MSF intervention in care homes
COVID-19

Our response to the coronavirus COVID-19 pandemic

Last updated: 26 April 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.

Since the middle of 2020, this training has largely concluded. Most COVID-19-related activities have been integrated in our regular projects, although we are maintaining some COVID-19-focused projects. Over the last six months, our COVID-19-specific activities have been opened (or reopened) and closed as the second wave of infections determines the need to scale 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
With Brazil becoming the world’s COVID-19 epicentre, MSF teams keep their focus on the country’s north, where there’s a historical lack of material and human healthcare resources. In mid-March, we started activities in Rondonia’s capital, Porto Velho, with medical support and training in five emergency care units. Such facilities now keep patients, from moderate to critical, for long periods, as overcrowded hospitals cannot accommodate them. In March, we started activities in the state’s second city, Ji-Paraná, where the local 75-bed COVID-19 facility is overcrowded, understaffed and poorly supplied.

In Roraima, we provided training for health professionals in Pacaraima and Caracaraí, to improve care for patients.

We continue to provide mental health support for professionals from the biggest public hospital and one emergency care unit in Manaus, Amazonas.

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

Mexico
In Mexico, the MSF team based in Tenosique has extended their COVID-19 prevention activities to a shelter in Salto de Agua (Chiapas) which is receiving 150 to 200 migrants per day. Teams in Reynosa and Matamoros are conducting health promotion activities.

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

Peru
A severe second wave in Peru has led us to reopen activities. We are currently providing treatment for non-critical cases in an isolation centre in north Lima, as well as supporting the intensive care unit in nearby Huacho Hospital. We also provide community outreach to facilitate early detection of potential COVID-19 patients among people.

Closed countries
Throughout the Americas, MSF teams have responded to the pandemic in: Argentina, Bolivia, Canada, Colombia, Ecuador, Haiti, Honduras, 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, contact tracing and health promotion activities in the community.

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 where large numbers of displaced people are. 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 treatment.

MSF teams had also been responding in Bobo-Dioulasso, Fada and Dafra.

Côte d’Ivoire
In Côte d’Ivoire, MSF teams have restarted our telemedicine project in partnership with a local NGO following the start of a COVID-19 vaccination campaign launched in early March in Abidjan. The team is supporting this campaign by helping to diagnose illnesses that could lead to complications with COVID-19.

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
In Eswatini we implement a home-based care approach, where patients with comorbidities are visited at home to ensure continuity of care. This team is being trained on critical care in preparation of the anticipated third wave.    

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
In Malawi, MSF is providing staff, oxygen and technical support to Queen Elizabeth Hospital in Blantyre.

MSF has also responded in Neno, Dedza and Nsanje districts.

Mali
Across Mali, we continue to strengthen outpatient activities, such as improving dedicated COVID-19 patient flow and triage areas in health centres, medical follow up of COVID-19 positive patients at home, and raising awareness in communities.

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

MSF teams had also responded by treating patients in Bamako.

Mozambique
In Mozambique, we have scaled up our national response following an increase in cases. In Maputo, we set up two tents able to accommodate 16 people with moderate or severe symptoms in Mavalane Hospital. We installed GeneXpert machines to improve testing and diagnosis and provided technical support for the organisation of the new COVID-19 treatment centre and IPC training to local front-line health workers.

In Montepuez, we continue to support the local hospital, setting up pre-triage points there and in three health centres. We’re also providing training for health staff to open a COVID-19 treatment centre.

We assist the MoH in Beira with triage in two health facilities and at Central Hospital. We are also supporting the isolation centre with 20 beds and are providing IPC and treatment training to MoH front-line health workers. The capacity of health staff was also scaled up with one doctor, five nurses, six health promoters and 14 cleaners.

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

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, Dungass 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.

We continue epidemiological surveillance and community awareness.

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.

Our teams have set-up isolation units in Gwoza and Pulka where suspected and confirmed cases of COVID-19 are treated. The capacity of the unit has been reduced to five beds in each facility. In Ngala, where cases have been confirmed for the first time in mid-February, we have increased epidemiological surveillance and started to run IPC and health promotion activities.

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 at the end of last year. Anticipating a new wave, our teams across the country are now actively working towards a state of readiness in areas already hit hard – drawing on our experience and focusing on care inside hospitals.

In addition to previous projects in KwaZulu-Natal and Western Cape provinces, MSF teams had also worked in Port Elizabeth, 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
We are supporting Parirenyatwa Hospital Isolation Centre, Zimbabwe’s main referral site for COVID-19 cases in Harare, to help them prepare for the next potential surge in COVID-19 infections. We work towards improving infection prevention and control (IPC) measures, improve patient flow and tackle shortages of PPE, essential medicines and medical supplies. Additionally, MSF has recruited and sent medical staff to support the hospital.

MSF is also supporting a second COVID-19 isolation centre, the Wilkins Hospital in Harare.

In Zimbabwe, we had also conducted activities in Beitbridge, on the border with South Africa.

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

 

Middle East and North Africa

Iraq
In Iraq, as a second wave sweeps through Baghdad, we have expanded the capacity of our COVID-19 centre in Al-Kindi hospital from 36 to 51 beds. We are treating only serious and critical cases and are constantly full, with people waiting in the emergency room for a bed to become free.

Iraq saw its highest-ever number of COVID-19 cases reported on 25 March – 6,513 – but even that number is likely to be largely underestimated. Only 386,000 doses of a vaccine have arrived in Iraq so far, a number barely sufficient to cover the country’s 216,000 doctors, nurses and paramedical staff.

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 Mosul, 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 Lebanon, MSF, in collaboration with the Ministry of Public Health, started vaccinating elderly people and healthcare workers in nursing homes across the country. We provide the personnel to vaccinate these groups – as per MoPH priority criteria – and we are supplied with vaccines through the MoPH.

In parallel, we conduct health education sessions, which include informative messages about COVID-19 vaccination and the ways to register to get vaccinated.

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, MSF operates 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 carrying out COVID-19 and mental health promotion activities to affected households.

In Nablus, we support a Palestinian Red Crescent Society hospital with skilled human resources, medical and logistic supplies. In Hebron, we work in Dura hospital on infection prevention and control measures and triage, support the intensive care unit, and assist water and sanitation services.

In Palestine, MSF teams had also responded in Gaza.

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 undertaking screening and triage activities in Herat regional hospital.

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.

India
After activities in India were wound down in February, MSF teams are responding to COVID-19 once again following a massive surge in new cases. From mid-April, our teams in the M-East Ward of Mumbai have restarted shielding*, digital health promotion, and water and sanitation activities.

Meanwhile, our teams are undertaking screening and triage for tuberculosis patients at Shatabdi hospital and at the MSF independent clinic, both in Mumbai. MSF is preparing to support two units in the city, each with a 1,000-bed capacity, with medical and technical support, including with oxygen supplies. Five additional medical doctors and five nurses have been recruited to strengthen the response.

Other MSF response activities in Asia:

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 provides COVID-19 mental health and psychosocial support activities in Banten province and in Jakarta.

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

Papua New Guinea
Since early March, the number of confirmed infections in Papua New Guinea has tripled to 3,500. This outbreak includes a large number of healthcare workers as well as other key groups of concern, such as incarcerated people and people working in closed settings including mine sites. Around one-third of MSF staff working in the tuberculosis projects have tested positive, limiting our response capacity for the regular programme, as well as response to the outbreak of COVID-19. MSF is currently finalizing the plans to support a makeshift 43-bed COVID-19 treatment facility in Rita Flynn hospital in Port Morseby.

MSF is also supporting the Rita Flynn hospital with one lab technician and cartridges to analyse samples of PCR tests for SARS-CoV-2 infections.

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 Bangladesh, Cambodia, China, Hong Kong, India, Japan, Nepal, Papua New Guinea, and the Philippines.

 

Europe

Belgium
In Brussels, Belgium, MSF teams are 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.

Two mobile teams support authorised structures, such as reception centres for asylum seekers, with awareness raising and infection control and prevention measures. An outreach team provides support to people 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 runs mobile clinics in the Île-de-France region and around Paris, providing COVID-19 tests and referrals if needed. We also provide medical assistance in a COVID-19 centre specifically dedicated to people who are COVID-19 positive but unable to self-isolate at home.

In France, MSF teams have worked extensively in previous projects – especially in nursing homes –  across Paris and the Île-de-France region, plus in Marseille, Reims, the regions of Provence-Alpes-Cote d’Azur and Occitanie, and in the département of Haute-Savoie, in the country’s east.

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.

In Palermo, on the island of Sicily, we run 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.

Portugal
In Portugal, our teams are providing health promotion in areas of in Lisbon and Vale do Tejo which have a majority of people of Roma and African descent.

We also provide training on digital health promotion and provide donations of IPC materials and hygiene kits, including masks, soap, bleach, and hydroalcoholic gel.

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.

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, Spain, Switzerland, 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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