We are deeply concerned about how COVID-19 might affect people living in precarious environments such as the homeless, those living in refugee camps in Greece or Bangladesh, or conflict-affected groups in Yemen or Syria.
The high level of supportive and intensive care required has placed a heavy burden on some of the world’s most advanced healthcare systems.
For comprehensive information, including how to protect yourself against the disease, please visit the World Health Organization (WHO) website on COVID-19.
COVID-19 (short for “coronavirus disease”) is caused by a virus discovered in early January in China. It appears to be transmitted through droplets spread by coughing.
The virus affects the respiratory system. The main symptoms include general weakness and fever; coughing; and in later stages sometimes pneumonia and difficulty breathing.
Identified by Chinese scientists, the virus is now called SARS-CoV-2 because of its similarities to the virus that causes Severe Acute Respiratory Syndrome (SARS).
The coronaviruses are a large family of viruses, most of which are harmless to humans. Four types are known to cause colds, while two other types can cause
severe lung infections (SARS and MERS – Middle East Respiratory Syndrome), similar to COVID-19.
Like all viruses, SARS-CoV-2 needs the cells of living beings to multiply. This virus seems to target cells in the lungs and possibly other cells in the respiratory system, too.
Cells infected by the virus will produce more virus particles, which can then spread to other people, by coughing for instance.
Protecting patients and healthcare workers is essential, so our medical teams are preparing for potential cases of COVID-19 in our projects.
In places where there is a higher chance of cases, this means ensuring infection control measures are in place, setting up screening at triage, isolation areas, and health education.
In most countries where MSF works, we are coordinating with the WHO and Ministries of Health to see how MSF can help in case of a high load of COVID-19 patients and are providing training on infection control for health facilities.
On any given day we are treating hundreds of thousands of patients for a variety of illnesses. We need to ensure we can continue to provide adequate and life-saving medical care in our ongoing projects.
This is challenging because current travel restrictions are limiting our ability to move staff between different countries.
Establishing future supplies of certain key items, such as surgical masks, swabs, gloves and chemicals for diagnosis of COVID-19 is also of concern.
There is a risk of supply shortages due to lack of production of generic drugs and difficulties to import essential drugs (such as antibiotics and antiretroviral drugs) due to lockdowns, reduced production of basic products, exportation stops or repurposing/stocking of drugs and material for COVID-19.
COVID-19 response (as of 6 April 2020)
Afghanistan: After completing an assessment of the Afghanistan-Japan Hospital in Kabul – the referral hospital for COVID-19 cases – we are providing infection prevention and control training. We are also looking at ways to support case management in Herat.
Burkina Faso: We are providing patient support and adapting infection control in our projects as well as training Ministry of Health staff.
Bangladesh: While regular activities in the Rohingya refugee camp are ongoing, our teams have put in place specific waiting areas for patients who show symptoms of COVID-19, as well as a dedicated ward and isolation rooms for eventual cases.
Belgium: We are helping hospitals increase their admission capacity and supporting aged care facilities and other vulnerable groups, such as homeless people and undocumented migrants.
Cambodia: We are contributing to the development of national guidelines for infection prevention and control and clinical care of COVID-19 cases. Once finalised, we will provide training in eight hospitals around the country, which have been defined as COVID-19 referral hospitals.
Cameroon: An isolation ward is being set up in Buea regional hospital with training for staff on managing COVID-19. We are also supporting the health authorities in Yeounde in case management and preparing Djongolo facility for cases.
China: We sent 3.5 tonnes of specialised medical protective equipment to Wuhan Jinyintan Hospital in the capital city of Hubei province, China.
Democratic Republic of Congo: A COVID-19 isolation unit has been set up in Kinshasa for HIV-positive patients.
El Salvador: We are adapting our activities according to local needs, including increasing ambulance service coverage and capacity in order to deal with non-COVID-19 cases.
Eswatini: We are providing support and technical advice to the Ministry of Health and adjusting models of care for patients living with non-communicable diseases.
France: Our work in France centres around supporting the homeless and migrants in Paris and the surrounding area through mobile clinics and screening. Some of our teams are deployed in shelters to evaluate people’s health and identify potential COVID-19 cases, while others are screening homeless people on the streets. We are also assessing the situation in some referral hospitals in Paris and elsewhere in France.
Gaza: We are supporting COVID-19 case management in Gaza.
Greece: We are providing support to asylum seekers on Lesbos and Samos, sharing health information with camp residents, with procedures in place to support referrals for potential COVID-19 cases. Our teams have also adapted facilities and procedures to ensure the safety of patients and staff, including increasing water and sanitation services and obtaining extra staff and equipment.
Hong Kong: We have conducted health promotions sessions, both face-to-face and online, with vulnerable groups. The team has also held workshops on coping with stress and anxiety to address mental health needs.
India: MSF is supporting the Bihar State Government by providing crucially needed personal protective equipment for frontline healthcare workers. This includes N-95 masks, eye/face protection, gloves and high quality body protection, and viral transport mediums used in the testing of COVID-19 patients. The equipment will be used by medical staff in Nalanda Medical College and Hospital and other facilities in Bihar to ensure their safety.
Indonesia: We have started COVID-19 health promotion in the communities where we work in Banten province, West Java. Our staff have also provided training sessions and webinars on infection prevention and control measures, and guidelines on the use of personal protective equipment.
Iraq: We are donating personal protective equipment to a hospital in Baghdad with training protocols for use. A hospital in Mosul rebuilt by MSF is now the main COVID-19 patient referral unit in Ninawa Governorate. Existing projects are continuing to provide healthcare.
Italy: We are currently supporting three hospitals in the Lombardia region, the first epicentre of the outbreak in Italy, with infection control and a few doctors present. Outside the hospitals, our teams are doing outreach activities, including through telemedicine and supporting family doctors and healthcare workers assisting vulnerable people and those in isolation at home. We have also started activities in Marche, central Italy, where the number of cases is increasing and are supporting a network of nursing homes in several cities to prevent the disease from spreading among such vulnerable groups.
Ivory Coast: In Abidjan, we supported the Ministry of Health at a transit centre to screen and refer people with coronavirus symptoms to a care centre. In Bouake, training activities for health workers and screening at the different entry points to the city are already underway. Water and sanitation activities are also being implemented.
Jordan: We are preparing for medical facilities to be repurposed to receive COVID-19 patients.
Kyrgystan: We are working with the Ministry of Health around preparedness planning and have provided personal protective gear.
Libya: We have delivered trainings on infection control and case management to nurses and doctors in hospitals in Tripoli.
Malaysia: We have donated food supplements and are providing COVID-19 health education in Penang.
Mali: We support the management of a COVID-19 unit in Bamako, set up by the Ministry of Health. Our teams have also installed water points at the hospital and health centres around Niono, and an isolation tent in Tominian.
Mexico: We have increased medical activities in Matamoros camp, providing physical and mental health services, and health promotion.
Mozambique: We are implementing infection prevention measures and triage in health facilities, and adapting models of care to allow for social distancing. Our teams are also providing logistical support to two hospitals in Maputo.
Netherlands: We are providing psychological support in one hospital, including stress management for groups and individuals.
Niger: We are adapting triage and infection prevention at our paediatric hospital in Magaria. A treatment centre is also under construction in Niamey. In both places, health promotion activities are underway and training will be provided for health workers.
Nigeria: We are establishing isolation facilities in our projects. Health promotion and washing points are also being facilitated in local communities and camps.
Norway: We are providing strategic advice and infection control support to a hospital hosting 10 to 12 percent of the hospitalised COVID-19 patients in Norway.
Pakistan: In Timurgara, the team is doing pre-triage for COVID-19 cases and seeing suspect cases. We are also running the isolation ward after planning the layout, patient flow design, and infection control measures.
Papua New Guinea: We have started providing training on infection control, screening and triage in 22 provinces across the country.
Senegal: We are supporting health authorities in Dakar and providing training and support for water and sanitation activities.
Spain: We have set up two hospitals with a capacity of more than 200 beds in Madrid. Teams are extending their support and advice on decongestion models to several other hospitals in the city. In Barcelona, we helped design external structures and patient circuits in one of the main hospitals. We are also supporting municipal hospitals in central Catalonia and homes for the elderly in Basque country, providing advice and training on personal protective equipment.
South Africa: We have redirected staff from all projects to COVID-19 responses in Gauteng, KwaZulu-Natal and Western Cape provinces. Our teams are also assisting with contact tracing, the development and dissemination of health promotion materials, and ensuring HIV/TB patients get medicine delivered at home. In Tshwane, we are supporting vulnerable groups including asylum seekers, the elderly and homeless people.
Sudan: We are supporting preparations for a COVID-19 response, including infection prevention measures and treatment centres.
Switzerland: We are providing logistical and sanitation support in areas where vulnerable people are living in Geneva. We are also exchanging medical expertise with the university teaching hospital in Geneva (HUG) and assisting with the management of deceased patients.
Syria: In the northwest, we have donated protective equipment and are reviewing triage systems to ensure faster detection and isolation. Our teams are also providing training and technical support to facilities in Azaz and Idlib, including the identification and implementation of isolation areas and patient flow design. Health promotion has been increased, focusing on hygiene, COVID-19 symptoms and social distancing.
Tanzania: Our health promotion team in Nduta camp, Tanzania, are working to sensitise and educate the community on hygiene and best health practices, to improve preparedness for a potential threat of COVID-19 within the camp.
Ukraine: We have expanded health education activities and are increasing infection control measures in our projects and offices.
Uzbekistan: We have launched a health promotion campaign targeted at tuberculosis patients, who are among the most vulnerable to COVID-19.
Yemen: Support is being provided to the Ministry of Health in Aden as they set up an isolation facility.
Zimbabwe: We are supporting case management in Harare and increasing facility capacity while providing support in communities.
We must do everything to prevent and delay further spreading of the virus. It is already straining some of the world’s most advanced healthcare systems.
Access to healthcare
Preserving access to healthcare, both for COVID-19 patients as well as for any other patient, is paramount. This means ensuring that hospitals don’t become overwhelmed and that health staff can cope with the number of patients requiring intensive care and continue providing treatment to other patients who need it too.
Protecting healthcare staff
Infections of healthcare staff can happen easily in places that are overwhelmed by large numbers of patients. Places dealing with limited supplies of personal protective equipment for staff and a probable reduced workforce (as healthcare staff will also be part of confirmed cases through transmission in the community) are also at risk.
Infected healthcare staff will further reduce the capacity to admit and treat patients. Safety for healthcare workers should be a top priority in every healthcare facility.
We know from our experience that trust in the response and in health authorities is an essential component for outbreak control. Clear, timely, measured and honest communication and guidance is needed. People need to be empowered to protect themselves.
To ensure that the medical tools urgently needed to respond to COVID-19 are accessible, affordable, and available concerned stakeholders including governments, pharmaceutical corporations and other research organisations developing treatments, diagnostics, and vaccines should take the necessary measures to: