The COVID-19 coronavirus has recently reached Cox’s Bazar, Bangladesh, home to the largest refugee camps in the world, according to the United Nations. 

The number of confirmed cases remains relatively low, but limited testing capacity likely obscures the true scale of the health crisis, according to the Economist. Aid groups fear that the virus could rapidly overwhelm the camps, leading to thousands of deaths, and compounding an already dire humanitarian crisis. 

“This is our last window of opportunity to really prevent human catastrophe from happening,” Deepmala Mahla, who oversees three refugee camps in Cox’s Bazar for the international humanitarian nonprofit CARE, told Global Citizen. “We need to get all hands on deck to essentially provide a rapid scale-up of testing, aggressive contact tracing, medical care, and quarantine centers.”

Mahla said that various factors make the refugee camps highly susceptible to a massive outbreak. 

More than 860,000 Rohingya refugees live in camps throughout Cox’s Bazar in an area that has a population density double that of Manhattan, according to Democracy Now. 

“Most families live in a shelter that’s basically a low raised platform that looks like a thatch hut with a mud wall partition,” Mahla said. Physical distancing is extremely difficult in such an environment, she added. 

Clean water and quality sanitation, which are essential to combatting the virus, are scarce throughout the camps. A report from 2018 found that 56% of households across the 34 camps do not have enough water to meet their needs, and that wait times for getting water are extreme. 

“The facilities related to WASH — water collection stations, bathing points, and toilets — are all communal,” Mahla said. 

CARE and other aid groups have begun distributing soap and other cleaning supplies and have set up handwashing stations to improve hygiene standards, but a chronic shortage of supplies complicates this effort. 

Health care facilities, meanwhile, are inadequate for the scale of the population, and there are no ICU beds if someone gets critically ill. If an outbreak occurs, the health system would be rapidly overwhelmed, according to Mahla. 

To make matters worse, many people throughout the camps have compromised immune systems. Malnutrition is widespread in the camps and other infectious diseases are common. Further, Rohingya refugees survived expulsion from Myanmar by the country’s military, labeled a genocide by the United Nations — an experience that left extensive trauma.

The approaching rainy season could also worsen the crisis. The powerful Cyclone Amphan mostly missed Cox’s Bazar — although it displaced 400 refugees — but future cyclones could devastate the camps, contaminate water supplies, and spur the spread of COVID-19 and other diseases, Mahla said. 

“My worst-case scenario is continued, if not rapid, spread of the virus along with the harsh monsoon season,” she said. “Our shelters are so flimsy, monsoon season is always a concern for us.”

The usual apprehensions are growing as more Rohingya get infected, Mahla said.  

“There is fear, there is panic, there are some people that are not taking it that seriously,” she said. “Some think it’s God’s wish; there are some rumors about how it can be cured with lemons or anything sour. There are some people who say, ‘There are so many problems already, so OK, this another one — I am already very troubled, what more can this virus do?’” 

“The general sense is high anxiety and fear of the unknown,” she said. 

The arrival of COVID-19 has set back other humanitarian efforts in the camps. Remote education, for instance, is very difficult in the camps when internet access is minimal. Additionally, efforts to stop gender-based violence and promote women’s rights could be put on hold during the pandemic. 

“One of the things we’re really concerned about is that when we permit only essential services, services related to gender-based violence should be considered essential,” she said. 

Mahla said that countries can still contain the virus in Cox’s Bazar, but resources need to be mobilized rapidly. The United Nations is calling for $320 million to address the crisis.

“If we leave the largest refugee camp in the world with coronavirus, none of us are safe,” she said.