The humanitarian health crisis

Jennifer Venis, IBA Multimedia JournalistWednesday 10 June 2020

Pic: Rohingya refugees from Myanmar wait for food aid in Kutupalong refugee camp near Cox’s Bazar, Bangladesh, 1 April 2017. Johari

Migrant communities are forced to live in precarious situations compounding their vulnerability to Covid-19. International conventions should ensure they’re protected but instead they’re perilously exposed, with some countries failing to meet their obligations entirely.

Numerous commentators – including politicians – have claimed that Covid-19 ‘does not discriminate,’ but the inequality of the pandemic has become very clear. It is disproportionately affecting minority groups, and among those most impacted are migrants. There are myriad issues that make migrants particularly vulnerable, including pre-existing health concerns, but the conditions in which they are housed, whether in camps, shared accommodation or detention facilities, are a significant factor.

Giorgia Donà is Co-Director of the Centre for Migration, Refugees and Belonging at the University of East London. She says the ‘conditions in which migrants live often mean they can’t follow public health guidelines,’ and highlights overcrowding, lack of water and sanitation, and shared accommodation.

These are certainly not conditions where social distancing is possible. In Greece, Lora Pappa, founder of local non-governmental organisation METAdrasi, says ‘all aspects of refugees’ and migrants’ ability to take preventive measures remain very poor.’ She says more than 42,000 people are living in facilities intended for no more than 5,000, and the majority are now in wooded areas around the camps. Further, in the Moria camp on the island of Lesbos, ‘17,000 people must stand in lengthy queues for hours every day to receive rudimentary food.’

With conditions so overcrowded, sanitation is compromised. Doctors Without Borders called for the evacuation of Greek camps in March. The organisation says that in some parts of Moria there is one water tap for every 1,300 people and no soap available, and that families of six people are sleeping on cardboard boxes in spaces no more than three square metres.

Doctors Without Borders reports similar conditions in Bangladesh, with around 860,000 Rohingya living in 26 square kilometres of land in the town of Cox’s Bazar. It says that although some conditions, including clean water points and latrine provision, have improved, ‘conditions in the camps remain precarious.’ In late May, a cyclone hit Bangladesh and India. This exacerbated unsanitary conditions in refugee camps, ruining tents and forcing families to seek shelter with whichever neighbours still had a roof. And, on 1 June, the world learned of the first death of a Rohingya refugee from Covid-19.

Paul Spiegel, Director of the Johns Hopkins Center for Humanitarian Health, is also concerned about migrants in detention centres, where they can be housed in cell-like conditions. ‘When people are detained, they have much less independence to take care of themselves,’ he explains.

In the United States, Ronald Gutierrez, Clinical Director at Legal Services for Children in San Francisco, provides legal and social work services to unaccompanied migrant children in small shelter settings, which have developed protocols for protection. But he says adult detention, where higher numbers of people are kept in close quarters, lacks comparable oversight. Gutierrez says that some local prisons have released prisoners with minor sentences to mitigate infections, but he is not aware of the US Immigration and Customs Enforcement agency making the same practice decision

Access to healthcare

These conditions mean the pandemic could spread like wildfire. And if it does, Donà says: ‘Healthcare facilities in these camps are often basic and migrants may not have access to a hospital. There will be no specialist care.’

Donà highlights that many of the countries hosting refugees are low-income countries in the global south, where healthcare for even the general population is extremely limited. South Sudan, for example, has just four ventilators and 24 intensive care beds nationwide.

Spiegel is therefore ‘very concerned that governments will be under a lot of pressure to say when push comes to shove, unfortunately, we’re going to have to favour our own citizens.’

Palestinian refugees in Lebanon are legally locked out of national healthcare. Dr Qassem Saad, Chairman and General Director of Developmental Action Without Borders, tells Global Insight that ‘a Palestinian refugee is denied access to medical and hospital insurance in accordance with Law 128/2010,’ and Lebanon’s ‘Universal Health Care Card Act is for citizens only.’ Dr Saad believes host governments in the region are affording refugees ‘nothing’.

Humanitarian agencies normally facilitate migrant healthcare around the world, but NGOs are finding their capacity, and ability to access camps, significantly reduced.

If the virus spreads among the internally displaced, we won’t even hear about it

Giorgia Donà
Co-Director, Centre for Migration, Refugees and Belonging, University of East London

Spiegel says that with epidemics, ‘the international community can surge in. But that’s not going to be possible here for a variety of reasons. Many of the healthcare professionals are already working in other areas and the quarantines of people coming in would make it extremely difficult.’

Spiegel expects there won’t be a surge in equipment either, because the whole world is affected by the pandemic, and countries are facing shortages everywhere. He says ‘right now, it’s a buyer’s market. And low-income countries are not going to be winning in that bid.’

Donà says humanitarian aid and healthcare are even harder to come by for internally displaced persons, because they are not in protected camps, and they may be actively persecuted by their national government. ‘If the virus spreads among the internally displaced,’ she says, ‘we won’t even hear about it.’

Supplies and evacuations

Within these contexts, humanitarian organisations are working to mitigate the significant threat that Covid-19 poses by addressing the conditions that make migrant populations so vulnerable. In May, the United Nations Refugee Agency (UNHCR) announced shipments of over one million masks to Bangladesh, Greece, Iran, Kenya and Uganda, as well as six tonnes of personal protective equipment and medical supplies.

Doctors Without Borders is building facilities devoted to Covid-19 in Bangladesh’s camps, including 300 isolation beds, but says this is ‘just a fraction of the capacity necessary if there is a widespread outbreak within the Rohingya community.’

Pappa tells Global Insight that to protect refugees and migrants in the Greek camps, as well as society at large, migrants kept on the islands must urgently be moved to suitable, less cramped accommodation on the mainland. However, they say there ‘has not been much (or any) positive or pre-emptive rhetoric about the need to protect these populations.’

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Migrants gather inside the buffer zone of the Turkey–Greece border at Pazarkule, in Edirne district, Turkey, 29 February 2020. IV andromeda

Liz Harding, Humanitarian Representative for the United Kingdom at Doctors Without Borders, says ‘what’s practicable and achievable is different everywhere, but the less congested alternative housing can be, the better. Access to hygiene, water and healthcare must be provided.’

In a statement in March, Doctors Without Borders wrote that while ‘evacuation during a time of pandemic may seem frightening, forcing people to live in overcrowded camps, unprotected, is negligent.’

On 1 June, over 11,200 registered refugees in mainland Greece faced new insecurity as their right to stay in temporary home expired. Greek authorities said they needed to make room for asylum seekers from the islands’ refugee camps and that refugees would have access to assistance; but NGOs worry effective access is limited.

A spokesperson for the European Asylum Support Office (EASO) tells Global Insight that EASO and the European Commission have worked together to provide support to national asylum authorities on how to implement European Union rules on asylum procedures, while ensuring the safety of asylum seekers and national staff. This has resulted in both Guidance from the European Commission, to which EASO contributed significantly, as well as EASO Recommendations for remote interviews for asylum applicants.’

The European Commission recently allocated €350m for Greece, €50m of which ‘will be for medical care.’ The funds are not a direct response to the pandemic, instead part of ‘continued support.’ They are intended, however, to develop reception facilities, improve border protection and enhance asylum procedures.

The Commission says that 90,000 items of assistance have been given by 17 EU Member States following Greece’s activation of the Civil Protection Mechanism in March. All new migrant arrivals receive health checks and are housed in separate facilities until screening is completed. Several Member States have offered customised containers to provide shelter and medical care.

Small-scale evacuations of Greek camps have begun, and METAdrasi has been assisting with an EU scheme to relocate 1,600 of the unaccompanied minors in Greece to other Member States.

Pappa says this shows ‘when there is political will, things can move forward quickly. Other EU Member States should follow the same procedure and accept a larger number of children using a wider range of criteria.’

Barbara Wegelin is Refugee Officer of the IBA Immigration and Nationality Law Committee and a senior associate at Everaert Advocaten Immigration Lawyers. She believes the relocation plans for these particular children are not new and that Covid-19 is simply accelerating the speed at which the process is followed through.

Pappa has concerns that ‘children that were already eligible for reunification may be included in the 1,600, which would mean an eventual reduction of the actual net burden-sharing of these other EU countries.’ She highlights that there are 5,200 unaccompanied children in Greece, 1,500 of whom are in camps and 35 per cent of whom are cases of family reunification.

Wegelin says ‘when you look at the number of children that they are pledging to relocate, it’s marginal.’ ‘What we need is systemic change, and that’s not happening.’ Nor is it just about children, she says, as ‘everyone stuck in Greece suffers. These conditions are not fit for any human being.’

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Mexico City installed a shelter for caravans of migrant Central Americans heading to the US. There are still a large group of migrants in the hostel. Mexico City, Mexico, 5 November 2017. Carerra

Politics and negligence

The conditions in these camps are not new, nor are the calls to address them. Donà points out that ‘existing conditions and inequalities are exacerbating the impact of Covid-19 on refugees and asylum seekers.’ And these have been well known, but left unaddressed, for years.

Pappa believes ‘the basic tenet of the EU–Turkey deal, that the islands are used as a holding zone for migrants seeking asylum in the EU, must change. There are islands where refugee numbers exceed the size of the local population and we have been facing this awful and degrading situation for almost five years now.’

She says it’s natural, then, that some in Greece may feel resentful and perceive neglect on the part of other Member States.

Wegelin argues that ‘EU policies have exacerbated the Covid-19 crisis by creating this bottleneck in Greece and Italy. The only way forward is burden-sharing but there is no political will. So Greece and Italy are overwhelmed and people stranded are treated like cattle.’

According to Harding, the conditions in migrant camps are often so dire that they are actually causing underlying illnesses, such as respiratory diseases, which people are more likely to develop in overcrowded areas. She says ‘the inaction on the conditions in camps has made the Covid-19 crisis exponentially harder to deal with.’

Donà says camps around the world were meant to be a temporary solution to migration crises, but migrants now live in ‘protracted refugee situations’ – defined as more than 25,000 refugees of one nationality taking asylum in one country for five or more years. The UNHCR says the average length of these protracted situations is 26 years.

She explains that the capacity of low-income countries to integrate refugees is hampered by limited resources, it’s easier to keep refugees in camps where international aid is forthcoming. In turn, countries in the global north can contribute financially to the aid effort without taking on responsibility for the refugees themselves.

In the introduction to their book Forced Migration, Donà and co-editor Alice Bloch write that this imbalance of responsibility, ‘which has disproportionately impacted on less developed countries of the global south and east,’ is partially ‘due to the maintenance of the postcolonial world order which has, as part of its agenda, the aim of keeping refugees out of the global north and west.’

These conditions are not fit for any human being

Barbara Wegelin
Refugee Officer, IBA Immigration and Nationality Law Committee

Pappa says the ‘EU’s policy regarding migration flows has been to throw money at the problem and keep it at the margins of Europe, particularly with the rushed and unworkable EU–Turkey deal.’ She says decisions are made ‘with short-term political horizons in mind and bureaucratic delays are used as excuses to postpone implementing, for example, the family reunifications cases.’

Despite Member State obligations towards asylum seekers, Wegelin says ‘the legal argument to bring people across is not very strong, because the legal framework, the whole EU asylum system, is based on the fallacy that standards of reception, of access to services and so on, are the same throughout the EU. In practice, that’s not true. The legal reality is completely out of touch with practical reality.’

In countries that could help, Wegelin believes there is a reluctance to be seen as pro-immigration amid a rise in populism and an economic downturn. She highlights that the Netherlands has refused to join other Member States in accepting evacuated unaccompanied children, because the government views this as an ‘unsustainable solution’ to the situation in Greece.

Elsewhere, there is no need to speculate why some countries are not addressing these problems. Gutierrez says the current US administration has made it very clear that it is anti-migration, and has looked to create at least a virtual, administrative wall to block asylum seekers.

Spiegel is concerned that an outbreak in camps could bolster this sentiment. He fears that ‘given refugees in Bangladesh, Jordan, Lebanon and Turkey live in camps with increased density and poor hygiene, if there is a massive outbreak in one of these camps or the urban areas in Jordan and Lebanon, there could be significant refoulement.’

The principle of non-refoulement, under international human rights law, protects migrants of any status from being returned to a country where ‘they would face torture, cruel, inhuman or degrading treatment or punishment and other irreparable harm.’

Abandoned at the border

Covid-19 has in some ways compounded the need for migration, as the pandemic looms over countries already hit by conflict and economic hardship. Despite this, a series of border restrictions and regressions of migration rights are leaving people stranded between borders with dire consequences.

The EU already faces allegations of refoulement, but now Spiegel believes a lack of accountability is allowing many countries to circumvent their responsibilities. He says the obligations countries have are ‘often flouted, and now it’s even more egregious because countries are closing their borders and using public health orders to undertake anti-immigration and anti-refugee policies, stopping asylum.’

The International Organization for Migration (IOM) has warned of ‘invisible shipwrecks’ in the Mediterranean as the safety of migration routes is eroded by a drastic reduction in EU and NGO search-and-rescue operations. In the Bay of Bengal, approximately 100 Rohingya refugees are believed to have drowned because no country has been willing to let them in. In a joint statement, the IOM and other organisations reported people adrift without access to food, water and medical assistance.

The statement says ‘deterring movements of people by endangering life is not only ineffective; it violates basic human rights, the law of the sea and the principles of customary international law by which all states are equally bound.’

In the US, the right to asylum is being blocked at every opportunity in an extraordinary transgression of international human rights standards, says Gutierrez. He says that even before Covid-19, the current administration engaged in ‘diabolical tinkering to make claiming asylum more difficult.’

Now, the Trump administration is using a Public Health Services Act from 1944 to overrule immigration law and deny those without documentation – regardless of whether they come to an official entry point or cross elsewhere – the chance to apply for asylum.

At the US–Mexico border, the UNHCR has found thousands of migrants ‘in improvised camps, on the streets, or in shelters that have not always implemented health protocols to protect them.’


The UNHCR recently stated that: ‘In the context of Covid-19, accountability to affected people has never been more important.’ But accountability is lacking in many migration contexts.

Wegelin says ‘there is not one court that has ruled on the legality of the EU–Turkey deal. Instead they give the excuse that it’s not their jurisdiction because it’s not an EU instrument.’

This April, the Court of Justice of the European Union found that three EU Member States broke EU law for failing to take a share of asylum seekers in 2015. In 2019, the European Court of Human Rights found Greece, but no other implicated states, guilty of violating Articles 3 and 5 of the European Convention on Human Rights (ECHR), which prohibit inhuman treatment and arbitrary detention.

For Wegelin, these decisions do not constitute accountability. ‘These are piecemeal. It’s easy to find that Greece is violating international standards under the ECHR. Of course they are. But the system needs to be held accountable. Other Member States are responsible for letting that crisis escalate, and it would take a gutsy EU court to say that the wider EU is responsible for those violations by negligence.’

In Australia, a court will be asked to decide if the government has been negligent in its treatment of detained migrants. In April, a refugee launched legal action claiming that the Australian government has failed in its duty of care by not establishing conditions that allow him to comply with public health guidelines.

A spokesperson for Australia’s Department of Home Affairs says the department and ‘service providers remain focused on the health and safety of all detainees and staff during this time.’

Wegelin says this case is a ‘trailblazer’ for national accountability during the pandemic, but to address the ongoing, underlying problems, international conventions need to include accountability measures.

So many countries are closing their borders and using public health orders to undertake anti-immigration and anti-refugee policies, and stopping asylum

Paul Spiegel
Director, Johns Hopkins Center for Humanitarian Health

Harding tells Global Insight that wider recognition of the global responsibility for the causes of displacement, and the situations that migrants face in their search for safety, is needed.

‘Migrants have the same rights to healthcare and safety as we do. We need to ensure safe routes and not increase the dangers they face.’

Donà agrees: ‘Unless we mainstream migrants’ health with that of the global general population, we can’t tackle this pandemic in the systematic way that we need to and we will end up with greater inequality than before. Right now, “public health” is being used to prevent people entering countries, but we need to find the tools to think of public health as the health of humanity.


The EU Parliament’s Committee on Civil Liberties, Justice and Home Affairs is calling on the Parliament as a whole to present the New Pact on Asylum and Migration, which they believe is an ‘opportunity to give fresh and much-needed impetus to legal and safe migration.’

According to the European Commission, the Pact will ‘be a whole-of-route approach,’ and will deliver a ‘more humane and more effective migration and asylum system.’

Donà says that currently ‘the global community is failing in its commitments to human rights.’ To move forward, ‘there should be recognition that there are global solutions. So far, there has been little socio-political collaboration, instead countries are competing for access to health resources. The refugee issue is connected to broader issues. Protecting refugees is crucial to save lives and also to change the world we live in for the better.’

And Donà insists, there is hope. She says calling for a global ceasefire, as the UN Secretary-General António Guterres has done in light of the Covid-19 pandemic, would have been unthinkable before. ‘Radical and unthinkable measures are being taken. We just need more.’

Jennifer Venis is Multimedia Journalist at the IBA and can be contacted at