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'We're showering twice a day': Concerns over 'disastrous' consequences Covid-19 could cause in refugee camps

NGOs have warned that self-isolation is virtually impossible in refugee camps and informal settlements.

Órla Ryan reports from Lebanon 

IMG_20200312_184941_779 Burj el-Barajneh refugee camp in Beirut. Source: Órla Ryan

CONCERNS HAVE BEEN raised about the impact Covid-19 could have on refugees in Lebanon if the virus starts to spread in refugee camps or informal settlements.

Conditions in the camps – typically home to a mix of Palestinians and Syrians as well as migrant workers and vulnerable Lebanese people – and the informal tented settlements (ITS) – primarily home to Syrian refugees – are generally quite poor with several people often living in the same room or tent. 

More than 60 cases of Covid-19 have been confirmed in Lebanon to date, and two deaths.

As of yesterday, a nationwide closure of all schools and universities has been extended until at least the end of this month. Public gatherings have been banned and travel restrictions to and from countries experiencing outbreaks of the virus are in place. 

Many businesses such as bars, restaurants and cinemas have also closed as a precaution – another blow to a country experiencing a severe economic recession. 

Self-isolation, which is recommended for 14 days if a person has travelled to an area where there is an outbreak or come into close contact with a person with the virus, is essentially impossible for people living in camps or ITS.

Declan Barry, Médecins Sans Frontières’ (MSF) Medical Director for Lebanon, said the idea of self-isolation in a camp or ITS is “nonsense”.

“The idea of isolation, you know, quarantining yourself in your home and not being around people for two weeks, if you were in contact with somebody who had it, what does that look like in an ITS or in one of the camps? It’s just nonsense,” the Longford native told TheJournal.ie.

MSF is among the NGOs giving practical advice to people living in camps in Lebanon, such as regularly washing their hands and surfaces, and opening windows or tents where possible.  

“Once it does take hold in an overcrowded space, it’s going to be a tough one,” Barry noted.

Screenshot 2020-03-11 at 20.38.52 An informal settlement in Ghazze, west Bekaa. Source: Órla Ryan

Assem Chreif, Director of the Lebanese Organization for Studies and Technology (LOST), said that if Covid-19 cases are confirmed in ITS the results could be disastrous.

Speaking at LOST’s centre in Bednayel in Bekaa, an area where a large number of Syrian refugees live in ITS, Chreif told us: “Everybody knows that if the virus is spread among Syrian refugees it would be disastrous because nobody can manage their movements, they can’t contact everybody.

“When you see them living in close proximity like that – all of these tents are open and everybody meets everybody on a regular basis so you cannot control the spread of the virus.”

Showering twice a day

Aymon* (45) has been living with his wife, seven children and extended family in an ITS in Ghazze in west Bekaa, Ghazze, about 60km from Damascus, for seven years. 

He and his family fled Hama in Syria in 2013 after his cousin was killed by a bomb. Aymon said he is “very worried” his children will get sick from Covid-19, noting that two of them have asthma and another has allergies. 

“Now with the coronavirus, I’m being very cautious – my kids shower twice a day, they keep washing their hands, we’re washing our hands all the time.

“I’m afraid that if one person catches coronavirus, it will easily spread,” he told us.

Screenshot 2020-03-11 at 20.58.38 A water tank outside a tent in an informal settlement in Ghazze, west Bekaa. Source: Órla Ryan

It’s very difficult to know the exact number of Syrian refugees living in Bekaa, but it’s estimated to be between 350,000 and 400,000 people. The ITS vary widely in size – anything from five tents to over 100, with at least one family in each tent. 

Many ITS have reliable access to water, but others do not. LOST, for example, works with Unicef to regularly deliver water and soap to residents and will be stepping up efforts given the Covid-19 crisis. 

Chreif said a refugee could spread the virus to a person living in the host community or vice versa, noting: “The best course of action now is to segregate them, at least for the time being.”

LOST has for years helped to run hygiene promotion committees within ITS, and is using these people to disseminate practical advice to refugees about how to best protect themselves and their families.

While many of its operations are ongoing, LOST has had to cancel the educational and training courses it runs for young people aged 10-18 years until at least next month as these classes fall under the nationwide school closure.

Access to testing 

Speaking to TheJournal.ie in Beirut, Barry said another concern is the fact refugees and other vulnerable people often don’t have access to healthcare and many of them will not have access to Covid-19 testing. 

There is a concern that the measures that would be used to contain this are not particularly practical for the living conditions that so many people are living in.

“And also then if people [in camps and settlements] do get symptoms and they need to get tested, will they be able to access the services?” 

Barry said a lot of MSF’s focus to date has been on infection prevention and control, and making sure staff and service users have reliable information. The organisation is monitoring the situation and discussing ways it can adapt if and when the virus becomes more widespread or is detected in a camp or ITS. 

“Some of our operations are so big we couldn’t really close them down for two weeks, that would not be effective. So we’re looking at how we would maintain our activities in a way that would not put our patients who come to us at risk and not put our staff at risk,” he stated. 

Similar camps and settlements to those in Lebanon are, of course, present in many other countries.

The World Health Organization, which yesterday officially declared that Covid-19 a pandemic, had at the time of publication not responded to a request for comment about the concerns surrounding self-isolation and access to testing among refugees. Its general guidelines about the virus can be read here.

‘This won’t kill me’

Employees at MSF’s family clinic in Burj el-Barajneh refugee camp in the southern suburbs of Beirut – where it’s estimated up to 45,000 people live, mainly Palestinians – said some patients are bringing up Covid-19 but many are not as they have more pressing needs such as struggling to get food.

However, some pregnant women who are referred by MSF to Rafik Hariri University Hospital because they require more specialised care have raised concerns about going there.

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“They don’t want to go to the birth centre, it’s in Rafik Hariri grounds and that’s where the corona patients are being treated,” Dr Laura Rinchey, who works in the clinic, explained.

She added that staff members are reassuring these women about attending the hospital, noting that all patients with Covid-19 are being treated in a separate area to other patients.

Screenshot 2020-03-11 at 20.54.17 Dr Laura Rinchey and Mohammad Sunallah outside MSF’s family clinic in Burj el-Barajneh refugee camp. Source: Órla Ryan

Mohammad Sunallah, the clinic’s manager, said not that many patients are bringing up Covid-19 as they have more pressing day-to-day challenges.

“The population here, I think they have enough things to think about more than the coronavirus.

“They are still struggling with their daily life and things they are facing. And even if they discuss it, they discuss it in a sarcastic way, ‘After what we passed, all this history, the corona is not the one that will lead me to death.’ They have a lot of things to think about more than the coronavirus,”  Sunallah said.

*Aymon’s name has been changed to protect his identity.

This article is supported by the Simon Cumbers Media Fund. In the coming weeks, Órla Ryan will report on the reality of life in refugee camps and informal settlements in Lebanon, and the health and mental health supports available to refugees.

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