Our COVID Response's Weakest Link - Lebanon's Unvaccinated Refugee Population
Opinion analysis by Ricardo Bitar, Featured Writer
January 21st, 2022
As COVID cases rise in Lebanon in wake of the spread of the newest Omicron variant, the country is facing an alarming possible threat that has been present ever since the start of the pandemic, one that is dormant and rapidly emerging: a young, expanding, and unvaccinated population of refugees. These occupants are not a new addition to the Lebanese population; with the largest number of refugees per capita in the world, the country is well aware of the responsibility that is put on its shoulders yet is not willing to properly comply with them. When it comes to the COVID-19 pandemic, the government seems to have forgotten about their responsibility towards these people, leaving 1.5 million Syrian refugees and 14,815 refugees coming from other countries such as Iraq and Palestine in dire danger.
While international laws and conventions, including the Constitution of the World Health Organization and Article 25 of the Universal Declaration of Human Rights, among others, all seek to ensure equal access to healthcare, the Lebanese healthcare system as a whole is shunning refugees, especially undocumented ones, thoughtlessly. An Al Jazeera article delineates the extent of this issue, with some hospitals denying undocumented refugees the right to get tested. The Rafik Hariri University Hospital (RHUH), Lebanon's main COVID testing and treatment center, has a policy of turning away undocumented refugees and immigrants in non-critical cases, often denying them access to COVID testing. On the other hand, some hospitals such as Beirut's Saint George Hospital, relied on setting a prohibitively high price for undocumented citizens, charging them 750,000LBP for a single COVID test while it was available for 150,000LBP in other clinics for documented citizens (prices based on March of 2020).
This is a worrying trend; if undocumented refugees do not have access to the most basic aspect of healthcare, which is testing, then they most definitely do not have access to quality treatments. However, the issue is not restricted to undocumented refugees only. Even before the implementation of a nationwide lockdown in early 2020, municipalities had enforced restrictions on the movement of Syrian refugees. This made access to healthcare centers that much harder, leading to a 30% decline in visits to Médecins Sans Frontières centers in March of 2020. The repercussions of depriving refugees from healthcare were apparent, with data from the United Nations indicating that Syrians and Palestinians had a COVID fatality rate that was three to four times higher than the national average, respectively.
Amid such perturbing statistics, the Ministry of Public Health's vaccine roll-out plan came as a relief. Adopting an approach based on priority categories, the MOPH sought to vaccinate people of all nationalities, regardless of their residency status. This plan seemed like a promising solution to the refugees' plight, hopefully leading to lower infection rates and fatalities. However, their strategy failed miserably. As of October of 2021, whereas the percentage of the population receiving at least one dose was 29%, this number was at a shocking 4% for Syrian refugees. One might ask: why? According to the World Bank, government mistrust in the refugee community, high levels of poverty, and the aforementioned restrictions on the movement of Syrians are the main culprits. Moreover, refugees without formal documentation are being reluctant to get vaccinated out of fear of repercussions such as harassment, detention, arrest or deportation. As a result, most refugees do not want to take the vaccine, and the few who do want to find it difficult to reach vaccination centers. Another obstacle facing those who want to get vaccinated is digital literacy. Despite the importance of the online platform for pre-registration, it is inefficient in a population with low literacy and digital literacy levels. And while alternative methods of registration are available, they are not up to the mark.
Therefore, seeing as the refugees are not vaccinated, it might be safe to assume that they are at risk of catastrophic infection rates. However, refugees in Lebanon have something that worked in their favor overall: they are a young population. Despite all the vulnerability factors, the younger age of the refugee community in Lebanon affects the COVID transmission dynamics in a way that counteracts these vulnerabilities. As a result, with 55% of the Syrian population being under 18 years old in Lebanon, age is definitely a factor that kept COVID surges at bay within the refugee population. However, this is not to say that they are safe against COVID, especially not with the rise of the Omicron variant.
While possibly milder than previous variants, Omicron is extremely transmissible and contagious. As scientists are still figuring out the mechanism behind its spread, cases worldwide are rising at an alarming speed, leading to more and more people being infected. More importantly, there seems to be an exponential rise in COVID cases among children, with numbers far exceeding those seen in previous peaks in the United States. This might hint towards a worrying trend; Omicron can weaken the protecting effects of the refugee population's age distribution, bringing bad news not only to the refugees, but to the entire country.
Lebanon's refugee community is not separate from the host community: the two populations are interwoven and interact with each other on the daily. Thus, we must always remember that no one is safe until everyone is safe. As new and more contagious variants emerge regularly, the unvaccinated will act as an incubator for the virus, preparing it to engulf a country that is already suffering on many different fronts. All in all, this pandemic made us realize that the chain is indeed as strong as its weakest link.