People in crowded conditions can't self-isolate, while soap and water are in short supply.
Ask Syrian aid worker Osama al-Hussein how he's holding up and, like many of those engaged in humanitarian work, he deflects, telling you instead how others are faring.
Push him a little harder and he relents with a laugh.
"Actually, I don't know because I feel sometimes I am helpless and hopeless. But I try to do my best."
Al-Hussein is one of the international aid workers bracing themselves for the arrival of the coronavirus among communities least equipped to deal with it, a hit they believe to be inevitable and with the potential to decimate refugee populations.
"The last displacement reached up to one million in three months," said al-Hussein, who works for the Union of Medical Care and Relief Organizations in Syria, referring to the last big round of fighting in Idlib and the flight it prompted.
Many headed for already over-crowded internally displaced person camps along the Turkish border. Idlib province is the last rebel-held territory in Syria, a holding pen of human misery.
"If the coronavirus spreads in camps [then] we're talking about a catastrophe," al-Hussein said in an interview with CBC via Skype. "Another humanitarian crisis in addition to the crisis that Syrians live in."
At the time of our interview, there had been no case reported yet, but al-Hussein believes the virus is already present given the absence of testing, hidden among the respiratory illnesses they already struggle to treat.
He said an "epidemic laboratory" had been set up in Idlib city, but that they were still awaiting proper test kits.
Some parts of northwestern Syria had started to receive thermal detection equipment as well as information posters about the dangers posed by the virus.
But raising the alarm is a challenge in a war-torn country balancing on the edge of a ceasefire few believe will last.
"The huge interest of the whole globe in one virus is for Syrians something very small in comparison with the crisis, with the bombardment, shelling, killing," he said.
Community-based solutions
Much of the protective advice given to people living in cramped, crowded and squalid conditions is sometimes simply impossible to implement, a concern echoed throughout the aid community.
In an interview in London, Dr Louisa Baxter of Save the Children said her organization is currently "galvanised" around finding community-based solutions for those communities already grappling with complex crises, from the Horn of Africa to Cox's Bazar, where the Rohingya live in what aid officials say is now the world's largest refugee settlement.
"How do you tell someone in Cox's Bazar or in a very remote part of Congo, 'Wash your hands for 20 seconds,' when there's enough water perhaps to cook rice that night or when the soap [has run out] out four weeks ago?" asks Baxter.
"Populations that have been really battered by weak health systems, by poor public health infrastructure, they are really the most at risk at the moment."
The only possible way forward will be on community-based solutions, she said, "because so much of this is how people relate and interact with one another and look after each other.
"How to tell community health care workers when to bring people in, how to look after people in your own home when there might be only one room that you share."
According to the office of the United Nations High Commissioner for Refugees (UNHCR) there are more than 70 million forcibly displaced people worldwide, nearly 26 million of them refugees.
Aid agencies worry that traditional donor nations, grappling with the pandemic at home, will forget about them.
"We can't afford to close our eyes to the suffering around us because the solutions will be found globally and the actions have to be global," said Baker.
But it's a tall order when borders are being shut even tighter as a way of tackling the pandemic. Getting aid and vital protection equipment to doctors and nurses, even getting aid workers themselves to vulnerable communities, has become exponentially more difficult.
'Very much reaching breaking point'
On Lesvos, in Greece, Doctors Without Borders (MSF) was calling for the island's notorious Moria camp to be evacuated of refugees even before the current crisis.
"The coronavirus now is just an extra add-on to an island that's already very much reaching breaking point," said Mie Therkelson, MSF's nurse activity manager, in a FaceTime interview from Lesvos.
The Moria refugee camp on the island is already a petri dish of ailments easily passed from one to the other.
Set up at the height of the refugee crisis in 2015-16, when more than one million migrants swept through the Greek Islands en route to the rest of Europe, Moria was originally designed for from 2,000 to 3,000 people. Therkelson says its current population is 20,000.
"Normally you would say to people go home and rest in your house and self-isolate. Self quarantine."
"But when 20,000 people are living in a very confined space where there's almost no access to a toilet, to washing points, it's impossible to self-quarantine."
Health fears are also expected to raise already high tensions on the island between the refugees and a local population that has felt abandoned for years, not just by its own government in Athens, but by the European Union as a whole, because of the failure to deal with the refugee crisis.
"We called for an urgent evacuation of Moria because [these] people gathered in such a confined space is a huge health risk for everyone," said Therkelson.
"It's important that we at least evacuate the chronically ill, the children, the elderly," she said.
But she's not hopeful.
"In the media, coronavirus is the one [issue] that takes up the most time at the moment. Not what's going on in the refugee crisis around the world."
An added psychological burden for refugees with asylum claims already in process has been the inevitable delay that will result from the coronavirus crisis.
The UNHCR and the International Organization for Migration have announced that they will suspend resettlement departures for refugees, given the global travel restrictions now being enforced.
"This is a temporary measure that will be in place only for as long as it remains essential," they said in a statement last week.
Ask Therkelsen if she is prepared for the coming storm and, like al-Hussein in Idlib, she deflects.
"My concern will never be staff. We're going to be fine. The problem is that we've got 20,000 people out there in front of us that don't have any possibility of self-quarantine."
And she echoes Baker in London that now is not the time to look away from suffering beyond our own borders.
"I understand also that this is an international crisis and something that we haven't seen before. But I really [want to] do all in my power to try to spread the message."
SOURCE: CBC
