In the years prior to the coronavirus pandemic, Western and Central Africa were amidst a substantial refugee crisis due to increased political violence. Millions were displaced from their homes, and millions more fled their native countries in search of stability, depending on humanitarian aid for food, water, shelter, and medical care in overcrowded makeshift camps and facilities. When Covid-19 hit Africa, migrants, refugees, and Internally Displaced People (IDPs) were confronted by a crippled healthcare system with insufficient preventative measures against the spread of Covid-19, causing many migrants to risk their lives, and the lives of others, to escape the African Continent by any means necessary. 

A handwashing station in an Ukende refugee settlement, Nigeria. © UNHCR/Tony Aseh

In the years leading up to the pandemic, parts of Western and Central Africa were becoming increasingly volatile. On 13January2020, French President Emmanuel Macron addressed rising African tensions at a military intervention summit along with five Sahelian countries – Burkina Faso, Chad, Mali, Mauritania and Niger. The summit formed a military coalition designed to combat growing security threats in the region, particularly from terrorist attacks. According to a report published on 08January2020, the UN office for West Africa and the Sahel (UNOWAS) estimated more than 4000 deaths reported in Burkina Faso, Mali and Niger in 2019 alone compared to 770 deaths in 2016 just three years earlier. 

Continued volatility in West Africa and the Sahel (WAS) states produced a staggering amount of displaced peoples and refugees. In total, the UN labeled 8.3 million as “people of concern” in the WAS area: 5 million IDPs, 1.2 million refugees, 692,000 stateless, 27,000 asylum seekers, and 1.4 million returnees.

These 8.3 million people of concern could not be supported by the existing infrastructure in WAS prior to the pandemic. In Burkina Faso alone there were 1 million food insecure and 2 million people in need of water and sanitation aid near the start of the pandemic in March. Without proper hygiene, it is far more difficult to prevent the spread of Covid-19, and without adequate food and water, concomitant comorbidities reduce survivability in otherwise treatable cases. However, even with proper hygiene, food, and water, Burkina Faso lacked the medical infrastructure to treat a growing surge of patients. 135 medical facilities were forced to close due to rising violence with an additional 140 facilities at reduced capacity. 

As people came pouring into overcrowded urban centers, frontline humanitarian workers like Doctors Without Borders accepted that help was not coming soon. “No one is in a position to bring in new teams,” said Dr. Dorian Job, West Africa program manager for Doctors Without Borders, “and the medical supply system will be disrupted for weeks or even months…more attention to hygiene and infection prevention measures is also needed to avoid the spread of the virus in a country with limited water access in distressed areas.” 

In addition, Dr. Job warned that absolute focus on Covid-19 could lead to negligence regarding other epidemics. “As an example, malaria and measles, for which epidemic outbreaks have recently appeared in Burkina Faso and Niger, remain high-mortality diseases in the region,” cautioned Dr. Job. Outbreaks like malaria and measles require vaccines and coordinated prevention efforts made impossible by Covid-19. 

Today, Burkina Faso’s insufficient medical infrastructure forces more IDPs, refugees, and migrants into overcrowded cities, creating a pandemic time bomb. Many villages in Burkina Faso stand empty after their inhabitants were forced to flee rising violence from terrorist groups such as the Al Qaeda-linked Jama’at Nusrat al-Islam was Muslimin. “We could watch entire populations vanish” says Alexandra Lamarche, senior advocate for West and Central Africa at Refugees International. After a year of famine, drought and violence, these rural IDPs are at high risk of fatal coronavirus infection leaving empty shells of villages in the countryside.

Doctors Without Borders is calling upon individual countries to create tailored coronavirus response plans, learning from previous epidemics. Top priority is the safety of healthcare workers who are vital, not only in providing medical care for Covid-19 positive patients and those suffering from other conditions, but also disseminating information on how to prevent infection while alleviating panic. 

Despite humanitarian efforts, many refugees are becoming increasingly desperate to escape the African continent. Prior to 2019, WAS refugees seeking to enter the European Union risked the Mediterranean via the Moroccan Coast towards Spain. Since then, the EU has been providing funds to Morocco to stop migrants sailing from the coast. Other migrants are attempting to cross from the West African coast to the Canary Islands in a dangerous Atlantic voyage. According to the International Organization for Migration 250 people have died or gone missing in attempts to get to the Canary Islands and successful landings have increased 550% since the EU blocked the alternative Moroccan passage.

As exhausted migrants reach the shores of the EU, the threat of contamination is constant. Migrants can carry Covid-19 with them, or they can become infected from local populations. Either way, the migrant population is at serious risk of infecting their own communities and the communities around them. As the world becomes more and more interconnected, it becomes imperative that we provide at-risk populations the tools and infrastructure to prevent widespread infection before another global pandemic so they can protect their families and communities, while preventing dangerous contamination across national and international boundaries.

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