Refugees and COVID-19: achieving a comprehensive public health response

Bulletin of the World Health Organization
Volume 98, Number 8, August 2020, 509-580


Refugees and COVID-19: achieving a comprehensive public health response
— Qais Alemi, Carl Stempel, Hafifa Siddiq & Eunice Kim
Millions of refugees worldwide are exposed to violence, family separation, culture loss and exile. The coronavirus disease 2019 (COVID-19) exposes these populations to a new threat, one that could prove to be more devastating than the events forcing them to flee their homelands.

Refugees are vulnerable to COVID-19,1 as they live in conditions that disproportionately increase their risk of contagion. For example, in densely populated refugee camps, social distancing is challenging and if basic sanitation is lacking, proper hand hygiene is close to impossible.2 Projections in Cox’s Bazar, Bangladesh, which hosts over 600 000 Rohingya refugees, suggest that a COVID-19 outbreak could exhaust medical resources and overwhelm camp hospitals within 58 days, which would lead to a rise in deaths from other infectious diseases, such as malaria.2 Although limited evidence exists on whether infectious diseases increase the risk of COVID-19, the World Health Organization anticipates that people who have both COVID-19 and other infectious diseases, such as tuberculosis, may have poorer treatment outcomes, especially if tuberculosis treatment is interrupted.3 This prediction is alarming, considering that tuberculosis and malaria are highly prevalent in refugee populations, as are noncommunicable diseases, such as type 2 diabetes,4,5 known to increase susceptibility to severe COVID-19. This situation is compounded by language barriers that refugees face in host communities and their limited access to health care for obtaining health information, testing and treatment, which some may even avoid out of fears of being deported.4