How are you supposed to wash your hands regularly if you have no running water or soap? How can you implement ‘social distancing’ if you live in an informal settlement or a refugee camp? How are you supposed to stop crossing borders if you are fleeing from war? How are those with pre-existing health conditions going to take extra precautions if they already can’t afford or access the treatment they need?
Everyone is affected by the COVID-19 pandemic, but the impact may be felt by some more than others.
As COVID-19 spreads further, it will continue to expose the inequalities that exist in our health systems. It will expose the exclusion of certain groups from accessing care, either because of their legal status or because of other factors that make them a target of the state. It will expose the under-investment in free public healthcare for all, which means that access to quality care will for some be based on purchasing power and not medical need. It will expose the failure of governments - not just health services - to plan for and deliver services that meet the needs of everyone. It will expose the life-threatening vulnerabilities caused by displacement, violence, poverty and war.
The people who will especially suffer will be those already neglected - due to austerity measures, who have fled because of war, who don’t have access to treatment for existing conditions because of privatised healthcare. And it will also be those who can’t stock up on food because they already can’t afford a meal every night of the week, who are underpaid, overworked and deprived of sick leave, unable to work from home - and those trapped in conflict zones under bombing and siege.
And how are you supposed to treat patients without all the material that you need? Many health systems bracing for the impact of COVID-19 have already been hammered to breaking point by war, political mismanagement, under-resourcing, corruption, austerity and sanctions. They are already barely able to cope with normal patient loads.
COVID-19 is demonstrating how policy decisions of social exclusion, reduced access to free healthcare, and increased inequality will now be felt by all of us. These policies are the enemy of our collective health.
As MSF scales up its response to the COVID-19 pandemic, we will focus on the most vulnerable and neglected. We started working in Hong Kong earlier this year in response to the first cases of COVID-19, and we now have medical teams deployed to respond in the heart of the pandemic in Italy and offering support in Iran. We will continue to scale up as much as is feasible as this crisis spreads, including here in South Africa where MSF nurses are already assisting Departments of Health in three provinces with contact tracing of COVID-19 cases.
However, some decisions can be taken now that will already ease the impending disaster that many communities may soon face. The congested camps on the Greek islands need to be evacuated. That doesn’t mean sending people back to Syria where war still rages. It means finding a way to integrate people into communities where they will be able to practice safety measures such as social distancing and self-isolation.
In addition to this, medical and personal protective equipment supplies need to be shared across borders according to where the needs are the greatest – particularly in Africa ahead of a potential surge in COVID-19 cases and where countries’ ability to cope is already compromised. This needs to start with states in Europe ending export bans and demonstrating international solidarity as China has done.
As MSF, we will also need to manage the gaps we will face in staffing our other ongoing emergency projects. Our medical response to measles in DRC needs to continue. So too does our response to the emergency needs of the war-affected communities of Cameroon or the Central African Republic. These are just some of the communities we cannot afford to let down. For them, COVID-19 is yet another assault on their survival.
This pandemic is exposing our collective vulnerability. The powerlessness felt by many of us today, the cracks in our feeling of safety, the doubts about the future. These are all the fears and concerns felt by so many in society who have been excluded, neglected or even targeted by those in positions of power.
I hope COVID19 not only teaches us to wash our hands but makes governments understand that healthcare must be for all.
Jonathan Whittall is director of the Analysis Department for Doctors Without Borders (MSF) – Operational Centre in Brussels