Day 6

COVID-19 could spark a 'humanitarian disaster' in refugee populations, says public health expert

Cases of COVID-19 have sprung up around the world this week, including hundreds in the Middle East. That is causing concern about the region's vulnerable refugee populations, who have limited access to health care.

Confirmed coronavirus cases are on the rise in the Middle East, a region with a large number of refugees

A nurse cares for patients in a ward dedicated for people infected with the coronavirus at Forqani Hospital in Qom, 125 kilometres south of the Iranian capital Tehran, on Wednesday. Iran's Health Ministry said Friday the virus has killed 34 people amid 388 confirmed cases. (Mohammad Mohsenzadeh/Mizan News Agency/The Associated Press)

The spread of COVID-19 in Iran and the Middle East has raised concerns about what will happen if it hits the region's sizeable refugee populations.

A spokesperson for Iran's health ministry said Friday that the virus has killed 34 people out of 388 cases in the country, with the latest tally pushing the number of confirmed cases in the Middle East over 500.

Dr. Mohammed Jawad is working with Public Health England to respond to the coronavirus outbreak, and also researches the health effects of armed conflict at Imperial College London. 

He told Day 6 guest host Saroja Coelho that refugee populations could be particularly vulnerable to the virus. Here is part of their conversation.

Coronavirus cases are rising in the Middle East. How concerned are you that the virus will end up in refugee populations?

I am very concerned that will happen. As we see day by day, more and more cases are being declared around the world in different countries. I wouldn't be surprised if it had already happened and we're just waiting for some of the cases to be confirmed.

How easy would it be to identify the virus if it turned up?

Well, the virus itself isn't particularly special in the way it presents. It's very ordinary for a respiratory virus, and so many of the symptoms are common to us. We tend to get headaches, colds, runny noses, coughs quite regularly, and that's exactly how coronavirus presents.

However, there should be an air of calm around this because the percentage of people who are dying from coronavirus still appears to be quite low, despite some of the reports in the media.

Just how many refugees are there in this area?

We believe the number of refugees in the Middle East to be around 12 million, mainly centred around Lebanon, Syria, Iraq, Jordan, some in Egypt, some in Turkey and some in Iran, but those are the main countries.

What does their access to health care in those areas look like?

It does vary between country to country, but generally the access to health care is quite poor. Often, as you see for example in Lebanon, many refugees live out in informal tented settlements out in the valleys very far away from the nearest health-care centre. And so anyone who does fall ill with any condition really, not just coronavirus, will find it very difficult to access health care.

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And even when they do access health care, often the prices are quite high and won't necessarily be reimbursed by humanitarian agencies if they're not registered with them.

Are organizations that administer aid to refugees in the region on the lookout for coronavirus?

Absolutely. I think the whole world really is on the lookout now. It's very important that not only do we look out for it, but we're actually preparing our staff and giving advice to our colleagues and recipients of aid and care, with regards to spotting the signs of symptoms of coronavirus in addition to infection control and personal hygiene advice.

How easy would it be to identify the coronavirus if it did turn up in refugee populations?

I think it would be quite difficult to identify coronavirus in refugee populations mainly because the population is so mobile, tend not to have fixed addresses and generally live quite far from health facilities in order to have those tests done and have the follow ups provided to them.

Have we seen any outbreaks in the past that may give us a sense of what a coronavirus outbreak might look like among refugee populations there?

I'm not aware of coronavirus-like viruses spreading around refugee populations... but we do often see outbreaks of infectious disease in refugee populations, particularly vaccine-preventable ones.

The world was very close to eradicating polio, but due to the conflicts in Syria, in Iraq, Afghanistan and I believe in Nigeria, we saw a resurgence there among refugee populations.

Syrian refugee children receive medicine for polio and measles at a facility in Dohuk, Iraq, on Oct. 17, 2019. (Byron Smith/Getty Images)

Also, recently the Syrian refugees who have come into Lebanon have spread a very mild skin disease called leishmaniasis, or the Aleppo boil, which generally is well contained in Aleppo, which is in the northwestern part of Syria, but now has spread quite commonly across Lebanon.

How prepared are countries to deal with an outbreak in the refugee population should it happen?

It's a difficult question because countries vary in the level of resources they have available, and the number of refugees, and the context of those refugees.

I can imagine though, despite [a] high level of preparation, it will be very difficult to control and prevent the spread of coronavirus and other diseases in refugee populations, due to their high levels of mobility, not having fixed abodes [where they live], limited access to health care, difficulty eating and ... in some cases, language barriers.

What you've described to us is a situation of possibility; it's not inevitable that the coronavirus will enter refugee populations, but it is possible.

With that in mind, if the type of outbreak you're describing takes hold in these communities, what kind of global consequences could that have?

I think it would be a real humanitarian disaster actually, if coronavirus did spread to refugee populations.

I believe that because many of the refugees are vulnerable and particularly in the Middle East have poor health as it is, that would make them particularly at risk of high levels of death from coronavirus, which ordinarily doesn't cause death unless you are either someone who has pre-existing medical conditions or has a lowered immune system in general.

Written by Jonathan Ore. Interview produced by Rachel Levy-McLaughlin.

To hear more from Mohammed Jawad, download our podcast or click Listen above.