© MSF/Vincenzo Livieri

COVID-19 (coronavirus disease)

MSF is currently responding to the new coronavirus in five continents

COVID-19 is a new viral disease that affects the respiratory system

The World Health Organization (WHO) declared COVID-19 a pandemic on 11 March 2020. More than 200 countries are now reporting cases.

As COVID-19 continues to spread, MSF teams are racing to respond to the pandemic in the more than 70 countries in which we run programmes, while opening projects in new countries as they become pandemic hotspots.

Our COVID-19 response focuses on three main priorities:

  • Supporting health authorities to provide care for patients with COVID-19 
  • Protecting people who are vulnerable and at risk 
  • Keeping essential medical services running

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Where is MSF responding? 

Information as of 25 January 2021

Africa

Burkina Faso

In recent weeks, the country has seen an increase in the number of people with COVID-19, mostly via community transmission. The pandemic is affecting all areas, urban as well as rural.

At the request of the MoH, MSF will resume activities at the COVID-19 treatment centre in Ouagadougou, with outpatient follow-up of patients and health promotion activities in the community.

In Bobo-Dioulasso, western Burkina Faso, MSF again sent a team 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.

Cameroon

In the early stages of the pandemic, MSF implemented numerous initiatives in its projects and provided support to the national response in the central, far-north, northwest and southwest regions.

Over the past seven months, MSF has run trainings for healthcare staff (including those from the Ministry of Health) in infection prevention and control measures in our projects, and also in the commercial capital Douala.

Today, the number of patients being hospitalised has decreased, but there remain regions with little access to medical care, making the overall level of transmission unclear. In general, MSF’s response to COVID-19 in Cameroon has ceased, based on decreasing hospital admissions.

MSF’s research wing, Epicentre has been sequencing the different strains of the virus circulating in Cameroon. In October, Epicentre published an article in the Lancet on shifting approaches to mental healthcare in Cameroon during the ongoing pandemic.

Central African Republic

In Bangui, MSF built a COVID-19 treatment centre for patients suffering from acute respiratory distress syndrome. However, given the low number of severe cases, the centre did not open and the facility remains ready to be used. MSF continues COVID-19 related health promotion work with the communities.

Teams also launched shielding activities for people living with HIV in four outpatients’ treatment centres of Bangui, benefitting approximately 9000 people. A similar strategy, including soaps and masks distribution, food support and awareness raising sessions is implemented in Paoua and Carnot in collaboration with UNICEF and WFP, targeting around 4000 patients and their families.

Chad

In July, we provided support to Farcha hospital, in N’Djamena, since the facility is the referral hospital for COVID-19 treatment. MSF provided clinical training to the staff, and installed an oxygen generator to provide oxygen in large quantities and for several patients at once. Given the low number of severe cases, this hospital didn’t require further support from us. In the capital, our teams also supported to laboratory activities at central level to draw up biosecurity procedures.

Activities in N’Djamena also included surveillance support, as well as health promotion and community engagement across the capital, including with marginalised groups with lesser access to health information such as nomadic people in the outskirts of the city. We added COVID-19 related health promotion, medical screening and distribution of soaps and locally-produced cloth masks to our community-based activities in the three districts where we run malnutrition programmes.

Côte d’Ivoire

Activities closed

Restrictions have been largely eased in the past weeks and confirmed cases are slowly decreasing. The number of deaths remain stable. The mortality rate is currently up to 0.64% (18 167 total cases for 117 deaths).

We closed our two projects in Abidjan and Bouake, where activities were been handed over to the Ministry of Health.

The team is assessing the results from the pilot telemedicine project which was carried out in the COVID-19 treatment centre of Yopougon, in Abidjan. The Yopougon treatment centre is hosted in the university hospital (CHU), that is currently closed for rehabilitation. Access to health specialists is thus scarce and MSF implemented this telemedicine project in partnership with a local NGO and the Ministry of Health, to diagnose and rapidly detect co-morbidities such as diabetes, hypertension, respiratory failure and cardiovascular diseases, with the objectives to reduce mortality among the more vulnerable patients.

In order to do so, two MSF teams composed of doctors, nurses and care-givers provided 148 tele-consultations to COVID-19 patients at the Yopougon centre between July and August.

Democratic Republic of Congo

Across all our projects in DRC, our teams are working on awareness raising and health promotion and implement preventive measures, such as providing masks and handwashing stations, setting up triage and isolation areas, as well as contact tracing.

With the second wave hitting Kinshasa in December, and a lack of ICU beds available in the capital, we started supporting the Cliniques Universitaires de Kinshasa (CUK) – the Kinshasa University clinics – in January 2021 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.

Activities closed 

MSF support to COVID-19 prevention and care in the capital, Kinshasa with four health structures in the Limete health zone continued until mid-December 2020.

In addition, 15 communes of Kinshasa benefitted from MSF support from September to December, which included sharing knowledge about the outbreak and prevention measures to be respected. About 1,600 people were informed about the disease, notably people living with a disability, orphans and the elderly, and 33 donations were made to the specialised structures.

In South Kivu, with the closure of projects in Fizi territory, MSF handed over a COVID-19 isolation centre in Baraka to the MoH. Teams have also donated material in up to 21 health areas while monitoring and being ready to support the response to any deterioration in the epidemiological situation.

Eswatini

The number of COVID-19 hospitalisations and deaths are on the rise in the country. 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 now two teams 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. As the surge continues and Eswatini is likely to be severely affected for several months, the planning for the introduction of COVID-19 vaccinations becomes increasingly important, specifically since the more transmissible South African strain spreads fast.

Ethiopia

In Gambella region, in two camps for South Sudanese refugees (Kule and Tierkidi) MSF has set up a 20-bed COVID-19 isolation centre and another one with a capacity of 10 beds. 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 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. We have also been working on preparedness in all our projects putting in place preventive and hygiene measures.

Guinea

Activities closed

From end of April to early August, MSF has been supporting the provision of care to more than 350 COVID-19 patients in the Nongo Epidemic Treatment Center in Conakry. We had set up this structure in 2015 as part of our Ebola response epidemic, before handing it over to the authorities.

In April 2020, our teams rehabilitated a large area of the centre to bring it up to standard to have a proper 75-bed COVID-19 isolation and treatment unit to provide care for patients with mild and moderate symptoms of the disease, but also patients in need of oxygen therapy.

Beyond the provision of care, our teams also disinfected several homes of patients admitted to hospital, provided psychosocial support, and managed the tracing and following up on their contacts. The Nongo COVID-19 treatment centre and its equipment were handed over the authorities mid-August.

Guinea-Bissau

Activities closed

In Bissau, the capital of Guinea-Bissau, we provided different training at the National hospital Siamo Mendes including on the treatment of people with COVID-19, on IPC measures, water and sanitation improvement, and provided support with hygienists on waste management.

Kenya

The country is experiencing an intense surge of COVID-19, with an increased number of healthcare workers being infected. They are currently threatening a country-wide strike.

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

In the city of Homa Bay, the county isolation centres are either closed or insufficiently equipped to treat people with symptoms and underlying conditions in the increasing number of patients. MSF is 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.

Liberia

MSF is carrying out ongoing awareness activities on prevention measures in communities in and around Monrovia.

Malawi

As the country 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, where we already ran a cervical cancer programme.

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.

Mali

We are supporting the MoH in Point G University Hospital in Bamako (100 beds dedicated to COVID-19) 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 with a five-person team.

Mozambique

MSF continues to provide support to the MoH in areas where we already had activities. However, due to a surge of COVID-19 cases in Mozambique, particularly in Maputo since the start of 2021, we have scaled up our response.

In addition to continued support to the main COVID-19 referral hospital, Polana Caniço, we are now supporting Mavalane Hospital with technical and logistic assistance in the temporary 21-bed isolation ward, including the setup of a tent to extend capacity by seven beds for people with suspected cases, a donning and removing area for PPE, the improvement of the water system, the rehabilitation of 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.

MSF will also support with oxygen concentrators and the reallocation of GeneXpert PCR-test for COVID-19 diagnosis to Mavalane Hospital. We are also providing IPC training to local health authorities.

In Beira, in collaboration with an Italian NGO, we have been supporting two nurses who have been working in the COVID-19 response since November to reinforce the local capacity.

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.

Niger

COVID-19 remains active in Niamey as well as in all other major cities of the country. MSF is supporting with logistics and human resources in Lamorde 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 continuing epidemiological surveillance and undertaking community awareness. For Diffa and Agadez, we treat patients in our facilities.

Nigeria

We continue to support health promotion and provide local authorities, hospitals and healthcare centres with technical support, staff training and IPC in all projects. Our teams have prepared beds in Gwoza and Pulka, should isolation facilities be needed.

In Ebonyi state, we are supporting the MoH and Nigerian CDC 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.

In Sokoto, we have supported the MoH to renovate a 32-bed isolation and treatment centre. With the local authorities we helped conduct a community awareness campaign on COVID-19, reaching 370 settlements. We have carried out health promotion, installed water points and distributed soap to displaced communities in Benue and Zamfara.

Senegal

At the end of September 2020, given a clear reduction both on transmission and severity of cases, MSF decided to end our COVID-19 intervention and closed our projects in Dakar, in Guediawaye district (northern suburb of Dakar Region), and at the Hospital of Dalal Jamm.

All activities were handed over to the ministry of health. An increase in positive cases and deaths has been observed since the beginning of December 2020. MSF continues to monitor the situation and discussions are ongoing with the health authorities.

Sierra Leone

MSF is part of the case management and surveillance pillars at the national Emergency Operations Centre (EOC), and at district level EOCs in Kenema, Tonkolili and Bombali Districts. MSF epidemiologist continues to work with the Ministry of Health and Sanitation (MOHS) on surveillance, IPC and testing strategies.

From July 2020 until December 2020, in close collaboration with the district health management team, Western Area Urban, we worked with 10 community health workers from the Thompson Bay wharf area in Freetown, characterised by informal settlements. We organised health promotion and hygiene kits distribution. As the months progressed, the district medical team reported a higher number of people coming to the clinic, which was a great sign of the impact of the messages.

The health promotion activities stopped at the end of December 2020, with handover to the community healthcare workers and District health management team. We will continue to monitor the COVID-19 situation in Freetown and can respond in future if needed.

Somalia and Somaliland

There is a lot of stigma surrounding COVID-19 so people who feel sick are reluctant to go to a health centres out of fear of discrimination. The testing capacity is also extremely low due to shortage of testing kits and lack of funding.

In Somaliland, we train members of the MoH’s Rapid Response Teams on prevention of COVID-19. Due to infection prevention and control measures put in place to prevent the spread of the infection, regular programmes are affected, like routine immunisation and nutrition programmes.

South Africa

In November we received a request for support from public health officials in Port Elizabeth. Due to an outbreak of a new variant of SARS-CoV-2 – one that is associated with increased transmission – the health system was on the brink of collapse, with specialists in the main referral hospital reporting that as many as half of all COVID-19 patients who entered the facility in November may not have survived.

MSF assessed the needs in key facilities between 16-20 November, where we observed a critical shortage of doctors and nurses to treat COVID-19. With the aim of preventing as many COVID-19 deaths as possible, a team of 20 MSF doctors and nurses quickly went to work in Livingstone Tertiary Hospital and Elizabeth Mamisa Chabula-Nxiweni Field Hospital.

In Livingstone Hospital, the addition of four MSF nurses and four doctors enabled the opening of an additional COVID-19 ward. The ward already existed, fully equipped, but had been standing empty due to a lack of staff. By the end of November, Livingstone Hospital doctors were gradually able to begin decongesting and stabilising overwhelmed wards.

The addition of a similar-sized MSF team in the field hospital brought the doctor to patient ratio down from 1:70 to around 1:20. MSF provided much-needed treatment, seeing patients were weaned off therapy and discharged more efficiently, helping to decrease the number of patients from 300 to an average of 160 by the first week of December. With improved patient flow and more beds freed up, the overwhelmed hospitals in the area were able to refer more of the patients they were unable to treat.

As of January 2021, similar interventions have been initiated in Western Cape and KwaZulu-Natal provinces. In Western Cape, the team is providing support to Lenteguer Field Hospital which has a capacity of up to 200 beds. In KwaZulu-Natal, MSF is providing support to health facilities in King Cetshwayo District.

The intervention is focusing on increased support in a 100-bed ward at Ngwelezane Hospital, punctual support at specialist level, support of basic-level healthcare facilities in the project’s catchment area, and community support activities covering health promotion and shielding of patients.

South Sudan

MSF continues to support the Ministry of Health in the Juba Teaching Hospital with WATSAN materials donations and IPC training. We also continue to support the National Public Health Laboratory (NPHL) - the primary testing facility in the country - including with an MSF Laboratory Supervisor.

MSF is also in discussions with the MoH on possible technical support to the NPHL warehouse to help ensure improved and efficient stock management for COVID-19 testing.

Outside of Juba, with the completion of an MSF testing facility in Lankien, there are now four MSF testing facilities (one each in Lankien, Agok, Bentiu and Malakal Protection of Civilian sites) which add to the 23 facilities country-wide.

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.

Activities closed

In Juba, the water and sanitation component of the COVID-19 project has been fully phased out. 

Sudan

MSF has received approval to conduct a seroprevalence survey in Omdurman, and we are discussing with MoH to begin a home-based support system for COVID-19 patients, covering the same area.

We are supporting four main public hospitals in Khartoum 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.

MSF teams are supporting with trainings, reinforcement of infection prevention and control (IPC) measures, weekly donations of PPE. We also trained staff from 10 primary healthcare centres, donated IPC items and provided technical on-site support, which continues in different facilities in Khartoum. We are also supporting the MoH to manage isolation centres in East Darfur and South Kordofan states.

Tanzania

MSF is the sole healthcare provider in Nduta refugee camp, which hosts some 70,000 Burundian refugees. More than 250 MSF staff have been trained on COVID-19 preparedness and response measures to respond to a potential outbreak, and our teams continue to organise simulation exercises to maintain rapid response capacity.

We continue to have triage structures in the four health posts including 100 beds in the main hospital. Our community health educators in Nduta camp regularly sensitise the community on hygiene and best health practices. We also continue with temperature screening at the triage of the main camp gate and maintain handwashing points.

Uganda

Uganda has reported a low number of confirmed cases and no COVID-19 deaths so far. MSF teams have helped with logistics and hygiene measures in 3 MoH isolation units in Arua and Kasese.

We are raising awareness among the communities where we and distribute masks to patients and staff in MSF-supported health structures, as well as protective equipment to medical staff working with COVID-19 patients. In Adjumani district, in the North, an MSF team intervened to improve living conditions in a transit centre used to quarantine and test refugees, where conditions were particularly poor.

Zimbabwe

Towards the end of 2020, Zimbabwe saw the end of the first wave of COVID-19 with very few cases reported before the festive season. With the border between Zimbabwe and South Africa opened for the Christmas holidays, there was a sudden increase of positive cases and local transmission.

As of January 2021, the country is experiencing high numbers of local transmission and community deaths. MSF continues to support the Ministry of Health and local authorities in Harare in screening and referring COVID-19 patients, health promotion, health education, access to water and laboratory services. In Beitbridge, now with the border partially opened, MSF continues to assist at the point of entry with support in screening and awareness activities.

In response to the rising cases, MSF has carried out a needs assessment and is preparing for possible intervention in supporting local health facilities to increase bed capacity and improve quality of care.

Americas

Argentina

Activities closed

Between April and July, MSF offered technical support and advice to health authorities in the provinces of Buenos Aires and Córdoba. We helped to design protocols, circuits and infection prevention and control measures in health structures, alternative treatment structures, and nursing homes.

In Córdoba, we provided technical support to the province’s Emergency Operations Committee working group for enclosed structures (which includes nursing homes, haemodialysis units and prisons), and participated in training the staff.

In Buenos Aires, we collaborated with the secretariats in charge of the response to COVID-19 in the city’s vulnerable neighbourhoods on possible intervention strategies, definition of priorities, and in the trainings.

Overall, MSF teams provided direct training (in person and online) to more than 550 people who work with some of the most at-risk groups: staff from nursing homes, organisations for people with disabilities, homes for children and adolescents, and community representatives from vulnerable neighbourhoods. MSF also worked with the National Penitentiary Office, providing advice on general aspects of the disease, prevention measures in detention centres, psychosocial aspects and promotion of mental health.

Bolivia

A team assessed needs in the Beni region, a rural Amazonia-basin area in the northeast of the country. Our activities focused on training on IPC measures and medical training in six COVID-19 centres covering five municipalities. MSF also donated PPE and medicines.

Brazil

We went back to Tefé and São Gabriel da Cachoeira, two remote locations in the interior of the Amazonas, last November, after noticing a rise in COVID-19 cases. In Tefé, we support the local 24-bed hospital, we 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 increased the testing capacity of the municipality.

In the beginning of January, there was a sharp rise in cases in Manaus, the capital of Amazonas, that caused the local health system to collapse. There are shortages of oxygen and reports of people dying of suffocation in local hospitals. The collapse in Manaus made transfer of patients in critical condition to the state capital very difficult, resulting in patient deaths, including some of the people we assisted in Tefé. An MSF team has arrived in Manaus in January and has started activities.

In São Paulo, the palliative care project closed at the end of January and management passed to the hospital. The municipality has committed to provide some staff to ensure continuity of activities. In order to have a smooth transition, we will provide some staff as support for another four weeks.

Canada

Activities closed

MSF used its expertise in emergency outbreak response to provide valuable guidance to medical organisations, government agencies and remote indigenous communities to prevent and manage COVID-19 outbreaks. Teams created and shared two eBriefings related to COVID-19, one on infection prevention and control (IPC) and another on adapting and developing medical facilities. MSF also facilitated experienced field staff in Canada to other front-line organisations. MSF teams conducted several IPC assessments in shelters in Toronto for people experiencing homelessness and long-term care facilities in Montreal, providing recommendations to improve staff and clients’ overall safety.

The Canadian COVID-19 emergency highlighted systemic health inequalities in Canada that existed before the pandemic. Those living in remote locations continue to experience challenges in accessing secondary and tertiary levels of health care. Many communities still face challenges accessing primary health care and necessities, such as clean water. The economic barriers and unstable employment confronting too many Canadians before COVID-19 have been worsened. Canadians facing difficulties accessing medical care, because of insecure, inadequate, or nonexistent housing conditions, or geographic isolation remain vulnerable. The tragedies in Quebec and Ontario’s long- term care facilities highlighted the province’s catastrophic failure to care for a segment of Canada’s elderly population.

Despite existing and exasperated disparities in Canada, there is no need for MSF’s specific expertise currently. Although slow to start, generally, Canada's healthcare systems have not been overwhelmed by COVID-19. With lessons learned from the pandemic's first wave, systems and organisations should be better positioned to prevent and respond to future COVID-19 outbreaks in Canada. MSF Canada's COVID-19 activities ended on July 15, 2020.

Colombia

MSF is working closely with health authorities in Norte de Santander and Tumaco to support the local response. We are currently participating in outpatient triage and supporting the area for patients with respiratory symptoms at the Tibú hospital.

In Tumaco we are carrying out medical and mental health activities in the two public hospitals in the city. In each of these places we are also focusing a large part of our efforts on promotion and prevention activities in towns, villages and neighbourhoods through different community strategies and the media.

In Norte de Santander we continue to follow up on patients with chronic diseases, and we have maintained our mental health and sexual and reproductive health activities with Venezuelan and Colombian populations without access to the health system, as well as emergency attention for sexual violence and termination of pregnancy.

We have deployed a small technical team, the Flying COVID Team, which has been supporting local hospitals in Atlantico, one of the regions most affected by COVID-19. The team’s work, which is now supporting Erasmo Meoz Hospital in Cúcuta, has focused on rapid assessment, technical training, mental health care for health staff, and donations of medicines and supplies to help health facilities keep COVID-19 services safe at the peak of the outbreak.

Ecuador

A testing campaign was launched in Quito. MSF is supporting the health centres, to make sure they can follow-up on positive tests. MSF gives training and support for IPC, health promotion and mental health to mobile teams and to health posts.

In the Temporary Attention Center (CAT) in Quito, MSF will provide palliative care from mid-September, and train staff in this field. This is a pioneering project for whole country and will be implemented gradually.

The interventions in nursing homes and shelters for homeless people continue, with on-site support and trainings on IPC, mental health and health promotion.

El Salvador

MSF has strengthened our ambulances service in areas that are difficult to reach due to violence, in order to alleviate the workload of the emergency system that is dedicated to the transport of COVID-19 patients. MSF continues mobile clinics in communities of San Salvador and Soyapango affected by violence.

Haiti

After the initial steady increase of admissions at MSF's Drouillard COVID-19 treatment centre in Cité Soleil, Port-au-Prince, the number of hospitalised patients stabilised and decreased in July. A similar situation was observed in other COVID-19 centres managed by the Ministry of Health or other organisations in Haiti. From its opening in mid-May to its closure on 9 August, MSF teams in Drouillard centre screened 333 people and provided care to 192 patients who were hospitalised with severe symptoms.

MSF's emergency centre in the Martissant neighbourhood has also screened 69 people for COVID-19 since the epidemic was declared in March, referring patients to Drouillard when needed. A total of 66 deaths have been recorded by MSF (59 at Drouillard and 7 in Martissant) while more than 100 COVID-19 patients were discharged from Drouillard. Since 27 August, Drouillard hospital has reopened to treat patients with severe burns, which was its focus prior to COVID-19.


In several neighbourhoods of Port-au-Prince, community awareness and mobilisation activities on prevention measures and timely admissions continue through door-to-door health promotion, radio spots and training for community organisations and leaders. In Port-au-Prince, Les Cayes, Port-à-Piment and Port-Salut, our teams have also supported several hospitals and medical facilities in implementing infection prevention and control measures, triage and isolation.

Honduras

In Tegucigalpa, MSF has started medical activities in an adapted centre for severe COVID-19 patients, with the objective to help the metropolitan health system to keep the hospitals from being overwhelmed.

This included mental health, social work and health promotion activities. The activities finished on 12 October and MSF cared for 139 patients.

MSF has set up a mental health phone line for survivors of violence and sexual violence. An increase in mental health consultations has been recorded by the psychologists. MSF manages a health centre in a neighbourhood on the outskirts of Tegucigalpa. It is still functional and is prepared to detect COVID-19 cases.

Mexico

In December 2020, there was an increase in COVID-19 cases in the Tijuana General Hospital. We support their human resources area with an MSF doctor, who is supervising the installation and hiring of staff so that a new hospital floor can open for new COVID-19 patients.

In the northeast region, MSF is monitoring the flow of Mexicans repatriated and non-Mexican migrants deported from the US. MSF is also working with Nuevo Laredo’s health authorities to provide adequate COVID-19 response to migrants (and in Monterrey, Saltillo and Piedras Negras where migrants are still suffering the consequences of a lack of health and psychological care).

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. These visits to shelters began in the south of the country in Oaxaca, Chiapas, Tabasco, Veracruz, Nuevo Léon, Coahuila y Tamaulipas states.

In Guerrero, the MSF mobile clinics have carried out activities in 29 localities in the central regions, Tierra Caliente, and Costa Grande, to 2,989 people. Training was given to health centre personnel on: awareness, myths about COVID-19, IPC Measures, definition of suspected cases and referral routes, safe circuits for case management in health centres.

They have also trained rural communities (93 activities) on COVID-19, including on correct hand washing, proper use of face masks, with a donation of 9,987 units; 30 hand washing points were donated and installed and protective material was donated to the hospital of Coyuca de Catalán. During the activities, 5,605 outpatient consultations were carried out, of which 1,515 (27%) corresponded to acute respiratory infections and 12 cases, 0.8%, were referred to another level with a suspected diagnosis of COVID-19.

PAEC-LAT Project (‘Proyecto de Asesoramiento Estratégico ante el COVID-19 en Latinoamérica’)

Due to the difficulties in responding to the pandemic with the traditional approach, and as a way to overcome the restrictions for face-to-face work and staff movements, MSF created a free online strategic and technical support service aimed at institutions and staff that are at the frontline of the pandemic in Latin America.

This innovative digital solution takes advantage of the possibilities of virtual visits and online trainings to reach multiple countries, regions and different audiences, including health professionals, administrative staff, cleaning staff, community agents and indigenous health teams, mainly in remote communities and areas with limited access to healthcare services.

Since May, the PAEC-LAT has responded to more than 1,500 requests from health personnel working against COVID-19 in 14 countries in the region (Mexico, Guatemala, Honduras, Nicaragua, Costa Rica, Colombia, Venezuela, Peru, Uruguay, Argentina, Chile, Ecuador, Bolivia and Puerto Rico), and conducted 130 trainings and 35 virtual visits followed by recommendations reports.

Peru

Activities closed

In Peru, MSF launched a 3-months intervention to support the Ministry of Health’s COVID-19 activities in the Amazon region. This intervention ended at the end of September.

In cooperation with a team of the Basque health authorities in Spain we treated severely ill patients in the hospitals of Tarapoto, Huánuco and Tingo María while also providing support to primary health centres in the provinces of Datem de Marañón and Condorcanqui through donations and training.

United States

In collaboration with local authorities and/or partner organisations, MSF teams worked with migrant farm workers in Florida; people experiencing homelessness in New York; Native Americans –particularly Navajo Nation and Pueblo peoples– in the southwestern states of New Mexico and Arizona; clinical and non-clinical staff in nursing homes in Michigan and Texas; and a range of people and communities in need in Puerto Rico.

MSF has completed its programmes in Florida, New York, Michigan, and the Southwest. Medical programmes continued in Puerto Rico up until the end of September. In Texas, the team continued to offer on-site infection-control and mental health support to nursing homes up until October.

In Puerto Rico, since May, MSF helped support medical facilities with the immediate needs for personal protective equipment (PPE), provided training on infection prevention and control (IPC) measures to health care workers. MSF is continuing to provide hand hygiene and COVID-19 health education workshops to high-risk groups.

MSF also currently works in close collaboration with local partners to provide primary care consultations in homes and at ‘pop-up’ clinics to people suffering from chronic health conditions who had been unable to or fearful of going to health care facilities due to COVID-19. The team also monitors the symptoms of COVID-19 patients or people who test positive, but are asymptomatic. MSF works across the island in and around San Juan or travel to remote areas in the East, West, South and the third largest island Vieques.

In August, MSF took its infection-control training and wellness support model for nursing homes to Texas. Nursing home deaths make up more than 30 percent of the state’s total coronavirus fatalities since March. MSF is also providing its infection prevention and control (IPC) training tool kit and staff wellness model to schools of nursing so students can develop this expertise.

Venezuela

MSF’s response plan includes assisting with medical supplies and staff recruitment, as well as strengthening triage, diagnosis, treatment, infection control and peri-hospital system services in the projects in Amazonas, Anzoátegui, Bolívar, Sucre, Táchira and the Caracas.

MSF is also supporting with staff recruitment, treatment and peri-hospital system services in Vargas Hospital of Caracas, where we have 24 beds (including four for ICU).

Asia

Afghanistan

In response to the second wave of COVID-19 in Herat, the treatment centre in Gazer Gah was reopened on 2 December 2020, as the Ministry of Public Health’s facility in Shaydayee cannot respond to the increasing needs. MSF continues running the COVID-19 triage unit at the Herat Regional Hospital, the main referral hospital in the Western Region of Afghanistan. More than 700 patients with symptoms are screened and assessed on a weekly basis in the hospital.

In Lashkar Gah, MSF is continuing the referral of suspected COVID-19 patients to Malika Suraya Hospital – the main dedicated COVID-19 facility in Helmand. MSF agreed with the Ministry of Public Health to provide treatment and hospital care for four categories of patients infected with COVID-19 (TB patients, surgical patients, paediatric patients and maternity patients). In Boost hospital, there are 30 inpatient beds for patients with COVID-19 co-morbidities. MSF has provided GeneXpert diagnostic facilities for COVID-19 in Boost Hospital.

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. Refresher training on COVID-19 treatment was organised for MSF and Ministry of Public Health medical and paramedical staff. MSF now has GeneXpert diagnostic facilities for COVID-19 in the MSF DR-TB centre.

Over the last months, the project in Khost has been working to adapt to the “new normal” and turning back some of the strict measures that were put in place during the first wave of COVID-19. Family planning activities have restarted, and female caretakers will be admitted back into the hospital from late January. Since early November, we have PCR testing capacity onsite with a GenXpert machine; rapid antigen testing is also now available.

Bangladesh

MSF has created isolation wards in all our medical facilities in Cox’s Bazar. All MSF health facilities maintain triage and screening for respiratory tract symptoms and enforce strict infection prevention measures, while returning as far as possible to regular activities. Our teams are treating a number of patients with COVID-19, as well as monitoring patients with suspected COVID-19. Our focus is on treating all of our patients and ensuring we can give the best possible quality of care for COVID-19 and other medical problems, as well as continuing to work together with the Bangladeshi authorities, WHO and other health actors to limit the spread of the virus.

We are seeing the secondary impacts of the sustained reduction in access to healthcare and the de-prioritisation of community-based healthcare and social support in the camps. MSF has seen an increase in severity of non-COVID-19-related conditions, including increased deaths. Our teams are also carrying out HP activities in the camps.

In Kamrangirchar urban project, MSF has reduced regular activities to focus resources on our main clinic, where we continue to provide sexual and reproductive health services and SGBV, as well as health promotion for COVID-19. We are also supporting the local health facilities with IPC training.

Activities Closed

Because of the lower-than-expected direct impact of the pandemic, MSF's two dedicated isolation facilities have now been put into hibernation, but remain available if COVID-19 peaks again or if they need to be repurposed for an outbreak of another infectious disease.

Cambodia

Activities closed

Last spring, MSF teams implemented triage infrastructures in six hospitals bordering Thailand. They also participated in training 300 staff of the ministry of Health in IPC and case management.

Hong Kong

As Hong Kong is currently facing its most severe local outbreak since July, MSF has extended its COVID-19 emergency response from health education activities to providing emergency shelter and basic medical consultations to the homeless people. Homeless people in Hong Kong are particularly affected by the closure of publicly accessible facilities and suspension of services by local service providers or organisations.

Our emergency team is working with Impact HK, a local NGO, that has been supporting the homeless for some years already. The teams visit the homeless people twice a week in various streets of Hong Kong. Apart from distributing food, drinking water and hygiene kits, our caseworkers also follow up on individuals’ needs. Since June, the team has conducted 25 medical consultations and has arranged temporary shelter for 15 vulnerable individuals.

The COVID-19 outbreak lasts since January. Prolonged exposure to uncertainty can cause stress and anxiety. Therefore, aside from conducting anxiety and stress management workshops for vulnerable groups for several months, we have created a website for the general public offering tips and tools to help cope with the situation: https://howareyou.msf.hk/en/.

India

The Patna COVID-19 project is undergoing a reorientation of activities given the low numbers of patients presenting at our facility and government facilities across the state of Bihar. The project will transition out from IPD-based care into providing health promotion, mental health, and psychological first aid activities focused on frontline healthcare workers in government hospitals across the state.

In Mumbai, MSF continues to provide COVID-19 training to our DRTB/HIV, endTB and COVID-19 project staff, and has established IPC measures at all our work sites. Screening for COVID-19 is ongoing for people living with DRTB and HIV in our private independent clinic, endTB clinical trial site and in an OPD co-managed with the national TB programme.

Activities closed

Health promotion activities in the slums of Govandi (May-Dec 2020) have ended. On Dec 31, 2020, MSF concluded the intervention for COVID-19 & TB screening of homeless people in northeast Delhi, and their referral for testing and treatment. The intervention ran from Sep-Dec 2020. In addition to water and sanitation and disinfection activities in 20 community toilets at a hotspot slum in the M-East Ward of Mumbai, distribution of IPC materials, MSF is supporting the treatment of people with moderate cases of COVID-19 through high flow oxygen machines in a 1,100-bed MoH facility. This intervention will close mid-February.

In M-East Ward, with an estimated population of 100,000, a renewed preventive approach will scale up activities in two health posts for 2,000 high risk vulnerable people, including for patients with TB/DR-TB, diabetes and those on hypertensive medications. A digital health promotion campaign through Facebook will be rolled out from January 2021. This project will initiate a one-month digital health promotion campaign in M-East Ward on prevention messages and reduction of stigma within the community.

Indonesia

MSF continues to provide training of trainers to staff of health facilities and targeted groups in Jakarta. People trained by MSF are therefore capable of conducting health promotion sessions in their communities.

MSF also delivers mental health and psychosocial support interventions in Banten and Jakarta.

Japan

Activities closed

An outbreak of COVID-19 among crew members on a cruise ship docked for repairs in Nagasaki, in western Japan, led to 149 out of 623 staff on board testing positive for the new coronavirus. MSF sent a team of one doctor and two nurses to provide onshore medical assistance. The team assessed patients and assisted with referrals to further health facilities, depending on patients’ condition and the urgency of medical care. In Suginami, a district of Tokyo, MSF teams provided epidemiological analysis, supporting local health authorities.

Kyrgyzstan

MSF is supporting regional health authorities in Batken and Chuy oblasts in providing 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 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, we are providing COVID-19 health education in different languages, including Rohingya and Burmese, and translations in hospitals. Based on input from the community, MSF developed a COVID-19 health promotion campaign with R-vision, an online Rohingya news network. The videos produced reached the Rohingya in Malaysia, Myanmar, Saudi Arabia, India, the camps in Bangladesh and elsewhere.

As Malaysia entered another Movement Control Order (MCO) or lockdown in early 2021, the teams are ready to scale up support for people who can’t access their livelihoods and use digital information campaigns based on last years’ experience. Our advocacy continues to focus on a more inclusive COVID-19 response, calling on the government to halt targeting migrants and refugees in immigration raids, which could risk further spread of COVID-19 in detention centres.

Myanmar

The MSF Myanmar Facebook page continues to share COVID-19 prevention and health promotion messages. MSF teams provided medical assistance at quarantine sites and worked with the Ministry of Health and Sports (MoHS) during the COVID-19 outbreak in Rakhine State, (which culminated in Aug-Sep 2020 and subsided in the following months).

MSF also closely worked with MoHS helping to screen, test and isolate patients suspected of contracting COVID-19, while monitoring and treating patients who tested positive and providing preventive equipment, as well as improving hand washing and education on proper mask-wearing with communities in Sittwe and Pauk Taw camps.

MSF medical staff, in Sittwe, in collaboration with the MoHS, also took sample swabs from people in Sin-Tet-Maw and Kyein-Ni-Pyin camps, in Pauktaw Township.

Pakistan

In Balochistan, at the end of the three-month agreement signed with the MoH, MSF stopped directly supporting the 32-bed isolation ward for COVID-19 in Killa Abdullah New DHQ Hospital in Chaman. MSF was supporting with the infection prevention and control (IPC), waste management, provision of PPE for medical and paramedical staff as well as water and 24/7 electric supply and referrals of critically ill patients to Quetta.

However, we continue with our regular activities close to the MoH isolation facility and are monitoring the ongoing situation with the District Health authorities as well as the MoH Hospital Medical Superintendent. This will allow us to immediately re-engage our support to the MoH should the situation require it. The team is facilitating COVID-19 sample delivery to Quetta for testing.

In Karachi, we continue our digital health promotion activities within Machar Colony Community to debunk myths and raise awareness. The team also screened people for COVID-19 symptoms at the hepatitis C screening camp in late December. We have extensive awareness-raising activities ongoing on ways for people to protect themselves and prevent spreading the virus, and the protective COVID-19 measures and isolation areas are in place in most of the facilities we support across Pakistan.

Papua New Guinea

In Papua New Guinea, staff in health facilities have received training on infection prevention control, and screening and triage of people with potential cases of COVID-19 in 22 provinces. Our teams have also set up a large facility for treating COVID-19 patients in the capital, Port Moresby.

Philippines

In Manila, the team is supporting its partner organisation Likhaan with health promotion activities. Teams are also supporting with contact tracing and COVID-19 prevention activities at community level and helping to implement IPC measures in the health facilities that are caring for COVID-19 patients. We distributed ‘quarantine kits’ – including hygiene materials - to 726 COVID-19 patients and contacts between early July and mid-August.

In June, we started supporting the COVID-19 ward and the hospital laboratory at San Lazaro hospital, in Manila, with PPE, biomed equipment and pharmacy. The MSF medical team now counts 25 staff members who provide patient care on the COVID-19 ward since July. Our team is seeing a steady increase of COVID-19 patients.

In Marawi, the team continues health promotion activities and has trained the local health teams in 60 of the 72 communities in charge of COVID-19 surveillance and contact tracing.

Tajikistan

We prioritise the continuity of quality care for essential services for children and adults with TB, in collaboration with the Ministry of Health and Social Protection of the Population (MoHSPP) via existing MSF programmes focused on diagnosis, treatment and contact tracing. Our team assessed the Republican Centre TB dispensary in the capital Dushanbe.

The objective is to set up a new triage approach to decrease the risk of transmission of COVID-19 between patients and staff. The proposal has been discussed and approved by NTP. It is the first time such an approach has been tried in the country. We have developed a patient questionnaire to help with triage, built an outdoor waiting area and improved the patient flow in the dispensary.

After a two-week pilot phase of the new triage system, we constructed an adequate triage booth for nurses. Another two outdoor waiting areas have been built in TB centres in Rudaki and Vahdat and on-the-job training has been provided for the nurses working there. With these measures in place MSF teams have observed a remarkable decrease in the number of patients waiting in corridors and an improvement in infection control in the TB dispensaries.

Uzbekistan

We continue to support IPC measures across the primary healthcare system and also training on IPC measures were provided for the staff in COVID-19 treatment facilities. Additionally, we coordinate with the MoH for the treatment of patients co-infected with COVID-19 and TB. Standard operating procedures approved by the MoH, have been developed and distributed to all medical facilities.

Europe

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 others NGOs. This team also provides health promotion, infection prevention and control, contact tracing and psychological support.

Czech Republic

Activites closed

MSF is handing over our activities.

France

MSF provides support to nursing homes with teams of doctors, nurses, psychologists and health promoters, to strengthen the provision of medical care, infection prevention and control, and reduce psychosocial risks among staff through mental health activities. The programme is currently active in Provence-Alpes-Cote d’Azur and Occitanie regions, in southeast and southwest of France, respectively, and may be sent to other areas depending on needs.

Five days a week, we also run mobile clinics providing general medical care, as well as COVID-19 screening, testing and orientation for people living on the streets and in precarious settings in Paris. Other regular activities with unaccompanied minors in France continue as usual.

Germany

Activities closed

In Germany, MSF advised organisations, volunteer groups and state institutions working with the homeless, migrants and other vulnerable groups on IPC measures, to enable them to continue their services.

An MSF team had supported the authorities in the federal state of Saxony-Anhalt in a centre for asylum seekers in the city of Halberstadt, in which hundreds of inhabitants were under quarantine, with health education activities and psychological support. Activities in Germany ended by 8 May.

Greece

In Athens, we collaborate 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.

We also made PPE donations (gloves, masks, face shields, antiseptic fluids) to vulnerable social groups, including elderly, refugees, homeless, women/victims of gender-based violence, detainees, people with mental health problems as well as to the airlifting department of the National Emergency Aid Centre.

Italy

In Rome, we have been tasked by local health authorities to manage contact tracing and isolation for COVID-19 clusters in 10 buildings housing squats and one informal settlement, where migrants, refugees, and some Italian nationals live. Due to the increase of COVID-19 cases, our team refocused our operational strategy by giving more importance to response preparedness, rather than prevention. In collaboration with the residents of the spaces where we are responding, we have promoted the creation of hygiene and health surveillance committees that can monitor the presence of suspected COVID-19 cases, alert the authorities and act quickly to temporarily isolate suspect cases, and disinfect any contaminated spaces. This active surveillance system is proving effective.

In Palermo, MSF has responded to a COVID-19 emergency involving four informal shelters for migrant and Italian marginalised population, hosting overall around 800 people, many with complex medical conditions. These shelters were put under a strict lockdown without any support by the local health authorities. An MSF team continues to undertake health promotion and IPC activities in many official Migrant Reception Centres where there are new COVID-19 cases. In Palermo, we also provide IPC training and health promotion to the civil society organisations which provide services for homeless and marginalised migrants.

The Netherlands

Activities closed

In the Netherlands, we provided mental health support to frontline workers. This included a short video with a highly experienced and well-known MSF clinical and health psychologist which had been widely shared in hospitals and nursing homes across the country.

Norway

Activities closed

In Norway, MSF provided strategic advice and IPC support to a hospital close to Oslo which was located in one of the main clusters of cases in the country.

Portugal

Activities closed

MSF teams in Portugal visited nursing homes, and supported authorities and management teams to train staff and establish basic IPC measures. Our work in Portugal came to an end on 22 May.

Russia

We continue to support the MoH in the provision of health education about infection prevention of tuberculosis (TB) and COVID-19, including distributing MSF-developed leaflets on how to use face masks to all patients visiting the Arkhangelsk TB dispensary. MSF distributed hygiene kits and food parcels to multidrug-resistant and extensively drug-resistant TB patients in the northern region of Arkhangelsk, and these patients also receive health education from Ministry of Health nurses.

In Moscow and St. Petersburg, MSF continues the partnership with two community-based NGOs that support vulnerable people and people belonging to key populations.

MSF provides medical and paramedical staff with training on TB/HIV co-infection, COVID-19 and basic counselling. MSF also donates PPE (masks, gloves and hydroalcoholic gel) for the people accessing the services of the organisations. We have developed health information materials on COVID-19 infection prevention, TB and HIV that are being distributed.

Spain

Activities closed

Elderly and aged care homes have been hit particularly hard in Spain, and we focused many of our activities on aged care homes. Our teams worked in more than 300 aged care homes with a wide range of activities, including supporting management teams and authorities, implementing emergency measures to separate COVID-positive or symptomatic residents from the rest, supporting disinfection, and training of staff in IPC and risk mitigation. We worked with steering committees that manage aged care homes, to help protect the elderly through patient care and infection prevention and control measures. These activities were undertaken in Madrid, the Catalonia region (including Barcelona), the Basque country, Castilla y Leon, in Andalucia, Tarragona, Palencia and Asturias.

MSF had set up two health units to support hospitals around Madrid, with a total capacity of 200 beds. The units received patients with moderate cases, helping decongest the hospitals’ emergency and intensive care services, and were run by hospital staff, while our teams are provided them with logistical and infection prevention and control advice to protect healthcare workers and patients.

MSF also advised hospitals on staff and patient flow to manage infection control in Barcelona and the Catalonia region.

All MSF COVID-19 operations in Spain had ended, closed or been handed over by 22 May.

Switzerland

In mid-November 2020, MSF launched a new mission in Switzerland at the height of the second wave of new coronavirus transmissions. 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.

The team is currently using the expertise we acquired while responding to epidemics in our usual countries of intervention to care for vulnerable people and elderly people in nursing homes in Switzerland. These people are receiving insufficient support from a health system – that is certainly efficient – but was shaken by the exceptional context of a pandemic.

Given the plateau in the number of cases and deaths in Switzerland in recent weeks, the team is planning to scale down our activities and close the intervention in mid-February.

Ukraine

Since the beginning of the pandemic, MSF has been supporting Ukraine's Ministry of Health in responding to COVID-19 in Kyiv city, Donetsk and Zhytomyr regions.

In Kyiv city, MSF trained staff in nursing homes on infection prevention and control (IPC), and provided psychological support for residents of these facilities.

In Mariinka raion, Donetsk region, two MSF mobile teams continue to provide screening and home-based care for people with mild COVID-19 symptoms. The teams also assess hospitalisation needs based on the severity of symptoms and conduct follow-up visits for patients who need further medical supervision. To improve hospital care, MSF installed oxygen points and provided technical support to reinforce triage and patient screening, and refresher training on case management and IPC in Krasnohorivka.

In Zhytomyr region, MSF strengthened our outpatient care activities to ensure continuity of DR-TB care. For this, MSF teams ensured access to medicines and psychosocial support for patients with TB during the length of the declared lockdown. MSF conducted training on infection prevention and control (IPC) for healthcare workers to improve infection control in the hospitals, including sessions on managing psychological stress due to the additional risks and workload.

In both Donetsk and Zhytomyr, MSF provided psychological support through telephone hotlines for patients, relatives and healthcare workers.

United Kingdom

Activities closed

Our staff provided nursing and logistics support at the London COVID Care Centre, in partnership with the University College London Hospital Find & Treat team. The project provided rapid testing, accommodation in which to self-isolate, and medical care for homeless people with suspected or confirmed COVID-19; with the decline in new cases, MSF staff ended their support on 8 June.

Middle East and North Africa

Iraq

In Baghdad, MSF is supporting Al-Kindy hospital, which has been receiving large numbers of severe and critical COVID-19 patients. In September 2020, we moved from supporting the hospital’s respiratory care unit to managing a 24-bed COVID-19 ward for severe and critical patients. Recently, we further increased our capacity and moved to a new 36-bed ward (including 12 ICU beds) inside the Al-Kindy facility, to treat more COVID-19 patients. The number of people sick with COVID-19 has been decreasing in hospitals across Baghdad lately. We will hand over activities to the local health authorities at the end of February 2020 if the number of people with COVID-19 stay low.

In Mosul, MSF’s post-operative care centre was transformed during the early stage of the pandemic into a COVID-19 facility. Since the beginning of the pandemic and until the end of our COVID-19 intervention in the centre in December, we have received over 900 patients with mild and moderate COVID-19 symptoms. We have now stopped our COVID-19 operations in the facility and restarted surgical activities there. In the meantime, we opened 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, 4 beds of Sinuni General Hospital are dedicated to observing and stabilising suspected COVID-19 patients.

To promote health awareness around COVID-19, MSF also carried out a digital health awareness campaign, targeting the areas of Mosul and Sinuni.

In July, August and September 2020, MSF helped local health facilities in Erbil and Dohuk by providing technical support, logistic support and training for their staff on infection prevention and control (IPC).

In Laylan camp (Kirkuk governorate), MSF mobilised a 20-bed isolation and treatment facility and carried on triage for any suspected COVID-19 patients until the camp was closed by authorities in late November 2020. Our teams did a distribution of reusable cloth masks to Laylan camp residents and raised awareness about prevention measures there.

Iran

Activities closed

In Iran, MSF had reached an agreement with authorities to provide care for patients with COVID-19 in the city of Isfahan. We had flown over cargo, including an inflatable hospital, and staff, and were preparing to start activities, before authorities unexpectedly revoked permission.

After the Iranian Ministry of Health rescinded the approval for our intervention in Isfahan, MSF was asked to participate in the response dedicated to foreign nationals in the northeast of the country. A team went to assess the possibility of setting up our inflatable medical unit in places located between Mashhad and the Afghan border, but after discussion with local authorities, it appeared there was no location in this area where our medical unit could be sent in support of an existing medical facility, as planned in the original design of our intervention.

In early April, when it became clear that we would not launch activities to respond to the COVID-19 outbreak in Iran, the international team who had arrived to start activities left the country. In mid-June, the inflatable medical unit and the medical supplies which we had sent to Tehran for the response were shipped to Afghanistan. They are being used in Herat, in the COVID-19 treatment hospital which MSF has opened.

Regular MSF activities in Iran are continuing in South Tehran and Mashhad.

Jordan

MSF opened a dedicated 30-bed COVID-19 treatment centre, in collaboration with the Jordanian MoH, UNHCR and others, in Zaatari refugee campIn 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.

As the numbers of people with symptomatic COVID-19 (mild and moderate) is low at the moment, we are discussing with local authorities to close the health facility as of mid-February. MSF teams will remain on stand-by in case there is drastic increase of cases in the camp. MSF will also continue supporting with the medical assessment of people with confirmed COVID-19 in the isolation area as needed.

Activities closed

In our reconstructive surgery project hospital in Amman, MSF ran a 40-bed COVID-19 treatment centre for people with mild and moderate cases from 14 November to 31 December 2020. We received 47 patients and admitted 37. By the end of 2020, we decided to close the centre due to the low number of patients needing treatment and the declining number of cases in the country. 

Lebanon

In the Bekaa Valley, the MSF hospital in Bar Elias continues treating COVID-19 patients and the hospital’s ICU beds are fully occupied. MSF continues supporting the Elias Hraoui Governmental Hospital in Zahle, with the triage and screening of children. Children with suspected COVID-19 are screened in a designated area and receive appropriate care until their results are known. If positive, children are transferred to COVID-19 referral hospitals or to isolation centres, in collaboration with partners.

In Siblin, in south Lebanon, MSF is working with UNRWA (UN Reflief and Works Agency for Palestinian Refugees) in a training centre that has been turned into an isolation site. The centre welcomes patients who have suspected or confirmed COVID-19. The centre welcomes vulnerable people of all nationalities living in nearby areas, including Beirut, who cannot manage to home isolate due to overcrowded living settings.

As part of our continued efforts to spread awareness about COVID-19 preventive measures, MSF installed 8 water tanks in both Shatila and Burj Al-Barajneh camps (Beirut area), and 43 water tanks in Ain Al-Helwe camp (South Lebanon). The team also distributed 600 hygiene kits to reinforce infection prevention measures. The health promotion team conducted several awareness sessions on proper hand washing both on ground and through digital platforms.

MSF’s Medical Response Team (MRT) continues to support the Ministry of Public Health (MoPH) in its COVID-19 testing strategy across Lebanon. In the past month, the teams have been taking PCR samples at fixed points sites which will soon be shut down. They have conducted at least 229 PCR testing campaigns and conducted over 17,800 PCR tests. The testing capacity was also expanded to include 10,000 people crossing the Lebanese Syrian border point in Masnaa (Bekaa valley). The team has also been asked by the MoPH to take part in its national Influenza Like Illnesses - ILI - sentinel surveillance.

Alongside the MRT, MSF’s project-based Rapid Response Teams (part of the UN-led multi-sectoral emergency scheme) have been part of the testing campaign in their project areas, notably in Tripoli and the Bekaa Valley.

Libya

In Libya, we continue supporting the Ministry of Health in one COVID-19 testing site in Tripoli, as well as providing COVID-19-related trainings to medical and healthcare staff.

We also continue to reinforce IPC and prevention measures in detention centres (in Tripoli, Zliten, Zintan) - as much as possible given the inhumane conditions there.

Palestine

In Gaza, MSF teams trained the MoH teams who treat COVID-19 patients in the European Hospital; we donated oxygen concentrators to the facility and provided training on oxygen management, patient support, and intensive care and helped with the definition of COVID-19 oxygen protocols and hygiene management. We also continue providing infection and prevention control (IPC) support as well as water and sanitation and health promotion training in some basic healthcare centres in the north of the Gaza strip. We also conduct similar activities (on top of our regular ones) in Al-Awda hospital.

In the West Bank, MSF has been supporting the local health system in Hebron with technical advice and hands-on training on PPE, infectious waste, cleaning processes, oxygen therapy and bedside training in Dura and Alia hospitals, two facilities treating COVID-19 patients. MSF teams also adapted their regular activities to maintain psychological support by phone to people in need.

In Hebron district, the 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 and the medical personnel. Meanwhile, the team has distributed hygiene kits to affected households and has been carrying out health promotion and mental health promotion activities in the community.

Syria

(North-East) As part of the COVID-19 humanitarian taskforce chaired by the local health authorities, MSF contributes to the coordination of the COVID-19 response. MSF works alongside the Kurdish Red Crescent to provide medical care to people with suspected and confirmed COVID-19 at the only dedicated COVID-19 hospital in Washokani, near Hassakeh city. Both those discharged from care and those who can self-isolate at home with mild illness are supported with hygiene material, health education and identification of vulnerable people in their household, and offered self-protection advice, follow-up on their household contacts and a review of their health status at regular intervals for a month.

We increased our support in Raqqa with a focus on protecting healthcare workers, improving IPC in primary and secondary healthcare facilities; improving triage and care for suspect patients requiring inpatient care while they await test results; and sharing all lessons learnt from our Washokani response with Raqqa health organisations. PCR testing remains limited in the region with no supply pipelines secured at the moment. The average number of tests per day has declined to a very low level, making it difficult to determine the scale of the outbreak.

(Al Hol Camp) Across the camp, our teams continue to follow up the 1,900 people who have been identified as particularly vulnerable to developing severe symptoms if they contract COVID-19, and support them based on individual needs. Many of the identified people have non-communicable diseases, such as diabetes, hypertension, asthma or heart conditions.

(North-West) 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 regions, 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.

Yemen

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, which treats 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 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 are either to treatment centres in Lahj or Aden (for severe cases) or home (with observation) for mild cases.

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.

In Abs Hospital and Al-Ghomouri Hospital in Hajja governorate, MSF continues screening activities, as well as referrals for suspect COVID-19 cases. In Hajja city MSF supports referrals from Al-Ghomouri Hospital to Al-Rahadi isolation centre.

MSF and COVID-19

What is the new coronavirus disease?

COVID-19 (short for "coronavirus disease") is caused by a virus discovered in early January 2020 in China. It appears to be transmitted through droplets spread by coughing.

The virus affects the respiratory system. The main symptoms include general weakness and fever; coughing; and in later stages sometimes pneumonia and difficulty breathing.

Identified by Chinese scientists, the virus is now called SARS-CoV-2 because of its similarities to the virus that causes Severe Acute Respiratory Syndrome (SARS).

The coronaviruses are a large family of viruses, most of which are harmless to humans. Four types are known to cause colds, while two other types can cause severe lung infections (SARS and MERS – Middle East Respiratory Syndrome), similar to COVID-19.

Like all viruses, SARS-CoV-2 needs the cells of living beings to multiply. This virus seems to target cells in the lungs and possibly other cells in the respiratory system, too.

Cells infected by the virus will produce more virus particles, which can then spread to other people, by coughing for instance.

How is MSF responding?

Providing care for patients with COVID-19

In Europe and the US, which are currently the epicentres of the pandemic, MSF’s response focuses on improving care for the most vulnerable and at risk, such as elderly people in care homes, homeless people and migrants living in precarious circumstances where mortality rates have sometimes reached extraordinary and shocking levels.

In most countries where we have programmes, such as in Colombia, Iraq, and Nigeria, we have been opening dedicated wards inside hospitals and health structures to help separate COVID-19 patients from non-COVID-19 patients and to extend the hospitals’ capacity to provide care.

Helping people protect themselves, and reduce transmission

Worldwide, the response to COVID-19 has relied heavily on largescale lockdowns of the population and physical distancing measures, with the aim of reducing transmission and to prevent health systems from becoming overwhelmed. However, for people dependent on daily activities for their survival, such as day labourers, and those living in precarious or overcrowded settings, self-isolation and lockdowns are not realistic.

In some places, hundreds of thousands, sometimes even millions, of people live in such conditions, without any social safety net. It is crucial to provide people with the means and tools they need to be able to protect themselves and help protect others.

To help people protect themselves, MSF teams are running health promotion activities so that people understand the steps they can take to reduce the chances of contracting COVID-19 and to stop the further spread of the coronavirus.

Where possible, we are distributing soap and setting up water points so people can regularly wash their hands. These measures, and additional assistance such as the provision of reusable cloth masks, are even more crucial for people at risk of developing serious complications, including elderly people and those with other diseases, such as diabetes, hypertension, cancer, HIV or TB.

Keeping essential services running

Faced with suddenly having to treat huge numbers of new patients, countries with already fragile health systems, that have fewer health staff and weaker infrastructure, can quickly collapse under the pressure and the impact can be disastrous. If medical care were to falter, then common childhood killers, like measles, malaria and diarrhoea, would go untreated.

Other essential services we provide, such as sexual and reproductive care, emergency room services, maternity and surgical wards, and treatment of patients who have HIV or TB, would go unmet. This would have a terrible impact on the people we serve and would surely increase the number of deaths in the community.

In the hundreds of health facilities MSF works in around the world, our teams have been rolling out infection control measures and re-organising services to prevent transmission.

Across the world, our teams are training and supporting local health authorities on infection prevention and control methods and detection and triage of patients with COVID-19 to prevent health facilities from becoming amplifiers of the pandemic.

What needs to be done?

We must do everything to prevent and delay further spreading of the virus. It is already straining some of the world’s most advanced healthcare systems.

Access to healthcare

Preserving access to healthcare, both for COVID-19 patients as well as for any other patient, is paramount. This means ensuring that hospitals don’t become overwhelmed and that health staff can cope with the number of patients requiring intensive care and continue providing treatment to other patients who need it too.

Protecting healthcare staff

Infections of healthcare staff can happen easily in places that are overwhelmed by large numbers of patients. Places dealing with limited supplies of personal protective equipment for staff and a probable reduced workforce (as healthcare staff will also be part of confirmed cases through transmission in the community) are also at risk.

Infected healthcare staff will further reduce the capacity to admit and treat patients. Safety for healthcare workers should be a top priority in every healthcare facility.

Ensuring trust

We know from our experience that trust in the response and health authorities is an essential component for outbreak control. Clear, timely, measured and honest communication and guidance is needed. People need to be empowered to protect themselves.

To ensure that the medical tools urgently needed to respond to COVID-19 are accessible, affordable, and available concerned stakeholders including governments, pharmaceutical corporations and other research organisations developing treatments, diagnostics, and vaccines should take the necessary measures to:

  • prevent patents and monopolies from limiting production and affordable access;
  • guarantee access to repurposed drugs for patients suffering from disease;
  • prioritise the availability of the medical tools for the protection and treatment of frontline healthcare workers; and
  • improve transparency and coordination, making sure an evidence-based approach is put in place to continuously monitor the risk of the potential supply chain vulnerability on essential medical tools.

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We must do everything to prevent and delay further spreading of the virus. We know from our experience that trust in the response and health authorities is an essential component for outbreak control.

Clear, timely and honest communication and guidance is needed. People need to be empowered to protect themselves.

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