Last updated: 15 May 2020
MSF teams are racing to respond to the Coronavirus disease (COVID-19) pandemic in over 70 countries, including opening projects in new countries as they become pandemic hotspots.
Our COVID-19 response focuses on three main priorities:
• supporting authorities to provide care for COVID-19 patients;
• protecting people who are vulnerable and at risk;
• and keeping essential medical services running.
Across our projects, MSF teams have been improving infection prevention and control measures to protect patients and staff, and prevent further spread of the new coronavirus. It is absolutely crucial to prevent health facilities from amplifying the pandemic or being forced to close their doors.
Health systems worldwide are urgently in need of personal protective equipment – which face shortages of crucial items such as masks and aprons – so that essential medical services can stay open.
Having access to protective equipment, to COVID-19 tests, to oxygen and to drugs for supportive care, becomes more and more urgent as COVID-19 spreads in countries with little access to these tools.
Key concerns during COVID-19
We see this new coronavirus has crippled some of the most advanced health systems in the world. This has been in countries with a social safety net, where most people have access to running water and the space to self-isolate. Our greatest concern is for when the virus takes hold in places with more fragile health systems and no, or limited, basic safety net. Other concerns we have include:
- Protecting vulnerable people
We’re concerned how people living in precarious environments will be affected by the pandemic. People living in overcrowded conditions, on the streets, in makeshift camps or substandard housing are at particular risk of COVID-19. Many are already in poor health and excluded from the formal healthcare system. We know social or physical distancing will be infinitely more difficult or impossible for these groups of people. We have to find other ways to help people keep themselves protected such as mass distributions of soap, water, and, in carefully considered circumstances, reusable cloth masks.
- Maintaining healthcare
During the pandemic, babies will still be born, people will still need treatment for diseases like HIV and TB. Maintaining access to healthcare for non-COVID-19 needs is essential, including in MSF regular projects. In our projects all over the world, our teams are ensuring infection prevention and control measures are in place, setting up screening at triage zones, creating isolation areas, and providing health education to local staff and people
- Protecting healthcare workers
Protecting healthcare workers from contracting the virus is paramount for ensuring the continuity of care for general and COVID-related health needs. However, the global shortages of personal protective equipment (PPE) pose a great threat. Healthcare workers must have access to the equipment they need to do their jobs safely and effectively; countries should show solidarity and share protective equipment wherever possible.
- Protecting people most at risk
We also must protect those most at risk of severe forms of the illness. With COVID-19, that largely means the elderly, so much of our COVID-19 response focuses on strengthening the infection control measures and protection of the elderly in nursing homes. It also concerns those who have another illness, such as diabetes, HIV or tuberculosis. We don’t yet know what the impact will be for children who suffer from severe malnutrition, or for communities that have been hit hard by measles epidemics, such as in DRC or Chad.
- No Profiteering
There should be no profiteering on emerging drugs, tests, vaccines and other tools used for this pandemic. Governments must take any necessary measures – including overriding patents and other monopolies, and introducing price controls – to ensure production, supply, and availability of essential tools at an affordable price for all. High prices and monopolies of tools will only result in rationing, which will then prolong the pandemic. In addition, prices of other essential supplies such as masks, and other PPE must be kept accessible. Once approved or available, tools must be prioritised for healthcare and frontline workers first, and then supplied based on equity and need.
- 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 our visits to nursing homes, we always note a lack of basic protective equipment and a lack of screening for frontline workers and potentially infected residents,” says Caroline De Cramer, MSF medical adviser for our programmes in Belgium. “It is important to test care home residents as quickly as possible; they are extremely vulnerable because they are doubly at risk, due to their age and their communal living conditions.”
MSF teams are also providing care to vulnerable communities in other places, such as in Sao Paulo Brazil where we provide medical consultations and help to detect people with COVID-19 amongst homeless people, migrants, refugees, drug users and the elderly, referring patients in more serious conditions to hospitals.
In Spain, Italy, Belgium and France – all currently hotspots of the pandemic – we are also supporting several hospitals that have been overwhelmed by the number of patients with COVID-19. Depending on the specific needs, our support has ranged from providing advice and training on infection control and prevention methods, to set up wards for patients recovering from COVID-19 and for patients with moderate symptoms of the disease.
MSF is caring for patients in dedicated COVID-19 facilities in Burkina Faso, Democratic Republic of Congo (DRC), Cameroon, Ivory Coast, Mali and Pakistan, and is preparing dedicated COVID-19 facilities in Kenya, Lebanon, Niger, Philippines, Senegal, Syria and Yemen, among others. These facilities will care for patients with moderate to severe forms of COVID-19, including those who suffer from acute respiratory problems.
MSF is also sending an oxygen production unit to Burkina Faso, which will be able to produce oxygen in large quantities, for several dozens of patients at the same time. Patients with severe COVID-19 symptoms often suffer from hypoxia (low oxygen levels in body tissue) and need extra oxygen. Where there is little intensive care capacity, a key challenge is to provide patients with sufficient oxygen without the use of invasive techniques.
“Point G hospital has an oxygen production unit,” says Dr Idrissa Ouédraogo, MSF’s medical coordinator in Mali. “We are working with the hospital management on improving the flow of oxygen from the production unit and installing a wall-mounted supply system so that, in the new building, oxygen can be delivered directly to the patient’s bed.”
In most countries where we have programmes, such as in Colombia, Iraq, and Nigeria, we have been opening dedicated wards inside health facilities to help separate COVID-19 patients from non-COVID-19 patients and to extend hospitals’ capacity to provide care.
“The initial goal of our response is to help hospitals handle suspected or confirmed COVID-19 patients, to make sure they are welcomed and treated as well as possible under the circumstances, and to prevent their further spreading the virus to patients or staff,” says Shaukat Muttaqi, MSF Head of Mission in Iraq, where MSF is supporting hospitals in Mosul, Baghdad and Erbil.
Similar activities are being carried out around the world. In the Haitian capital, Port-au-Prince, MSF has re-configured an existing emergency care centre to isolate and refer patients suspected to have COVID-19.
In the Nduta refugee camp in Tanzania, where MSF is the main health provider for 73,000 Burundian refugees, we are building triage and isolation areas in health clinics and in the main MSF hospital where patients with suspected COVID-19 will be referred.
In Bangladesh, where nearly a million Rohingya refugees live in sprawling camps across Cox’s Bazaar district, we have built dedicated COVID-19 wards and isolation rooms in our field hospitals in different locations. The ongoing work will reach capacity for 300 beds.
- Providing people with the capacity to 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.
“Most recommendations for protecting people against the virus and slowing down its spread simply cannot be implemented in Idlib,” says Cristian Reynders, field coordinator for MSF operations in north-west Syria. “How can you ask people to stay at home to avoid infection? Where even is their home? We are talking about almost one million displaced people – at least one-third of Idlib’s total population – most of whom live in tents in camps. They no longer have homes.”
To help people protect themselves, MSF teams are running health promotion activities in practically all our projects, 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.
For example, in Uzbekistan, our health promotion activities include specially tailored messaging on tuberculosis (TB) and COVID-19 for TB patients and their families. In South Africa, MSF has re-purposed existing staff from all four of our projects to our COVID-19 response.
They are now working to limit the spread of the infection through contact tracing (both in-person and over the telephone) and the development and dissemination of health promotion materials.
Teams are also assisting vulnerable asylum seekers and elderly homeless people, particularly in containment sites where homeless people have been forcibly moved by authorities, to mitigate the impact of the national 21-day lockdown.
In Liberia, MSF teams are distributing soap, while in the Malian capital of Bamako, where there have already been confirmed cases, and in camps from Syria to Mexico, and Nigeria to Greece we are setting up water points for hand-washing and clean drinking water.
In Burkina Faso, Cote d’Ivoire, Mali, Niger and South Africa MSF has started producing cloth masks for use in the community. The cloth masks can be made locally and, while they are not the same as those required by medical staff, they can help prevent transmission of the virus if used appropriately and so long as handwashing and physical distancing are observed as much as possible in the local circumstances.
- 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. For example, consultations have been reformatted to maintain safe distances between patients and hospitalisation wards have been redesigned to allow enough space between each bed. Health facilities now have separate patient pathways to divert those with suspected COVID-19 away from other patients.
In Niger, rather than having large numbers of people visiting health centres to be checked for possible malaria, MSF community health workers go into communities to help provide this service.
In Kenya, MSF has adapted the way we care for people with HIV by giving antiretroviral drugs to patients in three-month batches, so they can come to health centres less frequently. In South Africa, our teams are ensuring HIV/TB patients get medicine refills delivered straight to their homes.
Across the world, from Cameroon and DRC, to El Salvador, Nigeria, Sudan, or Yemen, MSF 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.
“Continuing our medical activities in areas already facing massive health needs is an absolute priority for MSF,” explains Albert Viñas, MSF emergency coordinator for Cameroon. The COVID-19 outbreak in Cameroon poses an additional challenge for a country marked by violence that has displaced hundreds of thousands of people. “COVID-19 activities require extra resources, staff and materials in a situation where the global movements of people and goods has become very, very difficult. Our teams are working around the clock to maintain our regular, life-saving activities, while responding to this new outbreak.”
Unfortunately, a few projects have been suspended as a result of new restrictions linked to COVID-19, such as MSF’s paediatric surgical programme in Liberia, which received some of the most critical cases of children needing surgery. The project was suspended as a result of travel restrictions imposed to limit the spread of the COVID-19, making it impossible to replace the paediatric surgeon who left at the end of March.
We have also suspended activities that are not vital, such as elective surgery, and re-organised others to reduce the risks for patients and staff. For example, in Pakistan, we have put on hold our cutaneous leishmaniasis treatment services as a temporary measure to avoid the spread of COVID-19. In Jordan, MSF’s reconstructive surgery hospital for war-wounded in the Middle East, continues to care for 170 patients already present, but have stopped new admissions for surgery for the time being.
But despite these constraints, MSF teams in all countries of operation are striving to find ways to keep as much as possible of our life-saving medical work running, while adapting to the multiple and serious challenges that the COVID-19 pandemic is presenting.
In South Africa, our staff from all four of our existing projects have been responding to COVID-19 in Gauteng, KwaZulu-Natal and Western Cape provinces. MSF staff members are assisting with physical and telephonic contact tracing, and the development and dissemination of health promotion materials.
In Johannesburg, a mobile team conducts primary healthcare consultations and screening for COVID-19 cases in three homeless shelters, as well as links to an MSF testing and tracing team. In Eshowe and Rustenburg, we have set up triage tents and handwashing points, and continue to provide health promotion messages.
In Burkina Faso, we are providing patient support in Fada health centre. We are also training MoH staff and undertaking disease surveillance and health promotion activities. In Ouagadougou, MSF teams started the construction of a 50-bed hospital centre for the care of COVID-19 patients.
MSF has started activities in Bobo-Dioulasso, in the country’s west, where the second-biggest outbreak in the country is located. We are providing care for COVID-19 patients in a dedicated facility, in collaboration with the national health authorities. We have also installed an oxygen production unit, which can provide oxygen to dozens of people, direct to their beds, at once.
In Abidjan, Ivory Coast, MSF and Ministry of Health teams are now treating people with moderate COVID-19 in a treatment centre at Grand Bassam, just outside the city. In Bouaké, we have trained health workers and screening at the different entry points to the city are underway. Water and sanitation activities are also being implemented.
In Kenya, MSF is part of Kenya's National Taskforce on COVID-19. At Kibera South Health Centre, in the slums of Nairobi, the team is boosting infection prevention and control, triage, screening and managing referral of people suspected of having COVID-19 to a nearby hospital.
In Dagahaley camp, in Dadaab, Kenya’s largest refugee camp, MSF has set up a 10-bed isolation unit for COVID-19 patients. In Mombasa, we have set up isolation rooms at the Mrima health centre in Likoni subcounty, which will allow women who have COVID-19 to give birth safely.
In Tanzania, our health promotion team in Nduta refugee camp, is undertaking health promotion activities, raising awareness among the community on hygiene and best health practices. MSF has built four triage/isolation areas at each of our health clinics at Nduta refugee camp, and a main isolation centre at our hospital, where people suspected of having COVID-19 will be referred. Currently we have 10 isolation beds available, and are currently constructing another 50, with the ability to scale up to 100 beds if needed.
In Tripoli, Libya, we have delivered trainings on infection control and case management to nurses and doctors in hospitals in Tripoli. Teams are providing training to medical staff in Zliten, Misrata, Khoms, Yefren and Bani Walid, and reinforcing IPC measures in detention centres, including installing handwashing points, distributing soap and cloth masks, and undertaking health promotion with migrants and refugees, and detention centre guards.
In South Sudan, MSF is assisting the Ministry of Health with the training of healthcare workers in infection prevention and control measures and triage for symptoms compatible with COVID-19. In the capital city, Juba, MSF teams are installing handwashing points in several locations with high concentrations of people, including around hospitals and healthcare centres. Teams are also carrying out community assessments and engagement in the city.
In Yei, MSF is supporting the management of the COVID-19 isolation facility, at the request from the Ministry of Health, given constraints in staffing and supply.
Our teams across Sudan, are conducting health promotion and awareness sessions with the local community. We are also providing mentoring and training on a daily basis to health workers in the health facilities we support. We also run a mobile COVID-19 unit that supports other facilities, working on early detection and prevention of the disease.
At the Omdurman Teaching hospital, the largest hospital in the country, where MSF has a team of more than 60 staff, we are working closely with the MoH in the emergency department and to prepare to cope with COVID-19. We are also supporting the MoH to set up and manage isolation centres in two towns in East Darfur and South Kordofan states (Ed Daein and Dilling).
In Dakar, Senegal, we are supporting the health authorities in the Hospital Dalal Jamm, in the northern part of Dakar, where we are giving training as well as support for Water, Sanitation and Hygiene (WASH) activities.
In Mozambique, we are implementing infection prevention and control measures – including 16 new hand washing points – and triage for people with respiratory symptoms in all health facilities where we work. Our teams are also working with local authorities to improve patient flows by providing logistic and technical support for two referral hospitals in Maputo. In Pemba we helped local health authorities to install an isolation centre.
In Eswatini, we are adapting the models of care for patients living with HIV, TB and noncommunicable diseases in order to reduce their risk of infection. We have started Video Observed Therapy (VOT) for MDR-TB patients and we are running mobile TB clinics to reduce patients' risk of exposure. Our teams are doing health education in the communities on a daily basis. We are providing support to the Ministry of Health by assisting with infection control and triage at health facilities. We are also part of technical advisory groups to the MoH and we are supporting with testing.
In Zimbabwe, we are supporting COVID-19 patient care in Zimbabwe's capital, Harare, while our water and sanitation team provides additional support in communities.
- Middle East
In Jordan, the hospital is being repurposed to have the potential to receive COVID-19 patients.
In northeast Syria, we are providing training and preparedness measures in Al-Hassakeh National hospital and in Al-Hol camp. This includes creating a 48-bed isolation ward, introducing surveillance measures, identifying and treating people with COVID-19, and patient flow and triage processes. We are providing training on infection prevention and control measures and personal protective equipment usage training. MSF is also rehabilitating hospital wards to receive patients.
In the country’s northwest, we are reviewing the triage systems and patient flow in some MSF-supported hospitals and health centres, to ensure fast detection and isolation of people suspected of having COVID-19. In Deir Hassan camp, we have engaged with internally displaced people on IPC measures via health promotion, and distributed hygiene kits, which include soap, to more than 6,800 families. MSF supported the Idlib National hospital with the design of a COVID-19 isolation unit. An MSF team also delivered a COVID-19 training to staff from other NGOs and the Department of Health. In Azaz, our team has set up a COVID-19 triage tent.
In Yemen, we have provided support to the Ministry of Health and have set up a COVID-19 isolation unit in Aden. Also in Aden, MSF is now running the COVID-19 treatment centre at Al-Amal hospital.
In Hajjah Governorate, teams have been working in Abs and Al Jambouri hospitals, including setting-up screening points in both hospitals and establishing a 16-bed capacity isolation unit in Abs hospital. We have also improved IPC measures provided training to MoH staff on COVID-19 symptoms and case definition, treatment, and IPC measures. An MSF-supported COVID-19 isolation centre is now officially part of Al-Gumhouri Hospital and will be the referral hospital for COVID-19 for Hajjah governorate.
In Sana’a, we are supporting hospitals, including Sheikh Zayyed hospital, with technical expertise for screening set up, triage and infection prevention and control. In Ibb governorate we supported local authorities to build two COVID-19 treatment centres, putting in place IPC measures, and assisting with technical support, triage and screening, facility management including workforce planning, and waste management. Teams also provided training on health promotion for MoH staff and private carers.
We have conducted training on, and have implemented, IPC measures, in hospitals across Hodeidah, Taiz Houban and Taiz city. Our teams have also set up an isolation unit in Al-Salakhana hospital in Hodeidah, and triage, screening and identification for potential cases at the hospital in Taiz city.
In Hebron, Palestine, the MSF 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, medical personnel and other first responders, and families of detainees. Our team is also distributing hygiene kits to remote villages and food parcels to families that need it as a result of the outbreak-related movement restrictions and loss of income.
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. For the moment activities are on hold, but we remain willing and able to respond if asked.
In Hong Kong, where the outbreak is winding down and restrictions are being relaxed, we have shifted our focus to providing mental health support – via a website with tips and face-to-face sessions – for people caused by prolonged exposure to uncertainty.
In Timurgara, northern Pakistan, an MSF team is running an isolation ward and screening people for the virus in a number of departments in the local hospital. We are also providing support in Afghanistan, Kyrgyzstan, Uzbekistan, Bangladesh, Malaysia, and Indonesia.
In Japan, 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 are assessing patients and are assisting with referrals to further health facilities, depending on patients’ condition and the urgency of medical care.
Staff in health facilities in three provinces in Cambodia – Pailin, Bantey meanchey and Oddar Meanchey – have received training and technical support. MSF has also contributed to the development on national treatment protocols.
In Papua New Guinea staff in health facilities have received training on infection prevention control, and our teams have undertaken 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.
In Italy, we are supported three hospitals in the Lombardy region, in the country’s north, the original epicentre of the outbreak, with infection prevention and control (IPC) measures, as well as providing care to patients. Outside the hospitals, we are doing outreach activities in order to reach vulnerable people, and supporting a telemedicine programme (medical assistance via video conference), which is assisting people under isolation at home.
We are also working in one of the most affected regions, the Marche region in central eastern Italy, where we are supporting 30 nursing homes across several cities to prevent the virus spreading in such vulnerable locations, which have no specialised medical staff to manage patients. Our doctors, nurses, and hygiene experts are supporting staff and local municipalities with the implementation of infection prevention and control measures.
In Rome, we are undertaking health promotion and medical care through a clinic at Selam Palace, a building hosting more than 500 refugees, mostly coming from the Horn of Africa.
There are currently about 50 MSF staff involved in the response to the coronavirus pandemic in Italy.
The elderly and aged care homes have been hit particularly hard, and are not receiving priority attention. We are focusing many of our activities in Spain on aged care homes. In the last weeks, our teams have 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 are specifically working with steering committees that manage aged care homes, to help protect the elderly through patient care and infection prevention and control measures. These activities in Madrid, and the Catalonia region (including Barcelona) are being handed over, while activities continue in the Basque country, Castilla y Leon, in Andalucia, Tarragona, Palencia and Asturias.
In Spain, MSF has set up two health units to support hospitals around Madrid, with a total capacity of 200 beds. These units receive patients with moderate cases, helping decongest the hospitals’ emergency and intensive care services. These units are run by hospital staff, while our teams are providing them with logistical and infection prevention and control advice to protect healthcare workers and patients. We are specifically working with steering committees that manage aged care homes, to help protect the elderly through patient care and infection prevention and control measures.
In Barcelona and the Catalonia region, MSF has advised hospitals on staff and patient flow to manage infection control.
In France, we are helping to detect people with, and provide care for, coronavirus COVID-19 among the most vulnerable populations in Paris and the surrounding region. Activities include mobile consultations and screening of vulnerable people, and support with diagnosis, isolation and patient care in both existing and prospective shelters.
MSF teams are working in some of these shelters to evaluate their health and identify potential COVID-19 cases. Our teams are also working with homeless people living on the streets, evaluating people for COVID-19 and other illnesses. We are running two COVID centres for homeless and migrant people infected with the new coronavirus – where they can self-isolate and where our teams provide some medical assistance – in Châtenay-Malabry and in Aulnay-sous-Bois, in Paris’s southwestern and northwestern suburbs, respectively.
We have started providing support to nursing homes: teams are working in care homes across Paris, providing medical and psychological care assistance to residents, and IPC support to staff; while a team from MSF Switzerland has crossed the border to assist nursing homes, providing advice on IPC and medical awareness to staff, in the département of Haute-Savoie, southeast of Geneva.
We are also providing more support to hospitals and health centres. On 4 April, we set up inflatable tents to temporarily increase the ICU bed capacity at the hospital in Reims, east of Paris.
On 8 April, we started working at Henri-Mondor hospital in Créteil, in Paris’s southeastern suburbs, to increase capacity treating patients with severe COVID-19 who are well enough to leave intensive care, but still require inpatient medical care. MSF provides organisational and technical support as well as the staff that is in charge of managing a new 10-bed care ward.
Screening, counselling and testing activities in support of health centres in impoverished neighbourhoods in Marseille are underway.