Roughly two years into the COVID-19 pandemic, no massive outbreaks have been reported in refugee camps to date. Health experts have some theories about why, but they also urge continued wariness against “the very real and present danger of widespread transmission” in camps, as the World Health Organization has cautioned.

The U.N. refugee agency, or UNHCR, “had been fearing — and preparing for — large outbreaks at refugee camps, which fortunately did not happen,” spokeswoman Aikaterini Kitidi acknowledged in an email exchange with VOA.

“However, this doesn’t mean we are out of the woods yet,” she said. With new variants such as omicron, “which are far more infectious, we may very well see more cases. We must remain vigilant and scale up surveillance and testing, as well as the equitable distribution of vaccines.”

UNHCR estimates that roughly 80 million people worldwide have been forcibly displaced by persecution and conflict, with most living in low-resource countries with frail health systems. Millions of them live in camps — some formal, some informal — with limited water and sanitation facilities. They also face overcrowding, making social distancing a challenge.

Yet comparatively few COVID infections have been reported in the camps: 55 Central African refugees tested positive in the Democratic Republic of the Congo, for instance, as UNHCR reported in a global COVID-19 response update of December 20.

Because of population density, “early on, we were concerned that [COVID-19] transmission would be very high and so would deaths, even with the younger demographics” of refugee camps, said Paul Spiegel, an epidemiologist who directs Johns Hopkins University’s Center for Humanitarian Health. “That hasn’t been the case that we’re aware of — but then data have been very poor.”

Undercounting is a real possibility, Spiegel said. “There could be scenarios where it [COVID] actually has gone through the refugee camps at a high level” but symptoms weren’t severe enough for the infected people to seek care. He added that there hasn’t been enough blood testing “to know the extent that COVID has actually been transmitted in these settings. … It takes a lot of time and money to be able to do this.”

Individual circumstances

Transmission rates ultimately may vary depending on the individual camp or other setting, said Spiegel, a former UNHCR senior official who has responded to crises in the Middle East, parts of Africa and Asia. He was on a team that, early in the pandemic, advised the United Nations, governments and humanitarian groups on best responses.

In early December, Spiegel completed five weeks of touring and assessing health conditions in Afghanistan for the World Health Organization. In that country, he said, only three of 39 facilities intended for treating COVID were functioning; the rest were devoid of supplies or paid staff following the Taliban takeover in August and subsequent sanctions by the United States and other Western allies. Last week, the U.S. Treasury Department said it would lift restrictions on some humanitarian aid.

On behalf of UNHCR, Spiegel also is looking at COVID’s impact on two Syrian refugee camps in Jordan: Za’atari, a northern site with nearly 80,000 residents, and Azraq, a northeastern site hosting 38,000. Preliminary data indicate lower rates of infection and death in those two camps than among residents of surrounding areas, he said.

“So why would that be? We have some hypotheses,” Spiegel said, noting that those camps went into lockdown early, restricting refugees to the camp, limiting outsiders’ access, and promoting more handwashing and social distancing. Local and international NGOs sustained their support for the camps, he said, so residents could continue to access health care and food, “even if it’s not enough” to meet their caloric needs. He also noted that people in camps spend a lot of time outside.

Spiegel said he’s involved in additional studies of refugees and host communities in Bangladesh and in three African countries: Central African Republic, Democratic Republic of the Congo and Uganda. He said he anticipated their findings to be published in 2022.
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