The COVID-19 global health crisis continues to affect our collective feeling of safety and well-being. Unfortunately, for the more than 60 million refugees and internally displaced persons worldwide, this feeling of insecurity is not new and is only worsening as a result of the pandemic — and girls are uniquely at risk.
Refugees and forced migrants are people who flee their homes and countries due to fear of persecution on the basis of their race, religion, nationality, membership in a particular social group or political opinion. They typically live in crowded spaces with inadequate access to basic services. These conditions exacerbate risks of exposure to myriad protection and health risks, particularly for girls and young women. Recent modeling projections suggest that COVID-19 is likely to have dire consequences in refugee camps, and forced migrants are likely to experience heightened risks and challenges in accessing care.
Forcibly displaced populations around the global already face challenges in accessing basic routine — but lifesaving — services that prevent death and disease. The added health system burden of addressing COVID-19 is just one more layer of threat.
As we approach World Refugee Day on June 20, we should remember during these unusual times that everyone, including girls and young women living as refugees, has an equal right to safety and health.
What can we do?
In settings where health systems are fragile or where people are discriminated against, persecuted or exiled on the basis of race, ethnicity, gender, sexual orientation, age or physical ability, or where religious or political beliefs undermine a range of civic participation and rights, we must as a global community ensure access to basic minimum care and rights. Global minimum standards provide important guidelines to ensure that all people everywhere have access to basic lifesaving services. During active crises, these standards help responders focus on the immediate crisis without losing sight of essential lifesaving services.
One core set of standards familiar to the humanitarian community is the Sphere standards. In crises, young women and girls, in all their diversity, who are already living in refugee or emergency settings are disproportionately affected. Within Sphere, health standards include the Minimum Initial Service Package (MISP) for reproductive health, an evidenced-based package of services that saves lives during crisis and prevents morbidity, trauma and disability, particularly for girls and women. Ensuring access to this basic minimum package of sexual and reproductive health services averts preventable maternal and newborn deaths, unwanted pregnancies, unsafe abortions and transmission of HIV and other sexually transmitted infections, as well as addressing sexual violence and trauma. Because this package of services has been tested, proven to save lives and is already required in any emergency response, organizations like Plan International USA only need to figure out how to ensure access to these services, not to determine if they are necessary.
Unfortunately, vulnerable populations like girls are often most harmed by the disrupted access to care caused by COVID-19. For example, the pandemic has already threatened young women’s access to sexual and reproductive health services when they may need it the most. Sexual and gender-based violence increase during crises, and COVID-19 quarantines have elevated exposure to violence at home for many women, with obvious concerns for refugees or other displaced women who have no safe place to shelter in place. Linking young women with HIV-prevention messaging, condoms and treatment remains critical during the pandemic. Pregnant women, especially those who are very young, experience high risks during childbirth. Even without a pandemic adding stress to health systems, maternal mortality remains dangerously high. In fact, 75% of countries with maternal mortality rates exceeding 300 per 100,000 live births are considered fragile states.
As World Refugee Day approaches and we consider how best to respond and recover from COVID-19, let’s ensure that we are guaranteeing access to health services and meeting the needs of all populations — especially those who experience the greatest risks and vulnerabilities, like girls and young women.
Minimum standards are nonnegotiable. Where access barriers are greatest, we have to dedicate the most attention in order to meet the needs of everyone.