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The Next Wave

U.N. and relief agencies warn the coronavirus pandemic could leave an even bigger path of destruction in the world’s most vulnerable and conflict-riven countries.

A member of the Syrian relief group Violet Organization disinfects tents
A member of the Syrian relief group Violet Organization disinfects tents at a camp for displaced people in Kafr Jalis village, north of Idlib, Syria, on March 21. OMAR HAJ KADOUR/AFP via Getty Images

The United Nations is preparing to issue a major funding appeal for more than $1.5 billion on Wednesday to prepare for outbreaks of the new coronavirus in areas suffering some of the worst humanitarian crises in the world, including Gaza, Myanmar, Syria, South Sudan, and Yemen, according to diplomatic and relief officials familiar with the plan.

“While all countries need to respond to COVID-19, countries with existing humanitarian crisis are particularly vulnerable and will require all humanitarian partners to look at their existing operations to see how they can be reprioritized and adapted [to tackle the virus],” according to a confidential draft Global Humanitarian Response Plan reviewed by Foreign Policy.

But the request—which would be in addition to ongoing humanitarian operations—comes at a time when the world’s leading economies are reeling from the economic shock induced by one of the most virulent pandemics since the 1918 Spanish flu. U.N. and private relief officials expect it will be a major struggle to convince wealthy governments to open their pocketbooks. “Some of the biggest donors are seeing global recession about to hit them,” said one senior relief official. “How generous are they going to be when they have a crisis looming in their own backyards?”

As the arc of the pathogen spreads from global capitals to war zones and refugee camps, U.N. relief officials and aid organizations are bracing for what they fear could be a cataclysmic second phase of the pandemic: spreading in the close-quarters encampments of the world’s more than 25 million refugees and another 40 million internally displaced people.

[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic and learn how it’s affecting countries around the world.]

Rohingya women and children who fled Myanmar wait in line for food distribution in the Kutupalong camp in Cox’s Bazar, Bangladesh, on Aug. 26, 2018.

Rohingya women and children who fled Myanmar wait in line for food distribution in the Kutupalong camp in Cox’s Bazar, Bangladesh, on Aug. 26, 2018. Paula Bronstein/Getty Images

More than 3 billion people lack access to hand-washing facilities, depriving them of one of the most effective first lines of defense against the spread of the coronavirus, according to UNICEF. There is little hope of finding enough space to implement social distancing policies in overcrowded camps from Bangladesh’s Cox’s Bazar and Kenya’s Dadaab camp to an archipelago of refugee camps for Afghans, Syrians, Palestinians, and others throughout the Middle East.

“We are facing a global health crisis unlike any in the 75-year history of the United Nations—one that is spreading human suffering, infecting the global economy, and upending people’s lives,” U.N. Secretary-General António Guterres told reporters on Thursday, noting that a global recession of unprecedented scale is “a near certainty.” “We must recognize that the poorest countries and most vulnerable—especially women—will be the hardest-hit.”

“If we let the virus spread like wildfires, especially in the most vulnerable regions of the world, it would kill millions.”

Moreover, the effort to ramp up an international aid response is being hampered by the quest to ensure the safety of international staff. Those concerns have been amplified by the announcement last week that David Beasley, the executive director of the Rome-based World Food Program, had been infected with the coronavirus. Some international relief agencies have recalled senior field officers, fearing they could be infected.

“Many humanitarian operations are scaling back physical presence, recommending their international staff return home and closing offices,” according to a March 19 report by the Assessment Capacities Project, a Norwegian nonprofit that provides analysis of major humanitarian crises. “Ongoing restriction of travel, suspension and changes to scheduled flights is likely to continue to disrupt humanitarian operations.”

“It is making us preoccupied with ourselves,” Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, said at a March 19 panel hosted by the New Humanitarian news agency. “In donor capitals, the preoccupation is much more with the threats to their homelands.” Konyndyk, who worked on the response to the Ebola epidemic in West Africa for the U.S. Agency for International Development, said that U.N. and relief agencies are having to balance ensuring the health of their own staff with delivering care to needy communities.

“You would have a hard time designing a more dangerous setting for the spread of this disease than an informal IDP settlement,” he said. “You have a crowded population, very poor sanitation … very poor disease surveillance, very poor health services. This could be extraordinarily dangerous … and I don’t think that’s getting enough global attention yet.”

A woman and child sit together at a makeshift camp for displaced Yemenis in the northern Hajjah province Dec. 16. Coronavirus could have devastating consequences for Yemen, as its health care infrastructures are already overburdened after years of conflict.

A woman and child sit together at a makeshift camp for displaced Yemenis in the northern Hajjah province on Dec. 16. The coronavirus could have devastating consequences for Yemen, as its health care infrastructure is already overburdened after years of conflict. ESSA AHMED/AFP via Getty Images

In conflict-riven countries from Afghanistan to South Sudan to Yemen, dismal health care infrastructures are already overburdened after years of fighting. A coronavirus outbreak—and its economic effects—could stretch these countries past the breaking point.

“South Sudan’s health care system has been completely destroyed over the last seven years by the civil war,” said Sterling Carter, a former aid worker in South Sudan.

After five years of war, with millions of people on the brink of famine, Yemen’s population is more vulnerable to a coronavirus outbreak than those of most other countries. The conflict has left most of the country’s population effectively immunocompromised, one aid worker said.

“You have to basically picture the already overwhelmed public health system overwhelmed further … and then overlay a food security crisis on top of it,” said Scott Paul of the aid organization Oxfam America. “It’s hard to put into words how bad that’ll be.”

Internally displaced persons prepare food at the Korijo camp in South Sudan on Sept. 23, 2018. The country’s civil war has caused its health care system to crumble over the past seven years, making it particularly susceptible to the spread of coronavirus.

Internally displaced persons prepare food at the Korijo camp in South Sudan on Sept. 23, 2018. The country’s civil war has caused its health care system to crumble over the past seven years, making it particularly susceptible to the spread of the coronavirus. SUMY SADURNI/AFP via Getty Images

“I see the spread of COVID-19 in poor and fragile countries as a huge risk, as their health care systems are often very weak,” said Richard Blewitt, the U.N. representative for the International Federation of Red Cross and Red Crescent Societies. “At this time we need global and local solidarity and compassion with all those affected by COVID-19, wherever they live.”

The U.N. has provided guidance to U.N. field workers, refugee camp managers, and public health specialists on how to battle the spread of the virus. The guidance—produced this month by a U.N. Interagency Standing Committee—calls for the development of an “outbreak readiness and response plan” for each camp that would assess the risk of coronavirus infection and train staff to detect, test, and monitor its spread, as well as track and trace those infected with the virus and people they have come into contact with. “Wherever possible, mitigation measures to reduce overcrowding should be put in place,” according to the guidance. Action should be taken to promote social distancing and crowd management, particularly at times when basic necessities such as food and water are being distributed, to prevent large gatherings of people. Each site should have access to a laboratory to facilitate testing.

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But relief workers say that some of the recommendations, like social distancing, may not be feasible in some of the world’s largest camps.

“For many population groups, living in overcrowded conditions, social distancing is a challenge or impossible,” according to the Assessment Capacities Project report. Many countries that host refugee camps, such as Afghanistan and Bangladesh, are likely to be overwhelmed by the health needs of their own citizens. Nations with weak health systems “may struggle to screen, test, and contain the epidemic for the host population let alone the refugees,” according to the report.

In Gaza, the U.N. Relief and Works Agency (UNRWA), which provides primary care for about 70 percent of the territory’s more than 1.8 million people, is bracing for the likely arrival of the coronavirus in one of the most densely populated place in the world.

The U.N. agency—which the Trump administration defunded last year and has sought to dismantle—has some 22 medical clinics in Gaza, putting it on the front lines of the defense of the coronavirus.

On Sunday, the Palestinian health ministry announced its first official confirmations of coronavirus infections in the Gaza Strip, two Palestinians who recently returned from Pakistan. The development confirmed fears by health experts and U.N. officials that the lethal pathogen has found its way into one of the most densely populated places in the world.

The health system is already poor and struggling to survive with the critical needs of chronic diseases, and emergencies that erupted from military escalations,” Bassam Nasser, the manager of the Catholic Relief Services office in Gaza, told Foreign Policy. “Now we [have] to add to it the capacity to cope with coronavirus.”

A girl wearing a protective mask sweeps outside her home in Gaza City on March 22.

A girl wearing a protective mask sweeps outside her home in Gaza City on March 22. MOHAMMED ABED/AFP via Getty Images

“As long as we have emergencies all the time, it is not allowing us to work for development in Gaza,” he said. “It’s just emergency after emergency after emergency.”

The U.N. relief agency is running a public information program that encourages hand-washing and the need for social distancing. UNRWA has set up a triage system to monitor patients with respiratory illness, directing those suspected of having the coronavirus to the local hospitals. It will also try to help lessen the burden on hospitals by taking in patients with illnesses unrelated to the coronavirus. Gaza’s hospitals, already under strain, have only a fraction of the number of intensive care unit beds it would need to handle an outbreak.

“I’m told that there are 60 ICU beds in the hospitals,” Matthias Schmale, the director of Gaza’s UNRWA operations, told Foreign Policy. “If there is a full-scale outbreak the hospital sector won’t cope.”

The crisis, he added, has inspired a bit of dark humor among Palestinians in Gaza, who note one point of irony: Israel’s crushing economic blockade on Gaza is helping keep Palestinians safe from the coronavirus, which has already killed over 15,000 people worldwide. But that’s only for now, and the humor, he noted, masks a deep anxiety. “We are preparing for the worst and hoping for the best,” he said.

In fact, the West Bank city of Bethlehem had an outbreak of dozens of cases of the coronavirus earlier this month, after members of a group of Greek religious tourists were confirmed to have contracted it when they returned home.

The unprecedented nature of the pandemic has fueled calls for radical thinking about the international response to the coronavirus crisis.

The leaders of major relief organizations are pressing donors to grant them greater flexibility to redirect funding from existing programs that are likely to be paralyzed by the pandemic and use that money for programs—including clean water and sanitation projects—that could help stem the crisis.

Jan Egeland, a former U.N. relief chief who heads the Norwegian Refugee Council, has appealed to some 40 donors to allow his agency to redirect money earmarked for shelter programs ground to a halt by the pandemic, and to use it to expand sanitation and hygiene programs.

The international community needs to fundamentally rethink its funding priorities for the coronavirus and redirect foreign assistance to fighting the spread of the bug, Egeland said.

“As bad as it is now in the well-organized and affluent north, with health systems, good sanitation, and big infrastructure, imagine how it will be when it will hit crowded camps with refugees and displaced people,” said Egeland, who spoke by telephone from quarantine in Norway.

The Bardarash camp, pictured Oct. 24 in Dohuk, Iraq, swells with Syrian Kurdish refugees.

The Bardarash camp, pictured Oct. 24 in Dohuk, Iraq, swells with Syrian Kurdish refugees. Byron Smith/Getty Images

Egeland also complained that sweeping U.S. and U.N. economic sanctions imposed on governments in Iran, North Korea, and Venezuela are hampering relief efforts.

“Now is the time to lift sanctions. I don’t need a lot of sanctions legislation making it more difficult to work in the worst places on the planet, where the COVID virus will hit much harder than in New York, Oslo, and in Wuhan,” he said.

The call for ending sanctions comes as Iran has pressed governments to violate the sanctions. Iranian Foreign Minister Mohammad Javad Zarif tweeted on Monday to thank those calling for sanctions relief and urge states and businesses to defy “U.S. mass punishment.”

“U.S. is NOT listening, impeding global fight against #COVID19,” he wrote.

U.S. Secretary of State Mike Pompeo defended the measures, saying Tehran squanders money that could be used to fight the pandemic to fund terrorist operations in the region. He also said that “Iranian documents show their health companies have been able to import testing kits without obstacle from U.S. sanctions since January.”

“U.S. sanctions do not target imports of food, medicine, and medical equipment, or other humanitarian goods,” Pompeo added.

Egeland acknowledged that most U.N. sanctions regimes, including those for Iran and North Korea, include exemptions for the import of humanitarian goods. But the sanctions have scared financial institutions from providing vital financial services to relief agencies. “Not a single bank had the guts to transfer money, because they were all afraid to be sued by the U.S. government,” he said.

It remained unclear whether the U.N. appeal will be on top of previous appeals by U.N. agencies for funding to combat the virus. The World Health Organization announced earlier this year that more than $675 million will be required through April—including $61 million for its own activities—to mount an international campaign against the virus. Though WHO’s Director-General Tedros Adhanom Ghebreyesus said recently that more money would be needed. On Feb. 17, UNICEF issued an urgent request for $42.3 million to support the coronavirus response. It will be used to reduce transmission of the virus by promoting distance learning for kids who can’t attend school and public information aimed at shooting down misinformation.

The U.N. secretary-general—along with the U.N.’s emergency relief coordinator, Mark Lowcock; Tedros; and the executive director of UNICEF, Henrietta Fore—will launch the new appeal at a joint press teleconference on Wednesday.

The U.N. will ask that donors not reduce funding from other vital humanitarian aid programs to fund the coronavirus response. The new appeal “aims at addressing the additional needs from the COVID-19 pandemic while sustaining the ongoing humanitarian operations and life-saving programmes responding to the needs pre-dating the new emergency,” according to the draft plan. “This is essential to avoid further loss of lives and suffering, and the aggravation of affected people’s vulnerabilities.”

Guterres, meanwhile, expressed concern that the pandemic could claw back decades of efforts to raise international health standards and to scale back the most extreme levels of poverty, and undercut U.N. sustainable development goals, which are designed to improve the standard of living around the world by the year 2030.

A 7-year-old girl suffering from malnutrition lies on a bed at a makeshift camp for displaced Yemenis in the northwestern Hajjah province Sept. 28.

A 7-year-old girl suffering from malnutrition lies on a bed at a makeshift camp for displaced Yemenis in the northwestern Hajjah province on Sept. 28. ESSA AHMED/AFP via Getty Images

Guterres pressed governments to mount a coordinated global health strategy, ramping up health spending and pitching in to help poor countries. He contended that “global solidarity is not only a moral imperative, it is in everyone’s interests.”

“COVID-19 is killing people, as well as attacking the real economy at its core—trade, supply chains, businesses, jobs,” Guterres said. “Workers around the world could lose as much as $3.4 trillion.”

Countries must resist the temptation to erect protectionist trade walls and should take steps including waiving interest payments to poor countries, offering debt relief, and sharply cutting fees for migrants to send remittance payments to loved ones in their homelands, he said.

“We need to focus on people—the most vulnerable, low-wage workers, small and medium enterprises,” Guterres said. “That means wage support, insurance, social protection, preventing bankruptcies and job loss. That also means designing fiscal and monetary responses to ensure that the burden does not fall on those who can least afford it. The recovery must not come on the backs of the poorest—and we cannot create a legion of new poor. We need to get resources directly into the hands of people.”

Colum Lynch is a senior staff writer at Foreign Policy. Twitter: @columlynch

Robbie Gramer is a diplomacy and national security reporter at Foreign Policy. Twitter: @RobbieGramer