COVID-19 responses in Africa must include migrants and refugees

Prevention, testing and treatment should be available to all, regardless of nationality or immigration status.

Migrants and displaced people across Africa are particularly vulnerable to COVID-19 transmission. Governments should resist nationalist responses that could put vulnerable people more at risk and exacerbate the spread.

According to the International Organization for Migration, the COVID-19 outbreak is the largest mobility crisis the world has ever seen, with 209 countries affected to date – 52 in Africa. What started in the global north has rapidly moved into and across the continent.

Migration has changed extraordinarily in a short time. Opportunities for movement have reduced drastically. Many African countries have adopted strict migration measures aimed at, among other things, reducing entry into their territories through border closures, suspension of visa processes and implementation of severe travel restrictions.

Border closures, while broadly effective against the pandemic, carry some risks. These include increasing or changing irregular migration patterns and, in turn, potentially increasing transmission and reducing states’ abilities to trace it.

Afghans returning from Iran, one of the earliest COVID-19 epicentres, provide a bleak warning to African states. Approximately three million Afghans live in Iran. An estimated 200 000 have returned to Afghanistan since Iran’s coronavirus outbreak because many fear the disease and have lost work.

Border closures could heighten exposure and complicate health screenings and contact tracing

Some returning Afghans have used regular border channels, while many more are believed to be moving irregularly. Conditions are chaotic and rushed. Border agents are registering people, checking temperatures and providing information, but more than half of Afghanistan’s confirmed cases are returnees from Iran and the pandemic is spreading to regions where they are going.

South Africa has the most COVID-19 cases in Africa. It is also a regional migration hub, with an estimated 4.2 million migrants, primarily from neighbouring countries. Its immediate neighbours have substantially lower case loads and weaker health and governance systems to manage the virus.

As part of a nationwide lockdown, South Africa has closed ports with neighbouring countries. As many as 23 000 Mozambican mineworkers are estimated to have rushed across the main border crossing at Ressano Garcia in the days before the closure. Mozambican officials claimed all returnees were greeted by the health brigade and washed their hands on entry.

An estimated 13 500 Zimbabweans also returned home in that three-day period and were asked to self-isolate. On the first morning of South Africa’s lockdown, Home Affairs Minister Dr Aaron Motsoaledi visited the Beitbridge border post into Zimbabwe after seeing queues stretching for up to 7 km of people who hadn’t managed to cross before the lockdown began. The Zimbabweans were granted passage to return home.

Irregular migrants are less likely to seek care if they develop COVID-19 symptoms

Fears of these returnees transmitting COVID-19 in their home countries are high. Border closures don’t mean people stop trying to cross them, and often lead to an increase in irregular travel methods, which could heighten exposure and complicate health screenings and contact tracing. Many borders in Africa are notoriously porous and migrants cross illegally.

Many immigrants work in informal markets, have family members who rely on remittances and are not eligible for economic relief provided by the state. Health risks are also high for irregular migrants who stay put. Research by the Institute for Security Studies shows that they often fear authorities, including healthcare professionals. Many try to remain invisible and have low knowledge of their health rights. These migrants are less likely to seek care if symptomatic.

Concerns are also growing among aid agencies and service providers about the potential impact of COVID-19 on displaced people in Africa. Africa hosts more than 25.2 million refugees and internally displaced people. Most African refugee appeals are chronically underfunded and most displaced people are hosted in poor countries with already under-resourced health systems.

Africa houses four of the world’s six largest refugee camps (in Uganda, Kenya, Tanzania and Ethiopia). These camps are ideal spaces for transmission of the coronavirus. They are overcrowded and lack adequate water, sanitation and hygiene facilities.

Africa hosts four of the world’s largest refugee camps, where conditions are ideal for transmission

Many inhabitants have fled war or strife and have compromised immune systems as a result of malnutrition, high stress and other comorbidities. Healthcare facilities are basic; mechanical ventilators and intensive care beds are very rare. In these settings, social distancing or isolation will be extremely difficult.

Kakuma and Dadaab refugee camps in Kenya together accommodate 411 000 refugees (194 000 and 217 000 respectively). Movement between Kakuma, Dadaab and Nairobi was suspended in response to COVID-19. Four people from Kakuma are currently in isolation due to fears of exposure. A Somali-American grandfather had a high fever after he arrived from the United States to visit his family on 16 March.

Displaced people outside formal refugee camps are perhaps even more vulnerable. Many of these refugees are in makeshift camps or urban slums. These communities tend to be highly transient, poorly resourced and situated away from any source of official support. They rely on local charities for survival, many of which are now closed due to the pandemic and government-ordered lockdowns.

Detainees in immigration detention centres also face a higher risk of contracting and spreading the virus due to crowded conditions and a limited ability to take precautions. Many African migrants are held in detention on the continent. In Libya for example, thousands have been locked in horrific conditions for extended periods, some even for months. These migrants should be released and moratoriums on immigration detention implemented to help prevent the spread of COVID-19.

In their responses, governments should consider the possible unintended consequences of measures like border closures on transnational transmission of the virus. Refugee camps and detention centres must urgently be protected and provided with adequate hygiene and health facilities to prevent catastrophic outbreaks. Governments should ensure that prevention, testing and treatment is available to all, regardless of nationality or immigration status.

Aimée-Noël Mbiyozo, Senior Research Consultant, Migration, ISS Pretoria

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