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What does ‘leave no one behind’ mean for humanitarian crises-affected populations in the COVID-19 pandemic?
  1. Lucy Singh1,
  2. Neha S Singh2,
  3. Behrouz Nezafat Maldonado3,
  4. Sam Tweed4,
  5. Karl Blanchet5,
  6. Wendy Jane Graham6
  1. 1 University College London Institute for Women's Health, London, London, UK
  2. 2 Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  4. 4 Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, London, UK
  5. 5 Geneva Centre for Education and Research in Humanitarian Action, University of Geneva, The Graduate Institute, Geneva, Switzerland
  6. 6 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, London, UK
  1. Correspondence to Dr Lucy Singh; lucy.a.singh{at}

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Summary box

  • Over 200 countries are reporting local transmission of COVID-19, including four countries with the largest refugee populations—Germany, Sudan, Pakistan and Turkey—and dozens more hosting tens of thousands of refugees.

  • Health systems in humanitarian crises settings are often poorly resourced and suffer from workforce shortages, inadequate levels of water, sanitation and hygiene (WASH) and marked deterioration in routine infection prevention and control practices.

  • Poorly resourced and fragmented health systems in humanitarian settings with limited resources, including health workforce, are likely to struggle to prevent the spread of COVID-19, and consequently be placed under immense strain with implications for patient care.

  • We are likely to see a high spread of COVID-19 within humanitarian settings where overcrowding is an issue and interventions required to prevent the spread of COVID-19 such as social distancing will prove extremely challenging to implement.

  • During this pandemic, limited access to WASH facilities is of particular concern as hand hygiene is regarded as the key preventive action for limiting the spread of COVID-19.

  • Vulnerable populations including refugees in humanitarian settings must be included in the international, national and local planning and provision of services in this COVID-19 pandemic.

  • Humanitarian actors and governments must step up measures to reduce strain from COVID-19 on the healthcare workforce and provide appropriate support at the front line in humanitarian settings, including strengthening WASH, reducing overcrowding where possible, protecting populations vulnerable to COVID-19 and providing additional resources to health services to be able to cope with the response.

To date, over 155 countries and territories are reporting …

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