DZALEKA IS JUST ONE of hundreds of refugee camps typifying the outsized risk. Situated on 500 acres of what was once a national prison, the camp is now home to more than 48,000 refugees—nearly five times the capacity it was built for. The camp was set up in 1994 to assist refugees fleeing war, genocide, and violence in Rwanda, Burundi, and the Democratic Republic of Congo. It now includes refugees from Ethiopia and Somalia. 

The coronavirus threat to those living in Dzaleka is “alarming,” said Innocent Magambi, founder of There is Hope, a local nongovernmental organization (NGO) working in the camp to provide vocational training, education, and material needs. International aid groups, including the United Nations’ World Food Program, have cut food rations by more than half in the past year at Dzaleka, he said, and many refugees had started going into the community to farm. With growing restrictions over the coronavirus threat, they are no longer allowed to move freely. 

Magambi, who visited the camp on April 23, told WORLD by phone the next day that along with the spread of disease, he is worried about basic supplies for families to stay healthy. One widowed mother of five children with disabilities sustains the family by selling tomatoes and vegetables. Another single mother of four living with HIV/AIDS also trades small goods as a source of livelihood. 

“When people there think about it, it’s just like we’re just waiting to die,” said Magambi.

With the virus now gaining momentum on the continent, Malawian officials along with aid workers like Magambi met with the UN Refugee Agency (UNHCR) to organize a COVID-19 response. They agreed to build at Dzaleka the reception center and a quarantine site, which includes two tents with 30 beds each for refugees who may fall sick with the virus. But the camp does not yet have test kits, even while health officials confirm suspected cases in nearby Lilongwe. 

Testing for the coronavirus, not surprisingly, is emerging as the greatest challenge for combating rapid outbreaks. Every refugee aid agency WORLD spoke to cited it as its leading challenge. Even in areas where the World Health Organization (WHO) or private donors have supplied test kits, broken infrastructure and Ministry of Health bureaucracies are keeping them bottled up. Testing, too, is only as good as the ability to process test results in a nearby lab.

Magambi, like other providers, is also taking matters into his own hands, improvising amid dysfunctional healthcare systems and poor logistics. With his team, he said, he set up a group chat on WhatsApp, where he answers refugees’ questions on receiving assistance and sends details about the virus and its spread to combat misinformation. 

Contributions from a U.S. donor helped to fund emergency food packs of beans, maize, and oil, allowing There is Hope to assist 1,500 households in Dzaleka. Magambi hopes to scale that effort up to 3,000, with a focus on widows, the elderly, and people with chronic illnesses. 

The nonprofit’s refugee-run tailoring and craft center also started to sew face masks. In three weeks, he said, they made 16,000 masks and had to employ 50 more refugees to join their initial team of 38. 

Dzaleka is one of the five refugee camps Magambi has lived in since he was born to refugee parents in a camp in the Democratic Republic of Congo in 1993. “When I think about it as someone who has lived there, worked there, I really can’t see how people will cope,” he said.

THE CORONAVIRUS ALREADY is spreading rapidly in densely populated Bangladesh, where one of the largest refugee settlements in the world at Cox’s Bazar houses nearly 1 million Rohingya Muslims from Myanmar.

Rohingya families fled to Bangladesh starting in August 2017, when the military in neighboring Buddhist-majority Myanmar began a harsh crackdown against their villages. Global rights groups have joined the UN calling the military campaign a genocide involving rapes, killings, and torching of thousands of homes. 

The largest camp, Kutupalong, houses 600,000 Rohingya in an area of 5 square miles, or about 120,000 people per square mile. In New York City, a leading epicenter of coronavirus outbreaks, population density averages 28,000 people per square mile.

Since March World Vision has installed more than 3,700 new handwashing stations, said senior director Rachel Wolff, but hygiene is challenging with shared water taps and one latrine per 20 people.

Cox’s Bazar has one hospital. Its single intensive care unit has 10 beds and no functioning ventilators, according to Johns Hopkins epidemiologist Chris Beyrer in a video call with reporters last month.

Remarkably, by May 1 the camps reported no cases of the disease, but Beyrer and other health authorities do not expect that to last. Bangladesh was reporting 9,400 cases with 177 deaths. Without control of early transmission, he said, “probably 50 to 70 percent of everyone there will experience COVID-19 disease.” The one silver lining: The majority of the refugees are children, and likely to experience milder symptoms.

Numerous large NGOs work in the camps. But as Beyrer explained: “Of the 20 percent or so people with the coronavirus who are going to get more serious COVID disease in any population, about a third of them are going to need hospitalization, a significant proportion of them will need intensive care and ventilation support. And none of these NGOs have the capacity to do that kind of support.”

By late April Doctors Without Borders and others were ramping up dedicated COVID-19 wards, adding 20 isolation units and three quarantine centers to four existing field hospitals while expanding the number of beds. Food for the Hungry runs five health clinics in Ku­tupalong, and all have pivoted to aid in COVID-19 testing and to double as ­isolation or quarantine units as needed. Refugees International and other groups also appealed to the Bangladeshi government to lift internet and phone restrictions in the area, so that refugees can receive information about COVID-19 and report symptoms.

EUROPE HAS BEGUN to reopen after its coronavirus surge appeared to peak, but refugee camps housing 37,000 people on Greek isles in the Aegean Sea are at risk. At least 150 refugees have tested positive for the coronavirus in Greece, and authorities on May 3 began moving hundreds of vulnerable asylum-­seekers, including the elderly and sick, out of overcrowded camps. At densely populated Moria camp on the island of Lesbos, 19,000 refugees live in a once-temporary facility built in 2015 for 3,000 people. In some parts of the camp, 1,300 people share one water tap.

Aid groups called for the evacuation of camps like Moria ahead of a coronavirus outbreak, but instead Greek authorities sealed them. Greek police guard entrances, fearing an outbreak, and residents mostly stay in their tents.

Existing relationships are key to working under those conditions. Since 2015, Servant Group International (SGI) has partnered with a local evangelical church, sending short-term teams to camps like Moria. Now the Nashville-based group is still able to work through those locals, helping about 60 refugee families housed in a northern Greece camp near Katerini.

The local teams “visit them as allowed, take them food, pray with them, and try to secure urgent needs,” said Lisa Harris of SGI. She also holds a weekly call with workers to encourage them. “They are doing very well, but things in Greece are bleak for the ­refugees.”

Some aid workers worry most about displaced people who remain inside their own countries. Syria has 6.2 million internally displaced people, or IDPs, as a result of its nine-year war. Ongoing fighting has forced nearly 1 million ­people to flee their homes just since December, many of them taking shelter in makeshift camps or outside in the elements.

In Idlib province, where most fighting is taking place, satellite imagery shows how a relentless bombing campaign has reduced livable territory by 45 percent, yet the displaced population has remained constant at approximately 3 million. The satellite images show makeshift housing where crops grew only months ago. Cut off from food supplies, sanitation, and running water, these IDPs are newly susceptible to diseases like COVID-19.

“What health system they did have has been largely destroyed by the Russian bombing campaign,” said Hardin Lang, vice president at Refugees International.

Officially Syria by May 1 reported 44 cases of the coronavirus with 3 deaths. Aid blockades are hampering the COVID-19 response, with WHO supplying test kits but no recorded results. In March the Syrian government approved a mobile hospital clinic in Idlib run by a local Catholic charity with support from U.S.-based Partners Relief & Development. The clinic operates out of a converted shipping container, but to date, says Partners President Steve Gumaer, “we have no access to testing or labs.” Doctors say they are treating patients who show COVID-19 symptoms. They wear gloves and masks but have no eye protection or Tyvek coveralls.

OUTSIDE IDLIB, Syria’s embattled northeast has remained largely cut off from aid since Turkey seized key border towns six months ago. In March, Turkey cut the water supply to the region. Locals say it’s now restored but could be cut again as Turkey jostles for control.

Health authorities say IDP camps in northeast Syria already are showing a 10 percent death rate due to the spread of tuberculosis and other diseases. “All of these populations are at extremely high risk of coronavirus,” Thomas McClure, a Syria-based researcher at the Rojava Information Center, told a Kurdish television station. 

Large aid groups have pulled out of the region, and only small or local NGOs are able to deliver minimal supplies. In April, a Partners Relief team delivered masks, soap, and other supplies to abandoned schools housing 500 displaced families. As better-resourced countries see declines in cases, Gumaer and others hope reopened borders and supply reserves will boost their efforts.

A global pandemic hasn’t stopped the hostilities driving families from their homes throughout the world. The Syrian offensive in Idlib in recent months has increased the flow of refugees to places like Moria. The Myanmar army continues to target ethnic groups, and wooden boats carrying hundreds of Rohingya refugees have spent weeks at sea, denied port by Malaysia and Bangladesh due to coronavirus concerns.

Aid leaders hope the pandemic will prompt more attention to the refugee crisis and renewed interest in an international solution to ever-expanding refugee camps. “Outbreaks will continue to happen because displaced communities will get the last attention from governments and other authorities,” said Steve Gumaer of Partners Relief. “Or they will deliberately not be given any attention. They will survive on their own resources, or we will see them die in droves.” 

—with research by Michelle Schlavin