Putting epidemics and pandemics in context

Millions of people still die each year from infectious diseases that are preventable or can be treated.

Epidemics and pandemics are outbreaks of diseases such as cholera, measles and yellow fever that can spread rapidly and be fatal. Malaria is endemic in more than 100 countries. Millions are living with HIV/AIDS and tuberculosis. Viral hemorrhagic diseases such as Ebola or Marburg are rarer but are potentially fatal. The coronavirus COVID-19 pandemic affected virtually every country on earth, infecting tens of millions of people and resulting in the death of over a million more.

In the last couple of years alone, MSF have responded to outbreaks of yellow fever in Angola and Democratic Republic of Congo (DRC), plague in Madagascar, large-scale cholera and measles epidemics in several countries across Central and West Africa, and outbreaks of the long-forgotten disease diphtheria in Yemen and among Rohingya refugees in Bangladesh.

The people at highest risk are mainly living in poverty or in areas of great instability, such as in armed conflict or during mass displacement, where living conditions are precarious, access to healthcare is limited, and vaccination coverage is low.

Reacting swiftly once an outbreak is identified will ensure that the number of people at risk is quickly reduced and can significantly impact the number of people falling ill and those dying. Engaging in advocacy to support access to treatment, as in the case of HIV/AIDS and tuberculosis, is crucial in pushing for effective responses.

70,600

70,6

PATIENTS TREATED FOR CHOLERA IN 2023

3,724,500

3,724,5

CASES OF MALARIA TREATED IN 2023

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People queue outside the tent housing the MSF clinic at a refugee camp. It's easy for epidemics and pandemics to break out in these camps — MSF clinic in Arkoum refugee camp.

People in poverty or great instability

Epidemics and pandemics can place the strongest health systems under strain – but the people at highest risk are mainly those living in poverty or in areas of great instability. In these situations living conditions are precarious, access to healthcare is far from being granted to all of those in need, and routine vaccinations are often interrupted or have reduced coverage.

The resurgence of diphtheria in the refugee camps in Bangladesh in late 2017 is a testimony to the Rohingya’s exclusion from healthcare while in Myanmar. The majority of Rohingya were not vaccinated against any diseases, as they had very limited access to routine healthcare, including vaccinations.

People living in camp settings can also be extremely vulnerable to outbreaks, particularly if there is overcrowding and water and sanitation services are poor.

As part of their epidemics and pandemics response, MSF staff members set up tents for mobile clinics in Jabalia and Beit Hanoun — In response to Israel's destruction of the health system in the north of Gaza, MSF deployed mobile clinics in two locations, Jabalia and Beit Hanoun to provide medical assistance to the population through general consultations, treatment of non-communicable diseases, dressings and health promotion. In the first two weeks, our teams treated around 1,200 patients.

Armed conflict increases the risk of outbreaks

In armed conflict, the destruction or damage of health infrastructure, disruption of disease-prevention programmes, and weakened surveillance systems, all heighten the risk of a serious outbreak.

War-torn Yemen, where the health system has collapsed and many hospitals have been bombed, was plunged into one of the most severe and largest-ever cholera epidemics in 2017. Our teams treated 101,475 cases. In late 2017, an outbreak of diphtheria - a long-forgotten, vaccine-preventable disease - also emerged.

In Central Africa Republic, routine vaccination coverage plummeted after instability and violence hit the country in 2013. The vaccination coverage rate for measles and pneumococcal infections fell from 64% to 25% and 51% to 20%, respectively.

A man stares into the camera. Half his face is in shadow. He was photographed at an MSF mobile clinic set up to respond to epidemics and pandemics — Vasyl Kozyr is one of the few residents of Dibrova in Donetsk region who have stayed in their village. Less than a hundred people live here now. Dibrova has been without electricity for almost two years, and the infrastructure has been destroyed due to constant shelling. So Vasyl allowed MSF mobile clinic teams to use his home for patient consultations.

Socially excluded

Meanwhile, the COVID-19 pandemic has shown that people who are socially excluded, such as those who are homeless and the elderly – even in the world’s wealthiest countries – are vulnerable to disease, if they live close together with no proper outbreak prevention and control measures in place.

During the COVID-19 pandemic, people living in homeless and refugee shelters in France and Belgium were particularly at risk, with MSF teams setting up alternative accommodation for these groups of people with the coronavirus. Our teams also responded in nursing homes, which were badly hard-hit, in Spain, Belgium, France, the Czech Republic, the United States and other countries, where a lack of government response and measures had left elderly people – already at high risk – exposed and extremely vulnerable.

Tents and supplies are loaded into the back of a truck bound for an area his by epidemics and pandemics

An epidemic outbreak often requires a rapid and large logistics deployment, which depending on the situation, can range from setting up temporary facilities to treat patients, implementing infection prevention and control measures, or improving water and sanitation to help prevent the spread of a disease.

An MSF worker gives a woman a vaccination for diptheria in Niger, which was hit by epidemics and pandemics

During outbreaks of highly contagious diseases like measles and meningitis, prevention often means vaccination. In addition to organising mass vaccination campaigns in response to epidemics, our teams also reinforce routine vaccination coverage in the health centres we work in.

Three women - two in MSF T-shirts - sit talking outside a grass hut during an education campaign covering epidemics and pandemics

Awareness-raising is also important so that people know about the risks of the disease and how to help prevent its spread.

MSF vehicles and planes are parked at Juba International Airport, ready to respond to epidemics and pandemics — In September 2023, the National Ministry of Health in South Sudan declared a hepatitis E outbreak in Fangak county, Jonglei State. Since April 2023, over 493 cases have been treated at the MSF hospital in Old Fangak and 21 people – mostly women – have died. MSF has been treating hepatitis E patients at its hospital in Old Fangak since April 2023, where our teams have been running a treatment isolation facility.

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