Covid-19: It's too soon to lift lockdown

While we count the terrible toll of covid-19 (doi:10.1136/bmj.m1835) and continue asking hard questions of our governments (doi:10.1136/bmj.m2052), clinicians and patients are embracing new ways of doing things: virtual wards are helping to keep covid patients out of hospital (doi:10.1136/bmj.m2119), mental health services are experimenting with phone triage and virtual appointments (doi:10.1136/bmj.m2106), and doctors are supporting each other through their uniquely shared covid experience (doi:10.1136/bmj.m1499). [...]in other news the NHS has launched a race and health observatory, after The BMJ's call for action to end racial inequalities (doi:10.1136/bmj.m2191). The world is facing a scale of challenge not seen since the second world war. [...]rather than identify and empower local leadership (https://blogs.bmj.com/bmj/2020/05/27/chris-ham-test-and-trace-strategy-must-value-local-leadership-to-be-a-success), the government seems set to continue its centralised bungling and magical thinking (https://blogs.bmj.com/bmj/2020/05/28/public-trust-and-the-publics-health-two-sides-of-the-same-coin).

Tensions in Cultural Identity and Sense of Belonging for Internally Displaced Adolescents in Ukraine

This article examines the cultural, educational and mental health consequences of large-scale internal displacement for children and adolescents from the Donbas to other parts of Ukraine. The research findings and methodological innovations of the study are discussed in the context of forced migration and displacement caused by the previous (2014) armed conflict in East Ukraine and Donbas with additional challenges posed by the Covid-19 pandemic. Our data collection was halted by the military action in Ukraine that started in February 2022 that has caused another wave of forced migration. We reflect on the experience gained from conducting research on sensitive topics of displacement using online methods in the environment of restricted access to schools and adolescents. The adolescents who were interviewed described their experiences of displacement, which for some had taken place nearly eight years before. Trauma from conflict and displacement can have mental health, educational and social consequences for displaced adolescents. These displaced young people and their families face, as internally displaced populations, a double-edged sword in their relationship with their new contexts. They often have numerous challenges in their settling in a new location and public sphere given the existing ethnic, cultural and language diversity of Ukraine and yet have the advantage of being able to adopt and adapt to their new socio-cultural contexts relatively quickly and minimise their pre-migration identities, if they so wish.

Radio and Social Media as A Two-Way Communication Tool in Conflict- and Pandemic-Affected Communities in Burkina Faso

The article draws on the concepts of "felt needs” and "politics of listening” widely used in community development and applies them more broadly to the humanitarian crisis suffered by internally displaced persons in Burkina Faso. It investigates the two-way communication stream between radio journalists and listeners drawing on feedback collected remotely from 153 representatives of internally displaced and host communities in Burkina Faso during COVID-19. It argues that while a voice must be given to marginalised communities, it must also be listened to and acted upon. Rather than radio journalism being a loudspeaker for top-down messaging, the study argues that alternative approaches should be adopted in conflict- and pandemic-affected areas. It finds that a balance is needed between the information that listeners feel they need in their new extreme circumstances and the information that radio journalists, drawing on their expertise, feel would be strategically empowering. © 2023 The Author(s). Co-published by Unisa Press and Informa UK Limited, trading as Taylor & Francis Group.

Tourism of Ukraine as a Type of Business before and during the War

Ukrainian tourism as a type of entrepreneurship before and during the war was analyzed in the article. It has been noted that Ukraine is a hospitable country, endowed with incredible nature, ancient culture and has delicious food. But since February 24, 2022, the country has completely lost inbound tourist traffic, business tourism came to a halt, and local tourism turned into the migration of internally displaced persons. It has been determined that the longer the war in Ukraine continues, the more Europe suffers from it as well. Accordingly, the slogan "Stand with Ukraine", which sounds like the call for help, was proposed to be transformed into "to visit and help". It has been studied that great opportunities will open up for inbound tourism after the war. At first, routes related to the war and remarkable post-war locations will be relevant. At the same time, the beauty and hospitality of Ukraine will attract tourists. After the victory, Ukraine will be among the top five countries in the world attractive to visit. The sky is open, or at least nominally safe.

Challenges to Global Health Emerging from the COVID-19 Pandemic

The COVID-19 pandemic deepened challenges and opened new fronts where old and unresolved problems met with new problems triggered by the pandemic itself. There are several issues, problems, and challenges related to the post-COVID world we are in. This paper discusses some of them from different perspectives and elaborates on the future challenges and their solutions, which need to be tackled. Apart from the pre-existing problems, we are now also facing new military conflicts, interrupted supply chains, even in medicines supplies, as well as the worsening of climate change, further complicated by the military conflicts and a potential new global economic crisis. The COVID-19 pandemic left the world with many uncertainties about the future as there seem to be few answers ready to tackle the combination of the fallout of the COVID-19 pandemic coupled with the pre-existing problems and challenges. Inequalities in terms of socio-economic differences and inequalities in health are driving disease burden, which will again be marked by the population aging and non-communicable diseases (NCDs). Global collaboration and the joint search for solutions to global challenges have become inevitable. Research into behavioral determinants of health and health promotion are essential in understanding the sources of controversy regarding and resistance to proven public health interventions.

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review.

Objectives: The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention. Methods: The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach. Results and Discussion: This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants' inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information. Conclusion: This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

Breaking Barriers

In the advent of the coronavirus pandemic and the push to digital work, this op-ed argues that the emerging digital economy can be vital for enabling refugee women in the Middle East and North Africa (MENA) to overcome existing livelihood barriers. Since the outbreak of the Syrian crisis in 2011, over 6.5 million Syrian refugees have been registered by the United Nations High Commissioner for Refugees (UNHCR) globally. Neighbouring countries across the MENA region continue to carry the largest share of the burden. Across the region, refugees live on the margins, in camps, as well as urban and peri-urban communities, and other informal settlements. Existing gender disparities coupled with other social and logistical barriers, as well as restrictive legal and economic structures, exacerbate livelihood challenges for refugee women in MENA. Research demonstrates that the digital economy, particularly crowd and ‘on-demand' work, could provide opportunities that would enable women refugees to overcome these barriers to work. As it stands, however, the digital economy is still in its infancy, especially in host countries in MENA, and it is still fraught with challenges, including barriers to entry, employee protections and the lack of guarantees to decent work, especially for vulnerable and marginalised communities. We therefore argue that there is a need to direct efforts to maximise the benefits that the digital economy could offer, especially to refugee women – a need that has become even more pertinent since the coronavirus pandemic.

Refugees in the Digital Economy: The Future of Work among the Forcibly Displaced

The current scale and duration of displacement prompts renewed urgency about livelihoods prospects for displaced people and the role of humanitarian organisations in fostering them. This special issue focuses on how aid organisations, together with the private sector and other actors, have worked to include refugees in new forms of online work within the web-based digital economy. Building on comparative analysis and a comprehensive review of the field of digital livelihoods among the forcibly displaced, in this introductory article we argue that including refugees in this digital economy is currently neither a sustainable form of humanitarian relief nor is it a development solution that provides large-scale decent work. We show how digital livelihoods approaches have gained a special footing in the middle ground between short-term economic relief and long-term development. Indeed, digital economies seemingly offer a variety of ‘quick-fix' solutions at the transition from humanitarian emergency towards long-term development efforts. While digital economies harbour significant potential, this cannot be fully realised unless current efforts to include refugees in digital economies are complemented by efforts to address digital divides, uphold refugees' rights, and ensure more decent working conditions.

Approaches to Occupational Mobility under the Conditions of the Current Economic Crisis

The objectives of economic development in the modern world demand new approaches in the study, analysis and research of social aspects, labour markets and local and regional economic development in the context of the new transformations, the multiple crises that humanity is going through today. For the labour market, the geographical approach opens up the lens of analysis, formulation of priorities and the development of new methodologies that will help us build new theories and policies of local and regional economic development, the development of a labour market through the prism of economic geography. This approach will allow us to analyse the migration processes of occupational mobility and to develop viable policies and measures to create new jobs and ensure sustainable, smart and inclusive economic growth.

‘They tell us to keep our distance, but we sleep five people in one tent': The opportunistic governance of displaced people in Calais during the COVID-19 pandemic

When COVID-19 hit France, over 1,000 migrant people were living in insalubrious encampments in the northern city of Calais. A national lockdown was declared in March 2020, and in the face of the health risks the virus posed, it seemed the ongoing struggle between police and displaced people at this border might come to a halt. This article however argues that rather than appeasing tensions, the state leveraged the exceptional mobility regimes the pandemic brought about to strengthen its border deterrence. Drawing on 5 months of ethnographic research in Calais in the first half of 2020, and on interviews with displaced respondents and humanitarian workers through 2020 and 2021, I conceptualise the biopolitical mode of governance mobilised by the state against displaced people during this period as one of necropolitical opportunism. The lockdown period saw displaced people's survival at the border compromised by continued attacks on their encampments and access to services, as well as on the work of autonomous humanitarians seeking to hold the state accountable for its violence. This article contributes important new insights to debates on border biopolitics and the specific necropolitical agenda pursued by the French state at its northern frontier.

Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices—for example, hand hygiene—are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

Out of the Margins? Race, Racism, and Colonialism in Canadian Communication Studies

The current conjuncture is marked by a multitude of global crises that include the COVID-19 pandemic;global warming;conflicts in Ukraine, Afghanistan, and Palestine;growing global poverty and food scarcity;the exponential increase of forcibly displaced people;the escalating use of incarceration to manage migrants, including children;land conflicts with Indigenous peoples;and the persecution and genocide of religious, ethnic, and sexual minorities around the globe, from the Rohingya to the Uyghurs. In Canada, we nessed the of hundreds of unmarked graves of Indigenous children forced to attend residential schools;court rulings in favour of pipelines that violated the constitutional rights of Indigenous peoples;the global mobilization of Black Lives Matters;the escalation of anti-Asian racism;the heightened Islamophobia that resulted in the killing of members of the Afzaal Salman family;attacks on mosques and synagogues;and the ongoing criminalization, incarceration, and violent police murders of Black, Indigenous, and people of colour across the country. The recent occupation of Ottawa and other cities and towns highlights the rise of right-wing extremism that, along with the failure of the state to act swiftly to protect the rule of law, brings up the intersection of misogyny, racism, colonialism, anti-Semitism, Islamophobia, and populism (Karim, 2000;Mirrlees, 2021;Neville & Langlois, 2021). Drawing on their experiences working with the Community Media Advocacy Centre (CMAC) as scholar-activists, King and Odartey-Wellington argue that the canon of Canadian communications scholarship must be expanded to include Canada's history of colonialism and discrimination against ra- cialized people.

COVID-19 and its prevention in internally displaced person (IDP) camps in Somalia: impact on livelihood, food security and mental health.

BACKGROUND: Somalia has over 2.6 million internally displaced people (IDP) that depend on daily wages and humanitarian assistance for their livelihoods. This study investigated the impact of COVID-19 on livelihoods, food security and mental health of Somalia's IDPs. METHODS: A questionnaire was conducted with "breadwinners" (n = 585) residing in 15 randomly selected IDP camps. Mental health was assessed using the 5-item World Health Organization Wellbeing Index (WHO-5) and the Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to explore the effect of depressive symptoms on soap use and ability to pay for food/medicine/rent. RESULTS: Knowledge of COVID-19 symptoms, transmission and prevention was relatively high, however only 55% reported using soap for hand washing. Around one third perceived that prohibition of public gatherings had negatively impacted weekly earnings. Participants reported difficulty buying food (85%), medicine (82%) and paying rent (51%) because of COVID-19. The majority were assessed as having low wellbeing and high depressive symptoms (mean WHO-5 = 44.2/100; mean PHQ-9 = 18.6/27), with most (74%) indicating that they felt worse than before the pandemic. Compared to people with low depressive symptoms, people with high depressive symptoms were less likely to use soap (aOR = 0.3, 95% CI = 0.2, 0.7; P < 0.001) and more likely to report difficulty buying food (aOR = 2.2; 95% CI = 1.1, 4.3; P = 0.02). CONCLUSION: COVID-19 and associated restrictions have negatively impacted Somalia's internally displaced population. Livelihood and mental health support is urgently needed in the recovery phase of the pandemic and should be factored into future pandemic planning.

Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan.

BACKGROUND: We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started. METHODS: Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation. RESULTS: Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging. CONCLUSIONS: During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection.

Enhancing Respiratory Disease Surveillance to Detect COVID-19 in Shelters for Displaced Persons, Thailand-Myanmar Border, 2020-2021.

We developed surveillance guidance for COVID-19 in 9 temporary camps for displaced persons along the Thailand-Myanmar border. Arrangements were made for testing of persons presenting with acute respiratory infection, influenza-like illness, or who met the Thailand national COVID-19 Person Under Investigation case definition. In addition, testing was performed for persons who had traveled outside of the camps in outbreak-affected areas or who departed Thailand as resettling refugees. During the first 18 months of surveillance, May 2020-October 2021, a total of 6,190 specimens were tested, and 15 outbreaks (i.e., >1 confirmed COVID-19 cases) were detected in 7 camps. Of those, 5 outbreaks were limited to a single case. Outbreaks during the Delta variant surge were particularly challenging to control. Adapting and implementing COVID-19 surveillance measures in the camp setting were successful in detecting COVID-19 outbreaks and preventing widespread disease during the initial phase of the pandemic in Thailand.

REFOULEMENT AS PANDEMIC POLICY

A year and a half into a near-total shutdown of the United States border to asylum seekers, United States Border Patrol agents were recorded riding on horseback, swinging whips in the faces of Haitian refugees, and beating them back across the border into Mexico from Del Rio, Texas.1 The refugees were fleeing political instability and forced displacement-in July of 2021, Haitian President Jovenel Moise was assassinated,2 and a month later, a devastating earthquake killed thousands of people and destroyed 53,000 homes.3 Upon arriving in the United States, instead of being granted temporary refuge, the asylum seekers were forced to live in encampments along the United StatesMexico border, waiting and hoping for an opportunity to make their case for asylum-an opportunity that would never come.4 Many of them were expelled from the United States en masse before they were ever able to ask for asylum, and thousands more were left in limbo in Mexico.5 During this humanitarian crisis, Department of Homeland Security ("DHS") Secretary Alejandro Mayorkas issued a warning to Haitians: "If you come to the United States illegally, you will be returned. A. COVID, Border Closures, and Impact on Asylum Seekers On December 31, 2019, China reported the first cases of what would soon be recognized as the novel coronavirus COVID-19.8 On January 21, 2020, the United States Centers for Disease Control ("CDC") confirmed the first United States COVID case, which originated from a person who had traveled to Washington state from Wuhan, China.9 In early February, the United States and other countries formally imposed global air travel and quarantine restrictions.10 On March 11, the World Health Organization ("WHO") officially declared COVID-19 to be a global pandemic, and by midMarch 2020, U.S. states and localities began widely issuing stay-at-home orders to slow the spread of the disease.11 Across the globe, nations closed their borders to human migration and movement. A Pew Research Report found that, by April of 2020, 91% of the world's population was living in a country with some sort of COVID travel restriction.12 Canada closed its borders to foreign tourism.13 The European Union restricted incoming nonessential travel14 and many member states banned entry from countries with high rates of COVID infection, such as India.15 The United States banned entry for non-essential travelers from the European Union and the United Kingdom.16 The most devastating consequences of border closures, though, have been for asylum seekers and refugees. At the height of the pandemic, at least 168 nations had closed or restricted their borders and around 90 countries had closed their borders to those seeking asylum.17 Simultaneously, COVID-19 served as a "threat multiplier," compounding the effects of poverty, lack of healthcare, and violence affecting refugees and displaced people.18 There were 82.4 million forcibly displaced people in the world at the end of 2020, the highest number ever recorded,19 but fewer refugees were resettled in 2020 than any year in the previous two decades.20 The United Nations High Commissioner for Refugees ("UNHCR") estimated that about 1.5 million refugees and asylum seekers were unable to seek international protection because they were stranded by these border closures in 2020.21 Border closures are particularly harmful to asylum seekers, who rely on the ability to cross borders to seek safety and refuge.22 Asylum seekers, by definition, have been displaced from their homes, and they rely on access to territory outside of their country of origin to seek protection from persecution.

Formal Micro-Credit for Refugees: New Evidence and Thoughts on an Elusive Path to Self-Reliance

The provision of formal micro-credit for refugees has been promoted as a dignified way to improve their ability to generate income through small-scale enterprises and reduce poverty. As humanitarian funding declines in protracted displacement situations, such approaches are sought to transform refugees into self-reliant, resilient, entrepreneurial agents who are no longer dependent on aid and can overcome a crisis with their own resources and financial confidence. The paper in hand questions this claim on the basis of new, comprehensive empirical insights on the financial lives of refugees in non-camp settings in Jordan. By applying the perspective of the credit users, not the suppliers, our evidence shows that the pervasive use of debt (mostly informal) does not signify latent demand for formal micro-credit. In a context where refugees face restrictions on right to work, move, set up businesses, and imagine a future in the host country, formal credit cannot improve self-reliance. The paper sheds light on a larger variety of sources of debt that are crucial for refugees to manage their lives. In conclusion, the paper argues that the rhetoric around micro-credit as a path to refugee self-reliance has to be re-visited as problematic, even damaging, and humanitarian actors should push this agenda with caution.

A voice for the silent: uncovering service exclusion practices

Purpose>This paper aims to provide an in-depth conceptualization of service exclusion by drawing on our exploratory research as well as thick and rich insights from the authors’ qualitative data.Design/methodology/approach>Qualitative research was used to explore service exclusion practices against customers experiencing vulnerabilities. A total of 28 semi-structured in-depth interviews were conducted with refugees residing within Malaysia. The Gioia methodology was used for the authors’ data analysis and the findings were validated by an independent moderator.Findings>The authors’ empirical findings challenge how service exclusion is currently understood, by adding substantial depth and complexity beyond simply describing “the lack of access to services”. The authors also offer rich empirical findings describing 29 forms of exclusion, which were further reduced to seven types of service exclusion practices: discrimination, restriction, cost barriers, language and technology barriers, poor servicing, non-accountability and non-inclusivity.Originality/value>This study conceptualizes service exclusion from a process perspective, that is, “how” customers experiencing vulnerabilities are being excluded, rather than “what” is excluded.

Migration as Pursuit of the Social Determinants of Health

Immigrants, refugees and displaced persons are often a source of political and diplomatic tensions as they move away from their homelands. Their movement is often viewed with hostility by those they encounter in their travels. But most of these travelers are merely seeking a better life as evidenced by pursuit of social determinants of health. Their right to this pursuit is reflected in international law and by recognition of principles of social justice.