It’s hard to imagine what we’ve never experienced. To understand what we’ve never seen. We know what self-isolation, hand washing and protective equipment look like here in the U.S. But what does this crisis look like for refugees and other people living on the margins? Here are six of the realities that make this virus more terrifying – and deadly – for many people we serve around the world. 1. Social Distancing is Impossible Space. It’s the one thing almost all refugee camps lack. Crammed in, homes are often only a few feet apart. Refugees don’t have the luxury of self-isolating. They can’t escape the throng of humanity just outside their doors. Kutupalong Refugee Camp in Bangladesh, where Medical Teams responds to the health needs of more than 100,000 people. They can’t stock their fridges and freezers or order supplies on the internet. Every task – things like getting water, food or medicine – must be done by leaving their home, facing the crowds outside. In the world’s largest refugee camp in Bangladesh – where cases have begun popping up – there’s an average of 100,000 people per square mile. To compare, that is roughly four times the population density of New York City. 2. Keeping Families Inside is Difficult To further complicate matters, many refugees are children. Anyone living with kids during quarantine understands how hard it is to keep them occupied indoors. Now imagine living with your family in a small tent. In Lebanon, the average family’s home is 260 square feet – that includes a kitchen and living space for about five people. In such small quarters, how do you keep everyone inside? That’s what 10-year-old Nour deals with in Lebanon. As the eldest, she is trying to protect her 10 younger siblings by keeping them inside. “I am trying my best, but the preventative precautions for COVID-19 are not easy,” Nour explains. Nour, 10 years old, helps care for her younger siblings while her parents work. Living in such tight quarters, Nour struggles to keep her siblings from getting near neighbors. Nour’s mom also describes how hard it is to maintain social distance. “We are aware of the social distance requirements, but how can I do it when there is less than two meters distance between my tent and my neighbor’s?” 3. Critical Equipment is Scarce or Non-existent At best, COVID-19 can be managed at home. At worst, patients require ventilators and constant monitoring in intensive care units. Once placed on a ventilator, most do not survive. Even in countries with relatively well-equipped hospitals, we’ve seen substantial shortages in equipment. In the refugee camps where we work, the situation is even more dire. Clinics are already overrun and stretched thin as doctors and nurses provide life-saving care. Children come in droves to be treated for malaria. Mothers need emergency C-sections for complicated deliveries. Every bed is taken by someone fighting for their life. In Uganda, a Medical Teams health worker listens to the lungs of a sick baby. Add in a virus like COVID-19 that spreads rapidly and the numbers of people without access to care could be staggering. For those who secure a bed in a clinic, things like isolation units and ventilators would be virtually non-existent. “Establishment of specialized health care interventions such as an ICU is considered a luxury,” explains Dr. Patrick Ardani, Medical Coordinator in Uganda. Besides beds for patients, protective equipment for medical staff is scarce. In the isolation unit we’ve built in Bangladesh, there is currently only enough medicine for three months. Proper masks, face shields and gowns are not available or in short supply. 4. Simple Precautions Like Disinfecting are Unavailable Hand sanitizer – and even clean water for hand washing – is hard to come by. Latrines and water pumps are shared by the community. In Bangladesh, refugee families often share latrines with dozens of other households and must walk several minutes to get to one. Without a way to disinfect hands and surfaces, disease can run rampant. 5. Pre-existing Conditions are Prevalent One thing we know about COVID-19 is that it is often more severe for people with underlying conditions. For refugees, life-threatening conditions are common. In many places we work, malnutrition plagues children and older adults. Children under five suffer from pneumonia. People are sick from tuberculosis, malaria and HIV. With their bodies weakened, they stand little chance against a virus like COVID-19. In Uganda, Hellena and her baby girl, Christive, suffer from severe malnutrition and tuberculosis. 6. COVID-19 News is Slow to Spread While we can turn on the news, open the newspaper, or look up information on our phones, many people in crisis around the world have no news source. Even for those who have heard rumors about the virus, it’s likely they’ve received some wrong information. Confusion and misinformation circulating through camps is common. Misinformation has the potential to worsen the spread of the virus and increase the level of panic. We saw this happen in West Africa during the Ebola outbreak. Bad information increased transmission and resulted in the death of thousands of people. Since the COVID-19 pandemic began, there have already been reports of misinformation. In the refugee camps in Bangladesh, people have been told that the sick should be killed to stop the spread. Because of this, people with symptoms are afraid to seek care. We’re Working to Meet These Challenges Head-on While it is expected – and appropriate – that we would worry about ourselves and our families in this pandemic, it’s also important to remember our brothers and sisters around the world. This virus has revealed just how interconnected we really are. We are neighbors despite the miles between us. And, more importantly, we are all children of God. These challenges are many and they are serious. But we are determined to meet them head-on. We know in the coming months our frontline staff will be asked to work even harder. Every morning, they will go to work to courageously serve those on the margins. They will be uplifted and encouraged by the support you provide. Medical Teams staff transport a COVID-19 positive patient in Uganda. The need is great, which means our ability to meet it needs to be greater. We will continue to bring the best of what we have – decades of experience responding to health crises – to save lives. In our next post, we’ll show exactly how your support will help meet these challenges. You can help vulnerable, high-risk people around the world facing COVID-19 by giving here.