humanitarian responses have struggled to address both the medical needs associated with what are predicted to be very large epidemics of COVID-19 and the vulnerabilities associated with government response measures adopted in areas where humanitarian programmes operate. Government control measures were adopted swiftly across the Middle East and East Africa at a relatively early stage in the epidemic, causing so much hardship and disruption to daily life that in some places they have even eased up before the epidemics have really gotten underway.16 Given this context of low COVID-19 caseload but high preventive measure intensity, the main vulnerabilities being experienced to date have been due to border closures, travel restrictions, interruptions to businesses and schools, prohibitions on large gatherings, curfews and mandatory stay-at-home orders - a collection of measures which constrain mobility and are referred to collectively as ‘lockdowns’. VULNERABILITY TO COVID-19 IN DISPLACEMENT The COVID-19 pandemic has compounded insecurity and vulnerability for forcibly displaced populations on multiple inter-connected fronts, including by harming survival strategies. THREATS FROM COVID-19 TRANSMISSION Large-scale outbreaks of disease in refugee and IDP camps in the past prompted the introduction of minimum standards for the provision of housing, water and sanitation infrastructure and essential hygiene items to slow and control disease transmission in humanitarian responses since the 1990s.17 In many humanitarian settings, however, access to land constrains the space that is available to meet such minimum standards. Even when space is more plentiful, outbreaks still occur.18 For a disease as infectious as COVID-19, following the recommended basic protective measures, including frequent handwashing, maintaining physical distances, and isolating at home when sick is likely to be very difficult in camps and settlements. Some humanitarian actors are facilitating discussions with camp residents to reimagine living spaces to shield vulnerable people from transmission, though the constraints they face shouldn’t be under-estimated. Population and housing density in IDP and refugee settlements is often higher than in surrounding host communities. Population and housing density in IDP and refugee settlements is often higher than in surrounding host communities. In North-West Syria,a between 6 and 11 people who have been repeatedly displaced may share a small tent, caravan or one-room-shelter within larger formal or informal settlements. Most families share latrines with other households, sometimes having to queue for 30 minutes. Obtaining a Study conducted by LSHTM and NUS School of Public Health Syria Research Group on the perceptions and experience of displaced people living in settlements in Syria. KEY CONSIDERATIONS: COVID-19 AND FORCED DISPLACEMENT IN THE MIDDLE EAST AND EAST AFRICA Contact: a.wilkinson@ids.ac.uk 6