The impact of coronavirus (COVID‑19) on forcibly displaced persons in developing countries

Abstract

The focus of this brief is on the steps that governments can take to address the consequences of coronavirus (COVID-19) in situations of forced displacement in developing countries with a view to ensuring that no one is left behind. The brief examines the exposure of forcibly displaced persons to health risks and the socio-economic consequences of the pandemic, in particular in fragile contexts. It further highlights key protection safeguards to be integrated in the effort to improve health systems and resilience of societies.

People continue to be forcibly displaced while the world combats coronavirus (COVID-19)

While the world is mobilising to fight the virus and many countries have adopted exceptional measures to protect their borders, people continue to be forcibly displaced. Over 70 million people were forcibly displaced as of 2018, of which 25.9 million were refugees (UNHCR, 2020[1]). Eighty-four percent of refugees are living in developing countries, and seven out of the top ten developing countries hosting refugees are considered fragile in the OECD’s fragility framework (OECD, 2019[2]).

The health and socio-economic consequences of the pandemic are affecting the forcibly displaced disproportionally with implications for their protection. This brief examines some of the policy options that are currently being considered, to ensure that international regulations on refugee protection are applied, that the forcibly displaced are included in national and international health policies and programmatic responses, and that adequate response measures are financed and implemented.

Policy options to safeguard rights and protect health priorities

• Include refugees systematically into donor country health sector strategies and programming;

• Work with refugee-hosting and return countries to include refugees alongside host communities into national and local-level health response plans and social protection schemes;

• Manage border restrictions in a manner which respects international human rights and refugee law, including the principle of non-refoulement1;

• Build the resilience of health systems with particular focus on fragile contexts and ensuring urgent support is allocated to those with weaker health systems;

• Preserve ongoing humanitarian and development official development assistance (ODA) to ensure they are not diverted from their initial goals.

Coronavirus (COVID-19) increases the exposure of forcibly displaced to health risks

While as of 11 May 2020, no concentrated outbreak had been reported in refugee and internally displaced camps and settlements, the risk of transmission of COVID-19 could be heightened in situations of fragility, high population density and refugees living in camps (table 1). Out of 215 countries, areas and territories globally affected by COVID-19, 134 refugee hosting countries are reporting local transmissions (UNHCR, 2020[3]). The consequences of the pandemic may be aggravated by pre-existing structural weaknesses. As of 2018, 52% of the world’s refugees live in fragile contexts and six out of the ten top developing countries hosting refugees are exposed to high or very high structural COVID-19 risk as per the INFORM Covid Risk Index (INFORM, 2020[4]).

Forcibly displaced people in fragile contexts may be disproportionately affected by the crisis, having lost their means of livelihoods and at times lacking access to adequate living standards including housing, food, water and sanitation, education and access to health services. Barriers to accessing national health services include exclusion from public health care, high costs, lack of documentation and administrative hurdles. Their vulnerability may be compounded in fragile contexts with weaker health systems and capacities (Filipski et al., 2019[5]). The most recent figures show that more than half of the world’s refugees live in urban areas and 39% reside in camps or camp-like settings (UNHCR, 2019[6]). In Bangladesh for example, where almost 1 million refugees2 live under movement restrictions across 34 congested camps, refugees are exposed to a potential outbreak.3 Existing health facilities4 are already unable to treat current patients and a joint multi-sector needs assessment in 2019 found that 66% of individuals who reportedly sought medical assistance in the camps also incurred debt to pay for private health services outside the camps (ISCG, 2019[7]). Non-communicable disease management capacity and specialised medical equipment is lacking inside the camps and is insufficient outside to treat host communities and refugees (ACAPS, 2020[8]).

In conflict-affected areas, refugees sometimes reside in hard-to-reach areas, access to humanitarian assistance is curtailed due to the presence of armed groups, checkpoints and possible airstrikes (SIPRI, 2016[9]). These conditions not only affect the forcibly displaced disproportionately in the event of an outbreak, but also hinder the authorities’ and humanitarian actors’ ability to effectively put in place the necessary prevention and disease control measures.

Table 1. Population and refugee figures in top ten refugee hosting developing countries

Country of asylum	Population (million) 2018	Number of refugees 2018	Percentage of refugees out of total population	Population density (people per sq. km)	Fragile / extremely fragile country on OECD framework 2018	INFORM COVID Risk Index (0-10) High > 5 Very high > 6.5
Turkey	82.3	3 681 685	4%	107	-	-
Pakistan	212.2	1 404 019	1%	275	Yes	5.3
Uganda	42.7	1 165 653	3%	213	Yes	6.1
Sudan	41.8	1 078 287	3%	N/A	Yes	5.8
Iran (Islamic Rep. of)	81.8	979 435	1%	50	Yes	-
Lebanon	6.8	949 666	14%	669	-	-
Bangladesh	161.4	906 645	1%	1 240	Yes	5.2
Ethiopia	109.2	903 226	1%	109	Yes	5.9
Jordan	10.0	715 312	7%	112	-
Dem. Rep. of the Congo	84.1	529 061	1%	37	Yes	6.8

Source: Calculations based on the UNHCR Population Statistics 2018, the OECD’s States of Fragility framework 2018, the World Bank’s World Development Indicators 2018 dataset and the INFORM Covid Risk Index 2020. (UNHCR, 2018[10]) (OECD, 2018[11]) (World Bank, 2018[12]) (INFORM, 2020[4])

Coronavirus (COVID-19) will deepen pre-existing vulnerabilities of the forcibly displaced

Where vulnerable households are not included in health or social protection mechanisms prior to a crisis, they are more likely to experience economic shocks. With the majority of refugees living in low or middle-income countries under weaker health cover and social protection systems, and many experiencing pre-existing vulnerabilities, they may be disproportionately affected by the consequences of the pandemic. Any recent progress made towards increased refugee self-reliance in hosting countries, may also be at risk.

The negative impact of the pandemic on employment may lead to increased competition for scarce resources and reinforce exclusion of the forcibly displaced from the labour market. Refugees in most developing countries already have limited access to formal employment, if they ever did (Zetter and Ruaudel, 2016[13]). This is either because refugees are not granted the right to work5 or because of other legal and practical barriers (Clemens, Huang and Graham, 2018[14]). Such barriers may at times be motivated by concerns over decreasing jobs available to citizens or reduced wages. As a result, refugees who are able to secure a job are mainly working in the informal sector, which increases their vulnerability in case of reduced level of economic activity due to the crisis. Globally, it is estimated that up to 50% of refugees who have work are employed in temporary or transient roles (UNHCR, 2019[15]). In such situations, not only will refugees be more exposed to conditions that are not in conformity with decent work principles (ILO, 2020[16]), but they will also have limited or no access to unemployment benefits or social protection schemes in the long-run. In Turkey, for example, where refugees or those with temporary protection have the right to work or own a business, they can only apply for a work permit six months after applying for asylum. According to a livelihoods survey in 2019, only 3% of employed refugees in the surveyed provinces of Turkey were holding a work permit (Türk Kizilay and World Food Programmes, 2019[17]).

Yet, recent evidence has shown that providing refugees with the right to work and own a business alongside complementary policies such as freedom of movement generates gains for refugee self-reliance and can benefit both refugees and host communities (Betts et al., 2014[18]). Examples include countries such as Colombia, Jordan and Uganda, where refugees are increasingly accessing the formal labour market, and where trade networks throughout the countries benefit both refugees and host communities (Clemens, Huang and Graham, 2018[14]).

Economic and social impacts are not limited to diminishing employment options. Forcibly displaced persons who are unable to work, including female heads of households, unaccompanied and separated children, elderly persons, and persons with disabilities will find it harder to cope (United Nations, 2020[19]). In the absence of refugee entitlements to social protection systems, they will be even more impacted by the shock of the pandemic. Having to depend largely on humanitarian assistance or negative coping mechanisms such as skipping meals or increasing debt, they will be falling deeper into precarity. In particular, the most vulnerable amongst them often depend on their own savings, support networks and cash and voucher assistance programmes provided by the international community. In Iran, where nearly one million Afghan refugees and over 1.5 million undocumented Afghans reside,6 children are already particularly at risk, with every fourth Afghan refugee reporting having to take children out of school and every fifth having to send children to work due to increased economic hardship (UNHCR, 2020[21]).

Restrictive measures leave the forcibly displaced further behind

Even those who have not experienced an outbreak of the pandemic are facing its consequences. In times of a health crisis, Governments impose restrictions to protect public health in the interest of all. Nonetheless, viewed through a displacement and fragility lens, confinement and mitigation measures, in addition to health and livelihoods impacts, may have affected the rights of forcibly displaced persons and other vulnerable groups.7 These include the right to asylum, freedom of movement, right to education and work. Restrictive measures may have also influenced directly or indirectly patterns of displacement and potentially generated further displacement.

Due to severe disruptions of travel arrangements for resettling refugees, and to prevent refugees’ exposure to the virus, the UN High Commissioner for Refugees (UNHCR) and International Organization for Migration (IOM) suspended temporarily their resettlement travels on 17 March 2020 (IOM, 2020[21]).

Border closures may deny people seeking international protection the right to asylum. This could force people to return to situations of danger 8. As of 13 May 2020, UNHCR estimated that 161 states had partially or fully closed their borders to contain the spread of the virus. Up to 91 of them are making no exception for people seeking asylum (UNHCR, 2020[22]).

Border closures and lockdowns throughout national territory could also lead to an increase in irregular movements or result in populations on the move being stranded. Since mid-March 2020, an increasing number of Venezuelans have been returning to their country mainly due to economic hardship resulting from lockdown measures in the countries in the region9 where the majority of the 5.1 million Venezuelan refugees and migrants live (R4V, 2020[23]). With all neighbouring countries closing their borders with the Bolivarian Republic of Venezuela due to the pandemic, and despite critical efforts by the Colombian and Venezuelan governments to keep an official border crossing open,10 many are still returning through informal border crossings (trochas) putting them at heightened risk of exposure to the virus, human trafficking and abuse by armed groups (United Nations, 2020[24]) (International Crisis Group, 2020[25]).

Another example is the recent surge of spontaneous returns of Afghans from Iran, despite facing risks and insecurity. While Afghans continue to return to Afghanistan from both Iran and Pakistan, who host up to 2.4 million Afghan refugees and a significant number of undocumented Afghans, spontaneous returns from Iran through two main border crossings reached a new record high totalling 150 855 alone in the month of March 2020 (UNHCR, 2020[26]) (IOM, 2020[27]). They then decreased sharply to 40 025 at the end of April 2020, coinciding with lockdown measures adopted in the host country (IOM, 2020[28]). Reasons behind the increase in spontaneous returns could include economic hardships faced in Iran and fears of virus transmission11 (IOM, 2020[29]).

Ensure better protection and safeguard rights of the forcibly displaced

UN agencies, experts and NGOs have highlighted critical protection safeguards and minimum legal standards, and some have taken concrete measures to protect refugees and put in place preparedness measures as well as an emergency response. UN human rights experts reminded states that “any emergency responses to the coronavirus must be proportionate, necessary and non‑discriminatory” (OHCHR, 2020[30]). UNHCR reaffirmed key legal considerations with regards to access to territory for persons in need of international protection in the context of the COVID-19 response, warning against measures that deny persons seeking international protection an effective opportunity to seek asylum or that result in refoulement (UNHCR, 2020[31]). The Inter Agency Standing Committee (IASC) also issued interim guidelines on COVID-19 for outbreak readiness and response operations in camps and camp-like settings (IASC, 2020[32]).

Forcibly displaced persons must be integrated into national response plans and social protection schemes

Managing the COVID-19 crisis is extremely complex for governments, whose responsibility to protect is challenged by competing priorities. The pandemic further undermines progress on all dimensions of fragility. In times of crises, the most vulnerable may be scapegoated, putting refugees particularly at risk of stigma (OHCHR, IOM, UNHCR and WHO, 2020[33]). Key options advanced by global plans and various organisations on the response to COVID-19 in forced displacement situations point to the need to address risks of violence, discrimination and xenophobia and to the importance of inclusion of the forcibly displaced into health sector response plans and social protection schemes. Immediate response should include decongestion, surveillance, testing, treatment and awareness raising.

The COVID-19 Global Humanitarian Response Plan, a joint effort by members of the Inter-Agency Standing Committee, was revised and launched on 7 May 2020 for a period of nine months, requiring USD 6.7 billion. The plan aggregates the relevant COVID-19 appeals of various UN agencies, and complements other humanitarian plans developed by the International Red Cross and Red Crescent Movement. It also includes inputs from NGOs. One out of the three strategic goals focuses on protecting, assisting and advocating for refugees, internally displaced people, migrants and host communities particularly vulnerable to the pandemic (United Nations, 2020[30]).

As countries across the world are increasing the coverage of social protection and jobs programmes in response to COVID-19, there is an opportunity to include forcibly displaced persons and other vulnerable groups into social safety nets from the outset, As of 8 May 2020, a total of 171 countries introduced or adapted 801 social protection measures in response to COVID-19. Social assistance transfers consisting of cash-based and in-kind measures are the most widely used interventions - 60.7% of global responses, or 487 measures (Gentilini, Almenfi and Dale, 2020[31]). Aligning the cash and voucher assistance programmes currently being scaled-up by the international community with the national social assistance transfers by harmonising the targeting criteria, transfer mechanisms and monitoring systems would lay the grounds for a more inclusive and equitable process. The international community and refugee-hosting countries could also work together to turn national policy commitments for inclusion made towards the Global Compact on Refugees (GCR) into practice (UNHCR, 2020[32]).

In the meantime, some good practices in the COVID-19 response are emerging in different countries. In most Middle Eastern countries12 for example, where refugees are largely included in the national preparedness and response, governments are adapting in various ways. Jordan’s Ministry of Health currently provides measures such as vaccinations, family planning and secondary health care to refugees and is planning to extend these activities to respond to COVID-19 related needs (UNHCR, 2020[33]). On 10 March 2020, UNRWA launched its COVID-19 Strategic Preparedness and Response Plan for Palestinian refugees in its five fields of operations covering eight priority areas (UNRWA, 2020[34]). In the Asia and Pacific region, IOM country offices13 in co-ordination with health ministries are implementing Risk Communication and Community Engagement (RCCE) activities (IOM, 2020[35]). In Burkina Faso, the government recently adopted a COVID-19 response plan that integrates displaced people (The Intercept, 2020[36]). However, the unavoidable challenge remains that health facilities are ill-adapted and 1.5 million people overall are dependent on humanitarian health assistance. In such situations, the international community must continue supporting health facilities, particularly in remote areas (OCHA, 2020[37]).

Hard choices in times of crisis

Official development assistance (ODA) will have an important role to play in the recovery phase where many developing countries may be faced with liquidity risks. Trends of ODA during the economic recession in 2008 point to the resilience of ODA budgets in the face of crisis (OECD, 2020[38]). The magnitude of the crisis today may, however, put additional strain on ODA. During times of shifting priorities, the role of ODA in leveraging other sources of financing and most importantly in mitigating the impact of the crisis on the most vulnerable, thereby helping to reduce inequalities, will be more important than ever.

Based on publicly available information, initial estimates as of 20 April 2020 point to a total of USD 21 billion14 in ODA pledged as a response to COVID-19 by DAC donors, of which up to 4 billion are bilateral DAC public commitments.15 These include both additional and reallocated funds. The IMF supports countries with different lending facilities, and on 9 April enhanced the Fund’s Emergency Financing Toolkit to USD 100 billion for low-income and emerging markets and the World Bank will be providing up to USD 160 billion in financing to health and socio-economic impacts of the pandemic, including USD 50 billion of IDA resources on grant and highly concessional terms (IMF, 2020[39]) (The World Bank, 2020[40]). As of 15 May, the recently revised COVID-19 GHRP was funded at 15% equal to USD 1.1 billion (FTS, 2020[41]).

The OECD and the International Network on Conflict and Fragility (INCAF) good practice financing principles for refugee situations remain applicable to this response and are particularly relevant in terms of adapting financing systems and tools to displaced populations’ mobility strategies, concessionality wherever possible and supporting local and national systems through capacity building (OECD, 2019[2]) (INCAF, 2019[42]). The majority of donors are integrating the most vulnerable, including refugees, internally displaced persons and migrants, among their priorities and have launched fast track or simplified financing procedures. With 72% of ongoing ODA for refugee situations being humanitarian in nature and with protracted refugee situations becoming increasingly prevalent, it will be critical not to repurpose core contributions to humanitarian agencies and not to divert ongoing development programmes from their initial goals (OECD, 2018[43]).

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Notes

← 1.  Non-refoulement is a fundamental principle of international law that forbids a country receiving asylum seekers from returning them to a country in which they would be in likely danger of persecution based on "race, religion, nationality, membership of a particular social group or political opinion". The principle of non-refoulement is enshrined in article 33 of the 1951 Refugee Convention (UNHCR, 2010[32]).

← 2.  The number of refugees as of 15 May 2020 is 860,175. Table 1 in this brief depicts latest data available from 2018 for comparative purposes (UNHCR, 2020[14]).

← 3.  While Rohingya refugees represent 1% of total Bangladesh’s population, they represent 37% of the Cox’s Bazar district population (Filipski et al., 2019[5]).

← 4.  Standard health facilities across the 34 camps include 155 basic health units, 41 health centres and 5 hospitals (ISCG, 2019[15]).

← 5.  Some 75 of the 145 states parties to the 1951 Refugee Convention formally grant refugees the right to work (Zetter and Ruaudel, 2016[13]).

← 6.  It is estimated that Iran hosts between 1.5 to 2 million undocumented Afghans (UNHCR, 2020[20]).

← 7.  Different categories of confinement and mitigation measures in specific contexts have so far been identified to analyse their implications, including for forcibly displaced. (IMF, 2020[30]) (ACAPS, 2020[51])

← 8.  This could be considered as constituting non-refoulement.

← 9.  Countries include Colombia, Ecuador and Peru.

← 10.  Colombian and Venezuelan authorities in coordination with the international community have sought to ensure that returnees can make use of the main official border crossing through a carefully managed process following a series of health checks and a period of compulsory quarantine.

← 11.  In the month of April 2020, the number of spontaneous returns decreased from 150 855 to 40 025 people. Movement restrictions and lockdowns in Iran went into effect on 27 March 2020 (IOM). A direct link between the fall in the numbers of spontaneous returns from Iran to Afghanistan with the movement restrictions and lockdowns cannot be established and would require additional analysis.

← 12.  With the exception for Yemen, Libya, Mauritania and Western Sahara.

← 13.  IOM country offices in Afghanistan, Bangladesh, Cambodia, China, Lao PDR, Malaysia, Micronesia, Mongolia, Myanmar, Pakistan, Sri Lanka and Thailand.

← 14.  The figures are indicative and were extracted from countries’ official websites. The list includes Australia, Austria, Belgium, Canada, Czech Republic, Finland, Ireland, Italy, Japan, Korea, Luxembourg, the Netherlands, New Zealand, Poland, Slovak Republic, Sweden, Switzerland, United Kingdom and the European Union.

← 15.  Since 20 April, changes have applied to these figures and an OECD survey on COVID-19 and financing is under way.