Covid-19 skepticism and public health norms during refugee assistance: does skepticism always lead to poor safety protocol adherence?

BACKGROUND: Skepticism about COVID-19's existence or severity has spread as fast as the disease itself, and in some populations has been shown to undermine protective public health behaviors that can mitigate infection. For populations that are especially vulnerable to COVID spread and severity, such as refugees, COVID skepticism is particularly problematic. METHODS: We examine data collected from observations of humanitarian services provided to refugees in Lebanon, Türkiye, and Jordan to determine if skepticism is related to adherence to specific health-protective protocols (masking, social distancing, and hand sanitizing), and whether the effects of COVID skepticism are mediated by particular populations of refugees or the country in which those refugees receive assistance. RESULTS: We found that community skepticism (the frequency of COVID skepticism expressed by others within a service location) is associated with lower adherence to certain protocols and not others. We also found that with certain protocols, the country in which refugees receive services mediates the relationship between community skepticism and protocol adherence, but for other protocols the relationship between skepticism and adherence is independent of either country in which refugees reside or the refugee population being served. CONCLUSIONS: The existence of skepticism about COVID-19 does not always lead to an unwillingness to take protective measures to avoid infection. The mechanisms underlying the relationship between skepticism and adherence to health-protective protocols vary based on the type of protocol in question. In order to increase protocol adherence, the specific variables predicting adherence to different protocols need to be assessed in order to increase adherence and improve public health during humanitarian services.

Resilience to Nested Crises: The Effects of the Beirut Explosion on COVID-19 Safety Protocol Adherence During Humanitarian Assistance to Refugees.

To provide services safely to refugees during the COVID-19 pandemic, humanitarian non-governmental organizations (NGOs) have instituted public health safety protocols to mitigate the risk of spreading the SARS-CoV-2 virus. However, it can be difficult for people to adhere to protocols under the best of circumstances, and in situations of nested crises, in which one crisis contributes to a cascade of additional crises, adherence can further deteriorate. Such a nested crises situation occurred in Beirut, Lebanon, when a massive explosion in the city injured or killed thousands and destroyed essential infrastructure. Using data from a study on COVID-19 safety protocol adherence during refugee humanitarian assistance in Lebanon, Jordan, and Turkey, we conduct a cross-country comparison to determine whether the nested crises in Beirut led to a deterioration of protocol adherence-the "fragile rationalism" orientation-or whether adherence remained robust-the "collective resilience" orientation. We found greater evidence for collective resilience, and from those findings make public health recommendations for service provision occurring in disaster areas.