Unintended consequences of pandemic measures for refugees in camp-like settings

Abstract We present the results of a review that focused on refugees, asylum-seekers and internally displaced persons living in camps or accommodation centres, given their often closed character and crowded living arrangements. We systematically review the evidence on unintended consequences of public health and social measures (PHSMs) implemented in such settings. Relevant articles were identified in major academic databases from 12/2019 to 02/2023. Empirical studies reporting the results of PHSMs implemented to curb Covid-19 infections in camp-like settings were included. Following abstract and full-text screening, the described effects of PHSMs were extracted, distinguishing intended from unintended policy outcomes by their knowability (anticipated/unanticipated), value (positive/negative/neutral), distribution (subgroups/equity), and temporality. The “unintended outcomes evaluation approach” proved useful to identify unintended consequences of pandemic measures and examine the nature of their effects. Yet, few studies aimed at unintended outcomes, with these often being chance findings. The evidence reported thus often required some interpretation to capture and construct potential causal pathways from PHSMs to unintended outcomes. Preliminary results suggest that strict lockdown measures had negative effects on the mental health of individuals in camp settings, who already face a high burden of mental illness. Moreover, reduced economic and bureaucratic activities threatened the livelihood of individuals in camp settings through suspending asylum procedures, withdrawal of social and medical support, and the absence of legal economic opportunities. PHSMs thus drove individuals further into precarity, while the benefit of lockdown measures in this setting remains uncertain. Our review highlights the lack of research on unintended outcomes of public health measures, while demonstrating the importance of considering such outcomes for an equitable pandemic response.