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As COVID-19 Vaccines Begin Reaching Conflict and Crisis Settings, a New Study Highlights the Investments Needed to Strengthen Health Systems

  • A new study from the International Rescue Committee identifies current health system gaps and areas of opportunity in three challenging contexts.
  • Case studies from Jordan, Bangladesh, and Chad underscore the need to advance inclusive health policies and systems that address the unique needs of refugees
  • Ending this pandemic -- and preventing future ones -- requires strengthening health systems to effectively distribute COVID-19 vaccines to the last mile, while continuing to deliver other life-saving health services.

Today, the International Rescue Committee (IRC) released a new study examining the challenges --and best practices -- of integrating refugees into national health systems. Supported by The Pfizer Foundation, the study outlines case studies from countries across three different continents – Jordan, Bangladesh and Chad – and provides concrete recommendations for advancing inclusive health programs and policies that address the unique needs of vulnerable populations. As COVID-19 vaccines begin reaching conflict and crisis-affected settings, health systems must be further strengthened to reach the last mile, while continuing to deliver other life-saving health services. 

In Jordan, dwindling donor funds and limited resources hinder access to affordable health services for more than 1.3 million Syrian refugees – with 80% of Syrian refugee households in urban areas living below the poverty line. Responding to these urgent needs has led to the creation of parallel health systems, with refugees and vulnerable host populations largely dependent on free aid services. Ultimately, this inhibits efforts to integrate refugees into the national health system. The health system and already-limited funding have become even more stretched by COVID-19, with more than 700,000 infections and 8,600 deaths reported as of mid-April 2021. Still, Jordan has continued efforts to meet the needs of vulnerable populations and was the first country to include refugee and asylum seekers within its COVID-19 vaccination plans.

In Bangladesh, a lack of long-term planning for access to health services for refugees remains concerning for the 877,710 Rohingya refugees residing in 34 overcrowded camps in Cox’s Bazar. Even before the pandemic, a weak health system and shortages of qualified health workers resulted in low coverage of care, including sexual and reproductive health services – critical for the one in four women and girls in Cox’s Bazar who identify as survivors of gender-based violence. COVID-19 has intensified these vulnerabilities, disrupting other services like routine vaccines for measles and rubella. While the Bangladeshi government has partnered with the COVAX Facility to allocate 5% of its COVID-19 vaccines for refugees, it is unclear when Rohingya camps will receive doses.

In Chad, despite a government commitment to integrate displaced populations in the national health system, implementation has been slow. Coupled with human resource shortages, financial barriers, and challenges linked to climate change, health services are inaccessible to many of the 915,000 refugees, asylum seekers, and Internally Displaced Persons. COVID-19 has further limited access as already-limited funding was diverted from day-to-day services to COVID-19 response efforts, contributing to an outbreak of circulating vaccine-derived poliovirus (cVDPV) in February 2020.

“Strong and inclusive health systems are essential in providing life-saving services to the last mile – including COVID-19 vaccines,” said Mesfin Teklu-Tessema, senior director of health, International Rescue Committee. “We can’t end this pandemic unless we invest in strong health systems that deliver better health for all of us  This World Immunization Week, we are calling for investments to be made in health workers protection, infrastructure, health supply chain, and more to not only combat this pandemic, but to prepare for future ones and ensure people have access to ongoing, life-saving services.”  

In addition to examining challenges, gaps, and opportunities, the new study outlines different approaches that have been implemented in each context and could be leveraged elsewhere. Concrete recommendations include enacting long-term, flexible financing to ensure the sustainable provision of quality, affordable, and accessible health services; prioritizing the strengthening of national health systems from the onset of any humanitarian health intervention; developing inclusive national policies that promote equitable access to health services; and more.

Across more than 40 countries and 20 U.S. cities, the IRC provides high-quality health care to vulnerable populations and works closely with government stakeholders to invest in and strengthen national health systems. To learn more about the IRC’s work and to read the full report, written with the support of The Pfizer Foundation, please click here


*The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions. The Foundation’s mission is to promote access to quality healthcare, to nurture innovation, and to support the community involvement of Pfizer colleagues.

About the IRC

The International Rescue Committee responds to the world’s worst humanitarian crises, helping to restore health, safety, education, economic wellbeing, and power to people devastated by conflict and disaster. Founded in 1933 at the call of Albert Einstein, the IRC is at work in over 40 countries and over 20 U.S. cities helping people to survive, reclaim control of their future, and strengthen their communities. Learn more at www.rescue.org and follow the IRC on Twitter & Facebook.