COVID-19 Impact on Bhutanese Refugee Communities

The COVID-19 pandemic that began in early 2020 had a disproportionate impact on resettled Bhutanese refugee communities across the United States, Canada, Australia, New Zealand, and Europe. The Lhotshampa diaspora — approximately 113,000 people resettled from refugee camps in Nepal through the UNHCR third-country resettlement program beginning in 2007 — faced compounding vulnerabilities that made the pandemic especially devastating. High rates of employment in essential industries, multigenerational living arrangements, limited English proficiency among older adults, and pre-existing health conditions linked to decades of displacement combined to produce elevated infection rates, hospitalizations, and deaths within the community.

The government of Bhutan maintains that most Lhotshampa departures from the country in the early 1990s were voluntary, a characterization disputed by international human rights organizations and the affected communities themselves, who describe the events as forced expulsion. Regardless of the contested origins of their displacement, by 2020 the resettled Bhutanese refugee population had become one of the largest refugee communities in the United States, and their pandemic experience illuminated broader patterns of health inequity affecting resettled populations.

Essential Worker Exposure

A defining feature of the pandemic experience for Bhutanese refugee communities was the concentration of community members in front-line essential occupations. Across the United States, resettled Bhutanese adults worked disproportionately in meatpacking plants, food processing facilities, warehouses, nursing homes, janitorial services, and other sectors classified as essential during lockdowns. In cities with large Bhutanese populations — including Columbus, Ohio, Pittsburgh, Pennsylvania, Harrisburg, Pennsylvania, and several Texas and Georgia communities — community members continued reporting to physically demanding workplaces throughout the pandemic while many white-collar workers transitioned to remote arrangements.

Meatpacking plants emerged as particularly dangerous environments. Nationally, meatpacking facilities experienced some of the largest workplace COVID-19 outbreaks in 2020, and Bhutanese workers were among those affected. The combination of cold indoor temperatures, close physical proximity, long shifts, and inconsistent access to protective equipment created conditions conducive to viral transmission. Workers who contracted the virus in these settings then carried it home to households that frequently included elderly parents and grandparents — the very individuals most vulnerable to severe illness.

Many Bhutanese essential workers faced an impossible choice between income and safety. Refugee families frequently carried financial obligations including remittances to relatives remaining in Nepal, medical debt, and housing costs that left little margin for lost wages. Fear of job loss, combined with limited awareness of workplace safety rights and limited English fluency, meant that some workers continued to report to unsafe conditions rather than risk unemployment.

Multigenerational Households and Transmission

The Bhutanese refugee community's cultural practice of multigenerational cohabitation, while a source of social strength and economic efficiency, became a significant vulnerability during the pandemic. Lhotshampa families commonly maintain households with three generations under one roof — a pattern rooted in South Asian family structures and reinforced by the economic realities of resettlement. When working-age adults contracted the virus in essential workplaces, in-home transmission to elderly family members was frequently unavoidable. Isolation within the household was often impossible due to small apartment sizes and shared living spaces.

Elderly Bhutanese refugees — many of whom had spent fifteen to twenty years in camps and arrived in resettlement countries with chronic conditions including diabetes, hypertension, cardiovascular disease, and respiratory issues linked to years of inadequate healthcare — were at especially high risk for severe COVID-19 outcomes. The community experienced a significant number of deaths among elders, losses that carried particular cultural weight given the central role of grandparents in maintaining cultural traditions, language, and family cohesion.

Language Barriers and Health Information Access

The rapid pace of pandemic developments — shifting public health guidance, testing protocols, mask mandates, and vaccination rollout information — posed acute challenges for Bhutanese community members with limited English proficiency (LEP). While younger, U.S.-educated members of the diaspora could follow English-language news and public health communications, many older adults relied primarily on Nepali and had limited access to translated materials. State and local health departments varied widely in their provision of Nepali-language health information, and the rapidly evolving nature of pandemic guidance meant that even when translations were produced, they often lagged behind current recommendations.

Misinformation also circulated within the community, particularly via Nepali-language social media channels and WhatsApp groups. Rumors about vaccine safety, false claims about COVID-19 treatments, and conspiracy theories that had been translated or adapted into Nepali reached community members who lacked access to authoritative Nepali-language counter-messaging. This information environment contributed to vaccine hesitancy among some segments of the population, particularly during the early months of vaccine availability in 2021.

Community Responses and Mutual Aid

Bhutanese community organizations mounted significant grassroots responses to the pandemic, drawing on networks of mutual aid and collective action that had been forged during decades of displacement and camp life. Organizations such as the Bhutanese Community of Central Ohio and similar groups in other cities mobilized to provide food deliveries to quarantined families, translation of public health materials into Nepali, accompaniment to testing and vaccination sites, and emotional support for bereaved families.

Community health workers — known as swasthya swyamsevak (health volunteers) — played a critical role in bridging the gap between public health systems and Bhutanese households. These individuals, often bilingual community members with training from resettlement agencies or public health departments, conducted door-to-door outreach, fielded phone calls from confused elders, and helped families navigate testing and treatment systems. Their work was widely credited with improving health outcomes within the community and reducing the spread of misinformation.

Religious and cultural institutions also adapted. Hindu temples and Buddhist centers serving the Bhutanese community shifted to virtual services, and community leaders used religious gatherings — once they resumed — as opportunities to disseminate public health information and encourage vaccination.

Vaccination Outreach

The rollout of COVID-19 vaccines in early 2021 presented both an opportunity and a challenge for Bhutanese refugee communities. While many community members eagerly sought vaccination, others harbored concerns rooted in unfamiliarity with mRNA vaccine technology, distrust of government institutions, or misinformation encountered on social media. Resettlement agencies, community organizations, and local health departments in cities with significant Bhutanese populations developed targeted vaccination outreach programs.

Successful strategies included partnering with trusted community leaders — religious figures, elders, and community organization presidents — to endorse vaccination; hosting vaccine clinics at community centers, temples, and apartment complexes; providing Nepali-language informational materials and consent forms; ensuring Nepali-speaking interpreters were available at vaccination sites; and offering transportation assistance. In several cities, community-organized vaccination events achieved high turnout and helped close vaccination gaps between the Bhutanese community and the broader population.

The pandemic experience also accelerated advocacy for improved language access in healthcare settings. Community organizations used the crisis to press for systemic changes including permanent Nepali-language health information resources, interpreter services, and the inclusion of refugee communities in public health emergency planning.

Mental Health Impact

The mental health toll of the pandemic on Bhutanese refugee communities was compounded by pre-existing vulnerabilities. The Bhutanese refugee population had already experienced elevated rates of depression, anxiety, and post-traumatic stress related to the original displacement, years of camp confinement, and the stresses of resettlement. The pandemic layered additional trauma — isolation, loss of community gatherings, bereavement, economic precarity, and fear — onto this existing burden. The community's historically high suicide rate, which had drawn national media attention in the years prior to the pandemic, remained a concern as the isolation of lockdowns removed social supports that had helped mitigate risk.

Community organizations responded by expanding mental health outreach, offering Nepali-language telehealth counseling, and training community members in psychological first aid. However, the stigma surrounding mental health in South Asian communities, combined with a shortage of Nepali-speaking mental health professionals, meant that many individuals did not access available services.

Legacy and Lessons

The COVID-19 pandemic revealed both the vulnerabilities and the resilience of resettled Bhutanese refugee communities. The disproportionate impact highlighted systemic failures — inadequate language access in healthcare, insufficient workplace protections for essential workers, and the absence of refugee communities from public health planning processes. At the same time, the grassroots responses demonstrated the strength of community bonds and the capacity of diaspora organizations to mobilize rapidly in crisis.

The pandemic experience has informed ongoing advocacy by Bhutanese community organizations for improved health equity, language access, and the inclusion of refugee voices in public health policy. It has also underscored the importance of culturally competent community health worker models as a bridge between public health systems and linguistically diverse populations.

References

Ao, Tem, et al. "Bhutanese Refugee Health Profile." Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, updated 2014. https://www.cdc.gov/immigrantrefugeehealth/profiles/bhutanese/index.html
Hagaman, Ashley K., et al. "Suicide in the Bhutanese Refugee Community: A Qualitative Study." Transcultural Psychiatry, vol. 53, no. 3, 2016, pp. 308-330.
Taylor, Lauren A., et al. "COVID-19 and Refugee Populations in the United States." Journal of Immigrant and Minority Health, vol. 23, 2021, pp. 1095-1102.
Cultural Orientation Resource Center. "Bhutanese Refugees: Background and Resettlement." https://coresourceexchange.org/

This article was contributed by the BhutanWiki Editorial Team. If you have firsthand knowledge of the pandemic's impact on Bhutanese refugee communities, please consider contributing to this article.