Last updated: 27 November 2020
Highlights of our COVID-19 response activities can be found in the interactive map below; click on a country to read brief information.
To read detailed information on our activities per country, scroll down to the list below, or click on the regions on the menu to the left.
(Note: neither map nor detailed activities list below are exhaustive of all of our COVID-19 response.)
MSF response to coronavirus disease COVID-19
We started our first activities in our response to the COVID-19 pandemic in January 2020. As the new coronavirus spread, touching virtually every country in the world, MSF adapted or scaled up our ongoing activities and started new activities in many countries over the course of the first six months of 2020.
We committed substantial resources to developing dedicated COVID-19 projects, maintaining essential healthcare in our existing programmes, and accompanying ministries of health in preparing and/or facing the pandemic. This support was often in the form of training in infection prevention and control, health promotion and organisation of healthcare services.
In the second half of 2020, most of this training has concluded, and the greater part of our COVID-19-specific activities have been handed over or closed. Most COVID-19-related activities have been integrated in our regular projects, although we are maintaining some COVID-19-focused projects and, with the second wave of infections in some areas, some activities are re-opening, especially in Europe. Where we are doing so is very much dependent on the context: the local epidemiological situation, the local health needs, and our own resources.
It is still difficult to provide a global narrative on our operations, as the pandemic is affecting every country in the world, with different consequences, in different places. Therefore, our approach can also be very different from country to country or even from project to project.
Americas
Brazil
In São Paulo, Brazil, MSF staff are working in collaboration with MoH staff in providing palliative care to patients at the Tide Setubal hospital.
In the state of Mato Grosso do Sul, our team in Amambaí has been conducting IPC training while waiting for an authorisation from federal authorities to work in indigenous territories.
Closed projects
In Rio de Janeiro, we undertook screening and health promotion activities with the homeless and vulnerable people.
In Manaus, in the country’s north, an MSF team trained local health professionals on infection and prevention control. We worked at the public hospital 28 de Agosto, and provided treatment to people in ICU beds and in a ward for moderate and severe cases of COVID-19. We also ran an isolation centre for migrant Venezuelan indigenous people with suspected COVID-19.
In São Paulo, MSF teams ran medical activities at two isolation centres with a total of 140 beds, for vulnerable patients (homeless people, drug users and the elderly) with mild COVID-19. Teams worked with homeless people – in shelters and on the streets – youth in adolescent detention centres, and with heavy drug users, providing health promotion and IPC education, and ran a mobile triage clinic in the downtown area. At Tide Setubal hospital, in the city’s east, we opened an eight-bed intensive care unit and provided care to people from the neighbourhood and those from outside São Paulo; we closed these activities on 8 October.
In the same São Paulo neighbourhood as Tide Setubal, our teams undertook outreach for active case finding and contact tracing of people who were admitted to the ICU. MSF teams also ran health promotion activities in the neighbourhood’s slum districts, and developed health promotion activities, in addition to having installed handwashing points and distributed hygiene kits to residents, in partnership with local leaders. We ended these activities at the end of September.
In Amazonias state, teams worked in the remote towns of São Gabriel da Cachoeira and Tefé, several hours by plane from Manaus. In Tefe, we provided training at the town’s main hospital and undertook epidemiological surveillance in rural villages. In São Gabriel da Cachoeira, we ran a 10-bed ward where we treated people with moderate cases of COVID-19.
In the state of Mato Grosso do Sul, in Brazil’s south west, we ran mobile clinics in indigenous areas near the towns of Aquidauana and Anastacio, and in the Aquidauana urban area; we also supported the activities at the local hospital in Aquidauana. All activities in the region had ended by 12 October.
In Boa Vista, in Roraima state, MSF staff worked in a COVID-dedicated field hospital, providing medical care in an ICU ward treating people with moderate and severe cases. Our team also visited informal shelters where migrants and refugees from Venezuela gathered, and provided hygiene and physical distancing guidance to residents. We assisted in expanding access to water in formal and informal shelter and distributed hygiene kits.
In mid-September, we started providing medical care to prison detainees in Corumbá. Our staff monitored for COVID-19, but teams treated COVID-19 comorbidities such as TB and hypertension to men in the men’s prison, and we provided medical consultations at the women’s prison. These activities closed at the end of October.
Mexico
In Guerrero state, on Mexico’s lower Pacific coast, MSF teams have coordinated with the state health authorities to provide technical IPC support in several state hospitals. We are also providing training for health staff and support in setting up patient and staff flow.
MSF teams are also working in migrant shelters. The objective is to help shelters and migrant centres to adapt their structures to the pandemic response, including IPC measures.
Closed projects
MSF teams established an auxiliary hospital unit in a basketball stadium in Tijuana, in the far northwestern corner of Mexico. MSF medical staff provided treatment to non-critical COVID-19 patients, which relieved the burden on local hospitals.
In Matamoros and Reynosa, on the eastern Mexican/US border, our team provided medical care to mild and suspected patients, and severe patients that needed oxygen, in two adapted centres for COVID-19 patients.
Africa
Overview
As of end of November, over 32,000 deaths linked to COVID-19 had been recorded in Africa, when, in comparison, the continent recorded 380,000 deaths due to malaria in 2018. In the Sahel, it has been confirmed that the peak of malaria season struck more intensely and for longer this year, in particular because the rains started earlier and were heavier compared to previous years. In many countries of the sub-region, national prevention programmes have been impacted by the restriction measures put in place to deal with the COVID-19 pandemic. Mass activities such as mosquito net distributions or seasonal prevention campaigns have often been slowed down.
Burkina Faso
In eastern Burkina Faso, we are supporting community awareness activities and triage at the health centre in Fada. We are also training MoH staff and undertaking disease surveillance and health promotion activities. With the high number of displaced people in the northern, north-central and eastern parts of the country, our teams are monitoring the epidemiological situation throughout the country.
Closed projects
MSF worked in Bobo-Dioulasso, in the country’s west, where the second-biggest outbreak in the country had been located. We provided care for COVID-19 patients in a dedicated facility, in collaboration with the national health authorities. We installed an oxygen production unit, which provided oxygen to dozens of people, direct to their beds, at once. Teams reinforced other facilities’ capacities in terms of triage, isolation, protection equipment and infection prevention and control measures at the University Hospital Centre, and at the Medical Centres with Surgical Annexe of Do and Dafra. Following a sharp drop in cases in the area, we ended our activities in the city and surrounds on 15 July.
Following a better than expected evolution of the pandemic in the country, MSF teams, who had finished the construction of a 50-bed hospital centre for the care of COVID-19 patients in Ouagadougou,, handed over all activities to the Ministry of Health at the end of July.
Teams had been providing patient support in Fada health centre, in the country’s east, where we had also rehabilitated a 20-bed treatment site at the regional health centre. These activities were handed over to the regional health authorities on 28 July.
Senegal
In Dakar, the capital of Senegal, we are supporting the treatment of people with moderate and severe cases of COVID-19 in the Hopital Dalal Jamm. Here we are also providing training as well as support for water and sanitation activities, and simplified triage protocols.
We are providing support in Guediawaye district, in Dakar’s northern suburbs. Our teams are supporting the MoH on community engagement, case surveillance, testing mechanisms and improving IPC measures and continuity of care.
Middle East and North Africa
Yemen
In Hajjah Governorate, Yemen, teams have been working in Abs and Al-Jamhouri hospitals, including setting-up screening points in both hospitals and establishing a 11-bed capacity isolation unit in Abs hospital. We have also improved IPC measures and provided training to MoH staff on COVID-19 symptoms and case definition, treatment, and IPC measures. MSF teams are also supporting referrals of patients from Al-Jamhouri hospital to an isolation centre at Al-Rahadi, as well as the triage area of the centre.
In Aden, MSF is supporting the 22 May hospital with donations of PPE, and training for medical staff on how to manage triage for COVID-19 suspect cases and on IPC measures.
In Khamer (Amran Governorate), our COVID-19 treatment unit, in which we treat patients with respiratory infections and suspected moderate cases of COVID-19, is still receiving some patients.
In Haydan (Saada Governate), we downsized the capacity of COVID-19 treatment unit to two beds, due the decreased number of admissions.
In Abyan governorate, MSF has provided training for the COVID-19 centre health staff, including triage, diagnosis, medico-therapy, physiotherapy and ICU care of critical cases.
Closed projects
MSF ran the COVID-19 treatment centre at Aden’s Al-Ghanouria hospital; our treatment activities at Al-Amal hospital had been transferred to Al-Ghanouria in light of the reduction of cases and admissions. Both projects have now closed.
In Sana’a, MSF has handed over our activities at Sheikh Zayyed and Al-Kuwait hospitals, where we treated people with severe cases of COVID-19, to the local health authorities.
In Hodeidah, MSF teams conducted training in various districts across the governorate. In addition, our teams also assisted to set up an isolation unit in Al-Salakhana hospital and supported the isolation centre with supplies of drugs and PPE. MSF teams put in place IPC measures, set up screening and triage, and identification for potential cases in Al-Salakhana hospital and Ad Dahi rural hospital.
In Taiz governorate, we conducted training on, and implemented, IPC measures, in hospitals across Taiz Houban and Taiz city. Our teams undertook triage, screening and identification for potential cases at the hospital in Taiz city.
In Lahj governorate, MSF teams provided training to medical teams in Yafa'a district, on how to manage triage, isolation and referrals of COVID-19 patients. Referrals were either to treatment centres in Lahj or Aden (for severe cases) or home (with observation) for mild cases.
In Ibb governorate, we supported local authorities to run the Al-Sahul COVID-19 centre. The centre had 18 intensive care unit beds and 70 inpatient beds, and MSF provided medication and medical supplies, including PPE. Our staff coached the centre’s staff, and we put in place IPC measures, assisting with technical support, triage and screening, facility management including workforce planning, and waste management. Teams also provided training on health promotion for MoH staff and private carers.
Iraq
In Iraq, our teams have been supporting Al-Kindi hospital in Baghdad, which is the epicentre of the pandemic in the country. MSF teams were working in the hospital’s respiratory care unit by providing training for hospital staff on treatment for COVID-19, administering ventilation and conducting disinfection procedures, but we have now expanded our support and are operating a 24-bed COVID-19 ward for severe and critical patients.
In Mosul, we temporarily transformed our post-operative care centre into a COVID-19 facility; in early September, we scaled the centre down to 20 beds. Our teams work in collaboration with local health authorities to provide treatment to people with mild and moderate COVID-19 cases.
In Laylan camp, Kirkuk governorate, our teams are triaging people for suspected cases of the new coronavirus. We have mobilised a 20-bed isolation and treatment facility, and are providing health promotion messages to communities on IPC measures.
Closed projects.
In Erbil and Dohuk, MSF helped local health facilities in both cities by providing technical support, logistics support and trained their staff on infection prevention and control.
Our teams did a distribution of reusable cloth masks to Laylan camp residents and raised awareness about prevention measures there. To promote health awareness around COVID-19, MSF also carried out a digital health awareness campaign targeting the city of Mosul.
Asia
Malaysia
In Penang, in Malaysia’s northwest, we are providing health education in different languages for vulnerable people, including Rohingya and Burmese, and translations in hospitals. We have started a COVID-19 health promotion campaign for Rohingya refugees via an online Rohingya news network. We’re also providing health kits and hygiene items, such as soap, to people in immigration detention centres.
Indonesia
In Indonesia, MSF teams are conducting workshops and training for doctors and community health workers in Jakarta and Banten provinces, who treat suspected COVID-19 cases and those observing home-isolation. Training sessions are on topics including IPC measures, contact tracing and health education. Health promotion sessions are still ongoing – with over 68,000 people reached so far – with MSF teams now also conducting training-of-trainers targeting specific community members to ensure increased coverage and sustainability.
Closed projects. In West Java, health promotion activities, including leaflets on disease prevention measures, and setting up hand-washing points, have been carried out.
Europe
Czech Republic
In November, MSF started a small project in nursing homes in the Czech Republic, in partnership with the Ministry of Labour and Social Affairs. Even though the staff of these facilities is not obliged to have a formal medical education, they are on the front line of the COVID-19 response, treating one of the most vulnerable groups. In the first-ever MSF intervention in the country, two small mobile teams are providing assessments and training on IPC measures in nursing homes.
Working in facilities in the regions of Plzensky, South Moravian, Zlinsky and Central Bohemian, all located outside the country’s capital, Prague, the teams visited almost 40 nursing homes in the first three weeks. Our teams are providing training either on-site or through a Czech version of a website developed by MSF’s Barcelona section for their similar activities earlier this year - https://msfcovid19.org/. We are also receiving requests to provide support from other regions as well. Other areas of support are still being assessed.
Italy
In Italy, which had been an epicentre of the pandemic, our teams continue to work in Rome, where we working in informal settlements and squats, where we have been tasked by local health authorities to manage contact tracing and isolation for COVID-19 clusters in 10 buildings. In these settlements, we aim to strengthen COVID-19 surveillance among marginalised urban communities – who include migrants, refugees, and some Italian nationals – through the creation of COVID community health and hygiene surveillance committees.
We are training the committees on improving infection prevention and control measures in their structures and communities, and on identifying and temporarily isolating people with suspect cases, and how to alert the authorities and medical staff.
On the island of Sicily, the outbreak is growing exponentially in the city of Palermo, where we continue our activities in several centres hosting migrants. An MSF team is working in four reception centres in the province of Palermo, which have been quarantined after one person tested positive for COVID-19.
Closed projects
In the Lombardy region, in the country’s north, the original epicentre of the outbreak, we supported three hospitals with infection prevention and control (IPC) measures, as well as provided care to patients. We also undertook outreach activities in order to reach vulnerable people, such as the elderly in nearly 20 nursing homes, and local organisations working with homeless and migrants. We also supported a telemedicine programme (medical assistance via video conference), which assisted people under isolation at home.
We had also been working in one of the most affected regions, the Marche region in central eastern Italy, where we are supported 30 nursing homes across several cities to prevent the virus spreading in such vulnerable locations.
In the Lombardy, Piedmont and Liguria regions, MSF teams had worked in 15 prisons, to protect detainees, prison and police officers. The MSF team included doctors, nurses and hygiene experts, who implemented measures to contain the spread of the virus and protect people inside the prisons. We designed procedures which will identify suspected cases among new detainees, verify their diagnosis and identify the contacts of confirmed cases.
On Sicily, our team supported epidemiological surveillance service in Catania and Enna provinces.
Belgium
In Belgium, MSF has relaunched activities in nursing homes, as the second wave of the pandemic is again hitting these facilities hard. Three mobile teams are working in the three regions of the country. The focus this time is on accompanying nursing homes in carrying out medical/clinical care activities for residents, a new area of work for these structures. Our teams also carry out mental health sessions for nursing home staff.
An MSF outreach team is continuing to provide medical support to homeless and vulnerable people with confirmed or suspected cases of COVID-19, in the capital, Brussels. Our team is providing testing and follow-up of patients, and is part of an ‘Outreach Support Team’ working in partnership with other NGOs, which provides health promotion, IPC support, contact follow-up and testing (limited to a maximum of 30 people/day); priority is given to people living in non-approved structures, such as squats.
MSF rented out a hotel to provide accommodation to facilitate the follow-up of patients with suspected or confirmed cases of COVID-19. This structure doubles up both as accommodation and as a health structure in the centre of Brussels.
Closed projects
Mobile teams were supporting nursing homes for the elderly and reached 115 homes across Brussels, Flanders, and Wallonia. Support included psychological counselling and webinars for staff, and assessing residents for potential coronavirus cases. MSF established a 150-bed medical facility for vulnerable people, including migrants and refugees, in Brussels’ Tour & Taxis area. The facility, in which we also provided medical care for COVID-19, allowed people to isolate.
MSF teams had been supporting 10 hospitals to increase their admission capacity and on IPC measures. Support included providing technical and strategic advice, plus operating post-intensive care units.
Protecting people living in precarious conditions
Of particular concern is how coronavirus COVID-19 might affect people in precarious environments, such as the homeless, refugees living in camps in Greece or Bangladesh, or conflict-affected populations in Yemen or Syria. These people live under harsh, often unhygienic and overcrowded conditions, where their access to healthcare is already compromised.
How can we ask people to protect themselves when they don’t have easy access to water? Or to stay at home and self-isolate if they rely on daily jobs to make ends meet, or share a room with 10 other people? Nonetheless, it is very important to inform people of protective measures (such as washing their hands often) and help ensure they have the means to protect themselves (including self-isolation in case of contact with a person infected with COVID-19).
If COVID-19 starts to be transmitted in fragile settings like these, it will be practically impossible to contain. Basic health screening and, ideally, decentralised testing for high-risk settings such as refugee camps (Cox’s Bazaar in Bangladesh or on the Greek islands, for example) or high-density slum dwellings (Kibera in Kenya or Khayelitsha) needs to be implemented immediately.
Keeping healthcare workers safe
Protecting healthcare workers from contracting the virus is paramount for ensuring the continuity of care for general and COVID-19-related health needs. However, global shortages of personal protective equipment (PPE) pose a great threat. Healthcare workers must have access to the equipment they need to do their jobs safely and effectively.
As research and development is underway to find effective treatment for coronavirus COVID-19, we are closely tracking the trials and evidence concerning the potential medicines in the pipeline.
Any drugs, tests and vaccines for COVID-19 should be made available to all those who need them. It is crucial that governments prepare to suspend or override patents for COVID-19 medical tools by issuing compulsory licences. Removing patents and other barriers will be essential in helping ensure that suppliers can sell tests and treatments at prices everyone can afford.
Challenges in ensuring continuous care in MSF projects
We want to ensure continuous care for all patients where we work today and prepare our medical teams to manage potential cases of COVID-19. Protecting patients and healthcare workers is essential, so our medical teams are also preparing for potential cases of coronavirus disease COVID-19 in our projects. This means ensuring infection prevention and control measures are in place, including setting up screening at triage zones, creating isolation areas, and providing health education.
Our projects are still able to continue medical activities, but ascertaining future supplies of certain key items, such as surgical masks, swabs, gloves and chemicals for diagnosis of COVID-19, is a concern. There is also a risk of supply shortages for other diseases due to a lack of production of generic drugs and difficulties to import essential drugs (such as antibiotics, antimalarial and antiretroviral drugs), caused by community lockdowns, reduced production of active pharmaceutical ingredients, and reduction in export movements.
We face additional challenges because travel restrictions linked to COVID-19 are limiting our ability to move staff between different countries. We are trying to find ways to manage this, to avoid heavily impacting projects needing specialist profiles, such as surgeons. However, international staff represent just eight per cent of our total global workforce, so most MSF projects are run by locally hired team members.