COVID-19 incidence is decreasing after a recent surge across Europe. However, 2.8 million deaths were reported in the week 20th April just after COVID-19 precautions throughout the EU have been scaled back dramatically. Poland, which has welcomed the majority of Ukrainian refugees, ended its indoor mask mandate on March 28 for all public spaces except for hospitals and has rolled back testing, quarantine and isolation precautions. The continued COVID-19 cases across Europe has the potential to pose a risk to refugees fleeing the war in Ukraine and to slow essential humanitarian aid work.
Host communities with a rapid population influx—over 5 million people have already fled Ukraine and more are leaving daily —are an ideal environment for a COVID-19 resurgence. The refugees entering neighbouring countries are largely unvaccinated, which makes them vulnerable to infection and severe illness. Ukraine has an adult population that’s 34% vaccinated and 10% boosted and their paediatric vaccination campaign was in its infancy when the invasion began.
Refugees are congregating in the thousands in train stations and at border crossings and staying in emergency shelters as they transit through to safety in Europe. Ukrainians fleeing unspeakable violence and ongoing attacks are understandably focused on survival and reuniting with their families, not—COVID-19. But we in the international aid community have the capacity and the resources to mitigate the risk. Operating in complexity is the very nature of humanitarian aid work and strengthening coordination between agencies is a foundational pillar of how the humanitarian community operates. Now, in Ukraine and surrounding countries, there is an urgent need to expand that unified approach in how aid agencies coordinate on COVID-19.
The most recent guidance available for COVID-19 in humanitarian settings is from May 2020, published by WHO and a consortium of humanitarian partners. This guidance is outdated and does not directly address the humanitarian aid workforce. It does not reflect the current epidemiological situation of COVID-19, the emergence of new variants and other factors such as population immunity. It was developed prior to the availability and uptake of vaccines and self-administered antigen testing and is misaligned with the current understanding of the period of infectiousness and reduced isolation periods. Additionally, updated WHO recommendations for mask use in community settings where physical distancing cannot be maintained is not reflected. Furthermore, the existing guidance is focused on camp-like settings which fails to meet the needs of a dispersed humanitarian response operating across multiple countries.
Humanitarian aid organizations have varying occupational COVID-19 standards for their workers covering testing, quarantine, exposure and isolation requirements. Those standards are often based on the COVID-19 guidance in the countries where the organizations are based and may not be applicable in the Ukraine context. It’s unclear: Should organizations default to local COVID-19 policies where they are operating—guidance clearly not developed with a war and massive displacement in mind? If aid workers become infected with COVID-19 what are the isolation requirements? How might this potentially burden local health systems in terms of testing and hospitalizations? And how do we gauge the risk to refugees and host populations?
In Poland, where Americares has set up its base of operations for the crisis, we’ve seen aid organizations modify their mode of working in recognition of the COVID-19 threat. Some coordination meetings are being held remotely with Signal, WhatsApp and other messaging applications. However, there is no overarching guidance in a context of crowded humanitarian locations necessitating frequent contact and potential exposures.
There is an urgent need for COVID-19 guidance for humanitarian aid workers with buy-in across aid agencies to ensure continuity of operations and protect the humanitarian workforce, refugees and host communities. This guidance will likely need to be distinct and in addition to guidance from the countries where groups are operating.
This guidance may consider:
- Prevention strategies, such as universal mask-wearing by all humanitarian aid workers and a requirement for vaccination, including booster doses for those eligible when deploying from countries where boosters are accessible.
- Testing strategies such as regular antigen testing and the possibility of central repositories for COVID-19 antigen testing to be available to agencies.
- And isolation strategies such as a standard 5-day self-isolation requirement for asymptomatic individuals who test positive and a standard 7-day isolation requirement from the first positive test for symptomatic individuals or longer until symptoms resolve.
These efforts will ensure life-saving humanitarian operations can continue and avoid a workforce immobilized by COVID-19. We also must recognize the need to vaccinate and protect refugees by ensuring COVID-19 vaccination is offered as part of their resettlement.
Authors: Dr Unarose Hogan (PhD, MSc, BN, RN) is the senior infection control advisor at Americares with an extensive humanitarian career across Africa, Central and South East Asia.
Dr. Julie Varughese is the chief medical officer and vice president of Americares technical unit leading a team of experts. She is Board certified in infectious disease, internal medicine and pediatrics.
Competing interests: None
Handling Editor: Neha Faruqui