As the coronavirus (COVID-19) pandemic is unfolding, our teams are working in more than 70 countries around the world, providing urgent medical care for people fleeing violence, mothers giving birth and children needing treatment for measles or malnutrition. From the conflict in Syria to the continued displacement of Rohingya refugees in Bangladesh, these are some of the crises we must not forget in the time of COVID-19.
 

1. Ongoing conflict in northwest Syria

An MSF team distributes heating material in a camp for internally displaced people in northwest Syria. Staff unload a truck of supplies as people line up to receive their donations. 9 March 2020. © MSF

The military offensive carried out by the Government of Syria and its allies in northwest Syria has led to the displacement of almost a million people in the space of just four months in the Idlib region. People have fled their homes and camps where they were already displaced to escape daily shelling, aerial bombing and ground offensives.

Since the beginning of March 2020, we've been working to distribute more than 300 tons of heating materials to more than 22,000 people in 21 camps and settlements hosting families who have been displaced by the conflict.

Over the past months, we have also been distributing other essential items such as hygiene kits and mattresses to more than 17,000 people in 19 camps and settlements.

As the health system in Syria remains extremely fragile due to years of conflict, our teams are highly concerned about the potential impact of COVID-19 on the country.
 

2. The forgotten measles outbreak in the Democratic Republic of Congo

Jolie holds her 12-month-old daughter, Grace, who was treated and cured of measles in Biringi hospital, Ituri province, northeastern DRC. Grace passed the infection to her sister Moraku (foreground), aged three, who was also admitted to the measles unit. © Alexis Huguet/MSF

Since the beginning of the measles outbreak in January 2019, more than 310,000 people have contracted measles in the Democratic Republic of Congo (DRC) and more than 6,000 have died from the disease. This is the largest measles epidemic in the world today and the largest recorded in DRC for decades.

Measles is a highly contagious disease that is transmitted by air. There is no specific treatment once someone contracts measles, but a well-conducted vaccination campaign can reduce infant mortality by 50 per cent. A country devastated by violence, measles and malnutrition, COVID-19 would further overwhelm the health system and lead to increased suffering for Congolese people.
 

3. Unprecedented displacement of people in Burkina Faso

A nurse provides care to a child in Titao clinic, Burkina Faso. © MSF

In West Africa, Burkina Faso is now facing an unprecedented humanitarian crisis. There are incidents of violence almost daily, triggering massive displacement of vulnerable people. By the end of February, almost 780,000 people were internally displaced.

We've scaled up our activities in the country and our teams are operating in more than seven cities to provide people with basic healthcare and specialist medical care. We are also running water and sanitation activities, and non-food item distributions. Much more needs to be done as the upcoming seasonal peaks of malaria and malnutrition threaten to make the situation even more critical for populations who are already vulnerable, including young children.

Currently there is a window of opportunity to prevent severe deterioration in a very challenging security situation that makes carrying out large scale relief activities complicated. The COVID-19 pandemic may overshadow all other existing emergencies as there are already confirmed COVID-19 cases.
 

4. A broken healthcare system in Afghanistan

Women and children gather in the female inpatient ward in Boost hospital, Lashkar Gah, Helmand. © Kadir Van Lohuizen / Noor / MSF

After decades of war, and despite international aid, Afghans are still struggling to access basic and emergency medical care due to insecurity, distance, cost and the fact that many health facilities lack the staff and equipment they need. These are the conclusions of our report, Reality Check: Afghanistan’s neglected healthcare crisis, released earlier this month.

In-depth interviews with patients, their caretakers and our staff in Herat and Helmand provinces reveal that many Afghans face significant barriers getting medical care – a situation that has seen no improvement since we last released a report on this in 2014. Insecurity and widespread poverty continue to put healthcare out of reach for many people, and ensuring access to free, high quality healthcare is essential.

Our teams are worried by the increasing number of COVID-19 cases in Afghanistan and are working to support local health authorities to respond.
 

5.Treating malnutrition and malaria around the clock in Niger

A medical team administers an intravenous catheter for a patient in the paediatric unit of Magaria’s district hospital in Niger. © Laurence Hoenig / MSF

Every year, the combination of the 'hunger gap' and the rainy season triggers a spike in rates of malnutrition and malaria in southern Niger – particularly from July to October. Malnutrition can lead to a weakened immune system, making children more vulnerable to disease. These diseases can lead to further malnutrition, creating a vicious cycle of malnutrition and disease.

Hundreds of thousands of children continue to be affected by this chronic emergency and need timely, free and good quality healthcare, especially during the seasonal malnutrition peak.

In Niger and many other countries affected by malnutrition, the impact of a COVID-19 outbreak could have devastating consequences.
 

6. Mental health needs of Rohingya refugees

MSF patient Abdul stands at the entrance of his makeshift shelter in a camp for Rohingya refugees. Cox's Bazar, Bangladesh, July 2017. © Anthony Kwan / MSF

In August 2017, pillars of smoke could be seen rising from Rakhine state, Myanmar. The sight signalled the beginning of the largest-ever episode of violence against the Rohingya.

Those arriving in Bangladesh shared stories of their villages being burnt to the ground and of people being raped and killed, in a concerted campaign of violence by the Myanmar authorities. Today, close to a million Rohingya people are still stranded in over-populated camps in Bangladesh.

Lacking both citizenship rights in Myanmar and refugee status in Bangladesh – where they are unable to work or access formal education – they remain bound to a life of limbo and largely reliant on humanitarian aid. After fleeing persecution and extreme violence, many continue to experience physical and mental health issues related to the persecution and violence they have endured.

In December 2019, almost 450 patients sought mental health counselling in MSF’s Jamtoli and Hakimpara health facilities. Among these patients, teams were seeing a high prevalence of chronic psychosis – a severe mental disorder that requires psychotropic treatment.

In the context of the camps, where people are living in crowded conditions and are highly vulnerable, an outbreak of COVID-19 could have a rapid and severe impact.

 
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