Responding to the COVID-19 Pandemic in Complex Humanitarian Crises

Danielle N. Poole, Daniel J. Escudero, Lawrence O. Gostin, David Leblang & Elizabeth A. Talbot

International Journal for Equity in Health, Volume 19, Article 41 (2020)


Populations affected by humanitarian crises are expected to be particularly susceptible to COVID-19 due to displacement, crowded housing, malnutrition, inadequate water, sanitation, and hygiene (WASH) tools, and stigmatization. These settings lack the infrastructure, support, and health systems to mount a comprehensive response. Poor governance, public distrust, and political violence may further undermine interventions in these settings. Standard public health measures—to identify infectious cases, administer supportive care and novel treatments for the seriously ill, and trace contacts—are particularly difficult to perform in humanitarian settings.

Given these increased vulnerabilities, humanitarian crises should be viewed as a priority for national and international bodies that seek to combat the unfolding pandemic. Resources must be identified to protect healthcare workers, develop and deploy rapid testing, improve surveillance, and enact quarantine and isolation of contacts and cases. To mitigate the impact of COVID-19 on crises-affected populations, governments and agencies will implement familiar, global evidence-based approaches for combatting respiratory viruses—hand hygiene, safe cough practice, and social distancing. The authors argue that these guidelines alone may not suffice in humanitarian settings, and that interventions tailored to the needs of crisis-affected populations, delivered with transparent information, in the context of inclusive governance practices, are urgently needed in the global response to the COVID-19 pandemic.

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