Without a Nation: The Pandemic and the Displaced

With war ravaging the Near East and Western Asia, many have had to seek refuge from their own countries. With their safety being compromised in such a way, health becomes the least of these people’s concerns. Many have to live with rats, water supplies contaminated with feces and scabies.  Across refugee camps, unsanitary conditions and overcrowding have caused a high occurrence of infectious diseases such as tuberculosis [1]. These conditions do not bode well, especially at a time such as this, as they imply that epidemics can easily hit these camps. Before the pandemic had gripped the world, those in refugee camps had a higher mortality rate than non-refugees, with those high mortalities mostly being caused by infectious diseases [2].

 On top of the concerns involving infectious disease that refugees face, there are also concerns regarding mental health. Refugees have alarming rates of PTSD and depression, especially among children [3]. These are just the rates of those who were capable of being diagnosed for these illnesses, so the actual rates could vary from the ones reported, explaining the highly variable rates among refugees for these issues. These mental health problems are usually a result of the traumas refugees face as a consequence of becoming uprooted from their homes, loved ones and livelihoods. Such events can leave a considerable toll on a refugee’s psyche. The situations that they are forced into no doubt aggravate their mental health issues, leading to distressing thoughts and flashbacks to their trauma.

 These issues are further compounded that refugees are considered burdens on countries’ systems and so their well being is thus not considered a priority for the countries hosting them. Such is the case with the Venezualan refugees who are displaced across South America. Columbia was one such country that had deprioritized these refugees’ health by denying those hosted in the country vaccines for fear of a “stampede ” of people wishing to be vaccinated into the country. However, in February this year, Columbia granted these refugees a temporary protected status which would allow them access to the Columbian healthcare system and eventually, vaccines. This shift in policy is the only one of its kind, especially at a time when governments are limiting their funding going towards humanitarian aid.

The pandemic seems to have happened at the worst possible time, with a decade old war in Syria still raging on, the displacement of the Rohingya and the Taliban overtaking Kabul to displace thousands of Afghan citizens. The pandemic has resulted in a world-wide financial collapse which has led to dwindling support for refugees and subsequent cuts to international aid. New facilities need to be built to maintain social distancing on top of the myriad of public health measures that must be implemented to maintain the refugees’ safety. The measures needed to protect against the pandemic are not being provided, due to the funding slashes that have taken place against humanitarian aid. Refugees are now being denied the right to asylum under the pretence of the pandemic. The lockdowns have diminished the refugees’ mobility within and without their host countries, but because there are food shortages and thus a lack of incentive to stay where they are, refugees may leave to find a better place to live, which can help to increase the spread of the virus.

However, because refugees are kept in such insular communities with very little exposure to the world outside their camps, there have been very few positive cases [4]. By the end of September 2021, out of the 30 million refugees worldwide, 21,000 had tested positive for covid. Granted, the low incidence of positive cases is likely due to the fact that so few have been tested as there are few testing kits to go around, and It has actually been demonstrated that covid is highly transmissible among refugees [5]. It certainly does not help that there have been outbreaks in camps across Lebanon, Syria and Palestine, especially with Lebanon housing the largest population of refugees per capita in the world [6]. It is even more alarming that those refugees are the ones who need the vaccines most, and yet have the lowest access to them.

These worries are further primarily caused by the fact that refugees have more hurdles to overcome to obtain the health care they need. Refugees are thus affected by shortages in access to vaccines and hesitancy towards being vaccinated [7].These high rates of hesitancy among refugees are spurred by fears over the side effects of the vaccine and concerns over vaccine safety. This is exaggerated by diminished digital literacy, low literacy rates and fears over harassment when navigating the registration process due to a lack of documentation  which limits how many refugees can register for the vaccine. Because of these concerns, Lebanon has formulated a vaccine roll-out program that would mitigate vaccine hesitancy and barriers towards accessing vaccines among refugees. Lebanon is among the worst-affected countries in the world in terms of how it is faring in the pandemic, to the point where its healthcare system is on the brink of collapse; despite the strain on its resources, the country made it a goal to provide healthcare to those in need.

Jordan has implemented a similar program that made Jordan the first country in the world to vaccinate its UN registered refugees as a result of these intensive vaccination programs. There are problems that developing countries such as Jordan must face such as the very limited supply of vaccines that they are in possession of.

Countries such as Jordan and Lebanon made it clear that when working for the good of disenfranchised communities it works in favor for all, as they recognize this as not only a moral issue but a public health issue. Though the countries of the world all have insurmountable challenges to face, it is imperative for the sake of maintaining our well being that altruism must conquer our qualms against helping those who need it most.

[1] Eiset, A.H., Wejse, C. Review of infectious diseases in refugees and asylum seekers—current status and going forward. Public Health Rev 38, 22 (2017). https://doi.org/10.1186/s40985-017-0065-4

[2] Heudtlass, P., Speybroeck, N. & Guha-Sapir, D. Excess mortality in refugees, internally displaced persons and resident populations in complex humanitarian emergencies (1998–2012) – insights from operational data. Confl Health 10, 15 (2016). https://doi.org/10.1186/s13031-016-0082-9

[3] Hameed, S., Sadiq, A., & Din, A. U. (2018). The Increased Vulnerability of Refugee Population to Mental Health Disorders. Kansas journal of medicine, 11(1), 1–12.

[4] Kamal, Abu-Hena & Huda, Md. Nazmul & Dell, Colleen & Hossain, Syeda & Shuheli, & Ahmed, Shuheli. (2020). Translational Strategies to Control and Prevent the Spread of COVID-19 in the Rohingya Refugee Camps in Bangladesh. Global Biosecurity. 1. 1-10. 10.31646/gbio.77.

[5] Kondilis, Elias & Papamichail, Dimitris & McCann, Sophie & Orcutt, Miriam & Carruthers, Elspeth & Veizis, Apostolos & Hargreaves, Sally. (2021). The Impact of the COVID-19 Pandemic on Migrants, Refugees and Asylum Seekers in Greece: A Retrospective Analysis of National Surveillance Data (Feb-Nov 2020). SSRN Electronic Journal. 10.2139/ssrn.3788086.

[6] Jawad, Nadine & Taweeleh, Lina & Elharake, Jad & Khamis, Nicole & Alser, Osaid & Karaki, Fatima & Aboukhater, Layla. (2021). Refugee access to COVID-19 vaccines in Lebanon. The Lancet. 397. 10.1016/S0140-6736(21)00925-9.

[7] Alison F Crawshaw, Anna Deal, Kieran Rustage, Alice S Forster, Ines Campos-Matos, Tushna Vandrevala, Andrea Würz, Anastasia Pharris, Jonathan E Suk, John Kinsman, Charlotte Deogan, Anna Miller, Silvia Declich, MSc, Chris Greenaway, Teymur Noori, Sally Hargreaves, , What must be done to tackle vaccine hesitancy and barriers to COVID-19 vaccination in migrants?, Journal of Travel Medicine, Volume 28, Issue 4, May 2021, taab048, https://doi.org/10.1093/jtm/taab048

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