Cape Town/Tshwane/Johannesburg - Doctors Without Borders (MSF) teams have assessed several temporary shelters for the destitute and homeless in Cape Town, Tshwane and Johannesburg, finding poor infection and prevention control in all. Such conditions place occupants at vastly increased risk of contracting COVID-19, tuberculosis and other infectious diseases.
“If anyone were to develop COVID-19 or TB in Strandfontein Temporary Relocation camp the chances for medical staff detecting it early are small, whereas the risk for transmission to many others is very high due to gross overcrowding and because the availability of screening and healthcare services is erratic."
GILLES VAN CUTSEM, MSF SENIOR TB/HIV ADVISER
MSF now calls for the phased decommissioning of the Strandfontein Temporary Relocation camp in Cape Town, and for municipal authorities to invest more resources in their shelters to ensure these facilities actually meet COVID-19 prevention criteria as regulated.
MSF specifically promotes the development of smaller, community-based shelters sited closer to facilities that already provide certain required services, such as mental healthcare.
“If anyone were to develop COVID-19 or TB in Strandfontein Temporary Relocation camp the chances for medical staff detecting it early are small, whereas the risk for transmission to many others is very high due to gross overcrowding and because the availability of screening and healthcare services is erratic. The danger of doing harm is great and this should alarm anyone,” says Dr Gilles van Cutsem, a senior TB/HIV adviser with MSF, who completed an assessment of the Strandfontein camp on Saturday 11 April as part of a team investigating health conditions at the shelter.
The Strandfontein camp is currently home to 1,500 people who were relocated there from across the city of Cape Town since the first weekend of April.
The City of Tshwane Metropolitan Municipality initially opened similar large-scale, high occupancy relocation camps but appreciating the risks of such unworkable set-ups quickly changed their approach, and then opened smaller, less congested shelters that are easier to manage.
The City of Johannesburg Metropolitan Municipality is following a similar strategy.
However, all 12 shelters assessed by MSF medical teams during the last 14 days – including shelters MSF currently supports in Tshwane and Johannesburg – face the following common challenges to a greater or lesser degree:
- Overcrowding and the impossibility of physical distancing indoors;
- Insufficient access to water and sanitation;
- lack of COVID-19 related health promotion and education;
- Low levels of screening for COVID-19 and lack of reliable referrals for confirmatory testing and safe isolation;
- Erratic distribution of food; and
- The presence of heroin users suffering from withdrawal symptoms.
Although most of the facilities were supported by some type of medical service, it was not sufficient for the high numbers of people residing at each shelter.
“Government is clear that COVID-19 infections are projected to continue rising until a peak in September, and we should, therefore, accept that COVID-19 transmission will not decrease over the short term. What does this mean for the people in temporary shelters, finding themselves in potential breeding grounds for COVID-19 during the extended lockdown and thereafter? The need for medium and longer-term alternative solutions could hardly be more urgent,” says Liesbeth Schockaert, MSF Project Coordinator for Regional Migration.
Another common point across shelters is the presence of extremely vulnerable people with chronic conditions, increasing their risk of disease severity and death related to COVID-19.
“Residents of Strandfontein include several elderly people, at least one with severely altered mental state; several people with HIV, a known risk factor for tuberculosis and a potential risk factor for COVID-19; several people with severe mental health diseases such as schizophrenia and dementia; people with urinary and fecal incontinence; several people with chronic respiratory conditions; several people with hypertension,” says van Cutsem.
Temporary shelters and camps that MSF teams have assessed that offer better conditions tend to be smaller facilities located in communities where the community members offer support in the form of food or clothing for occupants, thereby enhancing the existing services and minimizing risks of social stigma.
“In addition to violating individual rights, it might further exacerbate the public health risk posed by COVID-19, because vulnerable people don’t all trust authorities, and their legitimate fears of detention might force some underground causing them to altogether avoid seeking care, even when needed."
LIESBETH SCHOCKAERT, MSF PROJECT COORDINATOR FOR REGIONAL MIGRATION
An added concern for MSF is the high level of uncertainty and ambiguity on whether people housed in the current camps, like Strandfontein, are there voluntarily.
“In addition to violating individual rights, it might further exacerbate the public health risk posed by COVID-19, because vulnerable people don’t all trust authorities, and their legitimate fears of detention might force some underground causing them to altogether avoid seeking care, even when needed,” says Schockaert.
MSF supports intense civil society efforts to ensure urgent relief to homeless and vulnerable populations in this crisis, and has submitted expert testimony to a court case brought by Ndifuna Ukwazi, which aims to bring an early end to the ongoing humanitarian crisis at Strandfontein camp.
MSF is currently involved in responding to the COVID-19 pandemic in 49 countries around the world, including South Africa.
MSF medical teams in South Africa are working in support of the national COVID-19 response in the following ways:
- In the Western Cape, MSF works with the Western Cape Department of Health and City of Cape Town Health, by supporting a coronavirus hotline daily, helping to clarify myths and assessing symptoms. MSF teams are also supporting community-based COVID-19 screening, contact tracing and referrals
- Gauteng MSF teams work in Tshwane and Johannesburg offering COVID-19 screening and contact tracing, as well as primary healthcare consultations at several shelters for the homeless while community based health promotion and education activities among vulnerable groups, including migrants and asylum seekers are ongoing.
- In KwaZulu-Natal MSF COVID-19 contact tracing efforts and support to health authorities in the Eshowe area where we operate an HIV and TB project.
Internationally, MSF has consistently raised the alarm about the risks of COVID-19 infection due to the living conditions of vulnerable people in confinement settings – ranging from emergency shelters for homeless people in Belgium and France where our teams provide medical care, migrant detention camps in Greece and Mexico where we have called for evacuations, as well as highlighting worries over the capacity to respond in refugee camps in Bangladesh and Tanzania.