By Lauren Odderstol April 25, 2020 Topics: COVID-19 Refugee Crisis Across the world in a refugee settlement, COVID-19 takes on a different meaning. In a small refugee home where families often have 10 people living in one room, social distancing is a luxury many cannot afford. Self-isolation is not an option. When 25 million people are living within close quarters in refugee settlements around the world, containing a global pandemic seems near impossible. But, there’s a solution: Community Health Workers. In refugee settlements where we work, Community Health Workers (CHWs) are the main line of defense against infectious diseases like Ebola and Coronavirus. They are the volunteers who go to every house to check on local refugee families, their neighbors. They provide education on proper health and hygiene practices. They make sure children get access to the health care they need. “I know that my work changes others’ lives. They know where to get health consultations now at a cheaper price, they know the proper way to breastfeed, and my elder neighbors recognize the symptoms of diabetes or hypertension,” says Raghda, a CHW with Medical Teams International in Lebanon. In the midst of the COVID-19 pandemic, here’s what Community Health Workers are doing around the world to protect refugee families from the Coronavirus: 1. They Educate Local Communities on COVID-19 Prevention Practices Since COVID-19 still has no cure or vaccine, refugees are at especially high risk of the disease spreading rapidly. Individuals whose immune systems are already compromised are at an even greater risk. Many refugees suffer from debilitating diseases, including respiratory illnesses like tuberculosis and pneumonia that can greatly increase the risk of death from COVID-19. The best way to defend against the pandemic is to educate the community on social distancing and hand washing. “For many people in remote regions of Sub-Saharan Africa and Uganda, Community Health Workers will be the first and possibly only the line of defense against COVID-19.” – Dr. Patrick Adrani, MTI Uganda In Uganda – one of the largest host countries for refugees in the world – Medical Teams has 1,724 CHWs. These health workers are a part of Village Health Teams, who collectively educate and care for refugee villages as a unit. “The health of Uganda and Her people is in the hands of brave, selfless and heroic health workers like Village Health Teams.” – Dr. Patrick Adrani, Medical Teams Uganda https://live-mti-wp.pantheonsite.io/wp-content/uploads/2020/04/Intro-video-for-the-activities-in-Rwamwanja.mp4 Medical Teams community health worker Bruno explains his COVID-19 community awareness and prevention work. Bruno, one of Medical Teams’ CHWs, goes door-to-door in his assigned village in Uganda, spreading information about COVID-19 prevention and hygiene practices. 2. They are Essential for Building Trust Community Health Workers are able to defend against disease because they have built trust in their communities. When Ebola hit much of Sub-Saharan Africa, we learned a few important lessons on the value of trust: Address Community Fears and Misperceptions Different cultures and contexts come with different expectations and perspectives – especially around health. In a refugee setting, the arrival of a deadly disease could be viewed as something superstitious, socially shamed, or otherwise. CHWs are vital in these situations because they know the cultural context – and they know how to explain and build trust around a protective and effective response to a pandemic. “Refugees have been stressed out for many reasons. Starting with rumors on different cases, fear of bullying/rejection from Lebanese that might lead to the loss of their so-called home, and they are well aware on the gap of the Lebanese health system.” – Samira Youssef, Medical Teams Lebanon Connect With Community Leaders CHWs build strong relationships with the community leaders to help guide the community. It’s an easy way to build rapport and engage the community in proper health and hygiene practices – through the trust they have in their leader. Be Transparent CHWs can explain what, how, and why a certain treatment will help, guiding refugee families through the reasons why hygiene practices are important. Giving clear, consistent, and transparent communication is essential to building community trust. 3. They Encourage Social Distancing Social distancing is a challenge in any refugee settlement, especially given their population densities. In a recent study, IRC said the Diamond Princess cruise ship had a population density 24,400 people per square kilometer and 19% of the passengers were infected with COVID-19 over the course of the trip. In comparison, Cox’s Bazar in Bangladesh – near the Kutupalong refugee settlement – has a population density of 40,000 people per square kilometer. With inadequate space for case isolation and poor sanitation, the transmission rate in a refugee settlement is likely to be more than double. Community Health Workers can use the trust they’ve built with these communities and leaders to encourage effective practices around social distancing. Though difficult in these population-dense spaces, keeping a distance from each other will reduce the transmission rate and save lives. Mothers like Zahra are getting the information needed to protect their children. “Mostly I am worried about my children, what would happen if they need to be isolated away from me? Or who will take care of them if I needed to be isolated,” said Zahra. With help from her CHW, Zahra has the information she needs to best protect her family from COVID-19. Without these Community Health Workers, we would have little to no defense against the spread of Coronavirus in refugee settlements. These volunteers put their lives at risk every day to help protect the millions of refugees living in settlements around the world. Help protect refugees against COVID-19.