Vulnerable children and their families living in informal settlements such as refugee and displacement camps, and areas with already weak health systems, cannot be forgotten as the world fights to contain the coronavirus outbreak, Save the Children warns.

Around the world, there are more than 12 million child refugees and some 70 million people have been forced to flee from their homes, many of whom are currently living in overcrowded conditions with limited or no access to healthcare. Refugees and forcibly displaced children are already vulnerable to infectious diseases in a number of ways, including reduced access to healthcare, water and sanitation systems and potentially weakened immune systems.

Save the Children teams across the world are preparing for potential outbreaks in countries with weakened health systems, fragile contexts or a limited capacity to respond due to other ongoing crises, such as conflict or natural disasters.

In Cox’s Bazar in Bangladesh, home to the largest refugee settlement in the world, there is currently no system in place to screen or test for COVID-19 and there are no intensive care units for the nearly 1 million refugees, half of whom are children. With freedom of movement severely restricted and cramped conditions also compromising people’s ability to self-isolate, the virus could prove catastrophic.

“Even though at present there are no confirmed cases of COVID-19 in Cox’s Bazar, we’ve kept an isolation unit with 15 beds in our primary healthcare center in one of the camps specifically for isolation as needed,” said Dr. Shamim Jahan, Deputy Country Director for Save the Children in Bangladesh. “If COVID-19 should spread widely, we’d still be able to keep running our primary healthcare center alongside the isolation unit which is crucial to saving lives but there is a risk we could become overwhelmed. The center normally treats children for pneumonia and offers pregnant women with vital maternal healthcare services.”

In Idlib, Syria, where conflict has forced nearly a million people to flee into inhumane living conditions in camps stretched far beyond capacity, self-isolation would be practically impossible during an outbreak of coronavirus with potentially devastating consequences for families living through the tenth year of the Syrian conflict.

In Sub-Saharan Africa, which hosts more than a quarter of the world’s refugee population, cases are rapidly being confirmed across the majority of countries. With just 0.2 doctors per 1,000 people, it’s the region with the fewest number of medical professionals per capita in the world—putting both refugees and host communities at risk as the virus spreads. By contrast, East Asia and the Pacific, where the vast majority of confirmed cases of COVID-19 have occurred, has 1.6 doctors per 1,000 people.

Save the Children runs major sanitation and hygiene programs across the globe and is working with health teams on the ground to share COVID-19 prevention messages like handwashing and self-isolation. These actions will ultimately support children’s ability to prevent infection and resilience to overcome it if they become ill, but more support is needed to bring these actions to scale.

“COVID-19 is a global health crisis which requires a coordinated global response,” said Dr. Zaeem Haq, Save the Children’s Global Medical Director. “It is in all of our interests to ensure we are doing everything to prevent further spread of the virus and this is especially significant in refugee and displacement camps where isolation and testing pose significant challenges. Children already bear the burden of many of the world’s infectious diseases including pneumonia, malaria and cholera and families already struggle to get adequate health care.”

Save the Children is calling on international donors and national governments to scale up investment in health systems to allow countries to respond to the outbreak without compromising other health services, and to roll out communications campaigns within refugee populations to stop new infections from occurring.

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