Before the current crisis, refugees, internally displaced persons (IDPs), asylum seekers, and stateless individuals were already the world’s most vulnerable populations. Now they risk suffering from the global pandemic at disproportionately high rates.

Jewish and Israeli refugee and humanitarian aid organizations supporting these populations find themselves charting unknown territory, swiftly adapting to the constantly changing health situation, deteriorating economic conditions, and tightened restrictions on freedom of movement in every country.

Greek refugee camps are on lockdown, with the UNHCR or national authorities only allowing medical and food distribution workers to enter. This forces all other international and local aid workers to devise other ways to continue to provide regular services, while taking steps specifically targeted at limiting the spread of the coronavirus.

American, Israeli, and international workers usually based in refugee hot spots have been required to evacuate to their home countries and work remotely, using technology to the extent possible.

A group of women, who lost their homes in the 2018 earthquake and tsunami, gather in a temporary shelter in a large DP camp outside Palu, Indonesia. With little access to medical care and living in overcrowded conditions, the community is at high risk for COVID-19. (Allison Joyce/AJWS)

“This is different from anything we know. It’s a shifting global phenomenon, so it is hard for us to focus and prioritize,” said Yotam Politzer, CEO of IsraAID, an Israel-based international non-governmental organization that has worked in emergency and long-term development settings in more than 50 countries. At this time it has 14 active missions worldwide.

The challenges posed by the pandemic within refugee, IDP, and asylum seeker communities are myriad. A lack of access to clean water, sanitation facilities and soap is just the beginning. As an example, Moria, the largest refugee camp on Lesbos, Greece, was built for just over 3,000 people. It is now inhabited by 20,000, and reportedly has one water tap per 1,300 people, one toilet per 167 and one shower per 242.

“There is little access to water at Kakuma,” said Annet Apio, IsraAID’s country director for Kenya and Uganda, about the Kakuma Refugee Camp and Kalobeyei Integrated Settlement in northwest Kenya. The camp houses 194,000 refugees, mainly from South Sudan. IsraAID runs three child-friendly resource centers at Kakuma.

Children using the safe water facility at IsraAID space in Kakuma, Kenya. (Lior Sperandeo/IsraAID)

“Access to soap and hand sanitizer is a luxury in a place like that. And people need to line up to access clean water, so it is all but impossible to enforce social distancing,” said Apio from her home in Nairobi, where she is working remotely because of the pandemic.

To try to alleviate the problem, IsraAID is working with local partners to set up additional hand washing stations. Other Jewish aid organizations are also working through their partners on the ground toward providing increased access to fresh water, soap and sanitizer for various refugee communities.

Melanie Nezer, senior vice president for public affairs at HIAS, a Jewish American organization assisting and advocating for refugees with almost 1,000 staff worldwide, noted that the coronavirus risks resulting from overcrowding are also prevalent in detention centers for asylum seekers in North America.

HIAS clients in Ciudad Juarez, Mexico, receive remote legal assistance from a pro bono attorney. (HIAS)

“We do a lot of work with asylum seekers at the US southern border. People forced to wait on the other side of the border in makeshift encampments in Mexico are living in tents with poor sanitation and hygiene, causing them to be at higher risk for exposure to the virus,” Nezer said.

Lack of clear information

Whereas Westerners have been bombarded with COVID-19 prevention information and updates through the media, the opposite is true for many refugee populations. Some refugee camps, such as Kakuma — a 16-hour drive from Nairobi — are extremely remote. Although almost all refugees in Europe have smartphones and some internet access, many elsewhere do not. Even among refugee families in Europe, not all members have phones, and many do not own laptop computers.

HIAS Greece translator Jalal Barezkai (right) works with a Syrian refugee in an encampment just outside the Moria refugee camp on the Greek island of Lesbos, May 9, 2018. Barezkai is a former refugee from Afghanistan.
(Bill Swersey/HIAS)

Samantha Wolthuis, director of humanitarian response and international operations at American Jewish World Service (AJWS), emphasized the importance of trust in the dissemination of information about the virus and infection prevention. AJWS, a disaster response and human rights NGO, supports 487 social change organizations in 19 countries. It supports refugees and internally displaced persons in several countries, including Sri Lanka, Kenya, Uganda, and Myanmar. In Indonesia, it works with internally displaced persons.

“When working with refugees and internally displaced persons, we work with trusted local organizations, many of which are managed by refugees or internally displaced persons and led by activists who have roots in these communities,” AJWS’s Wolthuis said. “Because these organizations are led by members of the refugee community, they are trusted to disseminate information and identify the needs of their communities. This is particularly critical when the spread of misinformation is rampant and trusted messengers are in shortly supply.”

IsraAID works on water systems on Vanuatu’s islands of Pentecost, Tongoa, and Ambae.The team has joined the Ministry of Health’s Risk Communication Group to help coordinate public messaging around coronavirus. (IsraAID)

AJWS has prepared a COVID-19 educational toolkit on hygiene, social distancing, symptom monitoring and how to care for sick relatives. The toolkit has been translated into seven languages: Bahasa Indonesia, Burmese, English, French, Kreyol, Rohingya and Spanish. AJWS’s local partners are disseminating the information by deploying community health volunteers from within the refugee communities, through local radio broadcasts, via social media, and by loudspeaker announcements in the refugee camps.

Notwithstanding efforts to educate about avoiding contagion, once the virus enters refugee camps, it will run rampant and likely sicken and kill untold numbers.

If we think this is a big issue in the US and Europe, we haven’t seen anything yet if COVID gets into the refugee population

“If we think this is a big issue in the US and Europe, we haven’t seen anything yet if COVID gets into the refugee population,” Adam Coutts, a public health researcher at Cambridge University, told The New York Times. Coutts believes that the virus has already infiltrated some refugee camps. The camps and their host countries are ill equipped to handle outbreaks.

A woman cooks in a community kitchen in a DP camp outside Palu, Indonesia. With little access to medical care and living in cramped, temporary housing, her community is at high risk for COVID-19. (Allison Joyce/AJWS)

Fighting food insecurity

Jewish and Israeli aid organizations are doing what they can to obtain medical supplies, especially personal protective equipment for medical staff. They are also trying to help fill in gaps identified by healthcare partners in the camps. For instance, at Kakuma they have to deal with malaria during the upcoming rainy season from April to June, and malnutrition is a problem among children under five due to drought. Both these factors would exacerbate an outbreak of COVID-19.

“We are working on procuring malaria testing kits and food supplements,” said IsraAID’s Apio.

According to Nezer, HIAS is working with local supermarkets in Ecuador to arrange for food for refugees from Venezuela and Columbia. “Our hotline is getting 600 calls a day with questions and emergency requests for food and medicine,” she said.

Voluteers with Mazon Neshama organize food donations for asylum seekers at Pesia’s kitchen, Tel Aviv, March 2020. (Gideon Ben-Ami)

Asylum seekers in Israel are also facing food insecurity and malnutrition as a result of the current crisis. According to Julie Fisher, founder of the Consortium for Israel and the Asylum Seekers, there are approximately 32,000 African asylum seekers in Israel, not including children. The majority, around 72%, are from Eritrea, and around 20% are from Sudan.

There are approximately 32,000 African asylum seekers in Israel, not including children

According to Fisher, about 80% of this community has lost their jobs in recent weeks due to the near-total shutdown of the Israeli economy. Lacking the social welfare and unemployment benefits afforded Israelis, and largely ineligible for Israel’s universal healthcare benefits, asylum seekers — already living below the poverty line — find themselves in dire straits.

“The organizations that work with the asylum-seeking community are feeling the enormous burden of taking care of a population without any resources during a crisis that could take months to resolve. There has been a huge increase in hunger… We are seeing a huge demand for more food, diapers, and infant formula as families are unable to pay for these things due to widespread job loss,” said Fisher, who is working round the clock with fellow volunteers to meet the needs.

Asylum seeker picks up fresh fruits and vegetables provided by Leket at Pesia’s Kitchen, Tel Aviv, March 2020. (Gideon Ben-Ami)

Business as usual, on steroids

Sivan Carmel, director of the HIAS Israel office, said her organization was working with Physicians for Human Rights Israel to translate and distribute coronavirus information to asylum seeker clients. In addition, despite having to isolate at home, it is business as usual for HIAS’s legal aid attorneys trying to have clients’ asylum cases heard.

“Our ongoing efforts to get the government to rescind the Deposit Law [by which the government deducts 20 percent of an asylum seeker’s wages and holds it until they leave the country] is even more pressing now,” Carmel added. “The asylum seekers need this money desperately.”

Precisely because the situation is even more stressful than usual for refugees worldwide, aid organizations are focused on mitigating the disruption to the regular routines of both adults and children.

HIAS staff member with refugee family in Ecuador (HIAS)

In Sindos, near Thessaloniki in northern Greece, IsraAID manages a community center serving locals and refugees living in shelters. It also runs a school just outside the Moria refugee camp in Lesbos.

According to IsraAID country director for Greece, Sarah Danby, the organization’s educational and psychosocial support programs have been moved online using a variety of social media platforms, including YouTube, Instagram, Facebook Messenger, Google Forms and WhatsApp. Local coordinators are also calling families from the school and community center once a week to maintain contact and reduce the ill effects of isolation and mental stress.

Another danger to refugee communities in some parts of the world are claims that they and other marginalized populations are to blame for the spread of COVID-19. (Studies show that this is not the case.)

Children and staff member at IsraAID child resource center in Kakuma Refugee Camp, Kenya. (Lior Sperandeo/IsraAID)

“This happened in Liberia as Ebola spread, and now again with COVID-19. This is a very dangerous time for minorities,” said AJWS’s Wolthuis, who fears violence could break out.

All the organizations agree that when COVID-19 finally subsides, it will be necessary to reassess how they work as the new reality brought on by the pandemic will require different approaches.

“The question is what has changed just for now, and what will have changed forever. We’ll have to see,” said Nezer, who hopes that aid workers will be able to get off their screens and back into the field as soon as possible.

“Some of our work needs to be face-to-face in order to build trust. Much would be lost if we lose this ability in the long term,” Nezer said.