Pandemics, like other disasters, strike hardest on the most vulnerable, including the world’s 30 million refugees and asylum seekers. They will likely experience elevated morbidity and mortality from COVID-19. Additionally, infections among refugees and asylum seekers could spread more widely, leading to repeat surges.

The vulnerability of refugees and asylum seekers has been long recognized, yet the vast majority of countries have not even included refugees and asylum seekers in their pandemic preparedness plans. Not surprisingly, little to no specific policies have yet been initiated to prevent or treat COVID-19 among refugees and asylum seekers.

What is currently happening on the ground in several hot spots?

Bangladesh, which hosts the world’s largest refugee resettlement of over 1 million Rohingya refugees recently documented its first COVID-19 death. The United Nations High Commissioner for Refugees (UNHCR) asked camp authorities to hold suspected COVID-19 cases in temporary isolation areas which lack capacity for testing or supportive treatment. The nearest hospital is outside in Cox’s Bazaar. In an effort to promote seeking health services without fear, the UNHCR has also requested that the government not arrest refugees and asylum seekers who lack documentation since the agency has placed its services on hold for two-weeks. An internet ban in and around the camps limits access to information about COVID-19. To contain the virus, the UNHCR also requested the government not to arrest any refugee of asylum seeker without documents so as to contain the virus.  Authorities fear that the virus could spread beyond the camp to the general population, where resources and preventative measures are also inadequate. The U.N. High Commissioner for Refugees (UNHCR) said on its website it had requested the government not to arrest any refugee or asylum seeker without documents or with expired documents as the agency had postponed all appointments, amid two-week movement curbs in the country to contain the spread of the virus.”

Turkey currently hosts 3.4 million Syrian refugees, some living in crowded camps, and the majority in densely populated urban areas. Turkey threatened to open its borders so the refugees could enter Europe, prompting France to send an additional $50 million in aid. COVID-19 cases are spreading across Turkey, and a curfew was imposed. The Turkish Red Crescent has 16 community centers that serve refugees. They inform the refugees about the pandemic, screen for signs of COVID-19, and distribute hygiene kits.

In Jordan, refugee camps have actually taken the same preventative measures as the rest of the country. Educational interventions have been rolled out and hospitals inside the camps are prepared to respond. There is tight control on movement in and out of the camps, yet concerns remain about close-quartered living.

In Greece, 42,000 asylum-seekers are held in five camps on the islands, most coming from Syria, Iran, and Afghanistan. Last week, the first case of COVID-19 was confirmed in Lesbos and the U.N. and local government called for the island’s most densely populated camp to be evacuated. To date, there is no pandemic emergency plan in place for these camps. Last July, the Greek government revoked social security numbers from asylum seekers and undocumented migrants, restricting their access to medical care. The Greek Ministry of Migration and Asylum has now suspended all services and prohibited NGOs from entering camps and providing aid. This week, 20 refugees in the Ritsona camp near Athens tested positive for COVID-19, placing the camp in a two-week lockdown.

Since COVID-19 first appeared in Italy, humanitarian rescues to the Central Mediterranean ceased, leaving most asylum seekers detained in Libya indefinitely. Services to asylum seekers have been slowed or placed on hold and humanitarian NGO workers are being redirected to supporting the COVID crisis. This placed a strain on Libya, where 90 percent of travelers crossing the Mediterranean to Europe originate. The UNHCR stood up health posts and water and sanitation facilities at disembarkation points.

On March 20, President Donald Trump closed the U.S.-Mexico border and ordered all migrants be removed without detainment. Immigration courts in the U.S. have been closed and all case hearings for non-detention cases were postponed. The 37,000 migrants held in overcrowded detention centers are seen as vulnerable to the spread of the virus — these are centers that have recently experienced mumps outbreaks and multiple flu outbreaks and refuse to administer mass vaccinations. There are now eight confirmed cases across all U.S. detention facilities.

At times, it seems like the only attention refugees and asylum seekers get comes from politicians who regard them as a threat for spreading COVID-19. Far-right Italian politician Matteo Salvini claimed without evidence that Italy’s outbreak could be traced to a ship of African asylum seekers that docked in Sicily before rescue missions were ceased. Hungarian Prime Minister Viktor Orban suggested a link between unauthorized migrants and the virus spread without evidence to support it. In the U.S., Trump referred to COVID-19 as the “Chinese virus” and has resisted releasing asylum seekers from detention facilities to prevent a widespread outbreak of COVID-19 in them.

The obstacles to remedying these and other appalling situations around the world are multifold. Top among them is lack of funding. Presently most countries are struggling to finance aid for their own populations amidst an extreme economic crisis. Helping refugees and asylum seekers, most of whom reside in Low- and Middle-Income Countries (LMICs), is no country’s top priority right now.

Presently the World Bank and the World Economic Forum are examining financial solutions that could put cash in hand to these countries to mount responses to protect their refugee populations. Recently, the United Nations launched a $2 billion fund and the United States pledged $1.3 billion to fight COVID-19 in LMICs. But will these funds actually be directed at refugees and asylum seekers? Last week, the UNHCR launched an appeal for an initial $33 million to help protect vulnerable refugees and displaced people from the virus. Far more funds will be needed, especially if the infection is allowed to spread.

In the absence of strong governmental leadership, some local officials and community-based organizations are stepping up with energetic and innovative responses to promote COVID-19 awareness and to teach social distancing, handwashing, and self-quarantine. Needless to say, in many settings, such as refugee camps, detention centers, or low-income housing, these strategies are not feasible due to overcrowding and lack of running water and soap. Refugees and asylum seekers who are day laborers have to choose between social distancing and starving if they don’t work. What’s more, refugees and asylum seekers lack access to accurate information about COVID-19, to testing, and to health care, especially hospital beds and ventilators.

Given their abundantly clear vulnerabilities to COVID-19, refugees and asylum seekers urgently need action to mitigate a disaster. The immediate priorities are clear: rapidly mobilize education about risks and preventive strategies; provide healthcare workers and other community workers with personal protective equipment and testing kits; transport persons with COVID-19 out of settings where they can expose others, but don’t deport them; move asylum seekers out of closed immigration detention, and; provide the sick with supportive treatment. To prepare for the next pandemic, countries and international agencies should commit to including refugees and asylum seekers in their policies and plans for pandemic prevention and care.

Nobody can honestly say they don’t know what is coming.

Image: Migrants and refugees, some wearing facemasks for protective measures, queue in a makeshift camp next to the Moria camp on the Greek island of Lesbos on April 2, 2020. Photo by Manolis LAGOUTARIS / AFP) (Photo by MANOLIS LAGOUTARIS/AFP via Getty Images