From Gaza to Syria to Yemen, overcrowded refugee camps lack what health care experts consider basic requirements to keep the virus from spreading. Putting space between people is an unattainable luxury, and running water for hand-washing isn't always available. There are about 30 million refugees worldwide, according to the United Nations.
While many war-ravaged countries appeared to be relatively unscathed so far as the virus spread elsewhere -- perhaps because of poor reporting -- Syria and Gaza authorities reported cases over the weekend, and the case count grew in the Democratic Republic of Congo.
Throughout the world, leaders have urged residents to practice social distancing while pledging hundreds of billions of dollars to keep their economies afloat, paying workers who are forced to stay home and subsidizing companies that need loans to stay in business.
There's no prospect of such aid in densely packed Gaza, where the health care system is already under strain and unemployment is above 40%. Many are left worrying just how bad it could get if the virus spreads more widely.
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United Nations Secretary-General Antonio Guterres on Wednesday announced a $2 billion fundraising effort to help the world's poorest nations -- as well as refugees stranded in camps by war and natural disasters -- cope with the pandemic.
"These are places where people who have been forced to flee their homes because of bombs, violence or floods are living under plastic sheets in fields or crammed into refugee camps or informal settlements," Guterres told reporters in New York.
The humanitarian aid would help install hand-washing stations in refugee camps and assist coronavirus patients in places where hospital beds are nonexistent. It also would supply tests and medical equipment to countries where travel bans have blocked the arrival of necessary goods and promote information campaigns with the help of non-governmental organizations.
"Let's not forget that in war-ravaged countries, health systems have collapsed," Guterres said this week.
Northwestern Syria and Yemen are especially vulnerable to an outbreak, according to an International Crisis Group assessment published on Tuesday. The two have already experienced health crises during their civil wars, with polio afflicting Syrian refugees in 2013 to 2014 and cholera plaguing Yemen from 2016 on.
"Many people fleeing clashes sleep in fields or under trees, and basic hygiene and social distancing practices are made impossible by the lack of running water or soap as well as cramped living spaces," the Crisis Group said in the report.
In a letter this week, a group of U.N. experts expressed concern that economically vulnerable people will become victims of a vicious cycle as "limited access to water makes them more likely to get infected." Infection then leads to "illness and isolation measures, making it difficult for people without social security to continue earning a living."
Also particularly vulnerable are the hundreds of thousands of Rohingya refugees from Burma living in crowded camps in Bangladesh. A viral spread there would be "exponential and catastrophic," said Courtland Robinson, who teaches humanitarian health at the Johns Hopkins Bloomberg School of Public Health.
Burma is often called Myanmar, a name that military authorities adopted in 1989. Some nations, such as the United States and Britain, have refused to adopt the name change.
"Anywhere you have high concentrations of people, a gathering of people desperate for help, you have increased risk of spread," Robinson said. "When you say 'stay at home,' some people can do that. Migrants and refugees can't. That is a fundamental dilemma."
The World Health Organization said testing will soon be ramped up in northwest Syria as U.N. officials express concern that the pandemic could reach camps in the Idlib region, where rebel groups are fighting the Russia-backed Assad government.
In Gaza, Hamas authorities took a series of precautionary measures, including ordering weddings, public markets and restaurants closed while banning prayer at mosques. Congo sent mining workers home to avoid the spread of the virus.
"Even before the outbreak of the virus, Palestinian refugees had already been living under very difficult conditions," said Khaled al-Sarraj, chief of the popular committee for refugees in al-Nuseirat Refugee camp in central Gaza Strip. "If the virus spreads here, I believe that the situation will be horrible and no one can imagine what will happen."
A Section on 03/27/2020