February 24, 2021

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Dozens of countries have no plan to vaccinate refugees. That could leave everyone at risk.

Among the world’s millions of refugees, her experience stands out. Jordan is one of the few countries to have begun vaccinating refugees as innoculation programs begin. Millions of others have been excluded from their host countries’ national vaccine programs or face added barriers to access. That could ultimately leave everyone at risk.

Of 133 countries which UNHCR, the United Nation’s refugee agency, has information on, 81 have finalized their vaccination strategies and only 54 have included explicit provisions to cover populations of concern such as refugees, asylum seekers and stateless and internally displaced people.

Refugee advocates warn that failing to include these vulnerable populations, many of which live in crowded and impoverished conditions, ultimately undermines a nation’s efforts to stop the coronavirus. International law makes host countries responsible for the health care of refugees and asylum seekers within their borders, but that norm has clashed with demands by some who say citizens should be prioritized.

“Those [countries] where they are not included, we are trying to understand better what the issues are,” Sajjad Malik, director of the Division of Resilience and Solutions at UNHCR, said of why UNHCR is not making the names of the countries public.

Some countries do not list specific categories of people in their coronavirus response outlines, so it is unclear whether refugees are included by default. In others, governments have been forthright: In December, Colombia said it would not provide vaccines to hundreds of thousands of Venezuelan migrants and refugees when its rollout began. Even in countries where all residents are in theory slated for inoculation, refugees may remain sidelined if they are undocumented or lack safe and clear access to health-care providers.

Covax, the World Health Organization’s global vaccine program for ensuring a more equitable distribution, said it is working to craft an “emergency buffer” that would set aside about 5 percent of available doses for humanitarian and emergency use. Low- and middle-income countries host most refugees, according to UNHCR.

“The principle is that buffer will supply vaccine to countries where humanitarian affected populations, including refugees, asylum seekers, stateless, remain excluded from national rollouts to ensure they are reached,” Kathryn Mahoney, a UNHCR spokeswoman, said in an email.

A spokesperson for Gavi, a vaccine alliance working with Covax, said that details are under discussion and that the board will vote on it “in the near future.”

Some countries have included refugees in their calculus from the start. Germany, which took in more than 1 million people during the migration crisis, classed those who live or work in refugee or homeless facilities as the second-highest priority in its vaccination strategy.

But some marginalized communities are not sure where they fit in. While Israel has raced to vaccinate its citizens, Zoe Gutzeit, director of the migrant and refugee program Physicians for Human Rights in Israel, said the government had been “moving very slowly” to create an alternative for many of the 30,000 African asylum seekers there who do not have access to the country’s health funds that are distributing the vaccines. In Greece, where tens of thousands of people remain stranded in crowded camps on islands and accommodations on the mainland, aid groups have argued that refugees in high-risk conditions should be prioritized.

When Jordan began its program in mid-January, it became one of the first countries to vaccinate refugees and asylum seekers along with the general population, according to UNHCR. The country is home to an estimated 1.3 million Syrians, around 660,000 of whom are formally registered with the United Nations. Jordan also has large Iraqi and Palestinian refugee communities, in addition to people from more than three dozen countries.

Alomur fled her home in Deraa, Syria, for Jordan in 2012. The University of Damascus graduate said she cannot find a suitable job. While confirmed infection rates are relatively low, Jordan has implemented several strict lockdowns to cut transmission, despite the deep economic impact on its struggling economy.

“Whether Syrian, or Palestinian, or Iraqi or Jordanian,” Alomur said, Jordan has “tried the best it can to control the virus and protect people.”

Coverage is still far from ensured, especially for refugees without legal residency, who might fear alerting the government to their status or lack healthcare access. But support for inclusion has come straight from the top: On Thursday, Jordanian King Abdullah II, at an event held by the World Economic Forum, said that “safeguarding the health and well-being of refugees” was “a global responsibility,” Reuters reported.

Official messaging has been far less refugee-friendly in other countries in the region, such as Turkey and Lebanon, with large Syrian populations. Both countries have issued vaccine guidelines pledging that everyone, regardless of nationality, will be included. Neither government, however, has laid out a program stipulating how rollouts will work for refugees. The majority of Syrians in Lebanon lack legal status, and the government has not specified whether undocumented refugees who seek vaccination will face repercussions.

Most Syrians in Jordan live in poverty in cities, and additional tens of thousands live in refugee camps in more isolated parts of the country. Ahmed Zghool, a health coordinator with Los Angeles-based International Medical Corps, which works in the two biggest camps, Zaatari and Azraq, said many isolated residents are uninformed or misinformed about the virus and the vaccine.

In Azraq, home to some 36,000 Syrians, IMC contacted about 3,700 people who, because of their age or health issues, met the national criteria for the initial groups eligible for vaccinations. Some 56 percent responded that they were interested in the vaccine, Zghool said. IMC has held sessions to educate people about the vaccine and help them navigate the online portal.

IMC expects to open vaccination clinics, coordinating with the Ministry of Health, in Zaatari and Azraq in the coming weeks. In the meantime, the organization has helped to transport refugees to cities for vaccinations. As of late January, some 200 people from Zaatari, home to 80,000 refugees, and seven from Azraq, have received the shot, Zghool said.

In Greece, Apostolos Veizis, the medical director in the country for Doctors Without Borders, said the government has said it will include refugees and asylum seekers but has not provided further assurances or clarity.

Most refugees in Greece are young and come from countries including Afghanistan, Syria and Somalia, where conflicts are ongoing. But people living in crowded refugee camps on the Greek islands are three times more likely to contract covid-19, compared with the general Greek population, and those in camps and accommodations on the mainland are 2.5 times more at risk, Veizis said. The isolation of camp life also has taken a mental and physical toll, adding to the health risks, he said. In September, a fire ripped through the largest camp, Moria, on the island of Lesbos, displacing some 12,500 people.

“The unfortunate thing is that for years, those people are being seen as numbers,” Veizis said. “They aren’t existing as human beings.”