Social distancing around water taps in Cox's Bazar (Photo: World Vision)

How the world’s largest refugee camp is dealing with the threat of Covid-19

As New Zealanders start to consider the end of the Covid-19 outbreak here, it’s time to look outward, to the many refugees in overcrowded, underfunded settlements worldwide.

In Cox’s Bazar on the southeast coast of Bangladesh, refugees fleeing war, famine and death live in one-room bamboo structures with plastic sheet roofs. Toilets are shared between up to 20 people and water stations are equally crowded.

For these families, the precautions we’ve been long asked to take here in New Zealand – hand washing, social distancing – are not possible. With an approximated 40,000 people per square kilometre, the rules can’t be the same as here, but the implications of an outbreak of Covid could be devastating. 

Around 26 million people around the world are considered refugees. They’re people who have been forced from their homes, usually because of humanitarian crises like war, religious or ethnic persecution, or natural disasters. Around 10% of the world’s refugee population lives in camps, the largest of which is Cox’s Bazar, home to almost 900,000 displaced people.

While there are currently no confirmed cases of Covid-19 in a refugee camp, various aid charities and organisations have been working hard to ensure a potentially calamitous outbreak doesn’t happen. It’s a looming threat, because the close quarters and lack of access to hygiene solutions in camps make them a breeding ground for infections and disease.

Grant Bayldon, national director of World Vision New Zealand, says while there is healthcare in refugee camps, the high-level care that is necessary for the worst cases of Covid is completely out of the question. “You’ve generally got very basic health services, it depends on the individual refugee situation, but what you certainly don’t have is access to any advanced medical care. Your chance of getting on a ventilator or an ICU bed are zero, really…”

Education is a priority, here a man is teaching proper hand washing techniques (Photo: World Vision)

For the time being, most of the aid work being carried out in camps involves trying to rapidly spread accurate information about how to keep safe, while continuing to distribute the food and healthcare supplies that so many refugee families count on to survive. 

Refugees are already vulnerable, not just because of their living conditions, but also because of their status within the country they live. The loss of documentation during the transition between countries often means refugees in and out of camps have a much harder time accessing healthcare. Add that to the struggle of living in confined areas with very basic hygiene equipment, and it’s highly likely that Covid-19 would spread wide and fast if it were to reach a camp. 

“Refugees are there either because of natural disaster or because of violence or war, and they’ve got all these layers of crisis that they’re already carrying… in a lot of these camps there might be issues of malnutrition, because being able to provide nutritious meals for a family is difficult,” explains Darren Brunk, a humanitarian specialist from Oxfam New Zealand. “There might be other disease outbreaks, like we’re seeing in Bangladesh right now. It’s a really bad year for dengue, four times the normal rate. You have these other risk factors that people are already carrying. If something like Covid-19 is introduced into these situations it makes people all the more vulnerable, and puts more pressure on an already totally overcharged health system.” 

For the 900,000 people in Cox’s Bazar, Covid-19 is just the most recent layer on top of a life already piled high with safety and health threats. Asia Pacific Migration and Displacement Coordinator for the IFRC, Ezekiel Simperingham, says at this time of year most of the organisations at Cox’s Bazar would be, among other things, preparing for the oncoming monsoon season that usually hits from June to October. In 2019, the monsoon season put hundreds of families at risk of landslides and flooding, and damaged at least 47 water distribution points and 600 latrines, intensifying health risks from water-borne diseases.

“It just accentuates all of the challenges that were already there, and not just the health challenges. We need to think about the experience of the whole person, so it creates more stress in the home and that can increase already high rates of domestic violence… It’s putting new increasing economic pressure on families who had no financial reserves and in many cases no access to livelihoods,” says Simperingham.

Much of the work currently being carried out by volunteers and aid workers is focused on trying to get accurate information out to the residents. Bayldon says there has been an issue with misinformation spreading in camps, so one of the most important tasks right now is making sure everybody knows as much as possible. He’s confident that the established web of connections World Vision has built through decades of work within these communities is wide enough to get accurate information into every corner of the camp.

“We have really good networks into those communities because we’ve been working there since people first arrived about three years ago. We also have a lot of contact points within the community. We have contact with everyone when they come to do their weekly food pickup, we have contact around water points.”

The refugees aren’t the only people in the camps that these organisations have a responsibility of care for. The health and wellbeing of aid workers, who are mostly locals, has also been a priority – ensuring not only that they’re safe but also that they’re not vectors for the virus within the camps. Part of the strategy to help aid workers and volunteers has involved stripping back of many of the services usually provided, says Simperingham.

“The government in Bangladesh has implemented a lockdown in the entire district and that’s really to protect the district from the cases that are in other districts. It means there’s a decrease in the kind of support that we can provide the refugees in the camp.

“There’s restrictions on the kind of staff that can enter the district and we’re restricted to providing really, really essential services only, so that’s food distribution, healthcare, making sure there’s enough fresh water, and making sure that we’re providing enough information to the communities.”

Hand washing stations like this one are being set up throughout the camps (Photo: World Vision)

In the last week, New Zealand has achieved its first “zero days” since the beginning of the outbreak here. Evidence shows the number of active cases decreasing day by day, and a move to level two is on the horizon, but as we start to look towards the rebuilding of our own economy, for those of us with the time and resources, casting our gaze further afield is crucial.

Simperingham, Bayldon and Brunk all say the most useful support they can get right now is financial donations. Bayldon urges those who have resources to spare to consider giving to those who need it most. 

“It’s the basic stuff that needs doing. If people want to have an impact, to help with the global effort against Covid-19 and to help the people who are suffering the most, donating is the most effective way to do that.”

But that’s not the only way people can amplify the voices of these vulnerable communities. “You can support by advocacy to the New Zealand government,” says Brunk. “Helping us to push them to provide an additional $25m for humanitarian assistance… if people have time for an action, that can be just as powerful if it moves the government to help us out.”

These organisations continue to work to support families who have already faced immeasurable hardship, all while we in New Zealand move from level three, to level two, and hopefully back to the way things were. But for millions of people around the world, “the way things were” is not the way they should be.

Click here to donate to Oxfam, World Vision or the Red Cross‘ Covid-19 appeals.



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