Medical vulnerability, travel history and lack of sanitation: refugees at risk of COVID-19

“Coronavirus will decimate refugee communities if we don’t act now,” a serious warning from the Norwegian Refugee Council (NRC) that addresses the vulnerable situation of millions displaced people around the world. Secretary General of NRC, Jan Egeland, foresees a “catastrophe” with “devastating” consequence if the virus hits one of the overcrowded and sanitation lacking refugee or displacement sites. The same sentiment was echoed by the Head of Health for the International Committee of the Red Cross (ICRC),  Dr Esperanza Martinez, who said that the spread of the virus would be “impossible to manage” if it reached the displaced communities of Syria or Yemen. Health organizations have made a number of recommendations to protect against COVID-19, but unfortunately many refugees live in a situation in which they themselves as well as their host government cannot follow healthcare guidelines.

Healthcare advise

To prevent COVID-19 the World Health Organization (WHO) advises the public to wash hands frequently and with soap, maintain social distance, seek medical care early and to stay informed and follow the advice of healthcare providers. The European Center for Disease Prevention and Control furthermore presses the importance of social distance and isolation. The World Health Federations (WHF) furthermore argues that travel should be reduced to a minimum, and to use a mask while travelling in public transport. WHF also warns that COVID-19 is likely to co-exist with other diseases in poverty stricken areas and lead to increased morbidity and mortality.

Along with the advice for individuals there is also advice for international organizations and governments. Besides facilitating healthcare, hygiene and proper housing it is also important to focus on coordination, education, information, trust building and protecting healthcare workers. Furthermore, as health group FHI360 states, governments, aid groups, and local health workers have to coordinate well; while national governments also need to coordinate and cooperate. Surveillance and communication are essential to track the outbreak of COVID-19 and to from a proper response.

COVID-19 and refugee host countries

Of the world’s 29 million refugees 84% are hosted by countries with weak health, sanitation and water systems, often in unstable and overcrowded conditions. Many African countries in particular are not prepared for COVID-19. One country that is especially significant is Ethiopia, a country that “faces one of the most complex human mobility environments in the world” according to the UN Migration Agency. Furthermore, according to health experts, Ethiopia’s direct link and high volume of trade with China means that there is a significant importation risk.


Internal displacement in Ethiopia happens for a number of reasons. Ethnic tensions, political unrest and communal violence have led to large-scale internal displacement. Furthermore, extreme weather conditions have led to flooding and droughts that have displaced 233.000 people. As a result at least 755.000 people have been displaced in Ethiopia between January and June 2019.  Besides the internally displaced, Ethiopia also hosts migrants and refugees from neighboring countries including Somalia and Eritrea. The living conditions of the displaced people are overcrowded, unsanitary, lacking in health care and many of the people lack nutritional and health resilience. A measles outbreak since January in the South of Ethiopia further complicates the situation.

Many of those people have also travelled a lot in vulnerable conditions and have been in close contact with people who are in the same situation. Both Ethiopia and the countries of origin are not prepared for an epidemic. Out of the 195 of the Global Health Security index for epidemic and pandemic preparedness Ethiopia came in 84th, Eritrea 178th and Somalia 195th. To combat the sanitation, health and shelter issues IOM pledged 77.6 million dollar to help 1.2 million people, but Ethiopia calls for at least 1 billion dollar to help 7 million people that are in acute humanitarian need.


However, these conditions are not exclusive to developing countries. Médecins Sans Frontières (MSF) argues on their website for the urgent closure of Greek refugee camps because the “extreme overcrowding, undignified and unhygienic living conditions, and lack of access to fundamental basic services” for the “perfect storm” for an outbreak that would be impossible to contain. MSF notes that there are 42.000 asylum seekers staying in five hotspots build to host 6000 people, with families of five or six sleeping in spaces just three square meters. In the Moria camp, there is just one water tap per 1.300 people with no soap available. Many people are already suffering from other health issues while not being able to get proper healthcare. The combination of these issues makes the asylum seekers extra vulnerable to COVID-19.

Right to care

Many refugees are trapped in a situation in which they cannot follow the health advise to protect themselves and those around them. Furthermore, they are hosted in countries that do not have the healthcare capacity to properly tend to their needs. Ethiopia and Greece are just two examples, but for the 655,144 migrants and asylum seekers trapped in the detention centers in Libya the situation is equally bad if not worse. Everyone has a right to health and it is important to protect this right not only to protect those who are vulnerable but also to maintain stability in a vulnerable region. Aside from the obvious health threat COVID-19 entails it also has severe economic consequences that further fuel inequality and vulnerability as well as inflated prices of basic goods. In order to avoid the decimation of refugee communities it is vital to help host countries fight COVID-19 while giving refugees and other displaced people the tools to protect themselves.  Furthermore, it is crucial that African experts are involved in the coronavirus fight. On the front of data science, the GO FAIR Foundation, Kampala International University and the Philips Foundation lead the way to make sure that accessible data is available to track COVID-19 data and thus strengthen the response capacity.