Doctors are warning that any outbreak of the coronavirus in refugee communities would have a devastating impact. The United Nations estimates there are more than 30 million refugees worldwide, many living in conditions that are ideal for transmission of the coronavirus.
As even rich nations struggle to cope with the pandemic, health experts say it's vital the international community is prepared for any outbreak among the world's most vulnerable groups.
People across the world are being told to stay home, to practice "social distancing" and keep away from other people, and to make hygiene a priority. Such actions are next to impossible in a refugee camp, says professor Richard Sullivan, co-director of the Conflict and Health Research Group at Kings College London.
"Many of these refugees are often packed very tightly into camps. And that makes a big difference to transmission," Sullivan told VOA. "The access, of course, to water, sanitation and hygiene makes a big difference. And also, just their general nutritional state. They're in a huge state of stress, anyway, which suppresses their immune systems, but nutrition makes a big difference to how strong our immune systems are."
Cox's Bazar in Bangladesh is home to 900,000 mainly Rohingya refugees spread across 34 camps, most of whom have fled violence in Myanmar. When VOA visited the camp earlier this month, knowledge of the COVID-19 virus appeared varied.
"I forgot the name of the virus," one male refugee said. "I heard that disease has occurred in different countries, people are dying. So, we should clean our hands."
Forty-year-old Azim Ullah said aid agencies have been giving advice on preventing transmission. "They tell us to use soap after using toilet, washing hand and feet. Do not eat any fruits without washing, and also do not consume any food from outside that was not covered."
This good advice, though, is mixed with rumor and conspiracy theories. One refugee said the virus had been created to destroy Muslim nations. Another spoke of misconceptions about coronavirus symptoms. "I heard that if you are attacked by the new disease, the hands and feet are disabled. Saliva falls from the mouth. The injured person barks like a dog."
Doctors say the main symptoms are a dry cough and fever.
The deputy commissioner of Cox's Bazar, Dr. Kamal Hossain, says camp authorities are doing all they can to keep the virus out. "We have instructed the foreign aid workers to scan their health condition themselves, and to not bring any new workers from abroad. And awareness programs are continuing for the Rohingya," Hossain said.
Any outbreak would spread quickly, with devastating consequences, says Sullivan. "If COVID gets into a camp, for example, you're going to see quite a spike in the death rate, because there's simply going to be no way of keeping them alive until they recover. But of course, many refugees and particularly internally displaced populations live in makeshift camps very far away from any sort of external official help. And those are the ones that are really very, very vulnerable."
That includes the hundreds of thousands escaping conflict in Syria's Idlib province and those stuck in makeshift camps on the Turkish-Greek border, hoping to reach Europe. Meanwhile, about 42,000 asylum seekers live in overcrowded camps on the Greek islands. Aid group Doctors Without Borders has warned that Europe must evacuate them urgently, describing the conditions as "the perfect storm for a COVID-19 outbreak."
"In some parts of Moria camp [on Lesbos Island], there is just one water tap for every 1,300 people and no soap available. Families of five or six have to sleep in spaces of no more than 3 meters squared," said Dr. Hilde Vochten of Doctors Without Borders.
Kakuma in Kenya is home to almost 200,000 refugees — among them is Burundian national and former nurse Renovat Manirageza. "Nothing has been yet done in terms of awareness," Manirageza told VOA in a recent phone call.
"The health officials I spoke to told me they are waiting for guidance and directions from the Kenyan health ministry. Those who have access to the internet, they use their smartphones to read news on the internet about the coronavirus, others listen to local and international radio to get more information about the spreading of the virus in other countries," Manirageza said.
Many camps are in countries with stretched or under-resourced health systems, such as Kenya, Bangladesh, Iraq and Lebanon.
"They're already operating at a very high capacity, and so the question is: Will they be able to redeploy to accommodate people who live in camps?" asked Kalipso Chalkidou, professor in global health at Imperial College London.
Even wealthy nations are struggling to cope with the coronavirus. Any outbreak among refugee communities could have catastrophic consequences.
Muazzem Hossain Shakil and Mohammed Rukon Uddin of VOA's Bangla Service, reporting from Cox's Bazar, Bangladesh; and Patrick Nduwimana of VOA's Swahili Service, reporting from Washington, contributed to this report.