Dear Editor,
I am a PhD student at the University of New South Wales, Australia with research interest
in refugee and asylum seekers health. Since the emergence of the COVID-19, I read
with great interest and concern news, information and issues relating to possible
and actual spread of the virus across refugee camps especially in low and middle income
countries (LMIC). At the same time, colleagues and students who share the concerns
of refugees in this challenging era continue to ask me how the COVID-19 would affect
older refugees in camps. This letter highlights what I mostly share with friends and
students and also call attention of relevant stakeholders to the plights of older
refugees as the current pandemic evolves.
Today, millions of older refugees are doubly-vulnerable due to old age and the refugee
status and live in unideal conditions. Often, they face significant number of psychological,
physical and social challenges such as poor health, anxiety, depression, stress-related
psychosomatic illnesses, dementia, post-traumatic stress disorders and loss of status
(Fawad et al., 2020). The physical and social conditions existing in areas where refugees
live in developing countries also add to their complex vulnerability (Raju & Ayeb-Karlsson,
2020). In many cases, older refugees comparatively have limited access to medical
help and health services, nutritious food, clean and quality water and hygienic sanitation
(Kassem, 2020). These conditions already make older refugees chronically stressed
population that is highly vulnerable to varied communicable and non-communicable diseases
(Kassem, 2020; Chen, 2020).
Amid this condition, a new and threatening phenomenon has emerged, namely the COVID-19
pandemic, to further exacerbate the already exiting precarious situation of older
adults including older refugees (Bouillon-Minois et al., 2020; Plagg et al., 2020;
Servello & Ettorre, 2020). As of 2nd June 2020, the world has recorded 6,568,510 confirmed
cases of COVID-19 and 387,957 deaths (Worldometers.info, 2020). Evidence suggests
that older adults are at higher risk of developing severe complications, morbidity
and mortality related to the virus as a result of their relatively weaker immune system
and increased number of medical comorbidities (Khoury, & Karam, 2020; Niu et al.,
2020). A study by Guan et al. (2020) published in the New Journal of Medicine (NEJM)
reported that the rate of older patients older than 65 years with COVID-19 infections
was 15.1%, while Wu and McGoogan (2020) research published in JAMA on the other hand
reported 3% for the proportion of older adults above 80 years. This evidence buttresses
the susceptibility of older adults to COVID-19 infection and fatality.
Indeed there has not been reports of major outbreaks or cases in refugee camps up
to this, the concern is that all hosting countries continue to witness daily increase
in COVID-19 cases while others continue to battle with local transmission of the virus
(Kassem, 2020). For example major refugee hosting countries like USA and Turkey have
reported 1,103,971 and 30,961 active cases of COVID-19 as of 2nd June, 2020 (Vieira
et al., 2020). The increasing COVID-19 cases and deaths as well as local transmission
may cast some shadows of doubt on the absence of major outbreaks in refugee camps
(Kassem, 2020). So far to the best of my knowledge, the only refugee camp with report
of confirmed COVID-19 case is the Moria camp in Lesbos, Greece (Raju & Ayeb-Karlsson,
2020). Though this is encouraging so far, there are suggestions that may explain reasons
for the extremely low infection rate at refugee camps. These include 1) lack of knowledge
regarding COVID-19 infection and symptoms, 2) lack of access to tests, which are limited
and insufficient for the needs of the hosting countries especially in developing countries,
and 3) fear of stigmatization and marginalization (Kassem, 2020). With these suggestions,
refugee camps may be COVID-19 ticking bomb, waiting to explode with time, which calls
for immediate isolation of older refugees and mass testing in refugee camps to avoid
catastrophic morbidities and fatalities.
More importantly, as COVID-19 pandemic continues to pose serious challenges and unprecedented
uncertainties, countries all over the world have taken some strict measures to curb
the spread of the virus including isolation (Chen, 2020; Servello & Ettorre, 2020).
However, some of the measures particularly social/physical distancing and self/isolation
that have been rigorously imposed on older adults including those in refugee camps
have serious associated health and social effects (Kassem, 2020). For instance, self-isolation
and quarantine has been found to be associated with an increased depressive and anxiety
symptoms in older adults (Armitage & Nellums, 2020). Also, Cheung et al. (2008) reported
that suicide rates in older adults significantly increased in Hong Kong following
the 2003 severe acute respiratory syndrome (SARS) epidemic. Imminently, older refugees
in refugee camps may pay the worst tribute of the COVID-19 pandemic, being the most
at risk, and those who nay suffer most. This is because a quick assessment of the
nature of the disease and ongoing rigorous containment measures reveal the potential
scope of threat to mental wellbeing of older refugees. It is wealthy to note that
though the containment measures may avoid an acute fatal issue, but it is also widely
known that many of the older refugees have witnessed catastrophic events and experienced
several levels of trauma, which affect them at a bio-psycho-social (biological, psychological
and social) level. Many older refugees already need stronger psychosocial support
because of their limited social networks and activities and as a result measures of
social distancing and self- isolation may worsen their mental wellbeing. Again, many
older refugees are associated with family separation, breakdown of family relationships,
social bonds and ties. This means older refugees may find COVID-19 restrictions reminiscent
of their previous social isolation experiences, which can aggravate their psychological
distress.
During this pandemic era, the author call for some global and urgent support for the
wellbeing of this already marginalized and overlooked population. Isolating older
refugees from refugee camps may be a prudent decision and providing them with opportunity
to live in places with access to internet and other engaging activities (Plagg et
al., 2020). This would make them socially-engaging and reduce their stress, anxiety
and depressive symptoms. Moreover, information about COVID-19 should be communicated
in culturally and linguistically responsive ways through diverse channels to reduce
the misinformation among older refugees. Complex terminologies about COVID-19 should
be stated in easy to read and understand language. International humanitarian community
must act now by adopting a social protection strategy that may act as a safety net
to save the lives of older refugees. Ageing out of place and being faced with everyday
COVID-19 information and misinformation is dreadful but with shared responsibility,
cooperation and solidarity, older refugees can have hope even in this difficult time
and beyond.
Declaration of Competing Interest
No relevant interests to declare.