Leaving no one behind in the Covid-19 Pandemic: an urgent global call to action for inclusion of migrants & refugees in the Covid-19 response
People on the move, whether they are economic migrants or forcibly displaced persons such asylum seekers, refugees, and internally displaced persons (hereafter called migrants & refugees), should be explicitly included in the responses to the coronavirus disease 2019 pandemic. This global public health emergency brings into focus, and may exacerbate, the barriers to healthcare these populations face. Many migrant & refugee populations live in conditions where physical distancing and recommended hygiene measures are particularly challenging. The Covid-19 pandemic reveals the extent of marginalisation migrant & refugee populations face. From an enlightened self-interest perspective, the Covid-19 disease outbreak control measures will only be successful if all populations are included in the response. It is counter- productive to exclude migrant & refugee populations from the preparedness and response to the Covid-19 pandemic. Statements from UNCHR (https://bit.ly/39YRB7V), IRC (https://bit.ly/34pOaWE) and a joint statement from OHCHR, IOM, UNHCR and WHO (https://bit.ly/2K7usG9) also call for the rights and health of migrants and refugees to be protected in the Covid-19 response.

The Covid-19 response globally should be guided by the following recommendations from the UCL-Lancet Commission on Migration & Health (https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)32114-7.pdf):

• Universal and equitable access to health services and to all determinants of the highest attainable standard of health within the scope of universal health coverage needs to be provided by governments to migrant populations, regardless of age, gender, or legal status.
• It is essential to recognise inclusion of mobility as key to effective health care and health systems and to shift away from the traditional structure and delivery of health systems through geopolitical borders.
• Racism and prejudice should be confronted with a zero tolerance approach. Public leaders and elected officials have a political, social, and legal responsibility to oppose xenophobia and racism that fuels prejudice and exclusion of migrant populations.

Lancet Migration and the below signatories call for:

**Urgent access to healthcare for all migrants & refugees throughout the response to Covid-19
R1. Immediate suspension of laws that limit migrants & refugees access to healthcare services and economic support programmes. This may be achieved through measures such as temporarily granting residency to migrants & refugees and suspending health care user fees. Internal migrants and those internally displaced need special focus during lockdowns, in order to ensure that these measures do not disproportionately disadvantage these populations, and that their previous lack of access to basic shelter, water, sanitation and hygiene, or food is not compounded.
R2. ‘Firewalls’ to be put in place between health data and immigration authorities. To encourage access to healthcare for migrant & refugee populations, it is of utmost importance that there is separation between health access and legal status as well as immigration enforcement during this pandemic.
R3. Action beyond the nation-state level to uphold human rights and global health security. The coronavirus disease 2019 pandemic cannot be defeated within borders. We urge countries to support the UNHCR’s call for US$255 million to support those living in refugee and refugee-like situations.

**Inclusion of all migrant & refugee populations in prevention, preparedness for and response to Covid-19
R1. Transfer of migrants & refugees held in overcrowded reception, transit and detention facilities to safer living conditions. There should be prioritised evacuation of the most vulnerable, such as those with underlying health conditions. Since such settings are generally overcrowded with poor sanitation and hygiene measures, the spread of Covid-19 has the potential to be rapid and devastating among affected populations and those working there.
R2. Deportations should be temporarily suspended, while asylum procedures should continue according to the 1951 Refugee Convention, with no forced return (refoulement).
R3. Urgent relocation and reunification of unaccompanied minors, who are particularly vulnerable as aid and support services to migrants & refugees are negatively affected by the coronavirus disease 2019 pandemic. Relocation and reunification efforts should be pursued to ensure children receive adequate fostering and care.
R4. Expedited temporary accreditation of migrants & refugees with healthcare-related degrees and qualifications to join the health and care workforce in their resident countries. With the health and care workforce in many countries stretched as never before, the workforce shortage is well documented in many migrant and refugee-hosting countries. Fast-tracking temporary accreditation of overseas degrees can help overcome this.

**Responsible, transparent and migrant-inclusive public information strategies
R1. Clear, transparent public communication is critical in pandemic response. This should include migrant populations, with a focus on linguistically and culturally appropriate information.
R2. Governments should also actively counter racism, xenophobia and discrimination that fuels prejudice and exclusion of migrant & refugee populations.
R3. An evidence-based approach should be key to communications during the Covid-19 pandemic.

The full statement on the Lancet Migration website (www.migrationandhealth.org) can be read here: https://bit.ly/3a1Zyt4

**Please add your name and affiliation below to publicly support this statement if you are an academic, healthcare worker, public health professional or working in the field of refugee or migrant health anywhere in the world. The full list of signatories can be viewed here: https://docs.google.com/spreadsheets/d/1JLnzZO4JhdsaLylg6jLxM-UBuxOpt88PthXn0Nvca0k/edit?usp=sharing
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