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MSF activities with a set-up adapted to Covid19.
Triage / Consultation (close physical examination) of patients with symptoms similar to covid19. New waiting area for patients with symptoms similar to COVID-19
A woman in a refugee camp on Lesbos waits to be examined by MSF staff after experiencing symptoms similar to COVID-19. Greece, April 2020.
© Peter Casaer/MSF

Five things we can do to protect people on the move during COVID-19

A woman in a refugee camp on Lesbos waits to be examined by MSF staff after experiencing symptoms similar to COVID-19. Greece, April 2020.
© Peter Casaer/MSF
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The COVID-19 pandemic is disproportionately impacting the world’s most vulnerable. Among them are more than 70 million forcibly displaced people worldwide – refugees, asylum seekers, internally displaced people (IDPs) – as well as migrant workers, including undocumented migrants.  
 
Many of these men, women and children live in formal and informal camps, reception centres, or in detention centres. Others live on the streets in informal housing arrangements. Most lack access to basic services such as clean water, sanitation or inadequate access to healthcare, and many don’t have a legal status.  

COVID-19 pandemic exacerbates and is exacerbated by poor living conditions.

In these settings, preventative measures are often not possible. How can we ask people to protect themselves when they do not have easy access to water or soap? Or self-isolate when they live in cramped tents side by side with 10 other people?

Frederic, a refugee in Greece “In the [refugee] camp we live five or six to a container. I know that I can’t stop people coming in to see my room-mate and I have no choice but to gesture to people to keep away.”
“I’d already experienced torture before leaving my country and crossing the sea. I’m using my past experience to help me deal with the pandemic”

Frederic*, who lives in a shared container in a Greek refugee camp, spoke to MSF about how he is coping with lockdown and the threat of COVID-19.

 

“At the start of this coronavirus saga, I thought it’d be all over within a week or two. But after finding out more about the disease and how it was spreading, I realised it was much more serious than I’d thought.

The death toll soared overnight. I hadn’t seen it coming and it caused me a lot of stress. When the number of deaths reached 600-700 in Italy and Spain each day, it took a psychological toll on me. I remember having to talk with my psychologist because I was really scared. 

I heard stories of people who were in good health one day and by the next day they were dead. Doctors and health workers, too, were falling victim to the disease, which seemed to destroy everything in its path.
 
Then the Greek government announced the lockdown. I had to stay in and stop work – my boss asked all of us to stop working. I realised then that the disease would have a real impact on me. I spent a lot of time just thinking about the disease – when it would end, whether I and people close to me would die in the pandemic.

I was thinking about it more and more. A lot of bad thoughts started popping up in my head and I had a lot of flashbacks. I’d suffered enough already and now it seemed the suffering would start again. I wondered how I’d escape it this time. 

I’d already experienced torture before leaving my country and crossing the sea. I’d already experienced a time when I was really sick and worried about my future. I went through this and then, thanks to God, after a long period of medical treatment, I recovered.  

When I recovered, I said to myself that I would use my past experience to help me deal with the pandemic. I realised that the difficulties I had been through in the past were bigger than this pandemic. This is how I convinced myself that the lockdown was no reason to stop me getting through this.

The only time that fear fills me is when I’m confined in my container. In the camp we live five or six to a container. I know that I can’t stop people coming in to see my room-mate and I have no choice but to gesture to people to keep away. But that's all I do.  

 

We have no alternative – this is the only space we have to live. At the same time, we’re aware that there are other people in even greater need – people who have even less space – so we have to make the most of the limited space we have. 

I feel lucky that at least I’m in a camp, with a place to live. We also have a stadium where we can exercise. So I’m in a better position than people confined in apartments with no space to exercise. 

I’m in a recovery process as my knee was injured back in my country. My medical consultation is currently interrupted due to this situation, but my doctor calls me often to check how I’m doing. 

I know that the whole planet is experiencing the same thing, but what’s different for us, as refugees, is that our living conditions, combined with the lockdown and the threat of the virus, impose a double stress. 

 

It's difficult not having people you can talk to. When you don't have people around you that you trust, it's not easy to relax. My psychologist, Zoe, is one of the few people I can really talk to. Since the lockdown started, I’ve talked with her most weeks. 

I’d like to thank all the MSF staff for the help they give us because it’s not easy, really. You can't imagine the difference it makes to have this support.”

*Names have been changed
An illustration of Frederic trying to ensure physical distancing from others in his shelter at a refugee camp in Greece during the COVID-19 pandemic.
© Carole Isler

Physical distancing is very difficult, if not impossible, in overcrowded camps and dense urban settings, where people live side-by-side in small-congested shelters with many family members. Having to queue for water points and food increases the risks of contamination.

In many settings, displaced people live in insecurity, facing risk of arrest or abuse and may be stigmatised as ‘disease carriers’ against a backdrop of increased xenophobia, limited access to reliable information and are sometimes fully dependent on humanitarian aid. In many areas, such aid is limited.

Cristian Reynders, MSF Field Coordinator in northwest Syria “How can you ask people to stay at home to avoid infection? Where even is their home? We are talking about almost one million displaced people in Syria, most of them living in tents in camps. They no longer have a home.”
Cristian Reynders, is currently MSF’s Field Coordinator for Northwest Syria.
NB: This picture was not taken in Northwest Syria but in Greece, during one of Cristian’s previous missions
Cristian Reynders, MSF field coordinator for northwest Syria, during one of his previous missions in Greece. March 2016.
© Alex Yallop/MSF

Moreover, in many places the pandemic is being used as an excuse to punish people on the move, and those that seek to care for them. At least 167 states have fully or partially closed their borders to contain the spread of COVID-19; 57 make no exception for people seeking asylum (UNHCR).

People seeking safety and shelter are being turned away at land and on the sea – often returned or transferred to countries where they may face serious threats to their life or freedom. Together with border closures to limit the spread of the outbreak, many states are also purposely denying entry to asylum seekers or indirectly preventing their access.  

People observe social distancing measures while waiting for a consultation at MSF’s mobile clinic, in an IDP camp in Northwest Syria.
People observe physical distancing measures while waiting for a consultation at MSF’s mobile clinic, in an IDP camp in northwest Syria. March 2020.
© OMAR HAJ KADOUR/MSF

So, what can we do to protect these especially vulnerable people?

  1. We must make sure that COVID-19 is not used as an excuse to enforce deadly migration control policies. Governments must not use COVID-19 as an excuse to enforce further restrictive migration control policies and evade international obligations towards refugees, asylum seekers and migrants. We understand the serious challenges presented by COVID-19, but safeguarding the wellbeing of those in your own country and upholding your international obligations towards refugees, asylum seekers and migrants are not mutually exclusive principles.
     
  2. We need to ensure human rights are respected. Governments must not use COVID-19 emergency public health measures to target refugees, asylum seekers and migrants. All restrictions on rights must be strictly necessary, based on scientific evidence and not applied arbitrarily or discriminatorily. They must be limited in duration, respectful of human dignity, subject to review, and proportionate. Governments must also continue to allow people to follow legal processes to request asylum.
     
  3. Lockdowns and mass quarantining cannot be cut-and-pasted or discriminatorily applied. Quarantine and lockdown measures should be applied equally to all without discrimination; healthcare, social and psychosocial support, and basic needs as food, water and other essentials should be provided to those in quarantine; and mass quarantine should be avoided where possible. Forcing people to live in overcrowded and unhygienic camps was always irresponsible, but is even now so more than ever, due to the COVID-19 threat.
     
  4. Displaced people at risk should be evacuated whenever possible. Where possible, MSF is calling for the evacuation of vulnerable refugees, asylum seekers and migrants. In Greece, on the island hotspots, MSF is calling for the evacuation of people the most at risk (people above 60 years and those with respiratory conditions, diabetes, or other health complications) as well continuing efforts to decongest the camps, including relocating unaccompanied minors and sick children to other EU member states. In Libya MSF is calling for the international community and the European governments to put in place direct humanitarian evacuation corridors for the most vulnerable refugees, migrants and asylum seekers exposed to the most imminent life-threatening risks, including those trapped in detention centres across across the country and in other places of captivity.   
     
  5. We need to safeguard the access to healthcare for all. COVID-19 control measures should not come at the cost of access to urgently needed healthcare. This means border closures must not stop urgently needed medical and humanitarian supplies, as well as medical and humanitarian staff, from coming into countries. Furthermore, governments must ensure restrictions in camp, detention or reception settings do not block people from accessing healthcare.