Q&A: Access to health services is key to halting COVID-19 and saving refugee lives

UNHCR’s leading public health expert says prevention and inclusion must be at the heart of the response for displaced people, especially in areas with weak health services.

By Jonathan Clayton in Geneva | 27 March 2020 | Español | Français | عربي

Ann Burton, Chief of UNHCR’s Public Health Section, outlines the dangers the new coronavirus poses to refugees and internally displaced people and describes how the agency is working to slow its spread, reduce its impact and save lives. Working from home in Geneva, she spoke with Jonathan Clayton of UNHCR’s communications service.


Most of the world’s 25.9 million refugees are hosted in developing countries, where intensive care units often have fewer beds and fewer ventilators. How important is it to prevent outbreaks among refugee populations?

It’s true that many refugees live in host countries with some of the weakest health systems in the world. An outbreak would put extraordinary strain on fragile local health-care services and likely result in avoidable suffering and death.

Preventing or delaying outbreaks, particularly among the most vulnerable, is the most important action we can take right now. Even if there was only a small number of acute COVID-19 cases, there would be limited access to the high level of care needed for the most severe cases.

Prevention is the best way to protect refugees and host communities.

Why is it important to ensure that refugees, asylum-seekers, stateless people and migrants have access to health facilities and services without facing discrimination?

COVID-19 clearly demonstrates that we are all connected – no matter where we live, no matter who we are. It knows no religion, no ethnicity, no borders. All people, especially the most vulnerable – including refugees, asylum-seekers and the stateless – must have access to health services.

The fact is, everyone benefits when these groups have access to health services. It is in everyone’s interest. It helps stop the virus spreading. That must always be our priority.

Inclusive and non-discriminatory policies are needed to combat COVID-19. If not, barriers to health care and discrimination create an environment where the ill are not treated, cases go undetected and the virus spreads.

The virus stirs deep fears and anxieties in individuals and societies. What are the public health consequences if people turn that fear against refugees and others on the margins?

Feeling fearful and anxious is a normal response, but we must avoid people channelling this fear and anxiety into xenophobia.

Above all, blaming refugees for a COVID-19 outbreak could result in refugees not feeling safe to seek health advice or even medical attention being refused to refugees. That would be in no-one’s interest at all.

Collectively, we have never lived through a situation like this, borders closing and quarantining on a global scale. As it continues, we must take precautions to support our own mental health and that of those around us.

UNHCR has dealt with previous epidemics, including outbreaks of Ebola, cholera, zika and SARS. How is that experience and expertise being brought to bear in tackling the COVID-19 pandemic? And what lessons can we share with the world from our experience battling the spread of epidemics among refugee populations?

We have drawn many key lessons from the Ebola response and other outbreaks.

First, preparation, preparation, preparation! The importance of being ready cannot be overstated. And so, UNHCR has drawn up extensive preparedness plans and measures. These are integrated with national plans.

Secondly, we have tried and tested methods to deal with such outbreaks. We have identified outbreak response teams for each settlement and camp. We have referral systems for laboratory specimens and we are prepositioning laboratory supplies including swabs, specimen containers, surveillance systems.

We have also learned that multisectoral responses are key. A single coordinated response brings together water, sanitation and hygiene, camp coordination and management, education, shelter and site planning and community-based protection.

“Preventing or delaying outbreaks, particularly among the most vulnerable, is the most important action we can take right now.”

Past epidemics have shown how vital it is to involve refugees themselves from Day One, both to address their concerns in outbreak response and to ensure that we take account of social and cultural sensitivities.

We know how important it is to ensure continuity of priority health services to ensure there is no increased mortality from other conditions.

Another crucial consideration is protection monitoring. This helps ensure that refugees and other persons of concern are not put at greater risk by measures which are not based on public health grounds as a result from misinformation, fear of foreigners or other stigmatizing attitudes.

Last but not least, inclusion of refugees in national responses is key. Communicable diseases can only be controlled with an integrated and inclusive approach. National health services often need support especially as refugees are hosted in isolated and remote parts of countries where health services are weaker.

Has UNHCR increased its medical stockpiles? How about things like training of health workers, public awareness activities, monitoring for symptoms?

We are stockpiling essential medicines and medical equipment, including oxygen concentrators. We are distributing soap for the general community, combined with hygiene promotion and hand sanitizer for health workers and other staff working in health facilities that UNHCR is supporting.

We have stepped up training of staff in early identification, notification, case management and contact tracing, data collection and analysis and interpretation.

UNHCR’s Health Information System is assisting us to monitor the situation. It includes an early warning system to alert country operations in the event of a surge in acute respiratory illnesses.

Could you describe your role as head of UNHCR’s public health section, and how you are currently working with front-line colleagues around the world on COVID-19?

We are working with UNHCR’s public health teams, and regional and country level staff, to ensure readiness at country level. We are in regular contact with all staff to answer questions and take feedback. We hold weekly webinars to update on the COVID situation and provide new guidance and response to questions relating to UNHCR operations. We are also looking at how to support our operations in not only preparing for COVID 19 but also to ensure continuity of essential health services.

We are also supporting resource mobilization efforts and assisting countries to identify gaps and needs based on the overall COVID response strategy.

What concrete steps is UNHCR taking to deal with a possible outbreak in a refugee camp, or among the great many refugees who live outside of camps? What challenges are you encountering?

We have stockpiled supplies, including personal protective equipment (PPE) for health staff, We are purchasing disinfectant, supplies to manage medical waste, laboratory supplies, pharmaceuticals and medical equipment for case management.

We have improved WASH [water, sanitation and hygiene] conditions and prepared isolation facilities in select camps and settlements.

UNHCR country operations are closely involved in all COVID-19 coordination meetings to ensure refugees remain at the heart of response planning.

We are training health-care workers in refugee sites on surveillance for COVID-19, case management and infection prevention and control.

We are monitoring restrictions on freedom of movement and access to asylum based on real or perceived fears of coronavirus transmission. UNHCR has been adapting information, education and communication materials to take into account the linguistic and cultural needs of refugees.

Right now, the biggest challenge is to ensure there are no barriers to refugees accessing national health systems. Another challenge, just like for most countries and organizations, is procuring PPE, medicines and supplies for treating acute COVID-19 cases.

How can donors and supporters help the efforts of UNHCR and its partners?

Support UNHCR now! There is not a day to lose. Support our COVID-19 preparedness and response plans. The more you support our health, WASH and protection activities through financial and in-kind contributions, the more we will be able to prevent or mitigate the direct impact of COVID-19.

Donors can help stop this pandemic. Also, by supporting UNHCR they can help reduce its secondary impacts – loss of livelihoods, disrupted learning and potential social instability.

Donate now