During its five years of controversial existence, the Moria refugee camp on the Greek island of Lesbos has earned a reputation as one of the worst refugee camps in the world. Vastly overcrowded, grossly unhygienic, and described as a ‘living hell’ by the British doctor Annie Chapman, Moria epitomises the potentially calamitous threat posed to refugees by Covid-19. 

Built to house 3,000 people but with a population of more than 20,000, parts of the camp have only one water tap for every 1,300 people and no access to soap, says Dora Vangi, Médecins Sans Frontières’ (MSF) field communications manager for the Balkans. Families of five or six are being forced to sleep in spaces of three square metres or less and have limited access to even the most basic hygiene products. It’s a similar situation on Samos, where 8,000 people are living in a camp designed for 650.

“The horrific camps where thousands of souls are stuck on the Greek islands are a result of a migration policy that is not working,” says Vangi. “A result of the EU-Turkey deal. Having these camps in place was always unacceptable but now it is even more urgent than ever before for EU countries to change these policies and to take asylum seekers from the Greek islands. MSF is calling for the immediate transfer of the high-risk population who, in view of Covid-19, are the elderly and patients with chronic diseases.”

As part of its preventative measures in Moria, MSF has scaled up the provision of sanitation services, adding 42 toilets and 30 showers. On Samos, it is providing an additional 60,000 litres of drinking water and toilets for those living outside the official camp. It is also promoting hygiene to camp residents, has put in place procedures to support the referral of patients presenting symptoms related to Covid-19, and has adapted its facilities and procedures to ensure the safety of its patients and staff. It is also scaling up its operations with the recruitment of extra medical, paramedical and support staff and the acquisition of equipment.  

“Despite all our efforts the hygiene standards are not even close to the minimum and the threat of an outbreak among people is very real; yet there are no epidemic response plans in place,” says Vangi. “We need to be realistic: there is no way we can contain the virus in a humane and dignified way in such camp settings… Forcing people to live in overcrowded and unhygienic camps as part of Europe’s containment policy was always irresponsible, but now more than ever due to the Covid-19 threat.”

That threat is frighteningly real. In Greece, the Ritsona refugee camp was placed under quarantine in early April after 20 of its residents were diagnosed with coronavirus, while camps across the Middle East are woefully unprepared for a global pandemic. Lebanon alone has the largest number of refugees per capita in the world, while Yemen and Syria are already beset by malnutrition, cholera and an insufficient supply of clean water and healthcare facilities. About 50 per cent of internally displaced people in Yemen have no access to clean water, says the United Nations High Commissioner for Refugees (UNHCR). All of these countries were already struggling economically and have extremely weak health systems.

Elsewhere in the world it is arguably worse. The Rohingya refugee camp at Cox’s Bazar in Bangladesh, where the population density is 40,000 people per square kilometre, is plagued by dysentery, cholera, typhoid and malnutrition. In Gaza, where there are more than 5,000 people per square kilometre and fewer than 70 intensive care beds for a population of two million, there are already 10 confirmed cases of Covid-19. 

“The pandemic risks being catastrophic, not just in refugee camps, but also in host communities and in all countries across the region already beset by conflict, and could shatter already fragile health and protection systems and broken economies,” says Dr Hadeel Qazzaz, Oxfam’s regional gender co-ordinator for the Middle East and North Africa. “For refugees and other displaced people living in camps or crowded urban areas with high population density and little basic infrastructure, lockdown, social distancing and washing your hands for 20 seconds is almost impossible. These conditions create a tinderbox for transmission to millions of already vulnerable people.”

Oxfam has distributed soap to 8,252 Syrian refugees in Lebanon, provided 200 beds to quarantine centres in Gaza, and is repairing and maintaining public water taps in Gaza. In Jordan’s Zaatari refugee camp, which is home to 76,645 Syrian refugees, it has scaled up its hand-washing and hygiene awareness sessions to 2,000 children and is using social media to engage and connect with refugees under the country’s new curfew measures.

In Lebanon and Jordan, where an estimated three million Syrians live as refugees, the threat is not only to crowded camps, but to informal tented settlements and to some suburbs of Beirut and other big cities where large numbers of vulnerable communities live. “These people are at higher risk of being affected because of the crowded settings they live in, the weaker average health status and the increased number of barriers many face in accessing health care in Lebanon,” says Caline Rehayem, deputy medical coordinator for MSF in Lebanon. “They are already living under harsh socioeconomic and poor infrastructural conditions. How can we ask people to protect themselves when they don’t have access to water or soap? Or to stay at home and self-isolate if they share a room with 10 other people?”

In Iraq, where 1.5 million people remain internally displaced, the threat is also to hospitals, healthcare facilities and rehabilitation centres, the majority of which are chronically under resourced. As a result, the International Committee of the Red Cross (ICRC) has redirected funds to the Iraqi Red Crescent Society’s Covid-19 response and is also supporting 18 primary health care centres, 14 physical rehabilitation centres and two hospitals by providing soap and disinfectant, personal protective equipment and non-contact infrared thermometers. A further 27 places of detention, housing around 45,000 detainees, are also being supported with donations of preventive materials.

“If the general population have problems getting the right support – because the World Health Organisation has difficulty bringing personal protective equipment into the country or hospitals don’t have proper intensive care units or enough ventilators – for those internally displaced people who have restricted movement it’s an even bigger challenge,” says Eve Charbonneau, health co-ordinator for the ICRC’s Iraq delegation.

“From my experience with Ebola,” adds Charbonneau, “what is important is the involvement and the commitment of the community to follow the rules . Because if they do not, this is what makes it difficult to fight the disease. So we have to make sure that the population is well informed, the community’s involved, and that the discussion through the health authorities is clear and transparent and the measures are respected.”

Yet none of this will be enough unless international assistance is forthcoming. Oxfam says it will need €100 million to fund its coronavirus response plan and has called for a package of nearly $160 billion in immediate debt cancellation and  aid for the world’s poorest countries. The UN has also issued a $2 billion appeal to fight coronavirus in the most vulnerable countries.

“The battle to fight this virus requires that no one is left behind, including refugees,” says Rula Amin, UNHCR’s senior communications advisor for the Middle East and North Africa. “If anyone is excluded efforts to beat this vicious virus will fail as it will only rebound and spread again. The outbreak is a global challenge that must be addressed through international solidarity and cooperation. In order to effectively combat any public health emergency, everyone – including refugees, asylum seekers and migrants – should be included in Covid-19 national preparedness and response plans, and be able to access health facilities and services in a non-discriminatory manner.”

In a bid to alleviate the threat posed to refugees and displaced people, Oxfam has called for “immediate ceasefires and the stopping of all forms of military aggression in Yemen, Iraq, Syria and the Occupied Palestinian Territory”, which Qazzaz says is “essential to ensure that these communities can survive the Corona crisis”. “We should all work together to support these communities and countries, to avoid a wave of the Covid-19 pandemic that would be devastating,” she says. “Refugees and displaced people cannot face wars and pandemic simultaneously.”

* An abridged version of this article first appeared in Vogue Arabia, April 2020