The exceptionally high rate of coronavirus spread that occurred on the Diamond Princess cruise ship is one of the highest documented thus far for COVID-19. Of the 3,711 passengers and crew members on the ship, at least 712 were infected with the coronavirus. Crowding created an ideal environment for the elevated risk of transmission. This harbinger sheds light on the amplified vulnerability of refugees living in excessively dense conditions and underscores the urgency of protective measures in these settings.
Gaza runs the risk of becoming the next Diamond Princess — it is extremely crowded, with 2 million people living in a 10 kilometer by 40 kilometer space. If this risk is not managed now, not only are Palestinians threatened, but the world may see COVID-19 reintroduced into areas that have been able to get the coronavirus under control.
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Palestine refugees are already burdened by a host of distinct vulnerabilities. Gaza's economy suffers from about 50% unemployment, a figure that is steadily climbing. Local health systems are extremely fragile and lack equipment and medicine. The United Nations Relief and Works Agency for Palestine Refugees in the Near East, or UNRWA, is the primary agency responsible for delivering health care, education, and protection to 5.6 million Palestine refugees in its fields of operation in Jordan, Lebanon, Syria, the West Bank — including east Jerusalem — and the Gaza Strip.
But provision of these services is imperiled due to a severe, ongoing funding deficit. If UNRWA is unable to insulate Palestine refugees from the effects of COVID-19, we could witness an excessive and devastating loss of life among a group that is already highly disenfranchised.
Lessons from experience operating in crises
The world has scrambled to maintain normal operations during this crisis by moving services online and adjusting medical facility capacities to address exponential rates of illness. UNRWA, however, has commonly operated amid crises, providing lifesaving, essential services to some of the world’s most vulnerable refugees.
To respond to the pandemic, the agency has deployed many of the same measures it has developed over the years. These include implementing risk-mitigation approaches in its health centers for patients who require hospitalization, as well as strengthening existing hotlines, telemedicine for phone consultations, and home delivery of drugs. To ensure the agency can provide essential food aid to the 1.8 million impoverished refugees who depend on it to stay alive, it is important to engage contactless delivery modalities that minimize the contagion risk for beneficiaries.
As hospitals struggle to service growing numbers of patients, the agency’s 140-plus health centers are on the front lines in combating the spread of the virus across the Middle East, including by responding to the exacerbated anxiety and mental health challenges that refugees already experience. In Syria, where Palestine refugees face the threat of COVID-19 amid prolonged conflict, cooperation with partners is essential to provide vaccinations against infectious diseases and maintain access to the vital services, medicines, and treatments that Palestine refugees require.
Given the unfortunate regularity of political and physical instability in the agency’s fields of operation, it has routine systems in place to quickly operationalize programs and resources during crises. The agency has long employed contingency strategies to avoid interrupting education services through innovations such as UNRWA TV, cellphone lessons, and computer-based interactive learning. And since the closure of all 709 schools and its vocational training centers, these tactics are being deployed for more than a half-million students.
Funding shortage as crisis unfolds
While the agency is screening suspected cases at its 22 health centers in Gaza, the impending impact of COVID-19 in the territory goes well beyond UNRWA’s current capacity due to funding limitations. To prevent a rapid outbreak in Gaza, not only is the agency running public information campaigns and implementing triage protocols to identify and treat those with respiratory issues separately, but its health centers are also continuing to serve non-COVID-19 patients, including pregnant mothers and those with chronic ailments such as diabetes and high blood pressure.
The administration of U.S. President Donald Trump has announced plans to withhold funding for the World Health Organization, just as it has for UNRWA. Since the U.S. — historically UNRWA’s largest donor — suspended its contributions in 2018, the agency has managed to maintain operations amid a serious budgetary deficit. However, if additional funding doesn’t come in imminently, critical services will have to be scaled back dramatically, further exacerbating the humanitarian crisis in the region it serves.
While UNRWA may have experience providing lifesaving services to millions of people in a crisis, the impacts of COVID-19 could act as a tipping point for an agency already stretched razor-thin — despite appeals for emergency funding. Most of UNRWA’s 13,000 staff members in Gaza are Palestine refugees who rely on this work as their lifeline. Current global efforts are focused on preventing the spread of the disease, but to help ensure that social distancing and stay-at-home orders are effective, we will need to also address the growing economic catastrophe unfolding in the communities we serve. Refugees, like workers everywhere in the world, will need increased access to cash and food aid to survive.
Now more than ever, it is critical that humanitarian agencies such as ours have a reliable stream of funding that allows us to repair infrastructure, purchase medical supplies, deliver emergency response and social services, and manage remote education and training programs.
Infectious disease knows no boundaries, and humanity cannot win the fight against COVID-19 if we are unable to control the virus in Gaza. Our COVID-19 response will fail if we cannot pay our health care workers and staff delivering food to 1 million people in Gaza. This simply means more funding from the world’s top humanitarian donors. This is not a time to pull back, but rather for donors to increase their generosity to the world’s most vulnerable.
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