key: cord-0856211-9unfk5fc authors: Raju, Emmanuel; Ayeb-Karlsson, Sonja title: COVID-19: How do you self-isolate in a refugee camp? date: 2020-05-08 journal: Int J Public Health DOI: 10.1007/s00038-020-01381-8 sha: 35e5239990cd4dc02b9ce4a95a02b1e52b140f03 doc_id: 856211 cord_uid: 9unfk5fc nan The first confirmed COVID-19 case in Lesbos, Greece, raised immediate concerns about the virus entering this vulnerable social setting. The Guardian describes Moria camp in Lesbos as overcrowded with 20,000 people in a space built for 3000, while struggling to access water. 1 In refugee camps, volunteers, UN agencies and NGOs generally manage the healthcare services (Carballo et al. 2017) . The global COVID-19 response here is not only troubling, but unfortunately negligible with refugee populations across the world. The first case of COVID-19 has also been confirmed in Cox's Bazar, Bangladesh near the refugee camps that are already facing infectious outbreaks due its dense population, poor sanitation and lack of water, putting extreme pressure on insufficient health resources. The camps are home to the Rohingya who fled violent persecution in Myanmar. Fear among the refugees in regards to COVID-19 is currently spreading due to misinformation; or as one person stated 'If anyone gets infected, the authority has to kill her/him. Because if (s)he stays alive, the virus will transfer to another person's body.' (ACAPS 2020, p. 4) . A COVID-19 outbreak would, as observed, put additional pressures on the strained healthcare services and the already-conflict traumatised population. Bangladeshi healthcare workers have expressed concerns over the lacking test kits and challenges of social (physical) distancing. About a billion people around the world live in slums, including roughly 30-50% of the urban population in the Global South (Lilford et al. 2017 -Karlsson et al. 2016 -Karlsson et al. , 2020 . In India, the media reported the first case of COVID-19 in a slum with 23,000 people in less than a square kilometre in Mumbai. The infected woman lives with six others in a 250 square feet room. Contact tracing of people sharing the public bathroom with the infected woman has become impossible. 2 Imaginably, WHO's COVID-19 guidelines of two metres physical distancing and 20 s of hand washing with soap will not be enough (Kluge et al. 2020) . The lockdown in India without any notice has left millions of daily wage labourers stranded on their way home or stuck in slums without an income while worrying about how to put food on the table. People trapped en route home are currently gathering streets and squares in large crowds awaiting government supplied meals. 'I will die of hunger long before the virus gets me' has been the standard response to any media coverage. 3 Based on our experience in disaster preparedness among vulnerable populations, we suggest to: • Upscale testing to identify, isolate and treat people early on. • Provide financial and social support to safeguard people who cannot work from home to avoid unnecessary movements. • Emphasise how handwashing and social (physical) distancing can save lives through social media and entrusted figures such as NGO workers and religious leaders, and set up free hand washing stations. • Mitigate health risks before they become unmanageable. For example, set up non-traumatic temporary evacuation plans of the settlements to safe areas. This includes ensuring that people can move with their loved ones, bring valuables and safely return home after the outbreak. • Adopt best practices from diverse case study contexts, and prepare for worst case scenarios. Preparedness plans must include increased capacity and resources of health services, global cooperation (open science, sharing testing, laboratory and medical advances) and closer collaboration between public and private healthcare sectors. Global pandemics require global solutions. Dhaka and Mumbai are home to about 20 million people each. Clearly however, from what we have seen in Italy and China, population size does not need to imply a larger catastrophe. The COVID-19 pandemic, outlines how social inequality increases the risks for marginalised and vulnerable populations across the world. We must act nowinternational efforts must adopt a social protection strategy that saves the lives of our most fragile populations-as always it will be our most vulnerable that will suffer the most in the end! Conflict of interest The authors declare that they have no conflict of interest. COVID-19 Rohingya response A peoplecentred perspective on climate change, environmental stress, and livelihood resilience in Bangladesh Trapped in the prison of the mind: notions of climate-induced (im)mobility decision-making and wellbeing from an urban informal settlement in Bangladesh Evolving migrant crisis in Europe: implications for health systems The history, geography, and sociology of slums and the health problems of 2 For media article see, Barnagarwala T. Case in a Mumbai Slum: Officials hit tracking hurdle want-to-go-home-the-desperatemillions-hit-by-modis-brutal-lockdown and, Dhillon A. Divided Delhi under lockdown: ''If coronavirus doesn't kill me, hunger will Managing COVID-19 in low-and middle-income countries Comment refugee and migrant health in the COVID-19 response Improving the health and welfare of people who live in slums Health inequalities and infectious disease epidemics: a challenge for global health security The health impacts of climate-related migration