From ... in Health — Apr 22, 2020

Lebanon’s refugee restrictions could harm everyone’s health

Expand 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. © 2020 Mahmoud Zayyat/AFP via Getty Images 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. Government responses to the spread of the COVID-19 virus have exposed the extra barriers to healthcare for refugees and migrants worldwide. But discriminating against already marginalized noncitizens not only erodes their capacity to avoid or survive infection, but inevitably has a negative impact on the wider society’s health. This is undeniably the case in Lebanon, home to nearly 1.5 million refugees—almost a quarter of its population. Both Palestinian and Syrian refugees have suffered from long-standing discrimination and marginalization as a result of Lebanese policies that deny them access to basic rights, including housing, work, education, and healthcare.

The COVID-19 outbreak in Lebanon has only heightened the marginalization of both groups. Many municipalities have introduced unjustifiable, discriminatory movement restrictions and curfews on Syrian refugees that do not apply to Lebanese residents as part of their effort to combat COVID-19. And leading Lebanese politicians have fueled anti-refugee sentiment by implying that Syrian and Palestinian refugees will be responsible for spreading the virus. Yet, the Lebanese government’s national response plan for COVID-19 depends on self-reporting. People are advised to call a national health ministry hotline for advice about testing and treatment.

The United Nations Refugee Agency (UNHCR), which is responsible for Syrian refugees, and the United Nations Relief and Works Agency (UNRWA), which is responsible for Palestinian refugees, have both said that they will only cover the cost of testing and treatment of refugees if the refugee has first contacted the hotline and followed its instructions. While it is widely acknowledged that testing and contact tracing are key to tackling this virus, Lebanon’s response plan rests on an assumption that an individual experiencing coronavirus-like symptoms will feel comfortable enough to call a government-run service, travel to get tested and treated, and potentially share information about where they live, whom they live with, where they have traveled, and where they work. However, Syrian refugees have told Human Rights Watch (HRW) and aid agencies of their fear of further discrimination and stigmatization if they contract COVID-19. Some Syrian refugees have even expressed fears of deportation if they exhibit COVID-19 symptoms.

They cite these fears as a deterrent from seeking medical care, even if they experience symptoms. Our interviews with Syrian refugees lay bare the government’s failure to provide them with up-to-date and accurate information about the virus and the healthcare services available to them—a human rights obligation of the Lebanese government. More than a month into the COVID-19 outbreak in Lebanon, the majority of Syrian refugees that HRW interviewed said that they did not know what they should do in case they experienced symptoms, nor did they know of the existence of the health ministry hotline. Humanitarian organizations have cited similar findings. At a time when that trust is most needed, the Lebanese authorities are conducting business as usual and adopting policies that fail to alleviate the refugee populations’ mistrust of the authorities. This lack of trust could easily undermine efforts to prevent control and spread of the disease. Lebanese policies should guarantee access to health care for refugees, including testing and treatment for COVID-19.

The government should simultaneously push an information campaign to provide refugees with all the facts that they need to protect themselves against infection and to seek healthcare in a timely manner.

The authorities should also proactively reassure refugees that they will not face retribution or stigmatization if they seek testing or treatment for COVID-19. The international community must also step up. Lebanon has the highest number of refugees per capita in the world. While not an acceptable excuse for the discriminatory and abusive measures that marginalize refugees or endanger their health, the burden is something the international community should help carry. UNRWA has suffered several funding cuts, including when its erstwhile biggest donor, the United States, cut its funding entirely, and is now running a deficit of over $120 million. In 2019, only 55 percent of the Lebanon Crisis Response Plan for refugees was funded. Other states may have been able to stem the flow of refugees across some borders, sometimes in unconscionable ways, but it cannot do the same with this virus. Lebanon and the international donor community should do better in assisting refugees to build their resilience by ending discriminatory practices and by ensuring that they are able to get healthcare and adequate housing. It should not take a global pandemic to force this position, but as the first case of COVID-19 was announced in a refugee camp in the Bekaa on April 21, the authorities may soon realize that they have no other choice.

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