19, such as refugees or IDPs living with a chronic an alternative to humanitarian assistance,81 with disease, to continue their treatment under food banks largely locally funded. lockdowns or while being shielded from transmission. STRUCTURAL CHALLENGES TO LOCALISING HUMANITARIAN ASSISTANCE Despite recent global commitments to localise humanitarian aid,82 and WHO COVID-19 guidance which advises that displaced people should be “recognized as co-developers as well as providers of health and other essential services and prevention efforts”,83 however, refugees and IDPs have nevertheless often been marginalised from disease control decision-making at all levels of the response. Their exclusion stems from legal and normative practices of host community governments, professional societies and humanitarian partners with consequences for the overall effectiveness of the COVID-19 response. Examples include: ◼ Limited participation of displaced people in COVID-19 task forces: In Uganda, refugee organisations have been excluded from COVID-19 response task forces at both national and district levels, even in places where refugees outnumber the host population. In many countries, the lack of consultation of displaced populations about the imposition and lifting of lockdown measures along borders and in camps and how they could be adapted is particularly problematic, given how much vulnerability these measures have created specifically for these groups. ◼ Legal barriers to registering refugee-led organisations: In Lebanon and elsewhere, organisations led by refugees face substantial legal and administrative obstacles preventing them from receiving direct funding, particularly if their staff are undocumented refugees.84 Even in settings where local organisations are not discouraged by national governments, they may be at a disadvantage in competing with international organisations and must survive on very small operating budgets.85 These obstacles prevent refugee- and IDP-led organisations from taking a larger role in response efforts. ◼ Exclusion of displaced healthcare workers from humanitarian responses: Despite the need for greater health human resources in a pandemic, many IDP and refugee workers are excluded from humanitarian and government responses because of local hiring laws and norms. Such practices conceal uncomfortable structural political questions on the representation of refugees in health systems and society.86 Whereas other regions of the world have addressed this issue through rapid credentialing schemes for migrant healthcare workers,87 public health responses to COVID-19 in the Middle East and East Africa appear to be overlooking the capacities of displaced HCWs, especially to build culturally sensitive healthcare programmes for patients through trusting relationships.88 KEY CONSIDERATIONS: COVID-19 AND FORCED DISPLACEMENT IN THE MIDDLE EAST AND EAST AFRICA Contact: a.wilkinson@ids.ac.uk 17