Public Health Threats and Pandemics
Refugees and Displaced Persons
Vice President of International Programs, HIAS
Professor of Biomedical Engineering, Boston University
FASKIANOS: Good afternoon and welcome to the Council on Foreign Relations Religion and Foreign Policy Conference Call Series. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. As a reminder, today’s call is on the record and the audio and transcript will be available on our website, CFR.org, and on our iTunes podcast channel, Religion and Foreign Policy.
We are delighted to have Rachel Levitan and Muhammad Zaman with us.
Rachel Levitan is vice president for international programs at HIAS, working closely with partners in the U.S. Department of State’s Bureau of Population, Refugees, and Migration, and at the UN Refugee Agency. She helps drive HIAS’ international efforts to increase protection for particularly vulnerable refugees, including survivors of torture and gender-based violence, persons with disabilities, older refugees, and sexual minorities.
Dr. Muhammad Zaman is Howard Hughes Medical Institute professor of biomedical engineering and international health at Boston University. His current research is focused on developing robust technologies for high-value health care problems in the developing world, particularly in the area of maternal and child health, and working on health and innovation policy issues in developing nations.
Welcome, Rachel and Muhammad, to both of you. Thank you for being with us. Today’s call is focused on COVID-19 and the implications and effects of this pandemic on displaced people. Rachel, I thought we could begin with you to tell us a little bit more about the work that you’re doing at HIAS and to talk about the effect of COVID-19, and how that’s affecting people you are working with.
LEVITAN: Sure. Thank you so much, Irina. Really wonderful to be with you, and Dr. Zaman, and all of the folks who called in today. Some of you may know already, HIAS is one of the oldest refugee organizations in the world, and certainly in the United States. We’ve been around for nearly 140 years. And we’ve worked to achieve protection for refugees throughout that period of time. We began by providing support to Jewish refugees. And we’ve continued to do that by expanding our mission to work with refugees of diverse faiths, ethnicities, and backgrounds. And we do out of a place of Jewish values, history, text, and experience. We are currently located in sixteen countries around the world.
So I work with all of our international programs, where we provide services to refugees and other forcibly displaced populations in four key areas: the first is legal protection; the second is gender-based violence prevention and response; the third is community-based mental health and psychosocial support; and the fourth is economic inclusion. And we, of course, work with a whole range of partners, including many, many other faith-based organizations and local and international organizations providing assistance to refugees to ensure that we’re giving them exactly what they need. In the U.S., we work with seventeen affiliate partners in eleven states, again, many of whom are faith-based organizations, and supported by very large faith networks, including many, many volunteers who have spent years creating welcoming communities for the refugees here in the U.S.
So from that place of understanding, I can share a little bit about what we know are the experiences of refugees during the COVID-19 pandemic, and the lockdowns, and other regulations that have been put into place. And also, I’ll share a few words about how HIAS and other partners are responding to the situation to ensure that we can reach all the vulnerable refugees that we previously worked with, and the many more who are desperately in need of support because of this global pandemic.
So as a starting point, how is COVID affecting refugees generally? We know that there are over seventy million refugees and forcibly displaced people around the world right now. And of the two-hundred-plus countries that are reporting COVID-19 cases—and that’s, of course, a number that is continuing to grow—more than 120 host very significant refugee populations. What we’ve seen primarily is that the economic impact of COVID has had a huge, and will continue to have a huge and devastating, economic impact on countries around the world, particularly in developing countries where we know about 85 percent of the world’s refugees live.
And as a result, because of the economic situation, because of political instability in many of those countries, overcrowded living conditions both in urban refugee areas and in camps, lack of access to clean water, lack of access to health care, we’re seeing that refugees, and asylum seekers, and other forcibly displaced populations are particularly vulnerable to contracting COVID-19. We’ve seen from our experience working with refugees and other displaced populations in the countries where we operate that there has been a huge impact on the ability of refugee families to support themselves through work. So most have found themselves immediately and quite drastically cut off from economic support, which has meant that they’ve had serious challenges securing food, maintaining shelter, securing medical care for themselves and their family members.
In some countries, we’re seeing that there has been a tremendous amount of pressure on governments, who face real political pressure to serve local vulnerable populations before serving refugees. So we’re seeing a rise in discrimination and xenophobia as a response. Another serious concern is that refugees and asylum seekers are, like so many other populations, seeing and experiencing increasing levels of gender-based violence, particularly domestic violence for those who are stuck at home and facing the tremendous pressures associated with the economic and other impacts of COVID-19.
And also, across the board in the operations where we are working, we’ve heard reports from clients of increases in mental health concerns. So that means greater levels of anxiety, greater levels of depression, more cases of suicidal ideation. And so there are actually tremendous challenges that refugees are facing globally. And we see that because they have been vulnerable to begin with, some of the challenges that they traditionally face have been seriously exacerbated.
How has HIAS and other humanitarian organizations responded? First, the way that we’re responding is for those staff who are continuing to have any face-to-face contact with refugees, we’re ensuring that they’re safe. So we’re getting PPE, protective equipment, out to our staff and to refugee community leaders where we’re working with them directly. But for the most part, we’re shifting to remote services. As one of our country directors said recently, we’ve moved from face-to-face to screen-to-screen. And so one of the first ways that we’re doing that is figuring out modalities to transfer cash to refugees, asylum seekers, and others, whether through creating new mechanisms for bank cards and electronic transfers, food vouchers, and other ways that we can get money to refugees. Because with the cut of their economic opportunities, this is really the only way they can secure their basic needs and protect themselves.
Another piece that we’re doing is relying on these remote platforms, whether it’s hotlines, individual calls, Instagram Live, Facebook. We’re shifting to providing either direct services, such as mental health counseling, gender-based violence counseling, legal services, and also providing basic information—how to keep yourself safe. What are the latest regulations that have been issued by your local government? How do you secure services from HIAS and other services? So we’re pushing that out to not only our own clients, but to refugee communities writ large, so that people can secure the protection that they need and have a direct line to the service providers, of which of course HIAS is one.
The other very critical piece of the work that we do is we engage in advocacy. So internationally that has looked like ensuring in Ecuador that refugees have access to medical services, pushing for unemployment benefits for refugees in Israel, which actually today, just through advocacy that we’ve done with a number of partners, overturned something called the deposit law, which was garnishing 20 percent of refugees’ wages. And so we’re doing advocacy internationally to ensure generally that refugees can have access to the services that nationals do, whether it’s medical services, basic support, and other types of assistance.
And we’re also working with other partners, including a wide range of interfaith partners and networks, to ensure that in the U.S., refugees are able to secure the same benefits and rights as citizens and residents, including through stimulus payments, testing, and health care. And so many of our partners, as I’ve said, are faith-based organizations that are working to press local governments, here in the U.S. and internationally, to ensure that refugees are able to access the services, the protections, the cash assistance that they need to support themselves. And of course, we will continue our work with partners, including many faith-based organizations internationally, to provide as many services and as much information to refugees that we can to make sure that they can protect themselves and their families, and secure the basic support that they need to survive during this time period.
FASKIANOS: Thank you, Rachel, very much for that overview. I appreciate it. If we could turn now to Muhammad. Could you talk a little bit about the medical testing and the social effect of all of this, that would be great.
ZAMAN: Thank you so much, Irina. I’m really honored to be a part of this conversation. And on the eve of Ramadan, I can only imagine what a privilege I have to talk to faith leaders and talk about issues of social justice and sort of taking care of people who are very vulnerable. So really, really honored. Thank you so much for the opportunity.
I think Rachel really covered most of the things that I wanted to talk about, the challenges that are there. I want to sort of challenge some of our assumptions here that I think are important, as we are realizing. First of all, if you look at sort of the international guidelines, they simply do not apply to refugee communities. So you’re talking about hand washing in communities that do not even have water to bathe or even clean drinking water. You’re talking about physical distancing in places where in tight little dorms, whether it is an urban environment or refugee settlements and camps, you have eight, ten people, a couple of families. And you’re talking about getting testing done when testing is at a hospital that requires you to go and take money out or go to a place that has risks—emotional, physical, mental harm.
So we really have to think about how inappropriate the context is here when we talk about sort of global guidelines. And this has meant something, which I think is a false sense of security, that the numbers aren’t very high in refugee camps. Well, the numbers aren’t very high because you haven’t done any real testing. I, myself, grew up in Pakistan. And I’m quite aware of the limited number of tests that have been done in that country. There is not a single report of any testing done in refugee villages. There are about a million and a half people in refugee camps; they’re called refugee villages in Pakistan. About a million or so live in urban areas. So that’s partly the challenge.
And testing is also hampered by the fact that even in this country, even in the state that I live in, Massachusetts, which seems to argue that technologically it is ahead of the curve, the false rates—the false negative rate is about 30 percent. So even in this place you have tests that are faulty. I know for a fact, when I was talking to colleagues in Uganda, that perhaps more of those tests that they have looked at, they have concerns about them. And on and on. So you’re looking at limited testing, and you’re looking at tests that are significantly flawed. And there are just not enough. So that’s the first problem. And that should not give us any sort of comfort that the refugee communities are somehow immune to this challenge, but in fact should be a cause for serious concern. So that’s point number one.
Point number two is, what alternatives are we offering? That is important to recognize, because there continues to be a stigma associated with getting tested and finding out you’re positive, right? What exactly is the information that is provided to them? That it is not your fault. It’s perfectly fine, and there are ways to handle that. And in our conversations, time and time again you see that that clarity of information isn’t there. What do you do if you are positive? And then that means that people do not want to be tested because of that stigma, that fear that is very real.
And the final point I think that Rachel so eloquently described is a very, very important one, and that is the fact that there is increasing nationalism, unfortunately in this country and elsewhere, where we are othering people, where we are sort of saying me first, and my family first. And I think there is some argument to take care of your loved ones, but it should not be at the cost, at all, for sort of discriminating against others. In a number of countries, as Rachel pointed out, people are sort of focusing on their own communities, their own vulnerable communities, and the refugee communities are nowhere on that pecking order. In Pakistan in terms of cash transfer, in terms of good and provisions you need a national ID card, which many refugees do not—actually, none of them do. Many of them do not have any UNHCR documents either. That means that they’re truly looking at a very, very difficult time.
And the final point I think where we need to challenge our assumption is the number that Rachel mentioned, about seventy or seventy-one million includes a significant number of people who are displaced out of their homes but are in their own countries. The case in point here in Yemen, a place that has been ravaged by war over the last five to seven years and has had some of the worst cholera outbreak in human history. Now, you sort of overlay that with some of the some of the conflicts have still gone on, despite sort of the official calls for ceasefire, and the fact that a significant population is acutely malnourished. I’m not talking about there’s some micronutrient deficiency. I’m talking about acute malnourishment. And then you sort of have this COVID challenge. And it’s really become something that needs to be addressed. So we, I think, have to expand our horizon here and recognize that people may not have the capacity to cross international borders, but may be very, very vulnerable in their own countries when they are IDPs, or internally displaced people. And this is something that we have to pay attention.
And the last part is somehow there are other medical assumptions that need to be questioned. For example, we have somehow felt that children or sort of youngsters aren’t going to be hit badly, and they’re largely immune. This is a separate problem of ageism in this country, which is disgusting in its own right, where we have sort of decided to abandon our people who are elderly or people who have underlying health conditions, which is a separate issue. But even this assumption actually does not hold when you look at places like Yemen, where nutrition and immune response is really compromised because of longstanding challenges in health. So somehow thinking it’s only a certain group of people that need help and children are going to be OK is another assumption that we need to question and address in places where refugees are really struggling, and where you have internally displaced people.
So I’ll end here because Rachel really sort of covered the main component of what the challenges are, and why it is very, very, very difficult right now for these communities. And there’s a tremendous sense of anxiety about their health and wellbeing, about the economic future. And you sort of hear this over and over again if you look at the New York Times, the Washington Post, or the Guardian, that people are saying we’ll die of hunger before we die of the coronavirus. And I think that anxiety is very real and tells you how painful and how difficult this whole thing is for people.
FASKIANOS: Thank you, Muhammad. That was also terrific.
Let’s go now to questions from the group.
OPERATOR: At this time we’ll open the floor for questions.
We’ll take our first question in queue. Caller, please identify yourself by name and affiliation and proceed with your question.
FASKIANOS: Yes, go ahead. If you could identify yourself, that would be great.
GANDHI: OK. This is Homi Gandhi, representing Federation of Zoroastrian Associations of North America.
Thank you. It was a wonderful explanation of what’s happening. Sad. It’s really sad what’s happening. And thank you for helping out all those refugees. I have a two-part question. My first question is, you are transferring the funds to the credit cards or debit cards of the people who are wanting it so that cash can be used for various purposes. What about the people who are—who are in a country where cash—credit card or debit card transactions do not take place, and where the United States has a restriction of not transferring any funds? That’s the first part of the question. And the second part of the question, is if I donate a certain amount and request you to transfer it to particular group, would you be able to do that? Thank you.
LEVITAN: Thank you. Thank you so much for your comment. It is sad. It’s heartbreaking. And the stories that we hear of refugees who worked so hard to get themselves back on their feet in the last couple of years, who’ve lost everything in just a couple of months, is really—is really incredibly sad. And we’ve heard that story again and again from country offices that are working directly with refugees, particularly those with economic inclusion programs who’ve just been devastated by this current situation. So as you say, rightly, there are quite a few countries that use debit and credit cards a lot. You’d be surprised, Venezuela, Kenya, Ecuador. There are so many countries where debit cards, or a system of providing a cash transfer for debit cards, is very common. So that’s the great news.
To your question about places where people don’t have debit cards, or we don’t have a system in place to reach them, or people are sort of not registered yet, what we try to do is build on programing that we have to provide food and nonfood items through delivery packages. And that has been successful in a number of different locations where people don’t have cards. And it works in countries where we already have a system to provide that kind of service. Not every country provides food, nonfood items, or cash. So in the places where our clients really do need that support, refugee communities do need that support, we’re either working to quickly pivot to be able to provide that assistance or we’re working with partners who can deliver that because they’re already providing that service. So it’s either cash transfer or, in some cases where the spread is not great, we’re providing staff with PPEs to go out to communities to do distributions of food and nonfood items. Or, else we’re working with partners to do that.
In terms of the question about a donation, if you want to restrict a donation to providing cash assistance, you’re absolutely welcome to do that. And we’ve gotten a number of donations in that way. I’d have to refer you to someone who works on our development team if you had a particular, targeted type of donation that you wanted to make. And I’d be happy to do that, if you’d like to, offline.
GANDHI: OK. I’ll do that. Thank you very much. I appreciate your answering the question.
LEVITAN: Thank you.
FASKIANOS: Thank you. Next question.
OPERATOR: We’ll take our next question in queue. It comes from Katherine Marshall with Georgetown University. Please go ahead.
MARSHALL: My question is for both of you. Where do you look for some kinds of solutions to the tragic situation? If you could comment a little bit more—I guess everything from what you think should happen to where the most feasible place is to look for actions.
FASKIANOS: Who wants to start that?
ZAMAN: Go ahead, Rachel. Go ahead.
LEVITAN: OK, sure. I mean, it depends what kind of action you’re talking about. And thank you so much for that, because I think there’s been a big response. People are asking: What can we do? How can we contribute? How do we fix this situation? So it’s really a question on the top of so many people’s minds.
When we talk about program delivery, the place that we get a solution is really initially from the clients we serve. So we’ve done rapid needs assessments out there in the field, talking to our clients to say: What do you need? How do we best serve you? What are your priorities? As humanitarian agencies, we have to be very careful to check ourselves to make sure we don’t say: We know the answer to what you need. We need to listen to the voices of the people that we work with and seek to support. So looking to them is the first place that we go to get a solution on what the needs are. We then work with other agencies on the ground at the country level, including the UN Refugee Agency, and local organizations, other international NGOs that are providing services, to help think through: Who is providing the medical assistance? Who is making sure that refugee children are able to access remote services? Who is able to support the mental health, the legal, the gender-based violence to coordinate that?
At the advocacy level, in the U.S. one of the things that we always suggest is to sort of have a look at the highest-stake action page, which sort of sets out work that folks can do advocate for refugees in the U.S., to educate themselves about the situation—including about the impact of COVID-19 on refugee communities. There are also opportunities to volunteer or, of course, to donate. And usually I’m not the big pitcher around donations, but because cash is such a huge solution right now I really do feel like it’s something that we can do to help, which is to direct cash assistance to refugee communities who’ve been so abruptly cut off from income sources. But for instance, there’s an opportunity to sign a petition calling on the Department of Homeland Security to respect the human rights of asylum seekers in the United States during the COVID pandemic. And there are other places that you can educate yourself about how we and other organizations are taking action that can trigger some thoughts that you might have on an organizational level or on a personal level to identify what feels like the right solution for you and the organization that you work with.
So I’ll leave it there, and maybe, Dr. Zaman, you have some other ideas that you’d like to share.
ZAMAN: Thank you, Rachel. And great question, Katherine.
So I think one of the things—what we have learned in our work—and I must admit that our work is focused largely in the Middle East and North Africa, and East Africa, and Pakistan. So I cannot comment about some of the other places. But one of the things that is important is the trust element. So a heavy-handed approach using heavy military or police in a refugee camp is not going to get you what you need there. There is a lot of anxiety among refugees. So what I mean by that is we argue that there has to be local involvement of local NGOs and local institutions which have a longstanding trust and relationship with the refugee communities. There are many NGOs that work on the ground that employ refugees, that employ people who may be known to you, who live in that area, who are from your neighborhood.
And that is absolutely important because the deficit of trust is only going to make people more active and force them to take wrong decisions. There have been a number of cases, and I can share with your later on, where the idea for testing or quarantine was sort of met by a sense that this is one more way to get us, or to deport us, or to send us to authorities—all sorts of things. So the element of trust is absolutely essential. So what I tell people is that they have to sort of support organizations that have a longstanding relationship with the community, because that is what is going to get you to that little tarp tent at the end. That is going to get you to that mother who needs help, whether it is in an urban environment or in a camp. So that’s the first thing.
The second thing is you have to recognize that many countries, and Rachel alluded to that, themselves are struggling. These countries that are hosting refugees are struggling. So Lebanon, and Pakistan, and Uganda, and Bangladesh. So you have to sort of look at the local communities, which are non-refugees, and how they can be a part of the solution. The last thing we want is a local community that is not—that a citizen group feels alienated and feels that they are sort of not being taken care of these outside NGOs are only taking care of refugees. So we want to sort of support groups that are looking at this as an integrated development challenge, as opposed to one that is going to create antagonism between the host communities and the refugee communities. And truly this problem is something that manifests itself and only leads to further violence and further chaos.
FASKIANOS: Thank you. Next question.
OPERATOR: We’ll take our next question in queue comes from John Chane with Episcopal Church, Washington National Cathedral. Please go ahead.
CHANE: Yes. Thank you both for the hard work that you’re doing. I just—it’s amazing to me when you’re looking at, what, almost sixty-nine million displaced persons throughout the world, and when you’re looking at maybe a hundred and fifty thousand people already dead—and that number is increasing—throughout the world from COVID. I want to run by something to you—two things.
One, OFAC. OFAC restrictions can be a real problem in terms of funding an organization that’s working in a country that is designated by the Treasury Department as what they might call a bad actor. And so if, for instance, a not-for-profit gives money to the IRC or to the Red Crescent, working in a country which—with refugees that’s considered to be a bad actor, you as a not-for-profit can be in significant trouble with the United States government.
The other is that when you look at the numbers of displaced persons, and now the impact of this pandemic, I’m looking at the possibility—you know, we have a UN Security Council ceasefire resolution that’s blocked by the United States and Russia. That would really release a lot of support and aid not only for ending what’s going on—pick Yemen or any country—but also begin to address in a more contacted way the whole issue of refugees and displaced persons. And so it’s a huge issue. And nationalism, according—Muhammad pointed out a very important thing. Nationalism has become a real detriment to making any kind of cohesive response possible at this point. But it’s such a complex problem I’m not sure how you get to some kind of a resolution that has international cooperation attached to it. That’s kind of a broad statement-question question.
FASKIANOS: Rachel, why don’t we start with you, and then we’ll go to Muhammad?
LEVITAN: Sure. I mean, thank you for those observations. Bottom line, I think it is incredibly complicated to get all the players that are needed together to effectively respond from a funding perspective and from a regulatory perspective. To your first point, sure. I mean, OFAC restrictions do place significant limitations on humanitarian organizations at times. We have not had that experience ourselves. And so it’s hard for me to comment more broadly on how organizations who are trying to provide assistance and support to refugees and others, particularly in these times, have been affected by that.
Certainly, we know that Treasury has reached out to organizations providing assistance to refugees to ensure that those who are providing humanitarian assistance can continue to function. And we’ve had some positive interactions with Treasury in that regard, which we really welcomed, and so far have not been affected by that. So we’re thankful for that piece.
I think more broadly speaking, the most that we can do is really work with our partners across the international humanitarian organizations network, with donor countries who are interested, and able, and willing to support responses to COVID, welcome the flexibility that some of our government donors have had in recognizing that COVID is affecting organizations who are trying to pivot very quickly, both in the short and longer term, to ensure that refugees continue to get access to basic services, support, and protections. And then push to ensure that we can get the response that’s needed.
I think I alluded earlier to the advocacy that we’re engaging in. We’re finding right now that the advocacy that has been most effective and seen the most operational impact happens at the national level. And that’s because of longstanding relationships that we have with local communities, with host communities, and with local government agencies, who we’ve really worked to support and build the capacity of over the years. And so we’ve been able to get some of that regulatory—positive regulatory responses in those countries at the national level because of longstanding relationships. So that’s really been the approach that we’ve been taking, and where we’ve seen success. I’ll leave that there.
FASKIANOS: Muhammad, over to you.
ZAMAN: Thank you so much. So I actually don’t have much to add beyond what Rachel has said. I think you’re absolutely alluding to a very real point. I think we are underestimating the value of advocacy here. I’m not one who would sort of argue that’s all we should do, because I think there’s lots and lots of work that needs to be done on the ground. But I think at a time like this we should have people with all-of-the-above approach, and sort of strong relationships, strong international partners engaging groups that have a long history and a record of service, along with advocacy.
I think writing in the news media is one aspect of this. Certainly not the only one. But I think those kinds of things are underappreciated. In my own Muslim community I think there’s a lot of work that needs to be done. And I would say that we have not done nearly enough work in sort of advocating among our community members to sort of be champions for these issues, and really bring about a change within our communities, shed light on the importance of working with refugees across the world, across religious, and national, and ethnic divides. So I would agree with Rachel. I think this is a way to do it, while keep pushing the things on the ground.
FASKIANOS: Thank you. Next question.
OPERATOR: Our next question comes from Robert Golsimmer, Catholic Relief Services. Please go ahead.
GOLSIMMER: Hi. Thank you very much for your presentation.
I was wondering if you could comment on the status of the testing. You mentioned that there wasn’t much testing. And, we face this problem in the U.S. as well. But you would think it should be made a high priority in refugee environments, in camps, and so forth. So could you talk about why more testing isn’t occurring? Thank you very much.
ZAMAN: Thank you so much. The issue with testing is twofold. One is there are not enough tests available. And that’s true, certainly, in the United States, and true elsewhere as well. That problem is also compounded by another fact that countries are unable to buy supplies, basic supplies for testing, because they are being directed to whoever is bidding on them. So there is an international sort of bidding war going on, on all kinds of hardware, and instrumentation from testing, to ventilators, to PPE. As a result, countries that have deeper pockets are able to get them and countries that are struggling are unable to get them. So that’s part one. Not enough tests available. These countries may not have capacity to make their own tests. And they cannot go into international markets and outbid the U.S.’s of the world. One.
Two, even within countries the testing is prioritized on people who present a narrow case definition. Do you know somebody who has coronavirus? Have you traveled abroad recently? Do you have symptoms? And we know now that asymptomatic cases are significantly high. And often testing is done in a way that requires the person to be proactive. You have to go and get tested. The testing is not coming to you. Think of somebody is who is already tremendously anxious, lives in a vulnerable place, doesn’t really trust the system. And then there isn’t enough testing there. So the problem and what happens is you don’t have adequate testing—by a long shot. I mean, in these countries there’s not enough testing to begin with. And with the refugee communities, there’s almost none.
So again, I’ll go back to the example of Pakistan. Pakistan has conducted perhaps a hundred and twenty-five (thousand), one hundred and fifty thousand tests in a country of about two hundred and twenty million. By the same measure, the U.S. has conducted about four million tests, a little bit more. So populations are not that different, two hundred and twenty million versus three hundred million. One country does a hundred and twenty-five thousand tests; the other country does four million tests. And even the four million in the U.S. are nowhere as compared to per population tests in Germany, in Korea, and elsewhere. So then on top of this, you have inherent bias and racism. You have xenophobia. And you have tremendous anxiety. That makes for us a very difficult situation, where the burden is on the refugee to get tested. And then there are implications of that. How he or she would feel if that person turned out to be positive.
So I don’t have an answer that is comforting, except for the fact that we need to move on a lot of things here. We need to change the total number of tests done. We need to make it easier for refugees to get tested. We need to expand our case definition. And we need to make sure that those who tested positive are given the adequate support and not necessarily made even more vulnerable in their communities and beyond.
FASKIANOS: Thank you. Next question.
OPERATOR: Our next question comes from Dorothy Rau with the Turkish Fulbright Commission. Please go ahead.
RAU: Hi. I have a question for both of you.
With country populations hosting large numbers of refugees, in Turkey for example, which already seen increases in discrimination and blame being placed on refugee populations, especially as unemployment rates have increased in recent years, how do you go about maintaining trust or building trust with these communities where discrimination is likely to increase as resources become more scarce and unemployment continues to rise? Also, are you concerned about the transition towards that screen-to-screen contact that you mentioned, Rachel, exacerbating this problem, because it’s either harder to show digital empathy or because of the lack of digital resources in these communities? Thanks.
LEVITAN: Thanks, Dorothy. Excellent questions.
And these are questions, to be honest, that are things that we think about even before COVID. How do we build trust with local communities? Because xenophobia is not something, of course, new to this particular situation. It’s something that we’ve been dealing with for decades. And it’s something that we integrate into the approach that we take with our program. So for instance, one of the ways that we always work is to try to ensure that our services support local host communities as well. So we’ve done some amazing work around something called the graduation model, which helps refugees, quote/unquote, “graduate” out of poverty, and allows them to maintain sustained income and savings and inclusion in local communities.
The work that we do in the graduation model will always include local family members who are from national populations. So we always will do what we can to bring together both refugee and local host communities, so that we’re lifting up the economic situation or addressing the other protection concerns that are facing not only refugees and displaced populations, but the local community members where they live. So we see in Colombia, for instance, that the Venezuelans that we’re working with live in communities with displaced Colombians— there are seven million IDP, internally displaced Colombians—returning Colombians who’ve just come back from Venezuela, and Venezuelans who have fled the situation in Venezuela.
So our work there is to help lift up and support all of those diverse community members, so it doesn’t look like we’re only supporting a subset of the population with our assistance. And by doing that, we’re able not only to build trust between refugees and local host communities, but we’re able to make that connection with community members so that when we’re seeing a sort of bubbling up of xenophobic response, we have connections to local community leaders that can help address or tamp down the xenophobic response. And so it’s sort of an insurance policy, but it also just makes good sense because you don’t want to encourage bad attitudes toward refugees because they appear to be getting resources that poor local community members get.
In terms of the second part of your question, does screen-to-screen create more problems than it helps solve? So far, we haven’t gotten that feedback. We’ve gotten tremendously positive feedback from the community members that we’re working with. We’ve had some incredible gatherings on Instagram Live to help the groups that we work with deal with the buildup of anxiety. And we’ve done so much by Facetime or just by telephones through hotlines. It’s not perfect. It’s much better. And, so much of our work is about face-to-face communication, whether it’s through therapy, whether it’s helping a survivor of gender-based violence, whether it’s providing legal assistance, whether it’s doing vocational training.
All of that is work that, is much more effective when we can be there face-to-face with folks. But the feedback that we’ve gotten is: Thank God you’re here now, because I feel so isolated, and lonely, and unsupported, or at risk, or really fearful for my survival. Having you there, by phone, by Zoom, however it is, has been so important. And our staff in the field sort of works—we feel like we’re working day and night. They are really working day and night to field phone calls and have Zoom calls with clients who are feeling particularly in need right now. And so the response so far has been positive. It’s not a lifelong solution. And we hope that as there are rolling decreases in the restrictions, we’ll be able to safely provide that face-to-face support again. But in the interim, the response has been quite positive.
FASKIANOS: Muhammad, do you want to add anything?
ZAMAN: No, I think Rachel covered it very, very well. I would only say that building trust is not something that can happen right away. And it requires real effort, as you would imagine. I think one of the things that hasn’t happened much is, just as we want to make sure we have a strong effort to increase awareness here in the United States, we also need to do the same in other countries, Turkey and in Pakistan. And it’s important for you to have allies in the country, people who are respected and feel for the plight of the refugees, write in the newspapers, come on television, use social media.
I think it is going to be—I mean, I can certainly tell you that if I were to sort of make claims from here and sort of talk down to community leaders or political leaders in other countries, it’s going to backfire. But on the other hand, if somebody is rooted in those countries and has a relationship, and he or she speaks, then I think that’s going to make a big difference. And one of the things that we have seen is that sort of writing in the local newspapers, or coming to the local television, or being in the local media presence by community leaders or by citizens, that can make a huge difference.
And will not sort of erase by any means the challenge of xenophobia and racism, but really can soften the blow and give an opportunity to continue to do work. And I think that is, again, underappreciated in terms of our collective humanity of how we really need to build partners and allies, not just in refugee communities but also among doctors, and intellectuals, and concerned citizens, and civic groups in country—Turkey, Pakistan, Jordan, elsewhere. I think we need to do a lot more of that.
FASKIANOS: Thank you. Next question.
OPERATOR: We’ll take our next question in queue. It comes from Adam Carroll with Burma Task Force USA. Please go ahead.
CARROLL: Yes. Hi. I appreciate—
FASKIANOS: Go ahead, Adam.
CARROLL: I appreciate the discussion of trust building, and certainly the context of xenophobia which is, you know, we build trust but it’s also being destroyed by divisive political leaders. One thing is the targeting of minority groups in India during this crisis, for example. Regarding crackdowns on freedom of movement or communication, I notice that Senate and House leaders today sent a statement to Bangladesh asking for internet service to be restored to the refugee camps of the Rohingya. And I know that there’s similar restrictions on communications in Rakhine State, where the Rohingya are also still hunkered down there, reducing their access to medical services further. And it’s a real conflict area. So how does one deal with gaining those allies in media specifically, and local media, and Facebook, so that they stop promoting hatred and xenophobia? And then finally, with the UN system, where we don’t see a lot of traction on COVID in the Security Council? Thank you. That’s to either of you.
LEVITAN: OK. Thank you so much, Adam. I really appreciate the recognition of how crackdowns on freedom of movement and also expression can impact the situation and can exacerbate the situation for refugees. I think your question is a good one, which is: How do we build support in the media or over Facebook and other social media? And while I’m not our communications director, I’ve worked closely with our teams on the ground to help feed information to our networks, both at the country level—where our operations are working closely with refugees—and also in the U.S. And part of it is through education.
I know that’s sort of a general piece, but it’s a matter of building alliances with doctors along with making reference to sort of influential thinkers in countries where we’re operating, who can have a voice and influence large numbers of supporters across the country. I mean, like any good political movement, you have to have an appealing leader who can move things forward and who can challenge the narrative, and who can really identify why and how a crackdown on movement or expression is going to impact populations that we should care about. So building alliances through education of the press, and also finding those national folks, people to support refugee freedoms and rights, is one critical way that we try to build those networks over the media that can ultimately have a political impact.
In terms of the UN system, the most practical place where we have a relationship with the UN system is through the UN Refugee Agency and the International Organization of Migration. And they actually have been quite responsive to the situation, identifying where the major gaps are, working with donor countries to increase funding for sanitation and hygiene, access to water, access to health, access to education, addressing the protection concerns that arise because of COIVD, including child protection and gender-based violence. Addressing issues around access to food, access to work.
And of course, the work that they’ve done in that regard really is built on the partnerships that they have with us and many other partners who are delivering services to refugees. And it’s also built on the advocacy that we do, with the U.S. government, which will fund UN agencies. So there’s also a triangulation of that dynamic, so that we can ensure that the funding continues to be available, and let’s see for how long, but that it is directed both to UN agencies and to partners who are implementing programming to support refugees. And that that can be delivered as quickly and as flexibly as possible. We, in that regard, have seen some pretty great flexibility on the part of donors in the U.S. and the UN Refugee Agency, and International Organization of Migration.
So, so far it’s been positive. The broader UN system is another matter. And it’s a little bit further away, I would say, from the chain of directed impact to refugees that I know is a larger issues to tackle.
FASKIANOS: Thank you. Next question. Oh, go ahead, Muhammad. And then we’ll go onto the next question.
ZAMAN: No, no, that’s fine. I was just going to make one quick comment. And that is I think there are two kinds of arguments. We can make a humanitarian argument that resonates with a lot of people, I think everybody on this call, but it doesn’t resonate with quite a few other people. And for them you have to make a public health and an economic argument. As much as I hate to admit it, not everybody is persuaded by the humanitarian argument. So we have to argue that this is also smart policy. By protecting these communities not only is it good, and decent, and the right thing to do, but it’s also the correct thing to do to protect your own citizens, to protect the widespread sort of infection for staff and other people who come in contact. These people are in urban areas. So I think the economic argument has to be used not in lieu of the humanitarian argument, but in parallel. And I think that argument is often not made, but that often resonates with policymakers in government who may not be persuaded by the humanitarian argument.
FASKIANOS: Thank you. Next question.
OPERATOR: The next question comes from Liberato Bautista with United Methodist Church. Please go ahead.
BAUTISTA: Yes. Thank you very much. Thank you very much, Irina, for another important topic that you’ve organized at CFR.
The president of the International Migrant Alliance Eni Lestari, who is a nanny from Indonesia in Hong Kong addressed the United Nations in 2015 about the phenomenon of massive displacement. And she said that, and I quote her, “It used to be that others spoke for us on our behalf. Now we speak for ourselves.” I quote this, because this is an assertion that is very much needed today because the narratives and stories of migrants and refugees, even in this podium—in this conversation, is absent. The first-person narrative and the necessary framing of the issues are in dearth. So I think we need to start to bring to the table those narratives. And I say that because if we listen to them, at least from those that I listen, and this is where my question lies, is the dearth in the framing with respect to what migrants and refugees say are preexisting social inequalities.
So when I ask the migrants and refugees I talk to if they have a hierarchy of issues they want to address, sadly, the medical condition is lesser, because they want to deal with the social inequalities that have forced them to move. And I think—and I would like any of our two speakers—why is there a dearth in the discussion of the social determinants of health, which would have helped the public understand better the role of the World Health Organization not just on emerging epidemics, but on lingering illnesses and social inequalities?
FASKIANOS: Thank you. And we’re at the end of our time, so if you could each take a few minutes to answer that question and just to wrap up, that would be fantastic. Rachel, why don’t we start with you?
LEVITAN: Thank you so much for that really incisive comment and observation. And I hear you completely. There aren’t enough refugee voices out there representing themselves and the needs of their communities. It’s incumbent upon us as agencies, as individuals who are trying to advocate for refugee rights to ensure that their voices are heard, and oftentimes instead of our own. And we need to do a better job of that. And so I agree with you, refugees, as you mentioned, should be speaking for themselves. And we try at every juncture to do that, whether it’s through our needs assessments, through our communications, through the short films that we develop and through other opportunities to lift up their voices. We try to do it. We can always do that better.
To your point about the social determinants, it’s absolutely clear that social inequalities, discrimination, exclusions that are present in so many countries that are hosting refugees and forcibly displaced people has a tremendously negative impact on health outcomes across the board. And so your point is very clear. I’m going to turn it over to Dr. Zaman to close it out because I’m sure that he will also have some very important observations about that particular point.
ZAMAN: Thank you, Rachel. And thank you so much, sir, for the question. I know we’re coming up to the hour, so I won’t take up too much of the time. You’re absolutely right. We need to have more voices of refugees and let them be our eyes and ears about the challenges on the ground. There’s no question about that. But I think that your second point also merits absolute, absolute consideration. And this challenge is magnified because of social inequities. It is problematic. And it is going to be a problem moving forward. I’ll just give you one quick example. We how have data that more and more mothers are giving birth at home now, as opposed to going to hospitals. And we know what happens in these communities if mothers give birth at home. So there are indirect aspects of this that are going to manifest themselves. And they have to do with how the social inequity plays out, and how it is going to be exacerbated moving forward.
So I think we have to recognize this as a point where we reflect both on the past, why we are where we are, but also in the future of how this problem can become much worse if we don’t pay attention to it. I don’t like to look at silver linings at a time when there is such deep pain and anxiety. But one lessons could be that there are opportunities here to fix many things that can help not just in this pandemic, but beyond that as well. And that would be a very, very positive outcome from this otherwise very difficult situation. And we do have that opportunity to pay attention to the needs now but do things that can really fix things for the long term for the wellbeing and health of these vulnerable communities.
BAUTISTA: Thank you.
FASKIANOS: Muhammad, thank you for ending on a positive note. We appreciate that, because the situation, I think we would all agree, is challenging and is, at times, very depressing to see just the overall effect that it is having here in the United States and all around the world, and what is to come. So, Rachel Levitan and Muhammad Zaman, thank you so much for being with us today, for your insightful analysis, for sharing the work that you do and your insights, and to all of you for your questions.
We encourage you to follow Rachel’s work as well as the work of the other HIAS programs on Twitter at @HIASrefugees. And you can follow Muhammad’s work on international health at Boston University and on Twitter at @MhZaman. We also encourage you to follow CFR’s Religion and Foreign Policy Program on Twitter at @CFR_Religion. You can email us with your suggestions of future topics at [email protected]. If you want us to continue to focus on the effect of COVID-19, or if we should look at some other issues as well. And finally, we have a number of resources on our website on COVID-19 on CFR.org, Think Global Health, as well as our ForeignAffairs.com site. So I encourage you all to go there.
So again, thank you to Rachel Levitan and Muhamad Zaman. And we hope that you all stay well and stay safe. And we are on the eve of Ramadan, so wishing you all a blessed Ramadan, for those who are observing it. Thank you.