The biggest city, Guayaquil, was overwhelmed as cases rapidly surged. The authorities tried their best to respond, but were taken by surprise at the scale, speed and deadliness of the virus. By late March, the authorities were unable to cope with the number of deaths and bodies were left uncollected in the streets for several weeks.

MSF was not working in Ecuador but moved fast in April to bring in a team that had gained COVID-19 experience in Europe to support the Ministry of Health. Initially, the team assisted in health centres and nursing homes, with a focus on infection prevention and control. A health promotion programme was targeted specifically at more vulnerable communities to provide clear guidance about how to stay safe and keep others safe.

As the numbers came under control in Guayaquil, the situation started to become more critical in Las Esmeraldas region and in the capital, Quito. With resources stretched worldwide, the team could not bring in additional support and had to decide where we could be of most assistance. As the case numbers were rising more steeply in Quito,we decided to help the city authorities with COVID-19 testing, and conduct training for staff in both fixed health posts and mobile teams responding in urban and rural areas.

We also trained staff working in nursing homes and shelters for homeless people in the capital, drawing on the experience we had gained in Europe and Brazil.

In addition, the team supported a dedicated COVID-19 treatment centre set up by the authorities with donations of medical supplies and technical training to strengthen clinical care. We also helped to adapt part of the centre for palliative care.