The COVID-19 global health crisis continues to affect our collective feeling of safety and wellbeing. 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.
Refugees and forced migrants are people who fled their home and country 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 conditions with inadequate access to basic services. These conditions exacerbate risks of exposure to a myriad of protection and health risks. 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 life-saving and routine services that prevent death and disease. The added health system burden of addressing COVID-19 comes with an additional layer of threat.
As we approach World Refugee Day on June 20, one thing we should be reminded of during these unusual times of the COVID-19 pandemic is that everyone, including refugees, has an equal right to safety and health.
What can be done?
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, 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 life-saving services. During active crisis, these standards help responders focus on the immediate crisis without losing sight of essential critical life-saving services.
One core set of standards familiar to the humanitarian community are 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, HIV and other sexually transmitted infections (STI) and transmission, as well addressing sexual violence and trauma. Because this package of services has already been tested, proven life-saving, and required in any emergency response, one only needs to figure out how to ensure access to these services, not to determine if they are necessary.
Unfortunately, vulnerable populations are worst affected by the disrupted access to care resulting form 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 increases during crisis, and COVID-19’s has elevated exposure to violence in the 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 where needed remains critical during the pandemic. Pregnant women, especially those who are very young, experience high risks during childbirth. Even absent a pandemic adding stress to health systems, maternal mortality remains dangerous high and 75% of the countries that have maternal mortality rates exceeding 300 per 100,000 live births occur in 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 and meeting the needs of all populations — most especially those who experience the greatest risks and vulnerabilities.
Minimum standards are non-negotiable. Where access barriers are greatest, we have to dedicate the most attention to overcoming those barriers to meet the needs of everyone.