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The intersection of the Syrian civil war and the COVID-19 pandemic has created a multi-layered crisis for refugees and the organizations that serve them. This study examines the factors influencing when and how refugee service providers and refugees adopt COVID risk mitigation strategies, as well as why providers may sometimes fail to implement protective measures even when resources (such as PPE, handwashing stations, etc.) and knowledge about the efficacy of these resources are available. Drawing on 215 hours of observational data and interviews with refugees and humanitarian workers in Lebanon, Jordan, and Turkey, we explore how risk is assessed, perceived, and acted upon in humanitarian service settings. Our findings challenge the assumption that risk mitigation is strictly dictated by techno-scientific models which typically emphasize education and awareness. Instead, we demonstrate that risk assessment and adherence to mitigation protocols are shaped by socio-cultural and relational dynamics. Providers’ perceptions of refugee populations, often influenced by broader power structures, racial hierarchies, and paternalistic attitudes, contribute to uneven usage of protective measures. A “risk switch” emerges, wherein risk mitigation behaviors decline in situations perceived as socially or relationally safe, even when objective health risks remain. Additionally, stigma surrounding refugees amplifies their perceived infection risk, reinforcing discriminatory treatment and inconsistent safety practices. These findings highlight the importance of social context in shaping public health responses within humanitarian crises.