MSF intervention in care homes
COVID-19

Our response to the coronavirus COVID-19 pandemic

Last updated: 3 February 2021

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 or scaling up. 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
MSF teams in Brazil are working in the hard-hit and remote Amazonas province. In Tefé, we support the local 24-bed hospital, where we have donated in oxygen cylinders and oxygen concentrators. We are also providing tests to the local people. In São Gabriel da Cachoeira, we support the local infirmary and have increased the testing capacity of the municipality.

Teams are also working in Manaus, the province’s capital, where the coronavirus has caused the local health system to collapse, making the transfer of serious patients from smaller towns impossible.

We have also worked in São Paulo, Rio de Janeiro and in the states of Mato Grosso do Sul and Roraima.

Mexico
In Tijuana, far northwestern Mexico, an MSF doctor is supervising the installation and hiring of staff at the local general hospital, so that a new hospital floor can open for additional COVID-19 patients.

In the northeast, MSF is monitoring the flow of Mexicans repatriated and non-Mexican migrants deported from the US. We are also working with the Nuevo Laredo health authorities to provide adequate COVID-19 response to migrants.

A multidisciplinary COVID-19 intervention team (health promoter, psychologist, logistician, water and sanitation expert and IPC manager) is providing technical support, training and advocacy in decision-making on COVID-19 in migrant shelters along the Mexican migration route. This team also provides psychosocial support to migrants and staff with suspected or confirmed (or in contact with) COVID-19.

MSF teams have also responded to the pandemic in Oaxaca, Chiapas, Tabasco, Veracruz, Nuevo Léon, Coahuila, Tamaulipas, and Guerrero states.

Closed countries
Throughout the Americas, MSF teams have responded to the pandemic in: Argentina, Bolivia, Canada, Colombia, Ecuador, Haiti, Honduras, Peru, the United States, and Venezuela.

Africa

Burkina Faso
MSF teams in Ouagadougou, the capital of Burkina Faso, are working in the city’s COVID-19 treatment centre, at the request of the Ministry of Health (MoH). Teams are undertaking the follow-up of outpatients and health promotion activities in the community.

In Bobo-Dioulasso, in the country’s west, a team has been sent for six weeks to support to the local health authorities. We continue to follow up epidemiological situation throughout the country, as concerns remain high with the number of displaced people in the northern, north-central and eastern parts of the country. We have adapted triage and infection prevention and control measures in the health facilities we support, set up isolation units and trained staff in prevention and case management.

MSF teams had also been responding in Fada and Dafra.

Democratic Republic of Congo  
In Kinshasa, the capital of Democratic Republic of Congo (DRC), we are supporting the Cliniques Universitaires de Kinshasa (CUK) – the Kinshasa University clinics – to treat people with moderate and severe cases in the CUK’s 40-bed COVID unit.

In addition, the MSF-supported Hospital of Kinshasa, dedicated to HIV/AIDS patients, has been equipped with isolation tents for people with suspect and confirmed cases and a reference system put in place.  The same approach was implemented in Kasai province, in Kananga, where MSF supports the General Hospital with triage and donations to the hospital and health centres according to their needs.

MSF teams had also responded to the pandemic in North Kivu, South Kivu and Ituri provinces.

Other MSF response activities in Africa:

Eswatini
The number of COVID-19 hospitalisations and deaths are on the rise in Eswatini. With health facilities overwhelmed by the surge of COVID-19 patients, we have put up tents, added doctors and nurses, beds and oxygen therapy to relieve Nhlangano health centre in admitting critically ill COVID-19 patients.

In addition, we have been strengthening our home-based care approach, with two teams now in place who have evacuated more than 30 patients in need of inpatient care. Finally, the support for PCR COVID-19 testing and the expansion of the new point-of-care antigen tests continues.

Ethiopia
In Gambella region, Ethiopia, MSF has set up a 20-bed COVID-19 isolation centre and another one with a capacity of 10 beds in two camps for South Sudanese refugees (Kule and Tierkidi). In Gambella town, a team provides support to the COVID-19 triage and temporary isolation centre in Gambella hospital.

Since May, a team in Addis Ababa has been providing mental health support in to more than 5,000 migrants who returned mainly from Saudi Arabia, Kuwait and Lebanon, and are placed in three COVID-19 quarantine centres in the capital. MSF is supporting the MoH’s medical and non-medical staff who work in the quarantine centres by training them on migrants’ mental health needs.

Our teams support the regional health authorities in our different project locations in Amhara and Somali Region in their isolation and treatment centres and with health education.

Kenya
In the coastal city of Mombasa, in eastern Kenya, MSF is training MoH staff working in two new facilities currently being set up by the county’s Department of Health. Training is focusing on infection prevention and control, treatment and support in health promotion and other community engagement where needed.

In the city of Homa Bay, in the country’s southwest, the county isolation centres are either closed or insufficiently equipped to treat people with symptoms and underlying conditions in the increasing number of patients. We are setting up a COVID-19 high dependency unit (HDU) within the county’s referral hospital, to treat people with moderate to severe cases of COVID-19. Some of these patients come from the adult inpatient wards we already support as part of our regular activities. The HDU is in addition to our ongoing support of COVID-19 screening and suspect case management at the referral hospital.

MSF teams in Kenya had also responded to COVID-19 in Embu, Nairobi, Kiambu, Dadaab and Mombasa counties.

Liberia
In Liberia, our teams are undertaking health promotion activities on prevention measures in and around Monrovia, the capital.

Malawi
As Malawi sees a soaring number of COVID-19 cases that is quickly overwhelming healthcare facilities, MSF is providing staff, oxygen and technical support to Queen Elizabeth Hospital in Blantyre. We are also opening an additional 40-bed COVID-19 ward (considered an annex to Queen Elizabeth’s ward) under an inflatable tent, fully equipped and staffed by MSF.
MSF has also responded in Neno, Dedza and Nsanje districts.

Mali
In Bamako, the capital of Mali, we are supporting the MoH in the 100-bed COVID-19 unit at Point G University Hospital with the treatment of patients with a severe form of the virus and those who need oxygen.

Our teams support several health centres and are also present in two referral health centres for triage and case identification. We provide medical follow up to people with moderate and mild cases with comorbidities who can stay at home and do not need hospitalisation. Outreach and awareness activities are targeting people suffering from chronic diseases, such as diabetes, and who are particularly at risk of developing severe forms of the disease.

In Timbuktu, we are supporting COVID-19 screening activities in the Centre de Santé de Référence (referral health centre) with a five-person team.

Mozambique
In areas of Mozambique where we already worked before the pandemic, MSF is providing support to the MoH. In Maputo, the capital, we are supporting the main COVID-19 hospitals, Polana Caniço and Mavalane, with logistic and technical support. In Mavalane, we are also setting up a tent to extend bed capacity by seven beds for people with suspected cases, a donning and removing area for PPE, are improving the water system, rehabilitating a bathroom for patients suspected of having COVID-19, and facilitating electricity access, as well as providing mosquito nets and drinking water points for patients.

In Montepuez, MSF has collaborated with the Rural Hospital in the setup of a tent for triage of COVID-19 cases, provided training in infection prevention and control and treatment, and assisted in setting up patient flow in the new COVID-19 treatment centre that has recently opened, preparing for a possible wave of new cases. We are working in three other health centres in the region with IPC and logistics.

MSF teams in Mozambique had also responded to COVID-19 in Pemba and Beira.

Niger
COVID-19 remains active in Niamey, the capital of Niger, as well as in all other major cities of the country. MSF is supporting with logistics and human resources in Lamordé hospital in Niamey, where people with moderate cases are treated.

We are also supporting health centres in Magaria and Tillaberi with water and sanitation activities, distributing masks, organising the triage of patients, and helping the investigation and response team. We are also treating COVID-19 patients in our facilities in Diffa and Agadez.
MSF teams in Niger also worked on the COVID-19 response in Zinder, Maradi and Madarounfa.

Nigeria
In Ebonyi state, southeastern Nigeria, we are supporting the MoH and Nigerian disease control centre with testing, in the state’s first COVID-19 testing centre, and are currently supporting the re-opening of a 25-bed MoH facility in preparation for a second wave of COVID-19 in the state.

Across Nigeria, we have responded in Ngala, Sokoto, Gwoza, Pulka, Maiduguri, Benue, and Zamfara.

Somalia and Somaliland
We are providing health promotion to communities and technical advice or logistic support to set up isolation structures in some places; teams are screening people at the entrances to hospitals. In Somaliland, we are training members of the MoH rapid response teams on prevention of COVID-19.

Our teams in the country have also worked in Hargeisa, Galcayo, Las Anod and Baidoa.

South Africa
With a new local variant of the coronavirus, which saw the number of cases surge and hospitals in South Africa become overwhelmed, MSF teams returned to working in hospitals in the country starting in November. A team of 20 MSF doctors and nurses are responding in Livingstone Tertiary Hospital and Elizabeth Mamisa Chabula-Nxiweni Field Hospital, both in Port Elizabeth.
MSF medical staff are also boosting response capacity in Lenteguer Field Hospital, Western Cape province and in Ngwelezane Hospital, KwaZulu-Natal province. In KwaZulu-Natal, we are also supporting basic-level healthcare facilities, and community support activities covering health promotion and shielding* of patients.

In addition to previous projects in KwaZulu-Natal and Western Cape provinces, MSF teams had also worked in Johannesburg, and in Gauteng and North West provinces.

South Sudan
In South Sudan’s capital city, Juba, MSF teams are providing technical support to the MoH, the National Public Health Laboratory with a laboratory supervisor, and Juba Teaching hospital, with water and sanitation measures, donations and IPC training.

Outside of Juba, four MSF facilities in Agok, Bentiu, Lankien and Malakal Protection of Civilian sites run COVID-19 testing.  

In addition, in all projects across the country we continue to isolate and treat patients with suspected or confirmed COVID-19, although the numbers of confirmed patients remain low. We also continue to support and implement preventive measures, including screening and reinforcing IPC, awareness raising and health promotion, and training.

MSF teams had previously responded to the coronavirus in Yei, Old Fangak, and in Doro refugee camp in Maban.

Sudan
In Khartoum, Sudan’s capital, we are supporting four main public hospitals to strengthen their screening and triage system and the isolation areas. The objective is to protect or reopen lifesaving services and to reinstate confidence among health workers.

We are conducting a seroprevalence survey in Omdurman, just over the Nile River from Khartoum, and are discussing with MoH to begin a home-based support system for COVID-19 patients, covering the same area.

Our teams are also supporting the MoH to manage isolation centres in East Darfur and South Kordofan states.

Tanzania
In Tanzania, our health promotion team in Nduta refugee camp, is undertaking health promotion activities, raising awareness among the community on hygiene and best health practices. MSF has built four triage/isolation areas at each of our health clinics at Nduta refugee camp, and a main isolation centre at our hospital, with a 100-bed capacity, where people suspected of having COVID-19 are referred.

Zimbabwe
In Harare, the capital of Zimbabwe, we are supporting COVID-19 screening and referring patients to treatment centres. Our water and sanitation team is continuing to ensure access to water for communities.

In Beitbridge, on the border with South Africa, we continue to assist at the point of entry with support in screening and awareness activities.

Closed countries
Across Africa, MSF teams had been working in Cameroon, Central African Republic, Chad, Côte d’Ivoire, Guinea, Guinea-Bissau, Senegal, Sierra Leone, and Uganda.

 

Middle East and North Africa

Iraq
In Iraq, our teams are supporting Al-Kindi hospital in Baghdad, where we are operating a 36-bed COVID-19 ward for severe and critical patients.

In Mosul, we have opened and are operating a 16-bed COVID-19 intensive care unit in the city, where we provide care to patients with severe symptoms of the disease.

In Sinuni, we provide care to people in a four-bed unit of Sinuni General Hospital dedicated to observing and stabilising suspected COVID-19 patients.

Elsewhere in Iraq, our teams had also responded in Erbil, Dohuk and in Laylan camp.

Jordan
MSF, in collaboration with the MoH of health in Jordan, and other organisations, has opened a dedicated 30-bed COVID-19 treatment centre in Zaatari refugee camp. We treat confirmed and suspect COVID-19 patients in the treatment centre; our care includes providing psychosocial support. In a dedicated ‘transition area’ of the camp, MSF teams also carry out daily screenings for asymptomatic COVID-19 patients (confirmed cases and/or people who were close contacts of cases), transferring patients in need of medical attention to our COVID- 19 treatment centre.

We had also partly converted our reconstructive surgery hospital in Amman to a 40-bed dedicated COVID-19 treatment centre; the treatment centre has now closed and reconverted back to surgical activities.

Other MSF activities in Middle East and North Africa:

Lebanon
In Zahle, central Lebanon, where MSF runs a paediatric ward in the Elias Hraoui Governmental hospital, our teams are supporting the hospital staff by triaging children for COVIID-19 in tents outside the premises. Those who test positive are referred to hospitals managing COVID-19 treatment. In the Bekaa Valley, the MSF hospital in Bar Elias continues treating COVID-19 patients and the hospital’s ICU beds are fully occupied.

Our Medical Response Teams (MRT), which support the Ministry of Public Health, and our Rapid Response Team (part of the UN-led multi-sectoral emergency scheme), undertake COVID-19 testing across Lebanon, taking samples for testing from people who have been contact traced or are within active clusters of infection. In addition, the teams provide guidance and support to medical teams and people with COVID-19 in isolation sites. Our project-based Rapid Response Teams have also been part of the testing campaign in their project areas, notably in Tripoli and in the Bekaa Valley.

In Siblin (south Lebanon), the training centre of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) that had been turned into an isolation site in partnership with MSF, is taking in patients with suspected or confirmed cases of COVID-19. The centre admits vulnerable people of all nationalities, who cannot home isolate due to overcrowded living conditions.  

In Lebanon, MSF teams have worked in a number of neighbourhoods across Beirut, plus in Hermel, Saida, and Tripoli, among other places.

Libya
In Libya, our COVID-19 focused activities centre on providing training on infection prevention and control measures and treatment to nurses and doctors in hospitals in Tripoli. In the city, we are also supporting the Ministry of Health in one COVID-19 testing site.

Teams are reinforcing IPC measures in detention centres in Tripoli, Zliten and Zintan, including having installed handwashing points, distributed soap and cloth masks.

Palestine
In Hebron, in Palestine’s West Bank, the MSF team launched a hotline service to provide remote counselling in support to some of the people most affected by the COVID-19 outbreak, such as patients and their families, medical personnel and other first responders, and families of detainees. Our team is also distributing hygiene kits and carrying out COVID-19 health promotion and mental health promotion activities to affected households. We’re also supporting the local health system by providing technical advice and hands-on training on PPE, infectious waste, cleaning processes, oxygen therapy and bedside training to staff in Dura, and Alia hospitals.

In Gaza, we are providing water and sanitation plus IPC support to some basic healthcare centres in the north of the Gaza strip. We also conduct similar activities in Al-Awda hospital, along with training on health promotion.

Syria
In northwest Syria, MSF continues to provide care for patients with moderate and severe symptoms in Idlib National Hospital’s 30-bed COVID-19 treatment centre. We are working in three recently-opened COVID-19 treatment centres in the region, with capacities of 31 beds, 34 beds in Afrin, and 28 beds in Al-Bab. In the centres, we treat patients with mild, moderate and severe symptoms, providing oxygen support to those patients who need it. In the camps where we work in northwest Syria, our teams are still spreading awareness messages about COVID-19 and distributing hygiene kits to the families.

In Syria’s northeast, MSF teams are working with the Kurdish Red Crescent in supporting the only dedicated COVID-19 hospital in northeast Syria, on the outskirts of Hassakeh city, which also has some intensive care capacity. People who are discharged from care, as well as people who are able to self-isolate at home with mild illness, are supported with hygiene materials, health education, and with identifying vulnerable people within their household. Patients are also offered self-protection advice, and their health status is reviewed at regular intervals over a one-month period; we also follow up on their household contacts. We have increased our support in Raqqa city with a focus on protecting healthcare workers, improving IPC in primary and secondary healthcare facilities, improving triage, providing and care for suspect patients requiring inpatient care while they await test results.

In Al-Hol camp, our teams have identified 1,900 people who are particularly vulnerable to COVID-19, (due to having conditions such as diabetes, hypertension, or asthma).  MSF teams are supporting them as per their individual needs.

Yemen
In Hajjah Governorate, Yemen, teams are working in Abs and Al-Jamhouri hospitals, where they undertake screening and refer people with suspected COVID-19 to treatment centres. We 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 are treating people in a downsized COVID-19 treatment unit of just two beds, due the decreased number of admissions.

In Yemen, MSF teams had been working in Abyan, Hodeidah, Ibb, Lahj, Sana’a and Taiz governorates.

Closed countries
MSF teams also responded in Iran.

 

Asia

Afghanistan
In Herat, in northwestern Afghanistan, we are continuing activities in our 32-bed COVID-19 centre in Gazer Gah. Our screening and triage activities in Herat regional hospital continue and patients are being referred to other COVID-19 centres in case they show symptoms.

In Lashkar Gah, the team is referring people with suspected COVID-19 to the main COVID-19 hospital in Helmand province, Malika Suraya hospital. We are also treating COVID-19 patients with four identified risk factors: those with tuberculosis, surgical patients, children and pregnant women. In the city’s Boost hospital, we provide care to COVID-19 patients with comorbidities in a 30-bed ward.

In Kandahar, the team is supporting the designated inpatient facilities for the treatment of DR-TB patients infected with COVID-19 in the MSF DR-TB centre.

MSF teams had responded to the pandemic in a number of areas across Afghanistan, including in Khost, and Kabul.

Bangladesh
Teams in the Rohingya refugee camp in Cox’s Bazar, southeastern Bangladesh, are treating a number of patients who are COVID-19 positive, as well as monitoring others with suspected COVID-19, in isolation wards in our facilities in Cox’s Bazar. We are also undertaking health promotion activities among those in the camp and building two dedicated COVID-19 treatment centres.

In Kamrangirchar urban slum, in Dhaka, the country’s capital, MSF is focusing on providing health promotion about COVID-19 to residents. We are also supporting the local health facilities with IPC training.

Other MSF response activities in Asia:

India
Our teams in Patna, Bihar state, eastern India, are providing health promotion, mental health, and psychological first aid activities to healthcare workers in government hospitals across the state. Community health promotion and education activities are also taking place in the area.  

In Mumbai, teams are providing training and are screening in TB projects. We are also undertaking a digital health promotion campaign through Facebook in the city’s M-East Ward, with messages focusing on COVID-19 prevention and the reduction of stigma within the community.

Indonesia
In Indonesia, MSF teams are conducting workshops and training of trainers for doctors and community health workers in Jakarta, who treat suspected COVID-19 cases and those observing home-isolation. Training sessions are on topics including IPC measures, contact tracing and health promotion.

MSF teams in Indonesia had also responded to the pandemic in West Java and in Banten province.

Kyrgyzstan
In Kyrgyzstan, we are working closely with the MoH in Chuy and Batken oblasts (provinces), where teams provide home-based care for moderate and mild COVID-19 patients to prevent hospitals from being overwhelmed.

Our teams are also supporting health centres in Kadamjay raion (district) to reinforce COVID-19 preparedness measures, while offering technical advice, providing logistics assistance, supporting health promotion initiatives, and assisting in epidemiological surveillance through data collection.

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.

Pakistan
In Balochistan province, northern Pakistan, MSF staff are facilitating COVID-19 sample deliveries to Quetta. In Karachi, we are undertaking digital health promotion activities within Machar Colony Community to debunk myths and raise awareness.

We are also conducting extensive awareness-raising activities on ways for people to protect themselves and prevent spreading the virus, and we have added protective COVID-19 measures and isolation areas in most of the facilities we support across Pakistan.

Across Pakistan, MSF teams also responded in Timergara.

Tajikistan
In Tajikistan, we have developed a tuberculosis+COVID health education leaflet and shared the document with the health ministry to ensure accurate information is disseminated. In Dushanbe, we are working with TB patients, their families and their communities to explain how to prevent the transmission and infection of COVID-19.

At the Republican Centre TB dispensary, we are developing improved triage protocols and patient flow, and offering health promotion for people awaiting their consultation.

Uzbekistan
In Karakalpakstan, in Uzbekistan’s west, we have started a health promotion campaign aimed at TB patients on how to prevent contracting COVID-19. Additionally, we coordinate with the MoH for the treatment of patients co-infected with COVID-19 and TB.

Closed countries
In Asia, MSF teams responded to the pandemic in Cambodia, China, Hong Kong, Japan, Nepal, Papua New Guinea, and the Philippines.

 

Europe

Belgium
In Belgium, MSF teams are once again supporting nursing homes in Brussels, this time during the first phase of vaccination (from 5 January). We are undertaking health promotion and awareness-raising activities, both for residents and staff. We are also training staff for the implementation of the vaccination campaign. This is the third intervention MSF is carrying out in nursing homes in Belgium.

Since November 2020, in the centre of Brussels, we have been providing shelter and medical care to homeless patients who are COVID-19 positive or are likely to be COVID-19 positive. These vulnerable people are offered the opportunity to isolate themselves, to be medically monitored and referred for appropriate care, if needed. Since the shelter’s opening at Galia Hotel, more than 100 patients have been treated by MSF teams.

An outreach team also provides support to patients who are COVID-19 positive or likely to be COVID-19 positive, who are staying in unauthorised places (e.g. squats). MSF offers screening and medical follow-up in collaboration with two other NGOs. This team also provides health promotion, infection prevention and control, contact tracing and psychological support.

In Belgium, teams had also been working – especially in nursing homes – in Flanders and Wallonia.

France
In France, MSF has set up teams of doctors, nurses and psychologists to reduce the burden on the most vulnerable nursing homes and strengthen medical care – the teams are currently working in the Provence-Alpes-Cote d’Azur and Occitanie regions, in southeast and southwest of France, respectively.

This is in addition to our mental health support programme for nursing homes launched in July, which is currently focused on the Paris region. However, the programme will also be expanded to other regions of France in the coming weeks, depending on our capacities and the most pressing needs

In the Île-de-France region and Parisian suburbs, we have resumed screening people who are homeless and living in precarious settings for COVID-19. Our teams are doing this via mobile clinics, where they also provide general medical care.

In France, MSF teams have worked extensively in previous projects across Paris and the Île-de-France region, plus in Marseille, Reims, and in the département (administrative division) of Haute-Savoie, in the country’s southeast.

Other MSF COVID-19 response activities in Europe:

Greece
In Athens, our teams are collaborating with the 3rd Clinic of Internal Medicine of Athens University (NKUA-EKPA) by providing psychological support to frontline health workers, COVID-19 patients and their relatives.

In Greece, our teams had been responding to COVID-19 on the islands of Samos and Lesbos; the latter via a COVID-19 isolation centre in Moria refugee camp, which we were forced to close after being issued with fines and the threat of criminal charges by local authorities.

Italy
In Italy, which had been an early epicentre of the pandemic, our teams continue to work in Rome, where we are 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 four centres hosting migrants and marginalised Italians. An MSF team continues to undertake health promotion and IPC activities in many official Migrant Reception Centres in the city, where there are new COVID-19 cases.

MSF teams have worked extensively in Italy, including in the Lombardy, Marche, Piedmont and Liguria regions.

Russia
In Russia, MSF are distributing information leaflets on TB and COVID-19 which we developed to multidrug-resistant and extensively drug-resistant TB patients in Arkhangelsk region, in the country’s north. MSF teams are distributing food and hygiene packages during the patient visits.

In addition, are partnering with two community-based NGOs in Moscow and St Petersburg to support vulnerable people, where PPE (masks, gloves and hydroalcoholic gel) have been distributed with information materials developed on COVID-19, TB and HIV. MSF is also providing training on COVID-19 for these organisations.

Switzerland
In Switzerland, MSF is working in collaboration with the health authorities and charities in the cantons (states) of Geneva and Vaud and in neighbouring Haute-Savoie, France, where we are caring for vulnerable people and the elderly in nursing homes.

MSF teams in Switzerland responded to the pandemic in a number of different projects across cantons Geneva, Vaud and Jura.

Ukraine
In Ukraine, MSF is supporting the Ministry of Health to respond to COVID-19 in Donetsk and Zhytomyr regions. In Mariinka raion (district), Donetsk region, two mobile teams provide home-based care for people with mild coronavirus symptoms, in order to prevent health structures from being overwhelmed.

At Central District Hospital in Krasnogorívka, MSF is supporting health authorities in establishing an isolation ward for patients with moderate symptoms by providing 22 oxygen points, technical support to reinforce triage and patient screening, conducting refresher training for health workers on treatment and infection prevention and control (IPC). We are also undertaking screening and isolation activities, plus waste management, in four health facilities and a nursing home. Training and psychological support is also being provided to healthcare workers in Zhytomyr region.

In Donetsk and Zhytomyr regions, MSF is also providing psychological support through telephone hotlines for health workers, COVID-19 patients and their relatives.

Closed countries
MSF teams across Europe have responded to the coronavirus pandemic in the Czech Republic, Germany, Ireland, the Netherlands, Norway, Portugal, Spain, and the United Kingdom.

 

*Shielding consists of creating ‘green zones’, or safe zones, where individuals more susceptible to COVID-19 are kept protected from any potential source of infection. The areas where they stay can either be inside the household or in separate locations, in the neighbourhood. During the shielding phase, these people should have minimal physical interactions with their relatives and other community members.

MSF Intervention in Leganés

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.

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