From ... in Health — Apr 2, 2020

Lebanon: Refugees at Risk in COVID-19 Response

Syrian refugees in a building under construction they have been using as a shelter in a city in southern Lebanon, on March 17, 2020, after Lebanon urged people to stay at home for two weeks to stem a novel coronavirus outbreak. (Beirut) – At least 21 Lebanese municipalities have introduced discriminatory restrictions on Syrian refugees that do not apply to Lebanese residents as part of their efforts to combat COVID-19, undermining the country’s public health response, Human Rights Watch said today. Syrian refugees have also raised concerns about their ability to get health care and the lack of information on how to protect themselves against infection. Since early March 2020, at least eight municipalities, citing COVID-19 concerns, implemented curfews that restrict the movement of Syrian refugees to certain times.

The municipalities introduced these measures before the government called for a nationwide curfew, and the restrictions on Syrians exceed those that the government has imposed on the general population. “There is no evidence that extra curfews for Syrian refugees will help limit the spread of COVID-19,” said Nadia Hardman, refugee rights researcher and advocate at Human Rights Watch. “The coronavirus does not discriminate, and limiting the spread and impact of COVID-19 in Lebanon requires ensuring that everyone is able to access testing and treatment centers.” As of April 1, the Lebanese Health Ministry had registered 479 COVID-19 cases, including 14 deaths, with no confirmed COVID-19 cases among Syrian refugees. On March 15, President Michel Aoun announced a “medical state of emergency,” and the government ordered all non-essential public and private institutions to close except those meeting vital needs, such as bakeries, pharmacies, supermarkets, and banks.

The government announced that it would immediately suspend travel from countries with serious COVID-19 outbreaks, and included Syria in those countries, then closed all air, land, and sea borders on March 18. Prime Minister Hassan Diab on March 21 called on residents to observe a “self-imposed curfew,” and instructed security forces to step up measures to ensure that residents remain at home.

The government stepped up the measures on March 26 and announced a curfew – with limited exceptions – between 7 p.m. and 5 a.m. In contrast, on March 18, the Brital municipality in Baalbek announced that to “prevent the aggravation and spread of COVID-19,” Syrians are only allowed to move around the municipality between 9 a.m. and 1 p.m., and then only to perform “necessary” tasks, such as going to a pharmacy or supermarket.

The municipality memorandum said the municipal police would enforce these measures, and that Syrians caught violating them may face “legal measures” and that their identity documentation may be confiscated. Such measures risk the virus spreading if Syrians are too scared to seek medical help after 1 p.m.

The Kfarhabou municipality in northern Lebanon announced on March 16 measures to combat the spread of COVID-19, including a curfew on Syrian refugees between 3 p.m. and 7 a.m. On March 19, another northern Lebanon municipality, Darbaashtar, “prohibited” Syrians from leaving their homes or receiving visitors – without any exceptions. In all three cases, the only restrictions on other Lebanese residents were general restrictions on movement except for emergencies. At least 18 municipalities in the Bekaa valley – where nearly a third of all Syrian refugees in Lebanon live – have mandated restrictions other than curfews that only target the refugee population In Bar Elias, for example, refugees must appoint someone to procure and provide for the basic needs of their informal tented settlement and coordinate such movements with the municipality. Discriminatory measures against refugees are not new. No fewer than 330 municipalities had imposed curfews on Syrians as of January 2020. Human Rights Watch has criticized these measures for contravening Lebanon’s international human rights obligations and Lebanese domestic law. International human rights law requires authorities to address the health needs of refugees and, in the context of the COVID-19 pandemic, any restrictions on basic rights for reasons of public health or national emergency must be lawful and nondiscriminatory as well as necessary and proportionate.

The Lebanese government should communicate clearly to Syrian refugees that they can get medical help without penalty if they experience COVID-19-like symptoms, even if they lack legal residence or other documentation, Human Rights Watch said.

The government should also prioritize information sharing with the Syrian refugee population. In focus group discussions conducted on March 5 and 6 with Syrian refugees in Bekaa and Tripoli, Oxfam found that “knowledge and awareness in refugee communities in both Bekaa and Tripoli on the virus, how it spreads and what are the preventive measures that should be taken, seemed minimal.” Oxfam also found that the costs associated with access to health care was a major concern. Syrian refugees expressed fear of further discrimination and stigmatization if they contracted COVID-19.

They cited this fear as a deterrent from seeking medical care, even if they experienced symptoms. Health Minister Hamad Hassan said that the responsibility for refugee health care should be shared by the Lebanese government and by United Nations agencies, but criticized the international community for being slow to react to the COVID-19 crisis.

The UN Refugee Agency (UNHCR) said that it was already conducting awareness campaigns and distributing hygiene materials. UNHCR subsidizes the costs of basic medical care for Syrian refugees in Lebanon. Testing and treatment for COVID-19 is currently free at the Rafik Hariri University Hospital (RHUH) in Beirut for authorized individuals following a call to and screening by the Health Ministry’s hotline.

The Health Minister also announced on March 30 that nine additional public hospitals across the country have been equipped to receive coronavirus patients. UNHCR has stated that it would cover the costs of testing and treatment for COVID-19 for Syrian refugees in any treatment center, but only after the Health Ministry’s screening and recommendation. It is not clear what documentation hospitals will require from refugees. Further, although information that UNHCR provided to refugees on COVID-19 states that the Lebanese Red Cross may be available to transport the most severe cases to treatment centers, it is unclear on what basis the severity will be assessed or if this measure will be enough for Syrian refugees to access the hospitals, an essential corollary of the obligation to provide accessible health care. Syrians without legal residency risk detention at checkpoints throughout the country. In a recent survey by the Norwegian Refugee Council, 81 percent of refugees “lacked knowledge” that they should immediately call the Health Ministry hotline if they develop symptoms of the virus or if they want to report a suspected case. “Lebanon has a duty to ensure the health of Syrian and Lebanese residents alike, and it won’t be successful against COVID-19 unless it ensures everyone has access to information, testing, and treatment,” Hardman said. “But the international community should not leave Lebanon to shoulder the crisis on its own and should urgently step up their assistance efforts.” Coercive Environment for Syrian Refugees Due to restrictive Lebanese residency policies, only 22 percent of an estimated 1.5 million Syrian refugees in Lebanon have the legal right to live in the country, leaving the vast majority to live under the radar, subject to arbitrary arrest, detention, and harassment.

Their lack of legal status means they cannot move freely through the ubiquitous checkpoints that predate COVID19, have difficulty getting services such as health care or education, and find it difficult to register births, deaths, and marriages. Lebanon’s Higher Defense Council made several decisions in 2019 that increased pressure on Syrian refugees in Lebanon, including the summary deportation of those who enter Lebanon irregularly, the demolition of refugee shelters, and a crackdown on Syrians working without authorization. On August 26, 2019, General Security – the agency responsible for the entry and exit of foreigners – said it had deported 2,731 people to Syria since May 21, placing them at risk of arbitrary detention and torture. Lebanon’s Obligations Lebanon is a party to the International Covenant on Economic, Social, and Cultural Rights (ICESCR), which requires it to take steps to achieve “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Governments also have an obligation to protect the right to seek, receive, and impart information necessary to promote and protect rights, including the right to health.

The Committee on Economic, Social and Cultural Rights regards as a “core obligation” providing “education and access to information concerning the main health problems in the community, including methods of preventing and controlling them.” It is required to ensure the protection of these right to everyone in its territory, without discrimination. Lebanon has also ratified the International Covenant on Civil and Political Rights, which guarantees the right to freedom of movement. While countries may under certain circumstances restrict movement, such limits must be enacted in law and necessary “to protect national security, public order, public health, or morals, or the rights and freedoms of others.” Restrictions on movement must be proportionate in judging the areas concerned, the duration, the number of people affected, and the impact on their lives, in comparison with the aim to be achieved. Restrictions on rights, including freedom of movement and the right to health, cannot be imposed on a discriminatory basis, including by nationality. This fundamental principle applies even during emergencies. .

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Lebanon: Refugees at Risk in COVID-19 Response

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