The past year has brought immense challenges to all corners of the world, and this is especially true for the 80 million forcibly displaced people around the world. The COVID-19 pandemic has exacerbated the already precarious conditions of refugees, two-thirds of whom come from just five countries – Syria, Venezuela, Afghanistan, South Sudan and Myanmar (1). 40% of the world’s displaced people are children and 80% live in countries affected by acute food insecurity or malnutrition (2). Refugees often face limited access to services, including education, shelter, health care and livelihoods. In addition, social and legal discrimination can create additional barriers to accessing services, in addition to worsening the mental health impacts of living in displacement.
The COVID-19 pandemic has only worsened these existing problems, with refugees reporting difficulties adhering to pandemic prevention measures, lack of access to health services, growing xenophobia and increased levels of disease. anxiety and depression (3). SAMS has been at the forefront of the Syrian refugee crisis, providing dignified health services to refugees in Turkey, Jordan, Lebanon, Greece and Iraq, as well as 6.2 million displaced people. inside Syria.
Turkey hosts 4 million refugees, the largest number of countries in the world (4). 3.6 million are Syrian nationals enjoying temporary protection status in Turkey (5). Although there are seven official camps for Syrians in southeastern Turkey, the vast majority of Syrian refugees in Turkey live in urban areas (6). As of April 30, Turkey has confirmed more than 4 million cases of COVID-19 and 40,131 deaths from the virus. As vaccines were purchased and vaccine rollout began, supply shortages slowed immunization rates in the refugee camps. Turkey has also relied on intermittent full lockdowns to mitigate the effects of the pandemic. This has exacerbated existing gaps in livelihoods, protection services, education, etc. SAMS staff in Turkey noted an increased need for services to vulnerable populations over the past year. For example, there is a need for more physical rehabilitation services for people with disabilities. These services include physiotherapy, prosthetics, provision of hearing aids, mobility aids, and support for caregivers of family members with different abilities to better support and advocate for them. Ideally, in order to foster a protective environment, these services should be integrated with mental health and psychosocial support (MHPSS) and sexual and gender-based violence (SGBV) services to ensure that access to these specialized forms of protection is available to everyone.
Jordan hosts 755,238 officially registered refugees, although the actual number is likely to be much higher. 83% of refugees in Jordan live in urban areas and 46.2% are children under 17 years old. 88% of refugees in Jordan are from Syria (7). Jordan has confirmed 744,844 cases of COVID-19, including 9,622 deaths (8). COVID-19 cases have been significantly lower in refugee camps with a test positivity rate of 3% in the camps compared to a test positivity rate of 7% nationally (9). More than 2.5 million doses of vaccine have been administered, and refugees are increasingly among those signing up for vaccines. Before the pandemic, Syrian refugees in Jordan faced significant barriers in accessing education, health care, shelter and livelihoods. 21% of refugee households in Jordan are classified as food insecure, and 67% of households are considered vulnerable to food insecurity.
The pandemic has particularly exacerbated food insecurity, with unemployment reaching 22.6% among men and 32.8% among women. Protection issues for Syrian refugees in Jordan abound – mental health has declined and many refugees, especially women, report feeling unsafe in their communities (10). SAMS staff in Jordan have noticed an increased need for sexual and gender-based violence services due to the pandemic, as sexual and gender-based violence has increased around the world due to insecurity and lockdown measures. Creative solutions are needed to implement these services remotely, but the past year has proven that it can and should be done. Similar concerns to Turkey for people with disabilities also exist in Jordan, and more attention is needed to make humanitarian services more accessible to them and to tailor health and MHPSS services to the needs of people with disabilities.
Lebanon hosts 1.6 million Syrian refugees, making it the country with the highest number of refugees per capita in the world (11). 2019 and 2020 have been difficult years for Lebanon, between the COVID-19 pandemic, the explosion in the port of Beirut in August 2020 and a severe economic slowdown. 50% of Syrian refugees and 33% of refugees of other nationalities are classified as food insecure, as prices have increased and food resources have become scarce (12). Lebanon has confirmed 527,508 cases of COVID-19, including 7,302 deaths. 445,352 people have been vaccinated as of April 30, 2021 (13). Throughout the pandemic, NGOs have identified and stepped up efforts to address gaps in health care, MPSS, WASH services, education, child protection, sexual and gender-based violence, accommodation and social cohesion (14). The economic downturn, exacerbated by the pandemic, has worsened conditions in almost all sectors. 90% of patients referred to SAMS for hospital care coverage are unable to cover their share of the medical costs upon discharge, and perhaps more worryingly, many patients are unable to guarantee the admission fees demanded by them. hospitals. Testing fees, both for COVID-19 and other conditions, have also been difficult to pay, according to ASSM beneficiaries. The pandemic and economic crises have also increased the number of Lebanese households reporting a lack of access to health care, citing cost as the main obstacle. Secondary and tertiary care remain difficult to access, both due to cost and availability, and ASSM recipients requiring cardiovascular interventions have increasingly reported skipping treatments due to the cost. .
While the number of asylum seekers residing on the Greek islands of Lesvos, Samos, Chios, Leros and Kos has declined significantly in recent months, from over 19,000 at the start of 2021 (15) to 9,700 in June 13 (16), the needs of refugees remain acute, especially in the health sector. SAMS teams working in the Attica region report that the third wave of COVID-19 has hit hard and most intensive care units in the region are full. Vaccines are not yet available in large numbers and access for refugees is extremely limited. The surge in COVID-19 cases has resulted in increased access problems, as NGOs seeking to ensure the safety of their staff and beneficiaries turn to remote programming modalities.
The past year has been particularly difficult for refugees around the world. Displacement already poses many challenges – from lack of basic necessities to discrimination to mental health issues. The pandemic and deteriorating economic conditions in many refugee-hosting countries have exacerbated and highlighted these shortcomings while creating new challenges in their own right. Refugees need support more than ever. SAMS recommends that:
Parties to conflicts around the world cease hostilities, stemming the main cause of displacement
The international community continues to support the spread of the COVID-19 vaccine, ensuring equitable access that includes refugees and other displaced people
Donor support for humanitarian programs that meet the basic needs of refugees – food, shelter, livelihoods, health care and education – be increased to promote a healthier and more stable future for displaced communities
Mental health support and funding for related programs should be prioritized in humanitarian programs to help refugees and other displaced people cope with the stressors and trauma they experience.
Refugee host countries remove barriers for refugees seeking higher education, especially in medicine and mental health
(13) https://reliefweb.int/sites/reliefweb.int/files/resources/COVID-19%20response%20%E2%80%93%20Liban%20monthly%20situation%20report%20in%20April%20%2818 % 20May% 202021% 29.pdf