What lessons must we learn from the COVID-19 pandemic? — Stories behind the State of the Humanitarian System

This blog is part of a series of articles we are publishing that tell the humanitarian stories behind key findings and lessons emerging in ALNAP’s latest State of the Humanitarian System 2022 report.

The COVID-19 pandemic was a crisis unlike any other the humanitarian system had faced before, in scale, nature and global spread.

In 2020, the unprecedented measures that national governments around the world took to minimise the spread of COVID-19 soon led to unintended consequences for many vulnerable people who were already living through existing and protracted humanitarian crises.

The following case study, featuring in our State of the Humanitarian System 2022 report, focuses on the impact of the COVID-19 response in the Rohingya refugee camps in Bangladesh’s Cox’s Bazar. It highlights that, while there was evidence that the humanitarian sector was able to rise to the challenge of setting up emergency response systems to deal with the emerging health threat, measures to contain the pandemic placed the safeguarding and protection of vulnerable refugees in jeopardy.

The case study was researched and written by a local researcher in Bangladesh. Their name has been withheld at their request to protect their identity.

COVID-19 in Cox’s Bazar

In March 2020, models predicted that up to 1 in 200 Rohingya refugees in the camps could die from COVID-19 unless appropriate measures were taken.

Almost a million Rohingya refugees have been living in the dense tangle of 34 camps in Bangladesh’s Cox’s Bazar since 2017. An average of 40,000 people pack each square kilometre,¹ living with temporary shelters and infrastructure due to the host government’s policy of encampment and its refusal to grant longer-term status to refugees.

In these conditions, public health experts predicted that COVID-19 could spread quickly and with catastrophic consequences. In March 2020, models predicted that up to 1 in 200 Rohingya refugees in the camps could die from COVID-19 unless appropriate measures were taken.²

Initial response

Photo: UN Women/Fahad Abdullah Kaizer

In the first instance, the Bangladeshi authorities acted quickly. On 25 March 2021, the Refugee Relief and Repatriation Commissioner ordered the shutdown of all 34 Rohingya camps, limiting humanitarian access and restricting services to emergency food, health assistance and medicine.

Gatherings were banned, and schools and women-friendly spaces closed.³ Only essential workers were allowed access to the camps and had to travel in authorised vehicles that were inspected at check-posts for paperwork, social distancing and mask usage.

The public health response was slower to mobilise. In the first six months of the pandemic, there was little hospital capacity, no specific testing centre for refugees⁴ and limited provision of personal protective equipment (PPE) for health workers.⁵

“None of us know exactly how and why COVID-19 went through the camp quite as quick as it did and with very few fatalities.”

But within the camps the anticipated health crisis did not materialise. By the end of 2021, according to WHO, 3,250 COVID-19 cases and 34 deaths had been reported. As one humanitarian worker put it, ‘none of us know exactly how and why COVID-19 went through the camp quite as quick as it did and with very few fatalities’.

Despite inconclusive evidence as to why infection rates remained low,⁶ there is a sense that the humanitarian system performed well in the face of direct threats to health. One health coordinator in Cox’s Bazar noted that specialised facilities were set up with capacity for a large number of patients: ‘I think that the humanitarian system did rise to the challenge to some extent of the COVID-19 response.’

Immediate and longer-term humanitarian consequences

The system has been less able to mitigate or address the impacts of shutdowns and the shift to pandemic response and away from other assistance and protection needs. In the words of one INGO aid worker, ‘Once COVID-19 hit, all of our gains were reversed and worse’

“Once COVID-19 hit, all of our gains were reversed and worse”.

One UN representative explained how refugees’ fears of contracting the virus in healthcare facilities, combined with the strain on essential services, resulted in an increase in preventable non-COVID-19 deaths. Later in the response, healthcare facilities found themselves in high demand: as other services were closed down, people came to them with different concerns, including protection issues, which resulted in ‘some overcrowding, some dissatisfaction with health services’.

The impacts of the disruption went much wider. At the start of the pandemic, INGO and UN staff presence in humanitarian settings diminished, as aid workers chose not to return to duty stations, self-evacuated, were evacuated by their organisations, or got stuck outside Bangladesh when international borders closed. Several agencies found themselves operating with their heads of office in other countries.

Strict isolation and quarantine protocols were implemented for NGO and UN staff and in-person activities were cancelled, including assessments, awareness sessions and community consultations. Many organisations saw their facilities shut down or appropriated for use as isolation centres.

Funding was reallocated to COVID-19 prevention and response; proposals had to be rewritten and programmes stalled. One UN agency explained how a long-awaited shelter programme was placed on indefinite hold. Government officials ordered the postponement or closure of activities deemed non-essential, including protection. Income-generating and cash-based activities were restricted.⁷

“Safety and security conditions in Bangladesh are worse than in Myanmar.”

With the reduced humanitarian presence in the camps, security and protection threats increased significantly, with refugees reporting kidnappings, murders, extortion, rape, drug dealing and routine violence by criminal gangs. One focus group participant told our researchers that ‘safety and security conditions in Bangladesh are worse than in Myanmar’.

An aid worker summed up the prevalent sense of fear: ‘We also know that armed groups run rampant. Gender-based violence is a huge issue.

The camp, the humanitarians leave at three o’clock, and then it sort of becomes, from what people have told me, very scary and dark. And I think that the safeguarding and protection is a huge, huge gap in the response’.

Providing protection services remotely was a difficult task that became even more challenging when further shutdowns were imposed. In a May 2021 meeting of UN agencies, the Office of The Refugee Relief and Repatriation and the Bangladeshi authorities, it was decided that protection (in addition to education) was a non-critical activity despite the rise in protection threats, including gender-based violence.

‘Last year, we could provide both remote and in-person support,’ said one gender-based violence specialist, ‘but this year, it was just fully restricted. We could not provide any kind of in-person case management support to the survivors, so it’s telephone only.’

“Domestic violence has become more common, and since NGOs’ activities have decreased during COVID-19, gender-based violence cases can be seen immensely”

As the global evaluation of refugee rights during the COVID-19 pandemic confirmed, this deprioritisation of protection had severe consequences for affected people.⁸ As one focus group participant explained, ‘domestic violence has become more common, and since NGOs activities have decreased during COVID-19, gender-based violence cases can be seen immensely’.

While government shutdowns are widely felt to have helped contain the spread of the virus in the camps, many humanitarians are concerned that they have been used to further restrict humanitarian space, with immediate and longer-term impacts on education, security and protection, and on refugees’ faith in the humanitarian system.

‘The Rohingya don’t have any reason to trust anyone,’ said one expert. ‘I’ve seen them lose trust in the international justice process, in the Bangladesh government, and humanitarian actors, and in each other.’

That trust was further fractured by the absence of humanitarian workers during the pandemic, and according to many aid workers, it will be difficult to win back.

The 5th State of the Humanitarian System Report was published in September 2022. Read the full report on ALNAP’s website: https://sohs.alnap.org

[1] 53 Mohammad Mainul Islam and MD Yeasir Yunus, ‘Rohingya refugees at high risk of COVID-19 in Bangladesh’, Lancet Global Health 8, no. 8 (August 2020): e993–94. www.alnap.org/helplibrary/rohingya-refugees-at-high-risk-of-covid-19-in-bangladesh.

[2] Shaun Truelove et al., ‘The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study’, PLOS Medicine 17, no. 6 (16 June 2020): e1003144. www.alnap.org/help-library/the-potential-impact-of-covid-19-in-refugee-camps-inbangladesh-and-beyond-a-modeling.

[3] Human Rights Watch, ‘Bangladesh: COVID-19 aid limits imperil Rohingya’, Human Rights Watch, 28 April 2020. www.alnap.org/help-library/bangladesh-covid-19-aid-limits-imperil-rohingya.

[4] Rajon Banik et al., ‘COVID-19 pandemic and Rohingya Refugees in Bangladesh: What are the major concerns?’, Global Public Health 15, no. 10 (2 October 2020): 1578–81. www.alnap.org/help-library/covid-19-pandemic-and-rohingya-refugees-in-bangladeshwhat-are-the-major-concerns.

[5] MSF, ‘Five Challenges in Bangladesh amid Coronavirus COVID-19’, Médecins Sans Frontières, 2020. www.alnap.org/help-library/five-challenges-in-bangladesh-amid-coronavirus-covid-19.

[6] Some observers attributed this to differing immune responses, others to the effectiveness of domestic public health measures.

[7] Mohammed Masudur Rahman, Sarah Baird and Jennifer Seager, ‘COVID-19’s Impact on Rohingya and Bangladeshi Adolescents in Cox’s Bazar’ (Blog), UNHCR, 21 December 2020. www.alnap.org/help-library/covid-19%E2%80%99s-impact-on-rohingya-and-bangladeshiadolescents-in-cox%E2%80%99s-bazar.

[8] Taylor et al., Rights of Refugees. www.alnap.org/help-library/joint-evaluation-of-the-protectionof-the-rights-of-refugees-during-the-covid-19.

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