'Death on an appalling scale’ – David Miliband on the threat of COVID-19 to refugees

As COVID-19 cases begin to rise among the world’s most vulnerable populations – the poor and displaced, people living in crowded refugee camps – time is running out to prevent the pandemic overwhelming parts of the developing world.

There are more than 70 million displaced people globally, from Syria to Afghanistan, Africa to Bangladesh. More than three-quarters of refugees live in developing countries. They live in crowded conditions with little access to soap and clean water; few have access to adequate healthcare.

Headed by David Miliband, the International Rescue Committee (IRC) works on the ground to improve public health and stop the pandemic from taking root. Prevention is the aim, whether that's the introduction of handwashing stations, triage centres or isolation units. Without immediate international action to support healthworkers on the frontlines the consequence will be, as Miliband says, “death on an absolutely appalling scale”.

In this interview, the IRC CEO and president talks about the gathering threat of COVID-19 to these high-risk communities, the urgent action required to prevent a humanitarian disaster, and the coordinated international response that may already be too late.

What makes communities of refugees and displaced people so vulnerable to the coronavirus?

If you think it is really terrifying to face the prospect of COVID-19 in an advanced industrialized country – if you're worried about ventilators in New York City, if you're concerned about the health system in Italy – just imagine what it's like to face the prospect of a virus where there isn't running water, where there isn't a proper health system, where densities of population are not just the 25,000 people per square mile that New York City has, but the 40-70,000 people per square kilometre that are packed in to Cox's Bazar in Bangladesh.

Our concern at the IRC is with using the gift of time that we have in regions of Africa, in the Middle East, South Asia – where we know that the disease has not yet hit with full force – to do the preventative work. Because if we don't get the prevention right, there isn't the health system to take care of people. And there's going to be death on an absolutely appalling scale.

Listen to David Miliband in conversation in this podcast

Do you have a sense of how much time we have?

We now know that the disease is being recorded in the world's conflict hotspots. It’s being recorded in Syria, it's spiking in Afghanistan, it's being seen in Somalia. We're seeing that the conflict zones of the world – which, in the main, have the worst health systems and the greatest danger to public health – are now seeing recorded cases of the disease. So we're talking a matter of weeks before this disease, if unchecked, becomes really rampant.

Obviously the details of the epidemiology – and how climate and other factors affect it – has not yet been fully worked out by the scientists, but our message is an urgent and simple one. That, as well as focusing on the real needs that exist in advanced industrialized countries, we must tackle this disease before it becomes rife in displaced and poor communities around the world, because this is a disease of the connected world and we must address it as a connected world.

The UN is calling for $2 billion in emergency humanitarian aid, but as rich countries square up to this global recession, where's the money going to come from?

Well, money, we have discovered in the last few weeks, is one thing that we're not short of, because when governments determine that they will turn on the spigots in order to meet a crisis, money they can find. The tragedy is it's not being spent in a fair way, it's not being spent in the countries where the disease could run rampant. And while it’s right that the UN seeks to raise $2 billion – in the main for their own services – only $100 million of that goes towards the NGOs who’ve actually got the staff on the front line.

My appeal to governments around the world, but also to private individuals, to corporations, to foundations, is to remember that as a global human community we're only as strong as the weakest link in the chain. And the weakest links in this chain are in the conflict zones, they are in the poor states of the world.

So my appeal is a very simple one, that the people who are trusted on the frontline are those who have experience of infection prevention and control and have the confidence of local communities. We’ve learnt from Ebola that it’s trust that is the most precious commodity, not money. And if you and the corporations and foundations and governments of the world arm the NGOs with the resources to establish the handwashing stations, to establish the triage centres, to create the isolation units – even in areas where there is no proper infrastructure, even if you couldn’t isolate people there – we can get the job done to save people's lives.

What can individuals to do to help? Which organizations should we be prioritizing, which camps should we be looking at?

There are heroes in the health services of Western industrialized countries, but there are also heroes who are community health-workers on the frontline in some of the most dangerous parts of the world. And obviously the NGO community is one that is plugged in at grassroots level because we hire locally. IRC has 400 staff in north-west Syria, 400 in north-east Syria. Those are Syrians defending their own communities. And my advice would be to find organizations that have local roots and hire locally so they have the trust of the local population.

What people should never succumb to is the idea that this disease is so big that it can't be can’t be hindered in his path. We know that the basics really matter. And for want of handwashing the disease takes root, for want of triaging the disease affects the whole family, for want of an isolation centre the disease hits a whole community. And that's what we're fighting at the moment.

So you said that in Sierra Leone, there's only one ventilator. How can the rest of the world help a country like that to receive more equipment?

I really want to call out to people what it means to lack a health infrastructure. One ventilator in Sierra Leone; six, I believe, in Burkina Faso; 13 in the Democratic Republic of Congo. There's a very clear lesson in this, that universal health coverage is a million miles away from the people we're talking about, but also that this disease can’t be allowed to run riot until it overwhelms an already weak health system.

What’s important is public health: basic handwashing, triaging, testing and isolating. Obviously the call by the World Health Organization for a universal health coverage is absolutely right. But that's not going to be there in time for this disease, so we need to get the basics right.

Are there any initiatives or technologies out there, beyond the work of the IRC, that are doing an especially good job?

I think that the most effective technology is the voice of people who are on the frontline and are affected. There's nothing like a health-worker to tell you what it's like not to have the proper care. There's nothing like a survivor of the virus to tell you that even the mild symptoms are very serious indeed. There's nothing like a mother who's lost her son to tell you what it means that every life should count. And so I think that we've got to dig into the basic humanity that this crisis has exposed. It’s bought out solidarity and that needs to be brought to a much higher level.

The prospect of COVID-19 spreading among the world's vulnerable is a grim one. But is there a specific element of this looming crisis that keeps you up at night?

Well, my professional concern is about the staff and the clients of the International Rescue Committee who are daily risking their lives. The personal side is about kids bickering while they're meant to be doing home-schooling and, more seriously, about how my elderly mother is going to survive this crisis and to thank her care workers for the way that they're trying to look after her.

This is a unique global crisis. I can't think of any other time when the whole world has been so focused on one danger, one threat. And while one's first thought is for the nearest and dearest, I really hope that this crisis also brings out the shared experience that makes us all human and that makes us all vulnerable to a disease like this.

One of the jobs of the World Economic Forum is to help bring the world together. I hope that, through mechanisms like this, they can summon action, not just words, because there are attacks on the amount of talking relative to the amount of actions. It’s actions that are going to count and time is of the essence.

You have a particular concern about what’s being termed ‘pandemic orphans’...

International Rescue Committee does a lot of work around the world with what we call unaccompanied children. These are children who are separated from their parents. They're either separated because they flee or they're separated because their parents aren't allowed to work so the kids have to go out to work, and then they get arrested, and then they're no longer able to contact their parents.

This crisis raises a different prospect, which is that children seem to be better insulated against this disease than parents and grandparents, and so my own staff have been talking to me about the fact that there is a danger that kids lose one, or tragically two, parents to this disease. And we'll end up with the syndrome of pandemic orphans.

Now, in that case, we know what happens in the world's poorest communities: brothers and sisters who may only be 9, 10, 14 years old end up looking after younger children. Or grandparents step in. Now this disease threatens the grandparents too. And all of this points to the very simple point, that prevention is so much better and more reliable than cure. It speaks to the fact that every family that we can protect gives that family a chance of making a life later on.

How do you think the international community has reacted so far?

This is a disease of the connected world, but the governments and the governance of this global village is much less connected, much less coordinated, much less cooperative than it needs to be. Where is the group of 20 leading industrialized countries that was formed out of the financial crisis?

I was in government in the middle of the financial crisis, I was the foreign minister of the UK at the time and I saw the way Gordon Brown, Alistair Darling, Barack Obama, the leaders of the financial community came together to create the G20.

Where is the G20 today? I can tell you: it’s had one virtual meeting.

I am very concerned that the wrong lessons being learned. We cannot live in a world of a network of fortresses – that phrase of Yuval Harari. We've got to live in a world where the common elements of humanity are properly recognized. And I think it's time to call out the short-sightedness, the myopia that is governing too much of this response, because it needs to be beaten together.

Survival now is a team sport, and life is a team sport, and it's time that the governments of the world show that they understood that.