For Middle East refugees, social distancing is a privilege few can afford
For many of the millions of people in the region who fled wars and are displaced from their homes, social distancing is a privilege unavailable in the dozens of refugee camps, displacement sites or cramped apartment blocks.
They cannot practice self-isolation in comfort, like others are doing during the crisis, as most don't have a home to stay in. Regular hand-washing is also practically impossible to follow at crowded settlements where there is little to no running water. What clean water they have is needed for cooking, not hand-washing.
This is true for generations of Palestinian and Syrian refugees sleeping under the same roof, as well as for countless other people forced to flee due to conflict, or the fight against the Islamic State (IS), who remain in refugee and IDP camps in Syria, Iraq, Lebanon, Gaza and Yemen.
"I've seen densely packed informal settings in Yemen where social distancing is a joke, you can't mention it," Karl Schembri, Regional Media Adviser in the Middle East for the Norwegian Refugee Council (NRC) told The New Arab.
"The moment you touch the side of your small shelter, you're in someone else's tent".
|For the millions of people in the region who fled wars and are displaced from their homes, social distancing is a privilege unavailable in refugee camps
During his many field visits across the region, the media adviser has widely observed the overcrowded conditions, poor sanitation and healthcare in which refugees and displaced people live, namely in informal settlements and collective shelters.
Fragile health systems
The situation in Yemen is more than worrying, he explained, since not only the IDPs but all people have limited access to clean water, and the medical system has been decimated by five years of war, with hospitals and infrastructure bombed by the Saudi-led coalition or seized by Houthi rebels.
The emergence of the novel coronavirus would predictably overstretch the already fragile health system, which operates at around 50 percent capacity.
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In Syria, there is growing concern about the displaced after the health ministry announced on Sunday the country's first official cases of Covid-19. According to the World Health Organization (WHO), testing is to start within days in northwest Syria, where fighting continues between government forces and rebels, amid fears of a disaster if the pandemic reaches IDP camps.
As the epidemic spreads in neighbouring countries with porous borders, and damaged health care systems, the displaced populations in the north west are particularly susceptible to the pandemic.
Camps are hosting five times their intended occupancy, with people living under conditions that make them vulnerable to respiratory infections. Those include overcrowding, lack of housing, food and clean water, and poor levels of sanitation.
Health officials in Gaza have warned the besieged territory is not prepared to handle the spread of the virus after the first two positive cases were reported there last week. Local medical staff are concerned that the Gaza Strip lacks the needed equipment and expertise, especially in the small enclave, one of the most densely populated areas in the world, that is home to some of the biggest Palestinian refugee camps.
|The emergence of the novel coronavirus will overstretch already fragile health systems
The prospect of an large outbreak would pose a huge challenge for Gaza's healthcare system as dealing with the corona crisis is dependent upon the lifting of Israel's blockade to allow the entry of medical equipment, medication and protective gear. The ongoing siege coupled by the military conflict with Israel have left hospitals in Gaza overburdened and understaffed.
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In Iraq's Kurdish region, there were reports of some people suspected to be infected in two displacement sites, however they tested negative days ago. In an effort to anticipate the spread of Covid-19 among the refugee communities, humanitarian workers are taking early steps like training health staff, running awareness campaigns, and identifying spaces for quarantine use.
"We invest a lot in awareness and prevention methods. With the help of community outreach volunteers we are sticking posters, distributing brochures in the languages spoken by refugees with information on safety and hygiene practices, and talking to people", Firas Al-Khateeb, spokesperson for UNHCR in Iraq, told The New Arab.
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"Training of health workers in coronavirus response is ongoing. Within each camp, we are picking out different structures that can be turned into quarantine facilities to provide extra capacity outside public hospitals", he continued, "we are also contributing to supply health clinics with the necessary medical supplies and equipment for the response".
UNHCR staff in Iraqi Kurdistan are in the process of arranging cash assistance for hygiene kits in refugee and displacement communities to help people purchase essential Water, Sanitation and Hygiene (WASH) items in larger supply.
Despite the restrictions of the day-long curfew in Iraq, frontline workers are ensuring the delivery of key services in refugee and displacement areas while carrying on the plans of infection prevention, and communication and community engagement. Strict measures on camp re-entry were adopted.
'Nothing to eat, no way to survive'
Refugee camps in Jordan were recently placed on lockdown to contain the spread of Covid-19. With restrictions to their daily movement, humanitarian workers are juggling the need to limit exposure and prevent the risk of virus transmission and the duty to reach out to the most vulnerable at once.
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NRC's regional media adviser, who's based in Jordan, said the organisation is taking a range of critical measures to protect the refugee populations such as talking to camp residents about health and safety tent by tent, running information sessions via phone and web, and stepping up WASH programmes which in itself is very challenging since access to water is "extremely low".
Like other NGOs, NRC relies on Jordanian health authorities in dealing with any possible cases of coronavirus by making sure vulnerable people are not exposed to further risk, and suspects or those known to be infected are put in isolation. Some hotels are being used for quarantine purposes to relieve pressure on the country's public health system.
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On another note, Schembri pointed out that, besides handling sanitation and health issues associated with the Covid-19 crisis, one crucial area that needs to be addressed is the economic situation of refugees and IDPs by delivering cash assistance to buy food necessities, most critically at a time of curfew.
|Over 80 percent of the world's refugee population and nearly all internally displaced people are hosted in low to middle-income countries
"Refugees depend on their daily work, most of them don't have contracts. The day they cannot go to work, they have nothing to eat, no way to survive", he told The New Arab.
UNHCR, NRC and WHO have ramped up the distribution of clean water, soap and hand sanitiser to camps in Jordan, Lebanon and Iraq, and are working to share prevention information.
In Lebanon, the UN refugee agency and partner organisations are working closely with local authorities to support the expansion of existing capacity for hospitalisation and intensive care to ensure all people who would test positive with Covid-19 and require treatment can receive medical care in a timely manner.
Lisa Abou Khaled, communications officer at UNHCR in Lebanon, noted that they are looking at "contingency planning" and "stepped-up measures" for self-isolation and containment in the event coronavirus cases are detected among refugees. Among the solutions under consideration, Abou Khaled indicated, "erecting temporary structures for isolation" and "equipping existing structures for this purpose", and creating extra capacity for cases needing hospitalisation.
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Lebanon hosts the largest number of Syrian refugees per capita (about 1.5 million), along with 18,500 refugees from Iraq, Sudan and other countries, as well as 200,000 Palestinian refugees. The strain on the country's capacity and resources to adequately respond to the refugee crisis was already immense before the coronavirus outbreak. Syrian refugees in Lebanon are ineligible for government health care, meaning a coronavirus outbreak would leave them without care.
Although there are no confirmed cases in any of the Middle East's camps, there are increasing concerns about how ill-prepared these camps are in the face of a virus explosion. It is just a matter of time before the novel disease reaches refugees and asylum-seekers, according to experts.
Over 80 percent of the world's refugee population and nearly all internally displaced people are hosted in low to middle-income countries, which have too fragile health, water and sanitation systems.
"If an outbreak reaches the refugee population, the conditions are there for a catastrophic scenario", Schembri said.
Alessandra Bajec is a freelance journalist currently based in Tunis.
Follow her on Twitter: @AlessandraBajec