By Raahulan Rathagirishnan & Darwin Jimal
It was only in mid-January when my colleague and I were sitting in the lecture hall learning about the history of epidemics and pandemics. Assistant Professor and Jason A. Hannah Chair, Dr. Jenna Healey recounted a list of ten lessons to be learned from our history of dealing with crises such as the Spanish Flu. She left us off with lesson number ten; “There will be new epidemics”. Fast forward only a few months later, and we were in the midst of a pandemic. We definitely did not expect to learn that lesson so soon.
The novel coronavirus, Covid-19, has ravaged countries, rich and poor. The great “equalizer”, the virus was believed not to discriminate who it infects. At the end of the day, it is a virus looking for a host, and once it finds one, it continues to propagate its spread.
However, the idea of the virus affecting people across the world equally is not the reality. Here in our vast backyard, social distancing, mask mandates, and a healthcare system better equipped to deal with surge capacities and increased screening have allowed myself and fellow Canadians garner a sense of protection, or at least an adequate response, against the virus. As a country, there has been a general trend in changing behaviors to prevent increased rates of infection.
Unfortunately, areas in the midst of conflict and war have had very little capacity to respond to the virus, and the pandemic has only compounded and amplified the struggles people are facing in these areas. Antonio Guterres, the UN secretary-General has urged for a global ceasefire, urging nations to focus their efforts in mitigating the dangers of Covid-19 [1]. Unfortunately, areas continue to be embattled, even advantageously using the pandemic to drive conflict. In this short passage, we will highlight the autonomous region of Kurdistan and Yemen, two regions where Covid-19 and conflicts are entangled.
Kurdistan
Kurdistan is an autonomous region made up of 4 governorates in Northern Iraq: Erbil, Sulaymaniyah, Duhok, and Halabja. My own parents came to Canada as refugees from Sulaymaniyah in 1997. Since then, political instability has continued to affect nearly all facets of life. Through recent conversations with friends and relatives, I’ve learned of the added struggle citizens in Kurdistan face in the wake of the pandemic. As of July 20th, the toll of Covid-19 on the Kurdistan region of Iraq includes 11,109 confirmed cases and 419 deaths [2]. Given the limited access to testing, these numbers are likely highly underestimated. Despite attempts to limit the spread of the virus, which include mandatory face masks and closing of national and provincial borders, daily numbers continue to rise. However, people can’t afford to stay at home. The economy depends on bustling, crowded outdoor markets where social distancing is extremely difficult. Without government aid, the decision to close shop means an alarming number of families have gone without food. Teachers and other government workers haven’t been paid for months leading to large protests throughout the regions.
These regions are also host to over 22 UNHCR sponsored camps for refugees and internally displaced people (IDPs). Hundreds of thousands of Syrian Refugees and Yazidi IDPs live in these UNHCR-run camps [3]. The increased challenges those living in these camps face due to Covid-19 includes the closure of borders which prevent movement of refugees to permanent homes, halting of the already limited educational activities for children, and a rise in domestic violence [4]. Little data exists on how prevalent the virus is within these camps. Having spent time at one of these sponsored camps, it is very apparent that social distancing and increased levels of sanitation are not feasible measures to be implemented. Tents in these camps are directly next to each other, and with a limited and overburdened humanitarian presence, the future of these camps looks bleak and are at a high risk being Covid-19 hotspots.
Yemen
Previous to the pandemic, Yemen has been facing the world’s largest humanitarian crisis. Covid-19 has exacerbated this already dire situation. Since 2015, millions of civilians have fallen victim to a war that has no end in sight. The Saudi-led blockade of all sea, land, and air borders of Yemen–supported by the United States and United Kingdom–has led to a shortage of food, water, and medical supplies, and has collapsed water, sanitation, and hygiene infrastructure in heavily populated civilian areas. The dramatically limited infrastructure and aid led to over one million cases of cholera in 2018, the largest and fastest cholera outbreak recorded by the WHO since 1949 [5]. More than 24 million people–over 80% of the population–is in need of humanitarian aid and over 3.6 million are internally displaced. Hospitals and schools continue to be bombed and children have been robbed of an education and their futures. Healthcare workers in Yemen have not been paid salaries in over 3 years, and the UN is over a billion dollars short in funding due to decreased international donations [6]. In a country facing so much strife, the virus, as one Yemeni epidemiologist says “could be the straw that breaks the camel's back” [7]. A crippling healthcare system marred by political dogmatism means that Houthi, the perpetrators of the war against the Yemeni government-led cities like Sanaa are withholding test results and attributing Covid-19 deaths to casualties of the war [8][9]. With a lack of transparency and a limited supply of testing kits, the true impact of Covid-19 on Yemen remains unknown, leaving very little information for epidemiologists and public health officers to work with.
A need for a global vaccine
As governments continue to mitigate the risk of coronavirus, inequitable access to vaccines will be a future dilemma that will be of further disadvantage to countries in conflict and weaker economies. The United Kingdom, Germany, and the United States are just a few governments that have begun acquiring vaccine doses and the necessary equipment to deliver nation-wide vaccine administration [10][11]. As the initial production of vaccines will be slow, there is the potential that it will only benefit developed countries initially. It is the hope that public-private health alliances such as Gavi, that invest in a global vaccine, will help distribute the vaccine in areas of conflict and of lower-income with the help of developed countries’ funding [12]. In the words of Dr. Christos Christou, International President of Médecins Sans Frontières, “As the virus knows no borders, the collective reaction to this pandemic must also be managed without borders”.
Works Cited
1. Secretary-General Reiterates Appeal for Global Ceasefire, Warns ‘Worst Is Yet to Come’ as COVID-19 Threatens Conflict Zones [press release]. United Nations. 2020.
2. Coronavirus Dashboard [Internet]. Kurdistan Regional Government Council of Ministers. 2020. Available from: https://gov.krd/coronavirus-en/situation-update/#what-is-krg-doing.
3. A safe space for displaced Yazidi Youth. 2020. Available from: https://uefafoundation.org/action/a-safe-space-for-displaced-yazidi-youth/.
4. Iraq June 2020 Fact Sheet [press release]. The UN Refugee Agency. 2020.
5. Federspiel F, Ali M. The cholera outbreak in Yemen: lessons learned and way forward. BMC Public Health. 2018;18(1):1338-.
6. Yemen: UN makes urgent funding plea as vital operations end. 2020. Available from: https://www.aljazeera.com/news/2020/06/yemen-urgent-funding-plea-vital-…;
7. Stone R. Yemen was facing the world’s worst humanitarian crisis. Then the coronavirus hit. 2020. Available from: https://www.sciencemag.org/news/2020/05/yemen-was-facing-worlds-worst-h….
8. Michael M. Coronavirus spreads in Yemen with health system in shambles. 2020. Available from:
https://www.theglobeandmail.com/world/article-coronavirus-spreads-in-yemen-with-health-system-in-shambles-2/.
9. Yemen’s Houthi rebels crack down as COVID-19, rumors spread. Associated Press [Internet]. 2020. Available from: https://www.dailysabah.com/world/mid-east/yemens-houthi-rebels-crack-do….
10. Dyer O. Covid-19: Trump sought to buy vaccine developer exclusively for US, say German officials. BMJ. 2020;368:m1100.
11. EU to use $2.7 billion fund to buy promising COVID-19 vaccines2020. Available from: https://www.reuters.com/article/us-health-coronavirus-germany-vaccine/e….
12. More than 150 countries engaged in COVID-19 vaccine global access facility. 2020. Available from: https://www.who.int/news-room/detail/15-07-2020-more-than-150-countries….