This blog post considers human rights dimensions at the intersection of displacement and disease, in light of the ongoing covid-19 pandemic. Written by Matthew Scott, Head of People on the Move Thematic Area.
The post considers the impact of the virus on people in situations of displacement, and also considers the impact of the pandemic response. The blog argues that irrespective of immigration, citizenship or residency status, all persons are guaranteed the enjoyment of human rights without discrimination. It is of the utmost importance that this perspective remains influential as states and the international community respond and adjust to new circumstances engendered by the pandemic.
Impact of the pandemic on people in situations of displacement
Displacement can increase exposure and vulnerability to the virus, impacting on the enjoyment of the highest attainable standard of health.
Even before the pandemic outbreak, being in a situation of internal or cross-border displacement carried risks that people who are not displaced may not face. Whether displacement takes place in the context of armed conflict, civil unrest, disasters, or persecution (and these factors are often interconnected), displaced people often find themselves in evacuation centres, temporary shelters, camps and informal urban settlements that can be crowded and lack adequate water, sanitation and hygiene facilities that are essential to minimize the spread of infection. A report by Refugees International highlighted:
In parts of Moria camp, Greece, over 1,300 people share one tap and over 200 share a latrine. Rohingya refugees in one site in Cox’s Bazar, Bangladesh could face 590,000 infections and over 2,100 deaths in a year if high transmission occurs, according to new research from Johns Hopkins.
Rights-based international standards and guidelines, reflecting decades of experience in humanitarian settings, can assist authorities in fulfilling the right to health in situations of mass displacement. As the Inter-Agency Standing Committee highlights in recently published guidance:
It is of extreme importance from a protection, human-rights and public health perspectives, that people affected by humanitarian crises are included in all COVID-19 outbreak readiness and response strategies, plan and operations. There is a strong public health rationale to extend all measures to everyone, regardless of status and ensuring inclusiveness.
However, even before the global pandemic unfolded, international humanitarian actors, national governments, civil society organizations and others were struggling to ensure the attainment of minimum standards. Not only does the lack of resources impact on the ability to manage disease risk in situations of displacement, it also manifests in a limited ability to provide medical treatment to people who become infected with the coronavirus, increasing the risk of suffering, long-term health impacts and death. As the combined economic and public health impact of the coronavirus pulls donors and treasuries in multiple directions, chronically underfunded programmes in some settings will not have the resources to address the massive public health emergency threatening to unfold within displaced populations around the world.
Immigration detention or deprivation of liberty for immigration-related offences, either in transit countries or destination countries, also presents significant risks to people in situations of displacement (as well as any other migrant at the sharp end of immigration control). According to the UN Network on Migration, immigration detention forces people into
often overcrowded facilities where… misinformation is common, physical distancing impossible, hygiene and sanitation inadequate, and human resources stretched.
A rich and growing platform coordinated by the Global Detention Project provides details of developments worldwide in response to the pandemic, including some examples of progressive practices relating to the release of people from detention. The platform also contains information about the spread of infection within the detention estate in different countries.
Vulnerability is also increased through disruptions in legal status. Legal identity is often materially tied to place, and to physical documents that confirm citizenship, residence, professional or other status. Legal identity is readily disrupted by displacement, as people leave behind critical documents, or they are destroyed in conflict or hazard events. Recovering legal identity once the physical artefacts have been destroyed can prove impossible in countries lacking centralized registries or other hazard-resilient systems. Legal identity, including proof of residency status in a particular locality, can be a prerequisite to employment, social security, access to housing, access to education, access to healthcare, amongst others. Thus, in addition to the conditions that increase risk of exposure to the virus, how national and sub-national legal and policy frameworks regulate access to health for people in situations of displacement can significantly affect health outcomes. Displaced persons can thus be differentially vulnerable to the coronavirus if identity requirements exclude them from state-based support structures.
An often overlooked group includes people who do not seek international protection, or who have been denied such status, who are living in undocumented immigration situations. The particular vulnerability associated with living in an undocumented immigration situation can make people either ineligible for medical assistance, or unwilling to seek such assistance for fear of being detected by immigration enforcement authorities and deported.
Recognizing the particular exposure and vulnerability of displaced people, including people living an undocumented immigration situation, UN mandate holders have called on states to
take steps towards the regularisation of undocumented migrants whenever necessary, in view of facilitating their access to health services during the fight against the pandemic… No one should be left behind in this global fight against the pandemic. Governments must adopt measures ensuring every individual in the national territory, regardless of their migration status, is included and has access to health services in order to achieve successful containment of the COVID-19 pandemic.
International human rights law, as well as regional legal instruments, require states to respect, protect and fulfil the right to health without discrimination. Although states may establish legitimate distinctions between citizens and non-citizens in a range of contexts, such distinctions must not result in health outcomes that fall below a basic minimum standard. According to the UN Committee on Economic, Social and Cultural Rights:
States are under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons, including prisoners or detainees, minorities, asylum-seekers and illegal immigrants, to preventive, curative and palliative health services.
In the context of a global pandemic, there is every reason to take steps, to the maximum of available resources, to ensure access to the highest attainable standard of health for all, including people in situations of displacement.
Impact of the pandemic response on people in situations of displacement
Efforts by states to prevent non-citizens reaching their territory in an irregular manner have become so extensive that the notion of a ‘deterrence paradigm’ has become widely recognized. Pushbacks have been part of the arsenal that states have been using to deter irregular migration (including of people seeking international protection) since before the Second World War, and public health considerations have frequently been leveraged to justify immigration control in general. What we can expect, and have already seen, in the context of the coronavirus, is an exacerbation of existing practices. In particular, a new dimension in the context of access to asylum is the fact that many countries have entirely closed their borders to commercial operators, making inhibitions of access to asylum also a significant and widespread consequence of public health measures. Indeed, leaving one’s own country of origin or habitual residence is now made far more difficult in many countries, as a direct consequence of pandemic control measures.
The coronavirus, like other hazards that encounter exposed and vulnerable social conditions, does not necessarily introduce new challenges for displaced persons: it exacerbates harms that were already characteristic of the experience of displacement. There is clearly a desperate need to enhance measures to protect the right to health of displaced persons, whether living in camps, informal settlements or through releasing people from immigration detention. However, more fundamentally, as all of us reflect on the world that was and imagine how it must change for the future to be sustainable, we need a vision of humanity that respects and promotes the free movement of people, both within and between states.
This is a series of updates regarding the Coronavirus from Human Rights Experts – read more here
FOOT NOTES & LINKS
 See for example the joint publication by IOM, WHO and OHCHR (2013) International migration, health and human rights. https://www.who.int/migrants/publications/WHO_IOM_UNOHCHR-Publication.pdf?ua=1
 Refugees International (2020) COVID-19 in humanitarian crises: a double emergency https://www.rescue.org/report/covid-19-humanitarian-crises-double-emergency
 See for example WHO (2020) Interim guidance for refugee and migrant health in relation to COVID-19 in the WHO European Region http://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/publications/2020/interim-guidance-for-refugee-and-migrant-health-in-relation-to-covid-19-in-the-who-european-region,-25-march-2020 and Sphere (2020) COVID-19 guidance based on humanitarian standards https://spherestandards.org/about/
 See IASC (2020) Interim Guidance: Scaling-up Covid-19 outbreak readiness and response operations in humanitarian situations including camps and camp-like settings https://interagencystandingcommittee.org/system/files/2020-04/IASC%20Interim%20Guidance%20on%20COVID-19%20for%20Outbreak%20Readiness%20and%20Response%20Operations%20-%20Camps%20and%20Camp-like%20Settings.pdf
 See Development Initiatives (2019) The Global Humanitarian Assistance Report 2019. https://devinit.org/publications/global-humanitarian-assistance-report-2019/
 https://www.theguardian.com/world/2020/apr/22/fears-realised-as-first-covid-19-case-diagnosed-in-lebanon-refugee-camp; https://euobserver.com/coronavirus/148072; https://www.aljazeera.com/news/2020/04/greece-148-refugees-test-positive-covid-19-asymptomatic-200421134039733.html
 UN Network on Migration (2020) “COVID-19 & Immigration Detention: What Can
Governments and Other Stakeholders Do?” https://migrationnetwork.un.org/sites/default/files/docs/un_network_on_migration_wg_atd_policy_brief_covid-19_and_immigration_detention_0.pdf
 See Global Detention Project (2020) “Covid-19 Immigration Detention Platform’ – https://www.globaldetentionproject.org/covid-19-immigration-detention-platform
 UN OCHA (2020) “UN experts call on Governments to adopt urgent measures to protect migrants and trafficked persons in their response to COVID-19” https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=25774&LangID=E
 See UN Committee on Economic, Social and Cultural Rights (2000), “General Comment No. 14: The Right to the Highest Attainable Standard of Health” para 34 https://www.refworld.org/pdfid/4538838d0.pdf
 Nicholas F. Tan and Thomas Gammeltoft-Hansen (2017) “The End of the Deterrence Paradigm? Future Directions for Global Refugee Policy” (Raoul Wallenberg Institute) /publications/the-end-of-the-deterrence-paradigm-future-directions-for-global-refugee-policy/
 See for example the story of the SS St. Louis, which carried more than 900 Jews fleeing Germany in 1939, turned away by the USA – BBC (2017) “The Jewish refugees the US turned away” https://www.bbc.com/news/av/magazine-39857056/the-jewish-refugees-the-us-turned-away
 See for example Roberta E. Bivins (2015) Contagious Communities: Medicine, Migration, and the NHS in Post-war Britain, Oxford University Press
 See for example Izzy Ellis (2020) “In the news: COVID-19 port closures leave migrants stranded at sea” https://www.thenewhumanitarian.org/news/2020/04/13/mediterranean-italy-malta-migrants-coronavirus; Rebecca Ratcliffe (2020) “Hundreds of Rohingya refugees stuck at sea, say rights groups” https://www.theguardian.com/global/2020/apr/17/malaysia-and-thailand-urged-to-help-stranded-rohingya-refugees; Amnesty International et al. (2020) Responding to the COVID-19 Crisis While Protecting Asylum Seekers” https://reliefweb.int/sites/reliefweb.int/files/resources/COVID-19%20Asylum%20Statement.pdf