Last updated: 4 August 2020
As COVID-19 spreads across the world, MSF is racing to respond to the pandemic in over 70 countries where we run existing programmes, whilst opening projects in new countries as they become outbreak hotspots. In many of the places where we work, there is limited capacity to respond to an influx of patients with a new disease that may require intensive care.
Our key priority is to keep our regular medical programmes running for the tens of thousands of patients and extremely vulnerable communities we support around the world. Meanwhile, MSF emergency teams are responding on multiple fronts— supporting health authorities to provide care for patients with COVID-19, protecting people who are vulnerable and at-risk conducting health education, raising awareness on mental health, and providing training for vital infection prevention and control (IPC) measures to protect patients and staff.
As Hong Kong is currently facing the third wave of COVID-19 infections, MSF has extended its COVID-19 emergency response to providing emergency shelter and free basic medical consultations to the homeless people. Where public facilities and services have been suspended because of the virus, homeless people have been particularly affected. At the same time, Hong Kong’s homeless numbers have increased due to the economic downturn and increased unemployment rate. MSF is concerned that they are particularly vulnerable and often neglected during the pandemic. 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 28 medical consultations and has arranged temporary shelter for 17 vulnerable individuals.
Since the end of January 2020, an MSF emergency team has been responding to the COVID-19 outbreak in Hong Kong. Our team has been reaching out to vulnerable groups in the society and has conducted more than 32 face-to-face health education and mental health workshops. This focuses on groups who are less likely to have access to important medical information, such as the street cleaners, foreign domestic helpers, visually impaired people, the homeless, refugees and asylum seekers, and those who are more vulnerable to developing severe disease if they are infected, such as the elderly. Apart from sharing up-to-date, evidence-based medical information, we also listen and answer the many questions that the outbreak has generated.
From our long experience serving people in crises, we know that prolonged exposure to uncertainty can cause stresses and anxieties. Therefore, we have conducted workshops to help people deal with these symptoms, and created a website for the general public, offering tips and tools to help cope with these stresses and worries: https://howareyou.msf.hk. It is important to be both physically and mentally healthy to fight against the pandemic. Our team is closely monitoring the development of the outbreak in HK and will adjust our response accordingly.
Homeless people increase amidst the COVID-19 outbreak: MSF provides temporary shelter and free medical consultations
The response team in Herat is planning to set-up a COVID-19 centre and launch outreach activities in IDP camps. In Lashkar Gah, MSF is providing technical support for the management of the COVID-19 facility set up in Malika Suraya Hospital.
MSF has created isolation wards in all our medical facilities in Cox’s Bazar and is preparing two dedicated COVID-19 treatment centres. We continue to work with Bangladeshi authorities, WHO, and other health actors to limit the spread of the virus. Our teams are also carrying out health promotion activities in the camps. In Kamrangirchar urban slum, MSF is focusing resources on providing reproductive health, and sexual and gender-based violence services in our main clinic, as well as health promotion for COVID-19. We are also supporting the local health facilities with IPC training.
MSF’s team in Patna, Bihar opened a facility for mild and moderate COVID-19 patients in a converted sports hall to support the Nalanda Medical College Hospital. Community health promotion and education activities are also taking place. In Mumbai, MSF is carrying out COVID-19 screening of DRTB and HIV patients in its private independent clinic and in an outpatient department co-managed with the national TB program . MSF also opened a 24/7 mental health telephone hotline for English and Hindi speakers starting with five counsellors, recruited and trained by MSF.
MSF continues its support on COVID-19 preparedness in Labuan and Carita sub-districts in Banten province, including health education activities and support on task force surveillance at sub-district and village levels. Trainings have been organised with community leaders and community members on the virus and how it spreads.
We are ready to increase support to the national Ministry of Health and district authorities for contact tracing and testing. We also issued a call to the Malaysian government to repeal a circular, obliging public health facilities to report irregular migrants, including refugees and asylum seekers. In Penang, we are providing COVID-19 health education in different languages, including Rohingya and Burmese, and translations support to patients referred to hospitals. Our mobile clinics are suspended, but patients reach us through our phone hotline. Also, we donated food supplements to 100 vulnerable families.
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Our teams have implemented emergency preparedness plans in each project, including IPC and PPE training, additional handwashing points, establishing quarantine options for staff, and designing rotating work schedules. We also provided extra drugs to HIV and NCD patients. The MSF Myanmar Facebook page has started an awareness and engagement campaign, focusing on the dissemination of COVID-19 prevention and health promotion messages, reaching 1.7 million clicks in May 2020. MSF is also closely collaborating with the Ministry of Health and Sports, providing technical trainings, translations, and donation of hygiene items.
In Timergara, the team is screening on average more than 1,500 people every day for symptoms of COVID-19 and undertaking consultations for suspect cases. Over the last month, we have increased the bed capacity of the isolation ward from 14 to 30 beds for the management of moderate cases. We are referring serious patients to the tertiary structures in Peshawar or other cities in Malakand division. In Balochistan, we started our support to the Killa Abdullah District Hospital Isolation Ward, preparing donations of PPE, hiring support staff, and providing watsan, logistics and trainings to the health authorities. We continue to see hepatitis C patients in Karachi twice a week but we provided most with enough drugs to cover their treatment and avoid frequent clinic visits.
Papua New Guinea
MSF teams continue to provide training to the health care staff in health facilities designated to receive COVID-19 patients, particularly in the Gulf province, where one of MSF’s tuberculosis projects is based. Regular TB activities continue.
In Manila, where we run a regular sexual and reproductive health project in the slums of Tondo , we continue to support our partner Likhaan in their COVID-19 risk reduction communication activities. We are also preparing a new project to support health teams in charge of the contact tracing and COVID-19 prevention activities at community level. In San Lazaro hospital in Manila, we are preparing to support the COVID-19 ward and the hospital laboratory with human resources, PPE, biomed equipment and medication, in anticipation of an increase in cases.
In Marawi, in the south of the country, we continue with our "mobile information drive" to pass health promotion messages to vulnerable populations. Following the end of the community quarantine, MSF teams are back to providing services at three clinics which were reorganised to prevent COVID-19 contamination.
MSF has been supporting Ibn El Khateeb Hospital in Baghdad and health facilities in Erbil and Al-Shifaa hospital in Mosul. Back in March 2020, MSF donated beds to furnish a 50-room building in Al Salam hospital complex for the isolation of patients. MSF is also working jointly with local health authorities to facilitate the treatment of suspect cases.
We launched a pilot programme, consisting of training and assisting families in South Beirut and the Bekaa Valley with the practice of shielding, a voluntary process that can provide additional protection to people at higher risk of contracting COVID-19, such as the elderly or people living with chronic diseases. At the end of May to beginning of June 2020, MSF launched and managed a quick response unit in Ras Al Nabaa and Basta neighbourhoods in Beirut to support vulnerable people (mainly refugees and migrant workers), 70 of whom tested positive for COVID-19.
MSF is discussing with the Ministry of Health to support provision of care for patients with severe and acute symptoms. In the West Bank, MSF teams adapted the activities to continue to provide psychological support by phone to the population in need. In Hebron, MSF teams launched a dedicated hotline to support the mental health needs of people most affected by the spread of the virus, such as patients and their families, and medical personnel.
Across northeast Syria, MSF takes part in the COVID-19 humanitarian task force, chaired by local health authorities. We are providing training and preparedness measures in Al Hassakeh National Hospital and in Al Hol camp. MSF continues to support various health facilities and run regular programmes in Al Hol camp.
In northwest Syria, more than 1,000 COVID-19 tests have been performed so far, all of which came back negative. The number of cases tested and admitted in the isolation ward of the Idlib National Hospital, set up with MSF support, has been decreasing in the last weeks. In the other hospitals and health centres that we support or co-manage in different locations, we have reviewed the triage systems and patient flow to ensure fast detection of suspect COVID-19 cases and isolation from the rest of the patients. In some of the camps we intervene in, we have spread awareness messages and are adapting measures to help prevent the spread of disease.
MSF has put in place measures to keep staff and patients safe in our existing projects across 13 governorates in Yemen. Our teams are ensuring the continuation of lifesaving activities in the hospitals we work in (like Al Jambouri hospital) and is helping prepare hospitals to receive COVID-19 cases (like in Abs hospital and Sheikh Zayyed Hospital). Our teams have provided trainings and assisted the Ministry of Health in the setting up COVID-19 treatment centres and isolation units in Aden, Hajjah, Sanaa, Hodeidah, and Ibb governorates, and in Taiz City. In Abs, we are also working with communities to understand more about local perceptions and knowledge of COVID-19.
MSF teams have been training staff in the facilities we support in Bamenda, Kumba, Muyuka, Mamfe, and Widikum. In Yaounde, MSF is treating patients with moderate symptoms of COVID-19 in the 110-bed Djoungolo health facility. We have started operational research activities relating to the clinical evaluation of diagnostic tests, provided training, equipment and support to the teams, particularly on mental health and health promotion.
Democratic Republic of Congo (DRC)
Since 27 April, MSF teams have been treating COVID-19 patients at Saint-Joseph hospital in Ldimete, Kinshasa, in support of the Diocesan Medical Office, the Ministry of Health and in coordination with the COVID-19 national response team. At the Kabinda Hospital Centre in Kinshasa, where MSF supports HIV/AIDS patients, we have set up an isolation/stabilisation unit with 20 beds which is used before transferring patients to health facilities identified by the MoH. MSF mobile teams also supported 50 health structures in four health zones in Kinshasa to reinforce hygiene measures, provide masks and handwashers, and train medical staff and community relays on infection prevention and control. In Goma and Lubumbashi, MSF is preparing to support dedicated COVID-19 health facilities.
MSF is supporting several health facilities in Nairobi, Kiambu, Dadaab, and Mombasa Counties in conducting health awareness, case management trainings to staff, logistics support, boosting IPC, and triage. In Mathare informal settlements, teams are providing mental health consultations to survivors of sexual and gender-based violence by phone throughout the pandemic. Many patients picked up by MSF ambulances in Mathare have turned out to be positive for COVID-19 when tested. MSF has stepped up its protocols and increased used of personal protective equipment.
In eight MSF-supported health centers and in Nsanje District Hospital, MSF runs health promotion activities, trains health workers, advises on screening set-up, and installed handwashing points.
In Bamako, MSF supports the 100-bed COVID-19 treatment unit in Point G hospital, run with MSF and MOH staff. MSF supported the rehabilitation of the hospital’s oxygen distribution network and provides medical, nursing and hygiene control staff, as well as logistical and technical support. So far, 407 patients have been admitted in this unit, including 44 in ICU. We also support MoH activities such as case management, raising awareness among the population, improving prevention and setting up isolation structures for patients.
Across the seven states where MSF works in Nigeria, we are providing technical support to the Ministry of Health (MoH) and Nigeria Centre for Disease Control (NCDC) as they set up isolation centres for patients who may present symptoms of COVID-19, as well as undertaking community-based health promotion and setting up handwashing points and isolation areas in local communities and camps for internally displaced persons (IDP).
MSF is part of the case management and surveillance pillars at the national Emergency Operations Centre (EOC) and district level EOCs in Kenema, Tonkolili, and Bombali districts. In Freetown, MSF refurbished a government facility, Hastings CTC, into a 120-bed COVID-19 treatment centre. In Kenema District, MSF completed the rehabilitation of a lassa fever isolation unit in the Kenema Government Hospital into a 25-bed COVID-19 treatment centre.
MSF re-assigned existing staff from all four projects to COVID-19 responses in Gauteng, KwaZulu-Natal, and Western Cape provinces. MSF assisted with limiting infection spread through contact tracing , development and dissemination of health promotion materials, and by implementing various strategies for decongesting healthcare facilities. In partnership with local health authorities in Eshowe, MSF set up 35 medicine pick up points in communities for at-risk people with HIV, TB and non-communicable diseases. The drug-resistant TB team in Khayelitsha has started home-based care for the most vulnerable DR-TB cases, and witnessed major food security challenges within the community that complicates adherence to treatment.
Cases of COVID-19 continue to increase, including in MSF facilities and project areas in Yambio, Agok, Yei, Lankien, and Bentiu and Malakal Protection of Civilians (PoC) sites. In Bentiu PoC, UNMISS had granted permission to MSF to run a holding or transit facility wherein COVID-19 patients can be kept until they are transferred to the isolation or treatment facility in Bentiu town. Unfortunately, external actors have not pledged sufficient support for the rehabilitation of the facility. In Agok, MSF modified an ambulance to be used to transport confirmed and suspected COVID-19 cases and work on the isolation ward is ongoing. In Juba, MSF teams are carrying out community assessments and engagement, as well as installation of handwashing points in several locations.
MSF teams across Sudan are conducting health promotion and awareness sessions with patients and the local community, or at non-MSF primary healthcare centres. MSF provides daily trainings to health workers including bedside trainings and mentoring, in the health facilities we support. MSF also runs a mobile COVID-19 unit that supports other facilities and works on early detection and prevention of the spread of the disease.
MSF is the sole healthcare provider in Nduta refugee camp, which hosts 75,000 Burundian refugees. In preparation for a COVID-19 outbreak in the camp, we built four triage or isolation areas in each of the health clinics where we work in the camp. We completed preparation for a main isolation centre, where suspect cases of COVID-19 will be referred. We are in the process of constructing an additional 50 beds and have trained around 250 MSF staff for COVID-19 response.
MSF teams have reinforced measures to prevent and control infections, have worked to raise awareness and improve triage in all the sites of activity, in addition to logistic support and assistance with IPC strategies in three MoH isolation units in Arua and Kasese. In Adjumani district, in the North, MSF intervened to improve living conditions in one overcrowded transit facility for refugees. The HIV programme and the mental health activities have been adapted to reduce the frequency of patient visits by increasing anti-retroviral and mental health treatment supplies. Follow-up consultations are limited to urgent cases.
The support activities for hospitals and nursing homes have ended, including activities in the reception centre for vulnerable migrants and homeless people, at the site of Tour & Taxis in Brussels. An outreach team continues its IPC and contact tracing activities in shelters for vulnerable migrants and homeless people in Brussels. Also ongoing are lobbying efforts to different authorities to improve the functioning of nursing homes in case Belgium is hit by a second wave of COVID-19.
More than 33,000 people still live in overcrowded tents or containers on the Greek islands with limited access to running water and sanitation services. So far there is no positive case of COVID-19 in any of the Greek reception centers (RICs) but medical actors, including MSF, are coordinating with national authorities to respond in case the virus reaches the centres. In Samos and Lesbos, we adapted our facilities and procedures to ensure the safety of our patients and our staff. MSF is doing health promotion with the camp residents and we are increasing the provision of water and sanitation services in the camp. We are also scaling up our operations with the recruitment of extra medical, paramedical, support staff and the acquisition of necessary equipment.
In Athens, we are collaborating with the 3rd Clinic of Internal Medicine of Athens University (NKUA-EKPA) in 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 Center.
Following three months of intervention in Italy, we closed our projects in the Lodi area and Marche region. More than 50 MSF staff were involved and responded in three hospitals and close to 50 elderly homes. Several other activities were carried out such as telemedicine, to ensure only the critical cases where sent to hospital. MSF teams trained more than 500 health workers on IPC procedures and conducted sessions of psychosocial support.
The intervention of MSF in Italy continues in several detention centres in Lombardy, Piedmont and Liguria until the end of June. The MSF team comprises doctors, nurses and hygiene experts, and covers all measures to contain the spread of the virus and protect people inside the prisons (detainees, police agents and jail workers). We are also expanding our health services for vulnerable communities in Rome. MSF, alongside local health authorities and Médecins du Monde, will be introducing new prevention and health promotion activities in reception centres and informal settlements.
MSF is supporting the Ministry of Health in its COVID-19 response in Donetsk and Zhytomyr regions. In Mariinka Rayon, Donetsk region, MSF runs one mobile team providing screening and home-based care for people suspected of having COVID-19 and those with mild symptoms, in order to prevent health facilities from being overwhelmed. MSF is also providing psychological support through phone hotlines to residents of Mariinka, Volnovakha Rayons, and in Zhytomyr region. Almost 200 health workers across Donetsk and Zhytomyr regions have already received training on the use of protective equipment, infection control, flow of patients as well as waste management.
In Manaus, we started working at the public hospital 28 de Agosto, managing 12 ICU beds and 36 beds for moderate and severe cases of COVID-19. We are also running an isolation centre for migrant Venezuelan indigenous people with suspected COVID-19. In Tefe, we will manage treatment of moderate and severe cases at the town’s main hospital, and we are looking into the options for working in peripheral health centres, to help reduce the need for the vulnerable rural communities in the area to travel to seek COVID-19 care and treatment. In São Paulo, we run medical activities at two isolation centres for vulnerable patients (homeless people, drug users and the elderly) with mild COVID-19—a total of 140 beds. In Rio, activities expanded to popular restaurants, with screening and health promotion. We are also conducting street activities with homeless and vulnerable populations.
MSF is working closely with health authorities in Norte de Santander, Arauca and Tumaco to support the local response. We expanded our field teams and reoriented part of our services to respond to the disease. We are currently participating in outpatient triage and supporting the area for patients with respiratory symptoms at the Tibú hospital. In Tumaco, we started medical and mental health activities in the two public hospitals in the city. In Arauca, we provide technical advice to the hospitals and mental health support to the health staff. 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.
MSF has strengthened its ambulance services 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. The health centres have suspended outpatient consultations and only serve people with suspected COVID-19 and emergencies. MSF has started working in mental health care in an isolation centre dedicated solely to deported people (from Mexico and the US), while evaluating others for possible intervention.
After four weeks of activity, the MSF Drouillard COVID-19 treatment centre has seen more than 250 people come to the emergency room, including 132 severe cases who were hospitalised and 118 others followed up as outpatients. Community activities have been reinforced in Martissant with support for the Saint-Michel health center for the early detection of suspected cases of COVID-19, in the areas of triage and isolation. Our teams have visited several hospitals in Port au Prince which were forced to close their services, totally or partially, due to COVID to assess the support MSF can provide to reduce the impact of the epidemic on other medical needs.
MSF teams are attending to COVID-19 patients in an auxiliary hospital unit in Tijuana, in the north-western corner of Mexico. The centre is located in the Zonkies basketball stadium, refurbished as a medical centre with a capacity to care for up to 50 beds—all of them equipped with oxygen supply—for mild and moderate forms of COVID-19. MSF's response there is coordinated with the Baja California state Secretary of Health and a civil society organisation Apoyemos Tijuana (Let's Support Tijuana). MSF assessed and implemented IPC in migrant shelters across Mexico City and in different shelters in various districts. In addition, MSF has provided support at the Samuel Rodríguez Moreno Psychiatric Hospital in Mexico City, the Renacimiento General Hospital in Acapulco, and the Chilpancingo General Hospital in Guerrero.
MSF has been working in key sites around the country with local authorities and partner organizations serving vulnerable communities who often lack access to health care, including migrants and people experiencing homelessness. In New York City, MSF is helping reduce the spread of COVID-19 by partnering with local organizations to improve IPC measures for at-risk groups. MSF has opened temporary relief stations in Manhattan, offering free showers, toiletries, clean socks and underwear, and information on additional services to people who currently lack access to hygiene facilities.
In the Southwest, MSF works in partnership with local officials and community leaders from the Navajo Nation and Pueblo peoples in New Mexico and Arizona. Our teams provide guidance and training on IPC measures in nursing homes, group homes, and correctional facilities. We also delivered six “Training the Teachers” workshops on IPC to more than 700 employees of the Social Services Department.
In Puerto Rico, MSF is offering medical consultations in remote locations where access to care is being limited by the pandemic, including vulnerable communities affected by recent earthquakes. MSF has distributed over 2700 hygiene kits to this target population, donated 20,000 Personal Protective Equipment (PPE) to 21 health facilities, and conducted 11 IPC trainings to help essential workers, patients and others to stay safe.
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 and the Capital District—in Vargas Hospital in Libertador and at the Hospital Perez de León II in Petare. MSF is also supporting COVID-19 activities in Pérez de León II Hospital in Petare (Miranda) and Vargas Hospital in Caracas.
Whether we’ll be able to make similar offers to other countries will depend on the nature of the pandemic but also on our capacity to send staff.