National Post (National Edition)
Global health groups see increasing danger abroad
Refugee camps in fraught risk pool
As the developed world took increasingly drastic steps this week to slow the spread of COVID-19, many of those who work with the world’s most vulnerable looked on with growing unease.
Even the most draconian efforts at mass isolation and quarantine may not be enough to prevent the disease from overrunning some of the wealthiest health-care systems in the world, in places like Germany, Italy and Canada.
In the large refugee camps that now dot the globe, the risks are infinitely higher. “We’re extremely worried,” said Joseph Belliveau, the executive director of Medicines sans Frontiers (MSF) Canada. “These are particularly vulnerable groups of people.”
In countries like Bangladesh, Uganda and Kenya, millions live in cramped camps where simple hygiene is difficult and health care is basic at the best of times. Even in smaller camps, on the Greek Isles and in remote locations all over the world, core efforts to combat the spread of COVID-19, like social distancing and isolation, would be somewhere between “impossible and very difficult,” said Chiara Altare an assistant scientist at the Centre for Humanitarian Health at Johns Hopkins University.
“The main recommendation here would be washing your hands as much as possible,” Altare said. Many of the camps don’t have clean water as it is, “certainly not in the quantity that is needed,” she added.
Prevention and mitigation is hard enough. But treatment, if a mass outbreak did occur, would be even more difficult. Many refugee camp residents are suffering from years of chronic malnutrition and other comorbidities, like tuberculosis, said Belliveau. “All of which is going to make people more susceptible,” he said.
The capacity in any camp, anywhere, to treat severe cases, meanwhile, is “often very limited,” said Altare. Even the best-equipped refugee camps have reasonably few ICU beds and “mechanical ventilation is very, very rare,” she said.
What’s going to make things even worse for the most vulnerable is that wealthy countries playing desperate catch up are now doing everything they can to monopolize the global supply of crucial medical items like masks, gowns, ventilators and oxygen, said Belliveau.
Supply chains for other medicines and needed supplies are also breaking down as countries close borders and impose export restrictions. In many places now, getting new doctors, nurses and other staffers into the field has become impossible. The ones in place are facing a brutal dilemma: to stay and serve as conditions deteriorate and supplies dry up, to or come home while they can, knowing full well there’s no one coming take their place.
The flip side for organizations like MSF, built to operate in crisis in the poorest countries in the world, is that they are now applying those same lessons at home. MSF is already operating in Northern Italy for the first time ever, said Belliveau. It is active in Hong Kong and is ramping up operations in Germany and Spain.
In Canada, doctors, nurses and medical technicians used to working abroad are already looking at ways they can reintegrate into the Canadian health system, said Jason Nickerson, a humanitarian affairs advisor with MSF. The organization is also looking to connect experts in disaster logistics with Canadian communities.
“If there are relevant lessons learned from the places where we’ve worked, we could link these folks up with people who might be asking similar questions here in Canada,” said Nickerson. “You know, how do we actually do this? How do you expand a hospital if you need to relatively quickly? How do you manage a hospital during times of crisis? … It’s a fairly specific kind of expertise.”
For Altare, who lives in the United States, but was born and raised in Italy, the last few weeks have been surreal. “I was involved with the Ebola response last year in Congo,” she said. “But it’s very different seeing your own country going through such a crisis, seeing how unprepared everybody is and how challenging it is from a psychological point of view.”
Still, for now, her focus remains on the refugees. At times of crisis, there is a natural tendency to look after your own. The risk is that refugees, as they so often are, get left behind.