Keeping Displaced Communities Safe and Healthy
As COVID-19 Pandemic Takes Hold

By Angela Wells

A displaced man sits in his shelter with his children in a displacement site just outside Marib city in Yemen. Photo: Olivia Headon/IOM

Geneva – The COVID-19 pandemic has compromised the lives and health of millions and challenged the humanitarian community to form new ways of working to keep the people under their care safe and healthy.

In countries where humanitarian responses were already stretched – places hosting tens, if not hundreds, of thousands of people displaced by conflict and disasters - movement restrictions imposed to keep the disease at bay inevitably pose issues for humanitarian access.

Sustaining these operations amid the reality of COVID-19 remains a key priority for the International Organization for Migration (IOM). The Organization joined other humanitarian agencies to call for a greater commitment of funds and support in order to keep staff on the ground, humanitarian corridors open and supply chains expanded.

These measures are not only crucial for mitigating the health and economic impacts of the disease but also ensuring those who currently rely on humanitarian aid can still access food, health care and other services.

Approximately 26 million refugees live in situations of displacement globally. The Internal Displacement Monitoring Centre recently reported that internal displacement reached an all-time high at the end of 2019 with 50.8 million internally displaced persons (IDPs) recorded globally.

“Indeed, while much of the world’s population is urged to stay at home – millions of IDPs, forcibly displaced from their homes and habitual residences, live in crowded, unsanitary conditions, in camps, informal settlements or in peri-urban areas, with limited or very poor access to health services,” warned a consortium of global leadership last month on the 22nd anniversary of the UN Guiding Principles on Internal Displacement.

“Recommendations to mitigate transmission of COVID-19, including social distancing and isolation measures, therefore remain challenging or even impossible for many IDPs, heightening the risk for COVID-19 to take root and spread among already extremely vulnerable communities,” they add.

IOM has been a lead actor in responding to and driving forward long-term solutions for internally displaced communities for decades. Last year, the Organization supported 2.4 million people – including IDPs but also refugees and asylum seekers – in more than 1,100 displacement sites.

Displacement sites across Yemen continue to see an increased number of people of people seeking refuge from violence. Photo: Olivia Headon/IOM

Home to some of the world’s most vulnerable people, these sites are designed to offer urgent humanitarian assistance and protection to as many as possible in the aftermath of crises, for a temporary period of time.  

The resources allocated to keep camp residents nourished, safe and healthy are often insufficient to meet the consistent needs of all. People living there have limited opportunities to earn money or access clean water and health care, even in pre-COVID-19 times.

Health centres in camps are already under strain, responding to high volumes of women, children and men in need of care for conditions like diarrheal diseases, malaria or tuberculosis. They are not, however, equipped to provide specialized respiratory care this new disease demands.

“Now that the virus has started to reach some camps across the world, it will likely spread rapidly, despite our best efforts to contain it. Our teams are training and mobilizing communities to disseminate reliable and verified information about the disease and preventative measures that must be taken,” said Wan Sophonpanich, IOM's Global CCCM Cluster Coordinator.

“Keeping displaced communities at the centre of how we approach the response, we are working with government and humanitarian agencies to adjust how essential life-saving services can continue, while setting out contingency plans for the sites,” she added.

In the face of this new crisis, humanitarians are now adapting their operations.

In March, IOM published operational guidance on how camp managers can better put these responses into practice. For example, by re-organizing space; delivering aid in ways that allow for physical distancing; establishing quarantine and isolation spaces, or additional water and hygiene facilities; informing populations on how to stay safe and how to safely bury their loved ones.

Here is a look at how this is unfolding on the ground.

Rohingya Refugee Camps in Cox’s Bazar, Bangladesh  

New handwashing stations set up in Cox’s Bazar are helping to curb the spread of COVID-19 among Rohingya refugees. Photo: IOM 

In Cox’s Bazar, Bangladesh, more than 850,000 Rohingya refugees live in the world’s most populous camp for displaced persons.

In the past month, IOM has trained 600 staff there on how to recognize COVID-19 symptoms and prevent disease transmission, while 260 staff from IOM health facilities have been trained on how to manage suspected and confirmed cases, prevent further infections, communicate about the health risks, and engage communities.

Two isolation and treatment centres with 200 beds are being built while another four IOM-managed primary health centres have been identified to serve as separate isolation units for suspected cases where people can access the care and treatment they need.

A newly-establish isolation centre established to provide health care to Rohingya refugees in Cox’s Bazar. Photo: IOM 

In partnership with the World Health Organization, IOM has trained 19 ambulance staff, including drivers, medical escorts and hotline operators. Ambulances stand ready to transport people from triage centres to isolation facilities.

To counter the spread of misinformation, IOM is also tracking rumours in the camps, and addressing them by communicating with the communities through multilingual public audio forums, social media channels and radio programmes to communicate hygiene and health-related messages.

More than 700 handwashing stations have also been installed in communal locations to help prevent spread in the event of an outbreak.

Camps for Refugees and Migrants in Central Greece 

IOM staff prepare to distribute food baskets and core relief items to all refugees and migrants in Ritsona camp after the first report of COVID-19 cases. Photo: IOM 

Two camps and one hotel sheltering migrants and refugees in Greece have seen their first confirmed cases of COVID-19.  As of Friday 1 May, 202 migrants have tested positive for COVID-19 in three sites managed by IOM across Greece.

The first occurred in April in Ritsona camp where 2,700 migrants and refugees reside. The disease also appeared in Malakasa camp with a population of 1,600 people in early April and later in the month a temporary accommodation centre in the south of the country.

In all 30 camps on mainland Greece, IOM has been distributing disinfection products and educating people on transmission prevention techniques. Staff have also been provided with protective equipment, such as gloves, masks and uniforms.

When cases emerged in Malakasa and Ritsona camps, IOM and the Greek authorities put swift mitigation measures in place.

Following protocols developed by the Greek authorities, camp residents have been put in quarantine while those who have been infected have been transferred to isolation spaces, specially established for the affected population.

Doctors from the National Health Organization are present at the camps assessing the situation of infected persons and conducting follow-up tests with identified contacts.

Since then, IOM staff have been providing food baskets and hygiene kits to all residents in the camps in ways that ensure physical distancing, as movement to local markets is prohibited. 

Remote telecommunication channels have also been opened, allowing residents to report incidents of gender-based violence, mental distress or other emergencies. Multilingual information on disease prevention is disseminated to communities on social media.

IDP Camps and Host Communities in North-east Nigeria  

Shelter workers have begun the construction of quarantine facilities in north-east Nigeria for IDPs and host communities. Each shelter consists of units with individual water, sanitation and hygiene facilities.  Photo: IOM 

Borno State, the epicentre of a humanitarian crisis in north-east Nigeria, continues to see a rise in COVID-19 cases in areas surrounding IOM-managed camps hosting internally displaced persons.

Throughout the region, 1.8 million people internally displaced and 7.9 million people are in need of humanitarian assistance.

Half of the IDP camps in Borno State are overcrowded; the land provided for displaced communities is insufficient to meet the rising needs. A disease outbreak would prove devastating here.

IOM is supporting the COVID-19 preparedness and response measures in 80 camps in north-east Nigeria.

In coordination with health partners, the Organization is constructing 90 quarantine shelters across Borno, Adamawa and Yobe States to decrease the risk of COVID-19 spreading in densely populated camps and host communities.

These shelters, consisting of individual units with a latrine, shower, handwashing station and living quarters, will cater to people with contact history who might have been exposed to the virus.

Internal Displacement Sites in Yemen

An IOM doctor conducts a medical consultation with a woman and her child at the IOM clinic in Marib's Al Jufainah Displacement Site. Photo: Olivia Headon 

Yemen officially confirmed its first case of COVID-19 in mid-April. Only around 50 per cent of health facilities are fully functional across Yemen and there is a major shortage of resources, including health workers, medicine and medical equipment.

Food insecurity, malnutrition, and cholera and other communicable diseases remain widespread. Roughly 80 per cent of the population is need of humanitarian assistance.

Using modelling from the Imperial College of London’s, it is estimated that even with mitigation measures, more than half of the Yemeni population is likely to be infected by COVID-19, with upwards of 300,000 requiring hospitalization.

Accessing communities in need has always been a challenge but current events have further exacerbated the situation. This new reality will inevitably have a grave effect on migrants and displaced persons whose human rights are increasingly at risk, IOM warned in April.  

In governorates like Marib, where hundreds of thousands of displaced people are sheltering, the increased number of people seeking medical assistance has overwhelmed clinics and hospitals. The governorate is home to Yemen’s largest displacement camp: Al Jufainah Camp, which hosts over 5,000 families.

A recent escalation of hostilities has led to the displacement of at least an additional 9,000 families to Marib city and surrounding areas. Overcrowding in more than 150 displacement sites* across Marib raises concerns about the potential impact of the spread of COVID-19 among the displaced.

A child washes there hands at a water point in a displacement site in Marib. Photo: Olivia Headon/IOM 

IOM leads the humanitarian response in Marib, delivering hygiene kits, shelter and emergency items, cash assistance and water and sanitation services. Emergency health services and awareness raising sessions are being provided in 27 of the larger displacement sites via four mobile health clinics and one static clinic. The Organization is also working with the Ministry of Public Health and Population (MPHP) to establish an isolation ward in Marib city and quarantine sites in two displacement sites.  

Under the leadership of the WHO and the MPHP, IOM is undertaking other COVID-19 preparedness and response planning efforts across the country, in particular by delivering risk communication about infection prevention and control.

Community management and surveillance measures are underway to empower and equip communities to cope with the impact of the disease, ensuring displaced people in Yemen are armed with the knowledge to protect themselves from the virus.

*According to local authorities