Muhammad H Zaman
Howard Hughes Medical Institute Professor of Biomedical Engineering, Boston University
International news media have paid some attention to the myriad challenges facing refugees, both in camps and in urban environments, in light of the COVID-19 pandemic. Journalists commonly report the figure of nearly 71 million displaced from their homes. What is often missing, unfortunately, is a clear focus on the group that makes up more than half of that number: internally displaced persons (IDPs).
The challenges facing IDPs are similar in some respects to those facing refugees, but distinct in other ways, requiring nuanced, focused responses that are cognisant of the realities on the ground. Indeed, both refugees and IDPs face an absence of clean water to drink, with regular handwashing not a viable option. Similar to refugees, IDPs are often also forced to live in confined environments where physical distancing is not possible. IDPs – despite being citizens of the country in which they are displaced – are likewise not immune from xenophobia and racism.
There are, however, unique challenges facing IDPs that suggest that they are just as vulnerable, and in some cases at even greater risk in the COVID-19 pandemic as refugees. First, global awareness of IDPs is generally significantly weaker. That is not to say that global attention to the plight of refugees is by any means adequate – it, too, is woefully limited and often disconnected from reality. Yet, understanding of the challenges facing IDPs is even worse.
Let’s take IDPs in Yemen as a case study. These people were forced out of their homes due to a conflict that started in 2015, and which has continued virtually unabated despite several cease-fire agreements. Reporting from the ground has been limited, largely due to travel restrictions imposed by warring parties. As a result, international awareness – and subsequent responses to health and humanitarian challenges – has remained inadequate.
Secondly, for IDPs in Yemen, the COVID-19 pandemic comes on the heels of one of worst humanitarian crises of our time, where the world largely looked the other way. A cholera epidemic and acute malnutrition were already affecting millions of Yemenis before the first coronavirus case was detected there. Roads and hospitals had been destroyed in the conflict, lives and livelihoods lost. With international organisations hampered in their ability to provide basic food and medicines to those in desperate need, hundreds of thousands died, and millions more were at risk of starvation and death. For the population in general, and IDPs in particular, COVID-19 couldn’t have come at a worse time. Getting to healthcare facilities was already difficult, if not impossible. Those who do manage to reach the dilapidated facilities may find them unstaffed or without the most basic life-saving drugs. Living among destroyed infrastructure also means continued exposure to a hazardous environment and the ever-increasing risk of infection with superbugs.
The potential impact of COVID-19 on Yemen and other nations with high numbers of IDPs has not been studied adequately. The fact that only a relatively small number of COVID-19 cases has been recorded should not give us a sense of comfort, as this is largely due to poor testing (just a few hundred tests to date) and limited data. In all likelihood, the direct and indirect impacts will be severe, due not only to poverty and a broken health system but also the long-standing nutrition challenges facing the country. Data coming from higher-income countries about the limited impact of COVID-19 on young children needs to be reconsidered in the context of Yemen and other places where acute malnutrition is widespread. Given the strong connection between immunity and nutrition, there is a high likelihood that Yemeni children are much more vulnerable to COVID-19 than their counterparts in Western Europe or the US.
For IDPs in Yemen, COVID-19 adds to a continuum of acute public health catastrophes. With Yemen’s fractured and dysfunctional underlying public health system, the impact of the virus can be a deathly blow to a society that has suffered for so long. However, this latest calamity also offers an opportunity to turn a corner for a country ravaged by war and our collective indifference.
The window of opportunity is small but real. What is needed is an international effort that focuses on the unique and serious health challenges facing the country that include, but are not limited to, COVID-19: an appreciation of the local environmental, demographic and public health context; a multi-national approach to fixing the public health infrastructure with equity, dignity and access in mind; and a serious effort to bring peace to the country. It is by all means a tall order, but one that is neither impossible nor impractical. In fact, it is a task we must undertake to reaffirm our commitment to universal human dignity and the right of everyone to live in a safe, healthy world.
|Muhammad H Zaman (@mhzaman) is a Howard Hughes Medical Institute Professor of Biomedical Engineering at Boston University and focuses on access to healthcare among marginalised and vulnerable populations, including refugees and internally displaced persons. His most recent book is Biography of Resistance: The Epic Battle between People and Pathogens (Harper, 2020).|
Read Kaldor Centre Director Jane McAdam introducing COVID-19 Watch with ‘The impacts of COVID-19 on the world’s displaced people: A watching brief’, and find all the analysis in COVID-19 Watch. Don’t miss any new posts, follow the Kaldor Centre on Twitter, Facebook and LinkedIn and subscribe free to our Weekly News Roundup, delivered to your inbox every Monday.
Image source: UNHCR/Ahmed Haleen