Using COVID-19 as a pretext to control migration and to evade international obligations towards refugees and migrants is not only unacceptable, but would also be counterproductive in terms of outbreak control, and risk breaking the trust between health authorities and migrant populations, writes Apostolos Veizis, ex-Director of the Medical Operational Support Unit (2011–2021) for Médecins Sans Frontières (MSF) in Greece.
Protecting people living in precarious conditions
The COVID-19 pandemic has a disproportionate impact on the world’s most vulnerable populations, among them more than 70 million forcibly displaced people worldwide -refugees, asylum seekers, internally displaced people (IDPs) as well as migrant workers, including undocumented migrants. Often without a legal status and living in formal or informal camps, receptions centres, in detention centres or on the streets, sometimes in informal housing arrangements, many of these men, women and children lack access to basic services such as clean water, sanitation or adequate access to quality healthcare.
Of particular concern is how COVID-19 might affect people in precarious environments such as the homeless, refugees living in camps in Greece or Bangladesh, or conflict-affected populations in Yemen or Syria, to name only these few countries. People whose access to healthcare was already compromised, find themselves living in harsh and unhygienic environments, often in overcrowded conditions. How can we ask them to protect themselves when they don’t have easy access to water? Or to stay at home and to self-isolate, if they rely on daily jobs to make ends meet, or share their room with ten other people?
Nonetheless, it is very important to inform people about the best protective measures such as frequent hand-washing, and to help ensure they have the means to protect themselves (including self-isolation in case of contact with a person infected with COVID-19).
The transmission of COVID-19 in such fragile settings can be almost impossible to contain. Basic health screening and, ideally, decentralised testing for high-risk settings such as refugee camps (e.g. Cox’s Bazar in Bangladesh, camps on Greek islands) or high-density slum dwellings (e.g. Kibera in Kenya or Khayelitsha) must be implemented immediately.
Using COVID-19 as a pretext to control migration and to evade international obligations towards refugees and migrants is not only unacceptable, but would also be counterproductive in terms of outbreak control, and risk breaking the trust between health authorities and migrant populations, as well as with the rest of the public, thus making the response to COVID-19 much less efficient. To decrease such risk (breaking trust), health authorities must actively include asylum seekers in their outbreak prevention and response plans. Forcing people to live in overcrowded and unhygienic camps as part of Europe’s containment policy was always irresponsible, but it is now unacceptable due to the threat of COVID-19.
Challenges in ensuring continuous care in MSF projects
Protecting patients and healthcare workers is essential, therefore the organization must ensure infection prevention and control measures are in place. This includes setting up screening at triage zones, creating proper isolation areas, and providing appropriate health education.
Médecins Sans Frontières (MSF) is concerned about the risk of insufficient supplies of key items, such as surgical masks, swabs, gloves, and chemicals for diagnosis of COVID-19, as well as about the risk of supply shortages for the treatment of other diseases due to a lack of production of generic drugs and difficulties to import essential drugs (such as antibiotics, antimalarial and antiretroviral drugs) due to community lockdowns, reduced production of active pharmaceutical ingredients, and reduction in exportations. MSF must face additional challenges related to travel restrictions connected to COVID-19, which limit the organization’s ability to send its experts such as surgeons and other staff abroad.
Keeping healthcare workers safe
Protecting healthcare workers from contracting the virus is paramount for ensuring the continuity of care for general and COVID-19-related health needs. However, global shortages of personal protective equipment (PPE) pose a great threat. Healthcare workers must have access to the equipment they need to do their jobs safely and effectively.
As research and development is underway to find effective treatment for coronavirus COVID-19, MSF is closely tracking the trials and evidence concerning the potential medicines in the pipeline. Any drugs, tests and vaccines for COVID-19 should be made available to all those who need them. Governments should be ready to suspend or override patents for COVID-19 medical tools by issuing compulsory licences. Removing patents and other barriers will be essential in helping ensure that suppliers can sell tests and treatments at prices everyone can afford.
As the global health crisis continues to amplify and deepen existing inequalities and access issues, both political initiative and realistic implementation plans are needed to guarantee access to vaccines, treatments, and diagnostics for all.