Exploring the impacts of COVID-19 on Rohingya adolescents in Cox&apos;s Bazar: A mixed-methods study

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Highlights

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Displaced Rohingya adolescents face intersecting vulnerabilities during COVID-19.
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Food insecurity has been exacerbated for Rohingya adolescents during the pandemic.
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Resuming education is key for the long-term progress of Rohingya adolescents.
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Health crises in humanitarian contexts negatively impact adolescent trajectories.

Abstract

This article explores how intersecting vulnerabilities faced by Rohingya adolescents living in Cox's Bazar, Bangladesh, have been exacerbated during the COVID-19 pandemic. Both the direct health impacts and the indirect repercussions of COVID-19 mitigation strategies have served to heighten pre-existing risks, preventing adolescents from reaching their full capabilities. This article provides empirical mixed-methods data from the Gender and Adolescence: Global Evidence (GAGE) longitudinal study, drawing on phone surveys adolescents aged 10–14 and 15–19 (1,761), qualitative interviews with adolescents aged 15–19 years (30), and key informant interviews (7) conducted between March and August 2020 with both Rohingya and Bangladeshi adolescents residing in refugee camps and host communities, respectively. While this article focuses on displaced Rohingya adolescents’ experiences during COVID-19, we contextualize our findings by drawing on data collected from Bangladeshi adolescents who serve as comparators. Findings highlight that the pandemic has lead to a decline in Rohingya adolescents’ reported health status, exacerbated food insecurity, educational and economic marginalization and bodily integrity risks, amongst both girls and boys. This paper concludes by reflecting on the policy implications necessary to safeguard refugee adolescent trajectories in the context of COVID-19.

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Most cited references 32

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Refugee and migrant health in the COVID-19 response

Hans Henri P Kluge, Zsuzsanna Jakab, Jozef Bartovic … (2020)

In a continued effort to curb the spread of coronavirus disease 2019 (COVID-19), countries have been tightening borders and putting travel restrictions in place. These actions have affected refugees and migrants worldwide. The International Organization for Migration and UNHCR announced on March 10, 2020, that resettlement travel for refugees will be temporarily suspended, although the agencies have appealed to states to ensure emergency cases are exempted. 1 The COVID-19 pandemic has prompted some countries to take steps towards further reducing population movement that affects humanitarian corridors around the world. At the same time, there could be cases of refoulement with asylum seekers being returned to their countries of origin, where they are at risk of persecution and in an apparent breach of international law. As of March 29, 2020, WHO reported 146 countries and territories with cases of COVID-19 from local transmission of severe acute respiratory syndrome coronavirus 2, many of which have large refugee populations. 2 Search and rescue operations in the central Mediterranean, where more than 16 000 migrants have died since 2015, 3 have been suspended due to logistical difficulties caused by COVID-19. The few search and rescue operations conducted before the COVID-19 nationwide lockdowns led to the immediate quarantine of migrants in reception centres. These measures were taken even though there was no confirmed case of COVID-19 in Africa at that time. In fact, some refugees and migrants are travelling from countries not yet substantially affected by COVID-19 and entering countries with increasing numbers of COVID-19 cases. Measures to respond to the COVID-19 pandemic are a focus of communities in countries, but preparedness plans should consider refugees and migrants and their needs. Evidence shows that this vulnerable population has a low risk of transmitting communicable diseases to host populations in general. 4 However, refugees and migrants are potentially at increased risk of contracting diseases, including COVID-19, because they typically live in overcrowded conditions without access to basic sanitation. The ability to access health-care services in humanitarian settings is usually compromised and exacerbated by shortages of medicines and lack of health-care facilities. Moreover, refugees typically face administrative, financial, legal, and language barriers to access the health system. 4 Conditions in refugee camps are concerning. Many people who have been affected by humanitarian crises live in camps or camp-like settings in host countries. These camps usually provide inadequate and overcrowded living arrangements that present a severe health risk to inhabitants and host populations. The absence of basic amenities, such as clean running water and soap, insufficient medical personnel presence, and poor access to adequate health information are major problems in these settings. Basic public health measures, such as social distancing, proper hand hygiene, and self-isolation are thus not possible or extremely difficult to implement in refugee camps. If no immediate measures to improve conditions are put in place, the concern about an outbreak of COVID-19 in the camps cannot be overstated. Site-specific epidemiological risk assessments must be done to determine the extent of the risk of COVID-19 introduction and transmission in such settlements, together with case management protocols and rapid deployment of outbreak response teams if needed. Migrants and refugees are particularly vulnerable to the impact of COVID-19 in the wider community. They are over-represented among the homeless population in most member states—a growing trend in EU-15 and border and transit countries. 5 Living conditions for homeless refugees and migrants can undermine the ability to follow public health advice, including basic hygiene measures, quarantine, or self-isolation, because many people are in close contact and gather in large groups. Furthermore, international migrant workers and refugees can be affected by income loss, health-care insecurity, and the ramifications that come with postponement of decisions on their legal status or reduction of employment, legal, and administrative services. There is also scarce culturally and linguistically accessible information about COVID-19 and how to protect oneself and others, which further increases risks to refugees and migrants as well as host populations. © 2020 Alkis Konstantinidis/Reuters 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Additionally, states of emergency and lockdowns to deal with the pandemic have affected refugee and migrant volunteer community service provision for this population group. An inclusive approach to refugee and migrant health that leaves no one behind during the COVID-19 pandemic should guide our public health efforts. As governments tighten border controls and implement other measures in response to COVID-19, they need to consider the impacts on refugees and migrants and ensure that such actions do not prevent people from accessing safety, health-care services, and information. There must be no forced returns and refoulement justified by or based on fears or suspicion of COVID-19 transmission, especially because there is estimated to be low risk of transmitting communicable disease from refugee and migrant populations to host populations in the WHO European region. 4 Yet migrants and refugees are often stigmatised and unjustly discriminated against for spreading disease and such unacceptable attitudes further risk wider public health outcomes, including for host populations, since refugees and migrants could be fearful to seek treatment or disclose symptoms. 6 Refugees and migrants must be included in national public health systems, with no risk of financial or legal consequences for them. This approach is of the utmost importance, as there can be no public health without refugee and migrant health.

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COVID-19 in humanitarian settings and lessons learned from past epidemics

Ling San Lau, Goleen Samari, Rachel T Moresky … (2020)

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The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study

Shaun Truelove, Orit Abrahim, Chiara Altare … (2020)

Background COVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; standard deviation [SD], 18 years; 52% female). Projections of the potential COVID-19 burden, epidemic speed, and healthcare needs in such settings are critical for preparedness planning. Methods and findings To explore the potential impact of the introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Kutupalong-Balukhali Expansion Site, we used a stochastic Susceptible Exposed Infectious Recovered (SEIR) transmission model with parameters derived from emerging literature and age as the primary determinant of infection severity. We considered three scenarios with different assumptions about the transmission potential of SARS-CoV-2. From the simulated infections, we estimated hospitalizations, deaths, and healthcare needs expected, age-adjusted for the Kutupalong-Balukhali Expansion Site age distribution. Our findings suggest that a large-scale outbreak is likely after a single introduction of the virus into the camp, with 61%–92% of simulations leading to at least 1,000 people infected across scenarios. On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 2–65), 54 (95% PI, 3–223), and 370 (95% PI, 4–1,850) people infected in the low, moderate, and high transmission scenarios, respectively. These reach 421,500 (95% PI, 376,300–463,500), 546,800 (95% PI, 499,300–567,000), and 589,800 (95% PI, 578,800–595,600) people infected in 12 months, respectively. Hospitalization needs exceeded the existing hospitalization capacity of 340 beds after 55–136 days, between the low and high transmission scenarios. We estimate 2,040 (95% PI, 1,660–2,500), 2,650 (95% PI, 2,030–3,380), and 2,880 (95% PI, 2,090–3,830) deaths in the low, moderate, and high transmission scenarios, respectively. Due to limited data at the time of analyses, we assumed that age was the primary determinant of infection severity and hospitalization. We expect that comorbidities, limited hospitalization, and intensive care capacity may increase this risk; thus, we may be underestimating the potential burden. Conclusions Our findings suggest that a COVID-19 epidemic in a refugee settlement may have profound consequences, requiring large increases in healthcare capacity and infrastructure that may exceed what is currently feasible in these settings. Detailed and realistic planning for the worst case in Kutupalong-Balukhali and all refugee camps worldwide must begin now. Plans should consider novel and radical strategies to reduce infectious contacts and fill health worker gaps while recognizing that refugees may not have access to national health systems.

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Author and article information

Contributors

Silvia Guglielmi

Jennifer Seager

Sarah Baird

Nicola Jones

Journal

Journal ID (nlm-ta): J Migr Health

Journal ID (iso-abbrev): J Migr Health

Title: Journal of Migration and Health

Publisher: Elsevier

ISSN (Electronic): 2666-6235

Publication date PMC-release: 09 December 2020

Publication date Collection: 2020

Publication date (Electronic): 09 December 2020

Volume: 1-2

Electronic Location Identifier: 100031

Affiliations

[a ]Gender and Adolescence: Global Evidence (GAGE), Overseas Development Institute, 203 Blackfriars Road, London SE1 8NJ, United Kingdom

[b ]Department of Global Health, George Washington University, 950 New Hampshire Ave NW, Washington DC 20052, United States

[c ]Department of Anthropology, University of Chittagong, Chittagong University Rd, Chittagong 4331, Bangladesh

Author notes

[* ]Corresponding author. s.guglielmi.gage@ 123456odi.org

Article

Publisher Item ID: S2666-6235(20)30031-3 Publisher ID: 100031

DOI: 10.1016/j.jmh.2020.100031

PMC ID: 8352087

PubMed ID: 34405179

SO-VID: 536b9f25-4982-454e-bfc5-02016650deb9

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 30 November 2020

Date revision received : 4 December 2020

Date accepted : 5 December 2020

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Exploring the impacts of COVID-19 on Rohingya adolescents in Cox's Bazar: A mixed-methods study

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Most cited references 32

Refugee and migrant health in the COVID-19 response

COVID-19 in humanitarian settings and lessons learned from past epidemics

The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study

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