Addressing COVID-19 in humanitarian settings: a call to action

Alawa, Jude; Alawa, Nawara; Coutts, Adam; Sullivan, Richard; Khoshnood, Kaveh; Fouad, Fouad M.

doi:10.1186/s13031-020-00307-8

Cited by 40 publications

(29 citation statements)

References 10 publications

(9 reference statements)

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“…Refugee camps are typically crowded, and are often built quickly and with little regard to such things as tent spacing. In these settings, where social distancing and personal hygiene is difficult, the spread of COVID-19 is facilitated ( Greenaway et al, 2020 , Iacobucci, 2020 , Hargreaves et al, 2020 , Jozaghi and Dahya, 2020 , ACAPS 2020 , Vonen et al, 2020 , Hargreaves et al, 2020 , Alawa et al, 2020 , Peprah, 2020 , Spernovasilis et al, 2020 , Kondilis et al, 2020 , The Lancet 2020 , Gilman et al, 2020 , Alemi et al, 2020 , Carruthers et al, 2020 , Carruthers et al, 2020 , Commentary, 2020 ). For example, the Moria camp in Greece had an estimated population density of 133,000 per km 2 , with reports of one water tap shared between 1,300 people in some areas of the camp ( ACAPS 2020 ).…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Hayward

Deal

Cheng

et al. 2021

Journal of Migration and Health

242

228

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Section: Resultsmentioning

confidence: 99%

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Hayward

Deal

Cheng

et al. 2021

Journal of Migration and Health

242

228

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“…If a COVID-19 epidemic is established among refugees, it would still cause a heavy toll given all the vulnerability factors and the resource-poor healthcare infrastructure available to this population. Therefore, to prevent exacerbation of the current humanitarian crisis and catastrophic consequences, local and international actors and stakeholders should urgently mobilize and coordinate efforts to prevent the transmission of COVID-19, and mitigate its impact amongst the vulnerable refugee populations globally [ 20 ]. Special consideration also needs to be given to refugee populations when prioritizing vaccine deployment.…”

Section: Resultsmentioning

confidence: 99%

Vulnerability of Syrian refugees in Lebanon to COVID-19: quantitative insights

et al. 2021

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Lebanon, a middle-income country with ongoing political turmoil, unstable economic situation, and a fragmented and under-resourced health system, hosts about one million Syrian refugees since 2011. While the country is currently experiencing substantial COVID-19 epidemic spread, no outbreaks have been reported yet among Syrian refugees. However, testing of this population remains limited and exposure levels are high given dire living conditions and close interaction with the host community. Here, we use quantitative insights of transmission dynamics to outline risk and contextual factors that may modulate vulnerability of Syrian refugees in Lebanon to potentially large COVID-19 epidemics.Syrian refugees live in close contact with the host community, and their living conditions are favorable for epidemic spread. We found that the high levels of crowding within Syrian refugee households and among those in informal tented settlements, the inadequate water supply and sanitation, limited use of masks, inadequate access to health care, and inadequate community awareness levels are vulnerability factors that directly impact important parameters of transmission dynamics, leading to larger epidemic scale. Poverty, stigma, and fear of legal consequences are contextual factors that further exacerbate this vulnerability. The relatively high prevalence of non-communicable diseases in this population could also affect the severity of the disease among those infected. Mathematical modeling simulations we conducted illustrated that even modest increases in transmission among Syrian refugees could result in a large increase in the incidence and cumulative total number of infections in the absence of interventions.In conclusion, while the young age structure of the Syrian refugee population might play a protective role against the scale and disease-burden severity of a potential COVID-19 epidemic, the epidemic potential due to several vulnerability factors warrants an immediate response in this population group. Local and international actors are required to mobilize and coordinate efforts to prevent the transmission of COVID-19, and to mitigate its impact amongst the vulnerable refugee populations globally.

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“…COVID-19 poses significant risks for wellbeing among refugee and displaced persons [29,30]. Poverty, overcrowded living conditions, and poor sanitation elevate forcibly displaced persons' COVID-19 risks while limiting the ability to practice mitigation strategies such as handwashing and physical distancing [30][31][32]. COVID-19's psychosocial impacts may exacerbate existing stress [33].…”

Section: Introductionmentioning

confidence: 99%

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

et al. 2021

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Background Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths’ wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda’s 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16–24 in Bidi Bidi refugee settlement. Methods We conducted 6 focus groups (n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16–24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion. Results Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16–24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures. Conclusions Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.

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Addressing COVID-19 in humanitarian settings: a call to action

Cited by 40 publications

References 10 publications

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

Vulnerability of Syrian refugees in Lebanon to COVID-19: quantitative insights

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

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