New threat: COVID-19 can spreading in African refugee camps

Scary, distressing, catastrophic: A bleak assessment by experts, humanitarians and epidemiologists on what a severe coronavirus outbreak would appear as if in countries across Africa sheltering many refugees and other vulnerable people.

The virus that swept across the world has infected quite 660,000 people and killed some 30,000 since it had been detected in China late last year. In Africa, the confirmed figures are still fairly low - but on the increase . As of Saturday, 3,924 infections and 117 deaths had been reported across 46 of the continent's 54 countries.

As the rapidly spreading virus gains ground, aid groups warn of the doubtless disastrous consequences of a serious outbreak of COVID-19, the highly infectious respiratory illness caused by the new coronavirus, in places where healthcare systems are already strained and not easily accessible to large segments of the population.

Lack of funding and years of fighting have gutted critical infrastructure in several parts of the continent, which could leave many countries unable to reply to a surge in infections, said Crystal Ashley Wells, regional spokeswoman for the International Committee of the Red Cross (ICRC) in Nairobi.

For example, in South Sudan, where quite 1.6 million people are internally displaced, it often takes people hours, even days, to succeed in healthcare facilities, and therefore the leading explanation for death is "often preventable: treatable diseases like malaria and diarrhoea", Wells told Al Jazeera.

"We have surgical wards immediately that are filled with patients recovering from gunshot wounds," she said. "Then you've got this healthcare system that has suffered from decades of under-investment then conflict that has basically left people with little healthcare at the best ."

Some of the internally displaced in South Sudan have found refuge in overcrowded camps inside UN peacekeeping bases.

"They're literally living surrounded by walls and barbed wire" in tents that are only inches apart, Wells said.

So far, war-scarred South Sudan is one among the few African countries that has not had any confirmed cases of COVID-19, and therefore the government has introduced drastic measures aimed toward reducing the danger of spread, like suspending all aviation and barring public gatherings.

But Wells said the danger remains there: "It's a reasonably scary picture to believe - about what a disease like this might do to an already very fragile healthcare system."

In the neighbouring Democratic Republic of the Congo (DRC), where 58 cases are confirmed so far , COVID-19 has largely been contained within the capital, Kinshasa - unlike past outbreaks of diseases like Ebola, which struck remote areas.

"Today, it's possible to handle sick patients because the amount of patients has not yet exploded," said Jean Paul Katsuva, an epidemiologist performing on the COVID-19 response in Kinshasa, a city of 12 million people.

But the overall feeling is one among anxiety - especially as people watch countries better-equipped than the DRC struggle under the load of the pandemic. Serious assistance is needed, Katsuva said, for "a population that's already in distress due to this example during which the longer term is unclear".

'Global issue'
The contagious nature of the coronavirus, including its ability to cause severe illness, has also sparked fears over what could happen if it reaches densely populated refugee camps.

A country that's of particular concern is Burkina Faso , which has registered the foremost confirmed cases in West Africa - 180 - and nine deaths. An impoverished country of some 20 million people, Burkina Faso has been gripped by an escalating and sophisticated conflict that has caused "explosive displacement" over the past year, consistent with Wells.

"There are about 765,000 people displaced," she said. "It's up by quite 1,200 percent since 2019 … and it's expected to still rise. Security and access to those communities is additionally really challenging for humanitarian workers."

On the opposite side of the continent, Kenya has 38 confirmed cases so far - but none among refugees. "We would like to keep it that way," Eujin Byun, a spokeswoman for the UN refugee agency (UNHCR) in Kenya, told Al Jazeera.

The East African country is home to 2 major camps: Dadaab, near the country's eastern border with Somalia, had a population of nearly 218,000 refugees and asylum seekers at the top of February, and Kakuma, within the northwest near the borders with South Sudan and Uganda, counts quite 190,000 refugees.

Byun said having numerous people living in close proximity is one among the main risk factors for the spread of the virus, while ensuring that refugees have access to wash water and soap - two of the foremost effective weapons against it - is critical.

UNHCR has altered its operations within the camps to undertake to avoid gatherings, Byun said. for instance , to scale back the contact between residents and humanitarian workers, it plans to distribute two months' worth of food rations directly , whereas within the past, they were distributed monthly or every fortnight .

The agency has already stopped sending outside missions into the camps to stop a possible spread of the virus. Staff already within the camps will remain there to supply essential, life-saving services - and that they have access to psychological state support, Byun said.

Information is additionally being sent to residents via mobile apps like WhatsApp, she added, to limit social gatherings and "to reduce fear and panic within the camp and stop any quite misinformation".

Ninety beds are available inside the Dadaab camp itself to accommodate coronavirus patients, while 25 beds are found out in Kakuma, Byun said. COVID-19 isolation facilities also are found out in nearby Kenyan host communities, and both refugees and residents will have access to them.

"We're not doing this during a silo; we've to speak and coordinate with the agency ," Byun said, adding that UNHCR welcomed the Kenyan government's decision to incorporate refugees and asylum seekers in its national decide to combat COVID-19.

"This may be a global issue, and that we need to think [of it] sort of a global issue - not a bit like a refugee issue."

Refugees 'sidelined'
Indeed, UNHCR on Wednesday launched a worldwide appeal for $255m to reply to the coronavirus in refugee camps and other vulnerable areas, as a part of a wider humanitarian relief plan seeking $2bn.

"We must come to the help of the ultra-vulnerable - millions upon many people that are least ready to protect themselves," UN Secretary-General Antonio Guterres said, calling for stronger coordination to make sure the more vulnerable countries get the support they have .

On Thursday, the Red Cross involved $823m "to help the world's most vulnerable communities" stop the spread of COVID-19 and get over the pandemic. that has migrants and displaced people, homeless people, and people living in disaster-prone areas, among others.

But just what proportion donor countries are going to be ready to contribute to those funding drives remains an open question. Most governments are struggling to debar an depression within their own borders and to support their citizens, many of whom have lost their jobs, through the pandemic.

In that context, "governments are getting to face some really difficult decisions between allocating scarce resources to their own population and therefore the refugee camp", said Sally Hargreaves, professor in global health at the Institute for Infection and Immunity at St George's University of London.

"Refugees are going to be those that are sidelined altogether of this because the governments move towards supporting their own population as best [as] they will ," she said.

Hargreaves told Al Jazeera that refugees and IDPs must be included in national COVID-19 plans because they're vulnerable and risk being disproportionately suffering from the pandemic. She said it's getting to take a big international effort - and investment - to form sure these groups aren't left behind.

"We can't ditch them. we will not leave them to defend themselves," said Hargreaves. "We got to confirm governments prioritise them - not just their own populations - and [that] they're funded and supported in doing it."

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