Almost a year after COVID-19 was declared a pandemic by the World Health Organization, it is evident that pandemics and other emergencies increase the burden on the already-stressed technical, human, and financial capacities. This impact is much more apparent in under-resourced settings (e.g., developing countries) and informal settlements (e.g., sites hosting displaced people and refugee camps). For instance, Bangladesh hosts more than one million Rohingya refugees from Myanmar and has also been hit hard by COVID-19 with more than 535,582 reported and confirmed cases (as of February 2nd, 2021).
Although the standard COVID-19 prevention recommendations also apply to displaced populations, given their circumstances, implementing most of these recommendations can prove to be a great challenge as their access to resources and rights may not be the same as the host population. In informal settlements, a number of families may share shelters making it impossible to physically distance, access drinking water, sanitation and hygiene (WASH) that are deemed essential to prevent COVID-19 transmission might be reduced, and access to health services might be limited. The impact of COVID-19 on individuals and communities in these settings has been unequal - the vulnerable are most burdened, not just in terms of income and sustenance means, but also concerning basic conditions for survival and good health.
The UN Refugee Agency has estimated that a total of 79.5 million people were living in displacement due to conflict or violence at the end of 2019. The Internal Displacement Monitoring Centre has reported more than 25 million new displacements due to disasters in 2019. In some instances, individuals may be compelled to move due to poor access to public health and healthcare services, uninsured jobs, and reduced incomes, thus further affecting the rate of displacement. Sites and settlements hosting migrants and displaced persons face dire challenge to cater WASH needs as shown in connection with the Rohingya refugee camps in Bangladesh.
Figure 1 demonstrates the variety of challenges that COVID-19 may create for individuals and communities and for those living in informal settlements and refugee camps. Under such circumstances, the disproportionate gender burden and security repercussions are of critical importance, especially in migrant settlements that may be exposed to higher health hazards.
The key focus of this article is to showcase existing solutions to respond to the threat of and risks associated with increased displacement - linking to climate and water risks and presenting an argument how migration challenges can be best addressed when integrated within COVID-19 prevention and response measures. It is important to note that aiming for ‘pandemic resilience’ may be challenging due to the differences in the type of state responses, and the quantity and process of related resources and aid allocation. Considering the above arguments, a 5-Point strategic framework is outlined to reconsider the water-health-migration nexus while also addressing the burden of the COVID-19 crisis. The outline can be adapted for use by a variety of states and other stakeholders to support the achievement of ‘community resilience’.
5-Point Strategic Framework
Integrated planning - Delivering essential medical equipment to test and treat is only one aspect of needed health services. Installing handwashing stations, conducting public health information campaigns, establishing a community support network - all with special attention to migrant populations will also be essential. Additionally, tailored strategies towards cross-border population movements, youth, malaria, hunger, and poverty should be a part of a comprehensive,
- integrated COVID-19 management and response planning. Noting the disruption in the food production and processing systems, the enhanced focus on WASH delivery should not exclude food and fuel supplies. The integration of the WASH agenda in various health crisis responses and the integration of the relevant health indicators in monitoring effectiveness of WASH delivery can be a simple indicator of basic human right access in migration settings.
- Aligning health and water-related SDGs to build local capacity - Access to water and sanitation has been recognised as a human right by the United Nations (UN) General Assembly and specifies a minimum of 20 litres per person per day as necessary for personal and domestic uses. The SDG 6 target-focused interventions and projects aiming to improve WASH delivery have a significant role in preventing and combatting the spread of COVID-19 and thus, should be encouraged and facilitated. Programs and initiatives aimed towards strengthening the capacity of local actors and agents through mechanisms such as cooperatives or ‘cultural collectives’ [groups and leaderships based on customary norms] must be acknowledged and supported in COVID-19 response planning strategy. This will ensure that COVID-19-related preventative measures also facilitate the joint implementation of SDG 3 (to ensure healthy lives and promote well-being for all at all ages) and SDG 6 (providing access to clean water and sanitation).
- Boosting community resilience by scaling evidence-based best practices - Understanding community needs remains important to evaluate why and how to remodel knowledge delivery for different constituents. Working with locals is an option to be explored through collective agenda-setting and advocacy campaigns. Furthermore, the aid and attention to migration-related challenges, in its current form, is relatively scattered. For instance, migration is more or less explicitly addressed in most SDGs – 1 (poverty), 2 (hunger and food security), 3 (good health and well being), 5 (gender equality) ,6 (WASH) , 10 (inequality), 11 (sustainable communities), 13 (climate action), 16 (policies and institutions), and 17 (partnerships and collaboration for change). SDG target 10.7 calls to facilitate orderly, safe, regular and responsible migration and mobility of people, through planned and well-managed migration policies and practices and a holistic approach. Amid the COVID-19 crisis, appropriate migration planning measures will ensure that public health recommendations are followed throughout the migration journey and no human rights are violated.
- Addressing discrimination and other social outcomes in pandemic management - Stigma and discrimination may target citizens, migrants and health-workers. There have been numerous incidents of verbal and written attacks on people testing positive for the coronavirus. The United Nations guidance note on addressing and countering the COVID-19-related hate speech provides a set of recommendations relevant to situations of discrimination of migrants. As nations are showing solidarity to the “build back better’ narrative amid the plethora of economic, social and financial barriers, challenges pertaining to the inclusion of migrants in this narrative cannot be placed on hold. In addition, a collective approach to managing the pandemics will require addressing misinformation, and other social and cultural complexities. The message on International Migrants Day (2020), #WeTogether movement promised to facilitate a combination of behavioral and structural interventions at individual and community levels addressing the needs of all – including migrants and the displaced.
- Building robust partnerships with a gender-sensitive lens - The vision of ‘Leaving No One Behind’ promote gender-sensitive planning for building resilience, with specific focus on migrants and refugees. Challenges are also exacerbated for women and girls residing in low-income and vulnerable settings such as the hosting spaces for internally displaced and refugee camps. Many countries have reported rising violence against women and children; therefore, COVID-19 management plans need to be mindful of the various impacts on the social fabric. Partnerships for humanitarian assistance or research assessments to ensure that multiple needs of these fragile regions facing COVID-19 alongside decades of political conflict, poorly managed health facilities, climate change and a significantly large number of IDPs and refugees, are met. The integrated COVID-19 management strategies could explore the synergies between water and health crisis.
The impact of disasters and emergencies on migrants is becoming increasingly clear. The threat of COVID-19 is likely to remain with us for some time, thus requiring effort both in preventative and curative health measures. Addressing health issues together with water, food, energy is critical to prevent direct and indirect impacts from COVID-19.
The argument outlined in the article reiterates that innovative responses to COVID-19 included in the action plans outlined by development and state actors/agencies should clearly outline the strategy to support the most vulnerable. Short- to medium-term strategies could include tackling WASH needs through better budget allocation and integration of multi-sector regulations, or combining water provisioning and health-related outcomes. Moreover, better access to education and public health information will also be critical. Stakeholders can have adequate access to WASH, but the effectiveness of relevant services in preventing COVID-19 is dependent on awareness and education on appropriate handwashing technique. Therefore, fresh insights and various viewpoints of water-environment-health-education interlinkages remain pertinent to planning.
The long-term COVID-19 crisis management strategy should pay special attention to the needs of the vulnerable with an inclusive and gender-sensitive lens. The ‘one size fits all’ approach is dated and not as effective and impactful, although it may consume similar or equivalent human and financial resources. Strong policy, regulatory and institutional frameworks are of utmost importance to manage future pandemics. Furthermore, development planning, health policies and nature conservation need to focus on context-sensing in future program and try to integrate their agenda and streamline resources for aggregated and enhanced impacts.
Development researchers, agencies, and practitioners need to learn from the current crisis and act smartly. The need to swiftly move towards effective solutions for addressing the multiple crises faced by vulnerable communities is not only urgent, but also critical to accelerate universal access to WASH. These solutions remain critical to get ahead of the coronavirus and will determine how stability and sustainability can be achieved after the pandemic.
About the authors
Zoha Anjum is a current Doctor of Dental Surgery student at the University of Toronto (Canada) and a global health researcher. Prior to her dental education, Zoha completed her Master of Public Health from McMaster University, alongside her graduate diploma in Water Without Borders from the United Nations University, Institute of Water, Environment & Health. Zoha has interest and experience in access to WASH, women's health, and oral health research. With both her dental education and global health expertise, Zoha is hoping to practice as a clinician scientist and provide evidence-based care to her patients while also investigating broader scale global health issues specific to WASH and women. In addition to her academic pursuits, Zoha is a co-founder of Public Health Champs, a community initiative aimed to support aspiring public health professionals; president of her class council; and a mentor to many predental students and aspiring public health professionals.
Nidhi Nagabhatla is a Principal Researcher (Water Security) at UNU INWEH, Canada. She specializes in systems thinking and decision/learning support interfaces, and science-policy interfacing within the context of water-energy-food nexus, trade-offs in inter-sectoral water allocations, solutions to complexities in transboundary water management, trends, and impacts of water-driven migration. She leads the Water Security and Nexus project-an initiative that supports decision-makers and the development community in applying the water security agenda. In doing so, her recent research has extensively focused on gender burdens in the water sector for the most vulnerable, WASH, water, and climate crisis driven human mobility, peace, and political security links to water governance in conflict settings. Besides, programmatic responsibilities, she serves the capacity building coordinator for the institution and directs the youth-related programs aiming to build ‘Future Water Leaders’. She is also the Co-Director of the Water Without Program, a collaborative graduate program in water, environment, and health between McMaster University and the UNU-INWEH.