In New York City, hospitals have been so overwhelmed with coronavirus patients that nearly all of the 3,914 permanent ICU beds are full, and doctors have started sharing some of the city’s 4,000 ventilators between two patients at once. In South Sudan—which has almost 2 million more people—there are only 24 ICU beds and four ventilators in the entire country.
A report from the International Rescue Committee looks at what it calls a “double emergency” in the world’s most vulnerable countries, where the virus is now beginning to spread. The virus, they say, will cause both a health and a humanitarian crisis. In South Sudan, less than half of the health facilities in the country are open now. In Venezuela, more than half of the country’s doctors have left the country because of the ongoing political crisis: There are 84 ICU beds in a country with a population of 32 million, and hospitals are already facing shortages of medicine and other supplies. In Burkina Faso, there are 11 ventilators for 20.9 million people. In Somalia, there are 15 ICU beds to serve a population of 15.8 million. And in refugee camps around the world, displaced people are squeezed into spaces far more crowded than the Diamond Princess cruise ship, where the virus quickly spread. (In part of one refugee camp in Greece, more than 1,300 people share a single water tap.)
It’s difficult to know exactly how many people are already sick in the most fragile areas. “In some cases, we’re seeing the number of reported cases rise pretty significantly day on day, because they’re doing more testing,” says Elinor Raikes, vice president and head of program delivery for the International Rescue Committee. “It’s really hard to get an accurate picture at this point about the real number of cases. For the most part, our assumption is that all of the reporting is vastly underestimated because testing is so poor.”
If the virus becomes widespread in refugee communities, “I think it would be catastrophic,” she says. “If it really breaks out in one of the larger, more crowded refugee camps or some urban areas where there’s significant numbers of displaced populations residing, we expect that this would be really devastating and really hard to control.” The first problem, obviously, is the immediate health impact in areas that are overcrowded, with poor access to water and sanitation, and sometimes in remote areas. “These are also often communities that have more significant underlying health conditions than the average population,” she says. “Populations that have suffered due to war, conflict, displacement, are often more vulnerable in terms of their immune systems and the prevalence of chronic disease. You can also expect that the impact of the virus would be greater as well.”
There will also be secondary impacts for refugees, who “don’t have access to social safety nets, don’t have easy access to government services, and are very much in the informal sector,” she says. “It would be really hard to effectively enforce ‘at home’ measures for populations that might have to go outside to earn a living literally to put food on their plates that night.” People might not be able to get treatment for other health conditions. Domestic violence might increase. The pandemic is also affecting humanitarian supply chains that provide food in areas such as South Sudan, which might now risk famine.
The organization is acting as quickly as possible to try to prevent the worst outcomes, installing handwashing stations, training healthcare workers at refugee camps, and running campaigns to educate refugees about the virus. The team is also giving debit cards loaded with cash directly to refugees, something that it has found to be more effective than handing out food or other in-kind assistance. The IRC is also raising $30 million to try to scale up its efforts as quickly as possible. “There’s a very short window now to prepare communities,” says Raikes.