The Unseen Pandemic

Refugee camps such as those in Bangladesh are a tinderbox for the spread of the coronavirus.

Rohingya refugees fix their temporary shelter at a camp in Cox's Bazar.
Rohingya refugees fix their temporary shelter at a camp in Cox's Bazar. ((Turjoy Chowdhury / NurPhoto via Getty Images))

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For weeks, Robbi has been making his way up and down the hilly dirt paths that crisscross a huge refugee camp in Bangladesh, lugging with him a box filled with small supply kits containing gloves, soap, and sanitizing liquid to donate to families. He hands out surgical masks to wiry men, curious children, and women in brightly colored headscarves, showing them how to properly fit them over their nose. Along the way, he pauses to make announcements through a small megaphone about proper hygiene and social-distancing measures. Along with a handful of others, Robbi is working, he told me, “block to block, door to door, shack to shack, to try to educate the people” about the coronavirus pandemic tearing across the globe.

Hundreds of thousands of refugees in Bangladesh, most of them Rohingya Muslims who fled a military crackdown in neighboring Myanmar, live in camps such as this one, but authorities last year cut off internet access in the camps and imposed restrictions on phones, actions they described as necessary security measures. The curbs, which were briefly eased yesterday before being reinstated, have greatly limited the amount of reliable news refugees can access. “People aren’t getting much information, but they are getting rumors,” said Robbi, a Rohingya refugee who asked to be identified by a nickname, because the outreach he is doing is unsanctioned. For those like Robbi who manage to evade these communication restrictions, the incessant news updates have made for grim and ominous reading. He watched as countries with robust health-care systems, such as Italy and the United States, failed to stop the spread of the virus, their hospitals pushed to the breaking point and their death tolls racing upward daily. If these places were unable to contain the outbreak, he wondered, what could happen in Bangladesh? The thought, he said, frightened him. “This virus is very strong,” he said. If it makes it to the camps, he fears that “no one can stop it. Many people will die.”

With cramped living conditions, poor hygiene infrastructure, and a lack of health-care facilities, the camps in Cox’s Bazar, on the coast of the Bay of Bengal in southeastern Bangladesh, have the qualities that make them a tinderbox for the spread of the virus. But it is not just there that alarm is growing over an outbreak erupting among refugee and displaced communities. Of the about 25.9 million refugees globally, more than three-quarters live in developing countries, where health-care systems are already weak and, in some cases, where humanitarian crises are ongoing, further compounding risks. In Kenya and on Greek islands, in northwestern Syria and along the U.S.-Mexico border, some fear that an outbreak of a disease even wealthy countries have been unable to halt would prove catastrophic.

Refugees “have lost all of what is needed to defend yourself against the virus,” Jan Egeland, the secretary-general of the Norwegian Refugee Council, told me. “The displaced have lost their homes, their communities, their space, their hospitals.” Egeland warned in March that the virus could “decimate” refugee groups if preventative measures were not taken. (Last month, the United Nations appealed for hundreds of millions of dollars to mitigate the risk of the coronavirus spreading among displaced people.) Driven from their home by war, violence, or natural disasters, he said, displaced people have been forced to seek refuge in areas they believed to be out of the way of danger. “They have crowded these places that they thought were safe,” he said, “and now, of course, these are the places that can be the most unsafe places possible.”

In Cox’s Bazar, a patchwork of 34 refugee camps houses about 855,000 refugees, and more than 400,000 Bangladeshis live in close proximity to the camps. A risk report on the possibility of the spread of the coronavirus in the Cox’s Bazar camps produced in March by ACAPS, a Norwegian humanitarian-analysis group, found that the population density in the camps averages 40,000 people per square kilometer, but increases to 70,000 in the most cramped areas. By comparison, ACAPS said, the overall population density in Wuhan, China, the epicenter of the coronavirus outbreak, is 6,000 people per square kilometer. Since being hastily erected in 2017, the Cox’s Bazar camps have precariously survived despite nearly constant threats from monsoon floods, cyclones, and rampaging elephants, but the spread of the virus would be the “worst nightmare come true,” Egeland said.

The camps’ density, combined with their poor infrastructure, makes it hard to follow much of the advice coming from experts on how to slow the spread of the virus, such as maintaining distance from one another. “The measures which all health experts globally are putting forward are social distancing and isolation, which are simply not an option,” says Deepmala Mahla, the Asia director for CARE, a humanitarian agency with more than 1,000 staff members in Bangladesh, including some 450 in the Cox’s Bazar camps. Mahla told me that many people in the camps suffer from poor nutrition and have underlying health issues. Wash areas and public toilets are often crowded, with women in particular standing in long lines. “The situation is so risky, I shudder to think what could happen,” Mahla said.

Difficulties within the camps are compounded by the global response to the crisis, which has at times hampered humanitarian work, Egeland said. Restrictions on movement and curfews imposed by governments have kept aid workers from doing their jobs, forcing NGOs to scramble to find work-arounds. The collapse of air travel, both domestically within countries affected and internationally, has created logistical hurdles in moving around staff members too. “If we cannot do that,” Egeland said, “we cannot sustain the operations.”

Bangladesh, a poor country of more than 160 million, is, like many other places with large refugee populations, gravely unprepared for a wider outbreak. The authorities have imposed a near-total lockdown, shutting down public transportation and roads, and so far the country has recorded 54 cases of the virus and six deaths. But fewer than 2,000 people have been tested for the virus, health officials said Sunday, and the country’s health-care system is in dire condition. A response plan compiled by the World Health Organization and obtained by Netra News, a Bangladeshi news outlet, estimates that without interventions, 500,000 to 2 million people in the country could die from COVID-19. “These figures are not surprising when considered against modeling in other countries but they are astounding and should serve as a call to action,” the memo says.

The document, which the WHO confirmed in a statement to be authentic, notes that an estimated 9 million people moved out of Dhaka, the nation’s capital, before the government announced the lockdown on March 26, possibly quickening the spread of the virus. The WHO also warned of a “complete saturation” of the country’s already weak health-care system and “rampant” exposure of health-care workers to the virus due to a lack of personal protective equipment and extremely high patient densities at hospitals.

Last week, the first case of the virus was detected in Cox’s Bazar, and Bangladesh’s Office of the Refugee Relief and Repatriation Commissioner began imposing new measures within the camps. Officials closed learning centers and madrasas, and ordered tea shops and nonessential stores to shut down. They also limited access to the camps to only essential services, in an effort to limit the number of people going to and from them. On Tuesday, Prime Minister Sheikh Hasina said these restrictions should be further tightened. But with people reliant on manual-labor jobs, staying home is not a viable long-term option. Khin Maung, the founder of the Rohingya Youth Association, says he is worried about a coronavirus outbreak, but also notes that the restrictions are already keeping people from working and earning money, leaving them “suffering for their meals,” he said in an interview.

Louise Donovan, a spokesperson for the UN refugee agency in Cox’s Bazar, says the organization has been preparing for the arrival of the virus in the camps for the past few weeks, implementing education campaigns and working to increase the number of isolation beds, from 400 to 1,500. CARE has also ramped up its work in the camps, installing more hand-washing stations, trying to keep the number of people gathering in public areas to a minimum, and liaising with a private ambulance service, a preemptive measure in case government services are overwhelmed. But, Mahla said, the outlook is daunting in the face of the virus. “However much we do, it will not be enough,” she said. “It will definitely not be enough.”

Cape Diamond contributed reporting.