World Report Statelessness in the COVID-19 pandemic Millions of people have no nationality and are being overlooked in the response to COVID-19. Talha Burki reports. There are several ways that you can become stateless. You could have your nationality revoked. Perhaps your father has disappeared, and you live in a place which does not permit mothers to pass on their nationality. Perhaps your country of origin has broken up or been otherwise transformed. Thousands of residents of Kuwait were not granted citizenship after the Gulf state gained independence from the UK in 1961. After the dissolution of the Soviet Union, Estonia and Latvia demanded that ethnic Russians living within their borders pass a language test to become citizens. The two Baltic republics are now home to roughly half of Europe’s estimated 528 000 stateless people. But for the most part, statelessness is inherited. If your parents have no nationality, it is extremely hard for you to acquire one. According to the UN High Commissioner for Refugees (UNHCR), 4·2 million people across 76 countries are known to be stateless. However, this figure is likely to represent no more than a third of the overall stateless population. Three-quarters of people without a nationality are from minority groups. The Rohingya were stripped of Burmese citizenship in 1982. The 500 000–600 000 who remain in Myanmar’s Rakhine State are subject to discriminatory laws and sporadic pogroms. 2017 saw a brutal crackdown by the Burmese army. Reports emerged of murder, arson, mass rape, and torture. The violence prompted several hundred thousand Rohingya to flee to Bangladesh. The country now hosts almost 1 million Rohingya, 600 000 of whom live in the 23 settlements that make up the Kutupalong-Balukhali Expansion Site. Whether settled or part of refugee or migrant communities, to be stateless is to be vulnerable. Rohingya who www.thelancet.com Vol 397 April 24, 2021 attempt to leave Myanmar face an astonishing array of risks from people traffickers, ranging from debt bondage and extortion to slavery. Roma communities in Europe are subjected to xenophobia and hate speech. The invisibility of stateless populations can result in children being excluded from “‘There is a very real risk that a lot of stateless people will not get the vaccine’...” immunisation campaigns, and the lack of documentation makes it difficult to find jobs. If stateless populations have any access to health care, it is usually limited to emergency care. If their residency status is unsettled they risk lengthy periods of detention, and in times of crisis, their vulnerability only increases. A new report from the European Network on Statelessness (ENS) has outlined how Europe’s stateless populations have fared during the COVID-19 pandemic. The authors heard from stakeholders in 20 countries. Respondents described the difficulties inherent in maintaining physical dis­ tancing in overcrowded settlements and in apartments accommodating several families. An interviewee in Bulgaria noted that the pandemic has been expensive. “You pay to visit the doctor, you pay for the PCR test, you pay for medicine. We have to pay for masks, gloves”, they said. The social security schemes and aid packages that European governments rolled out in the wake of the pandemic have usually been restricted to citizens. “Stateless populations are deprived of a lot of welfare support that others are entitled to”, explains Nina Murray, head of policy and research at the ENS and coauthor of the new report. “They have struggled to mitigate the spread of the virus with non-pharmaceutical interventions and they have to keep working, if they can, which makes it even more difficult to keep their community safe from infection.” Stateless people tend to be in the informal economy, in sectors where pay is contingent on work. For example, they could work as day labourers or sell scrap metal. “A lot of people have suddenly lost their sources of work. They have been pushed into extreme poverty”, Murray told The Lancet. An interviewee for the ENS report recounted the story of a man who had been refused cancer surgery by the UK National Health Service before the pandemic. He was instructed to return to his country of origin for treatment, although the country in question had twice refused to accept him. The report added that there have been instances in which people with severe COVID-19 have died after being unwilling or unable to obtain medical care in the UK. “The British Government has guaranteed that no-one will be charged for COVID-19 care, but there is still a great deal of concern among people with insecure immigration status that they will be billed if they access health care”, said Murray. A survey by R2P, a Ukrainian nongovern­mental organisation, found that 46% of stateless respondents had been refused access to a community doctor over the course of the pandemic because they lacked identification. Noncitizens often worry that if they make themselves visible to health services, they will be reported to immigration services. The Irish Government has taken steps to ensure that information on patients does not leave the health department, but such measures are rare. Amal de Chickera is co-director of the Institute on Statelessness and Inclusion. For more on statelessness in a global pandemic see https://www.refworld.org/ docid/5f50a81e4.html Talha Burki was on the expert advisory group for the European Network for Statelessness report but was not involved in researching or writing it. 1529