© MSF/Vincenzo Livieri

COVID-19 (coronavirus disease)

MSF is currently responding to the new coronavirus on five continents

COVID-19 is a new viral disease that affects the respiratory system

The World Health Organization (WHO) declared COVID-19 a pandemic on 11 March 2020. More than 200 countries are now reporting cases.

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As COVID-19 continues to spread, MSF teams are racing to respond to the pandemic in the more than 70 countries in which we run programmes, while opening projects in new countries as they become pandemic hotspots.

Our COVID-19 response focuses on three main priorities:

  • Supporting health authorities to provide care for patients with COVID-19 
  • Protecting people who are vulnerable and at risk 
  • Keeping essential medical services running

For comprehensive information, including how to protect yourself against the disease, please visit the NHS website on COVID-19.

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Where is MSF responding? 

Information as of 9 September 2020

Africa

Burkina Faso

Since the end of May, the evolution of COVID-19 cases in Burkina Faso showed a less alarming forecast trend than expected. MSF therefore shifted management of the COVID-19 treatment centre in Ouagadougou to the MoH at the end of July.

Following the decrease of cases, on mid-July we ended our intervention in Bobo-Dioulasso, western Burkina Faso, where we provided care for COVID-19 patients since the beginning of April. A new increase of COVID cases (about 50 cases currently active) was reported in the city at the end of August, which are taken in charge by the MOH. Yet, we continue to actively follow the trend in case our support is needed again.

In the Eastern area, the treatment site set up by MSF at the regional health centre in Fada was also handed over to the regional health authorities on 28 July. We continue to support the community awareness activities and the triage in the same centre.
 
We are following up epidemiological situation throughout the country, as concerns remain high with the number of displaced people in the northern, North-central and eastern parts of the country. We have adapted triage and infection prevention and control measures in the health facilities we support, set up isolation units and trained staff in prevention and case management.

Cameroon

While insecurity and violence continue to rage in the western and far north regions, Cameroon is still the country most affected by the COVID-19 pandemic in Central Africa.

At the early stage of the outbreak, MSF implemented many initiatives in its projects and provided constant support to national response in the central, far-north, northwest and southwest regions. In the past 6 months, we trained staff in infection prevention and control measures in our different projects, but also in Douala, and strengthened measures to prevent the spread of the new coronavirus in the different health facilities we support. Today the number of hospitalisations is starting to decrease, but the situation has hardly improved within communities where transmission of the virus is particularly active and where many infected people do not receive adequate medical care. 

In Yaoundé, the country’s main source of cases, we treat moderate infected patients at Djoungolo hospital: from 25 April to 31 August 2020, 328 patients were admitted. Epicentre, MSF´s research and epidemiologic branch, is also carrying out operational research activities on the effectiveness of screening tests, in partnership with the national emergency operations centre.

At the end of July, we also launched community activities in Cité Verte - one of the three most affected districts in the central region - as there were visibly fewer people coming to the hospitals. MSF teams are now running community information sessions, as well as follow-up home visits for moderate cases and referrals to a dedicated hospital for the most severe cases. We are also supporting patient tracing and epidemiological surveillance in this district.

In the Northwest, MSF has set up isolation and treatment wards in Bamenda and in in Southwest region, and we refurbished and equipped a 20-bed isolation unit in Buea regional hospital. 

Continued support has been given to the hospital in terms of oxygen and other logistics equipment. A 38-bed isolation unit was also constructed at Tiko District Hospital. In Kumba, a 16-bed isolation unit was constructed at the Presbyterian General Hospital. 

In both Northwest and Southwest regions, health promotion has been strengthened at community level, especially targeting people affected and displaced by violence – using community health workers and nurses, as well as radio messages. Community Health workers have been equipped with communication materials and tools to educate their communities on COVID-19. 

In the Far North, we set up a triage and isolation circuit for alert cases in 9 health centres in the city of Maroua and constructed an 8-bed isolation ward in the district hospital of Mora. 

Central African Republic

In Bangui, MSF built a COVID-19 treatment centre for patients suffering from acute respiratory distress syndrome. However, given the low number of severe cases, the centre did not open and the facility remains ready to be used. MSF continues COVID-19 related health promotion work with the communities.

Teams also launched shielding activities for people living with HIV in four outpatients’ treatment centres of Bangui, benefitting approximately 9000 people. A similar strategy, including soaps and masks distribution, food support and awareness raising sessions is implemented in Paoua and Carnot in collaboration with UNICEF and WFP, targeting around 4000 patients and their families. 

Chad

In July, we provided support to Farcha hospital, in N’Djamena, since the facility is the referral hospital for COVID-19 treatment. MSF provided clinical training to the staff, and installed an oxygen generator to provide oxygen in large quantities and for several patients at once. Given the low number of severe cases, this hospital didn’t require further support from us. In the capital, our teams also supported to laboratory activities at central level to draw up biosecurity procedures. 

Activities in N’Djamena also included surveillance support, as well as health promotion and community engagement across the capital, including with marginalised groups with lesser access to health information such as nomadic people in the outskirts of the city. We added COVID-19 related health promotion, medical screening and distribution of soaps and locally-produced cloth masks to our community-based activities in the three districts where we run malnutrition programmes.

Côte d’Ivoire

Activities closed

Restrictions have been largely eased in the past weeks and confirmed cases are slowly decreasing. The number of deaths remain stable. The mortality rate is currently up to 0.64% (18 167 total cases for 117 deaths).

We closed our two projects in Abidjan and Bouake, where activities were been handed over to the Ministry of Health. 

The team is assessing the results from the pilot telemedicine project which was carried out in the COVID-19 treatment centre of Yopougon, in Abidjan. The Yopougon treatment centre is hosted in the university hospital (CHU), that is currently closed for rehabilitation. Access to health specialists is thus scarce and MSF implemented this telemedicine project in partnership with a local NGO and the Ministry of Health, to diagnose and rapidly detect co-morbidities such as diabetes, hypertension, respiratory failure and cardiovascular diseases, with the objectives to reduce mortality among the more vulnerable patients. 

In order to do so, two MSF teams composed of doctors, nurses and care-givers provided 148 tele-consultations to COVID-19 patients at the Yopougon centre between July and August.

Democratic Republic of Congo 

Since 27 April, MSF teams have been treating COVID-19 patients at Saint-Joseph hospital in Limete, Kinshasa, in support of the Diocesan Medical Office, the MOH and in coordination with the COVID-19 national response team. 

At the Kabinda Hospital Centre in Kinshasa, where MSF supports HIV/AIDS patients, we have set up a 20-bed isolation/stabilisation unit, which is used before transferring patients to health facilities identified by the MoH.

In North Kivu, we set up a 20-bed COVID-19 treatment facility in Rutshuru, – so far only simple and asymptomatic cases have been admitted. MSF is currently advocating for the local authorities to set up a decentralised laboratory to improve the current turnaround test time of approximately two weeks. 

In Goma and Lubumbashi, MSF has handed over to MoH the management of the two COVID-19 treatment centres which we built and equipped. In both locations, assessments are underway by our teams following the recent reported increase in community deaths. We also supported COVID-19 testing in these two cities by donating GenXpert cartridges to MoH laboratories. 

In Mweso, North Kivu, we set up isolation centres for the treatment of moderate COVID-19 patients in six health structures. At the General Referral Hospital level, we are focused on setting up a 12-bed isolation structure for the care of seriously ill patients who will need oxygen support. 

In South Kivu, MSF has a COVID treatment centre in Bwindi, and continues to treat COVID-19 patients at the Bukavu General Hospital. A series of security incidents in the Kimbi area has forced the teams to suspend all operations.

Across all our projects in DRC, our teams are working on awareness raising and health promotion, as community acceptance of the COVID-19 intervention remains challenging, as well as training for healthcare workers. We continue to implement preventive measures such as reinforcing hygiene measures, providing masks and handwashing stations, setting up triage and isolation areas, as well as contact tracing.

eSwatini

We are providing support to the MoH by assisting with infection control and triage at health facilities. We are also part of technical advisory groups to the MoH and are implementing adjusted models of care for patients living with HIV, TB and non-communicable diseases in order to reduce their risk of infection.

A mobile MSF team is starting to provide home-based care for COVID-19 patients. Teams are doing health education in the communities on a daily basis.

Ethiopia

In Gambella region, in two camps for South Sudanese refugees (Kule and Tierkidi) MSF has set up a 20-bed COVID-19 isolation centre and another one with a capacity of 10 beds. In Gambella town a team provides support to the COVID-19 triage and temporary isolation centre in Gambella Hospital.

Our teams support the regional health authorities in our different project locations in Amhara and Somali Region in their isolation and treatment centres and with health education. We have also been working on preparedness in all our projects putting in place preventive and hygiene measures.

Guinea

Activities closed

From end of April to early August, MSF has been supporting the provision of care to more than 350 COVID-19 patients in the Nongo Epidemic Treatment Center in Conakry. We had set up this structure in 2015 as part of our Ebola response epidemic, before handing it over to the authorities.

In April 2020, our teams rehabilitated a large area of the centre to bring it up to standard to have a proper 75-bed COVID-19 isolation and treatment unit to provide care for patients with mild and moderate symptoms of the disease, but also patients in need of oxygen therapy.

Beyond the provision of care, our teams also disinfected several homes of patients admitted to hospital, provided psychosocial support, and managed the tracing and following up on their contacts. The Nongo COVID-19 treatment centre and its equipment were handed over the authorities mid-August. 

Guinea-Bissau

Activities closed

In Bissau, the capital of Guinea-Bissau, we provided different training at the National hospital Siamo Mendes including on the treatment of people with COVID-19, on IPC measures, water and sanitation improvement, and provided support with hygienists on waste management.

Kenya

The number of newly confirmed cases is plummeting. Nationwide lockdown ceased in July and life is slowly returning to normal though schools remain closed, and a 9:00 pm to 4:00 am curfew is still in place. A positive trend in health-seeking behaviour of patients for non-COVID-19 related health matters is reported.

We are supporting Homa Bay hospital, the county’s referral hospital with triage and managing temporary holding area, which also served as a treatment unit when other isolation units in the county were closed for a month during a healthcare workers’ strike. We are also supporting smaller facilities that are now burdened by the increasing number of patients after some health facilities were turned into COVID-19 isolation centres. In Embu County, MSF is providing IPC support to 11 MOH health facilities as well as Level 5 hospital.

In Likoni, Mombasa County, we conducted a survey in Timbwani ward examining the residents’ perspective to COVID-19 management, impact and response with a view of determining gaps and needs. We are presenting the report to stakeholders with an aim to determine a proper response strategy.

Liberia

There are 1,305 confirmed cases of COVID-19 in the country, and 82 people have died (as of 31 August). MSF is carrying out ongoing awareness activities on prevention measures in communities in and around Monrovia.

Malawi

In Neno, Dedza and Nsanje districts, MSF’s Female Sex Worker (FSW) project provides COVID-19 information and measures to prevent COVID-19 transmission among FSWs and in the community. Community sensitisation with FSW-adapted health messages on COVID-19 has been conducted, as well as installation of handwashing points in key areas. Technical and direct assistance to ensure effective COVID-19 patient flow at health facilities and IPC was provided. 

MSF’s Zalewa Health Centre continues to screen patients for COVID-19 symptoms. MSF’s Advance HIV Disease (AHD) project provides direct daily support of the COVID-19 patient flow at Nsanje District Hospital (NDH), including screening and triage, health promotion and IPC measures. MSF continues to provide technical support to the MOH-run 19-bed IPD COVID-19 case management isolation ward at NDH. MSF’s also conducts COVID-19 health promotion activities and has installed handwashing stations at health care centres in the district. 

Mali

At the end of August, we ended our support to the MoH 100-bed COVID-19 treatment unit, which has been set up  within the grounds of the hospital where it runs its oncology programme (‘Point G’ hospital), in Bamako. We supported the rehabilitation of the hospital’s oxygen network and provided medical, nursing and hygiene control training to staff as well as logistical and technical support.

At the end of August 436 patients had been admitted in this unit – of which 270 were cured. The unit is now under the exclusive management of MoH. We also engaged on COVID-19 related health promotion/sensitisation with local actors, health workers and members of civil society organisations.

In link with MoH community-level and contact tracing activities in Bamako, MSF has set up handwashing stations and provided locally-produced cloth masks and soaps. More than 800 community health workers have been trained, 50 handwashing facilities installed, 20 000 soaps and 40 000 masks were distributed.

Additionally, still in Bamako, MSF is supporting the Hôpital du Mali, improving triage, patient and staff flows and the isolation of the COVID-19 treatment centre. In the Centre (Ségou, Niono, Tenenkou, Ansongo, Douentza, Koro), in the South (Koutiala) and North (Kidal and Ansongo) of the country, we strengthened hygiene and IPC measures and set up isolation areas in the supported hospitals and health centres. We also support MoH activities such as case management, raising awareness among the population, improving prevention and setting up isolation structures for patients.

New activities with a focus on COVID-19 are currently underway in Timbuktu, where MSF is conducting home-based care, contact tracing, patients testing and IPC promotion within the community.

Mozambique

In areas where we already worked, MSF is providing support to the MOH. In Maputo, we are supporting the main COVID-19 referral hospital, Polana Caniço.

In Pemba, we helped local health authorities to install two isolation centres, 18 de Outubro (30 beds) and Decimo Congresso (100 beds) and we are providing health promotion in two IDP centres in Metuge.

In Beira, we assisted in the installation of two isolation centres, 24 de Julho (100 beds) and Marazul (33 beds) and provide support for the follow up of HIV patients with COVID-19 at the emergency isolation unit of the main hospital. We are also providing help in patient flow and triage of suspected COVID-19 patients in 4 health centres.

Furthermore, we participate in the Mozambican Government COVID-19 coordination meetings and technical groups providing advice for the shaping of the response in the country and facilitating access to updated evidence for the latest COVID-19 protocols.

Niger

Close to the Amirou Boubacar Diallo National Hospital in Niamey, MSF and MOH’s health workers receive confirmed cases and suspected ones with complications. As of end of July, the COVID-19 treatment centre had admitted 34 patients – 30 confirmed and 4 suspected case. 26 confirmed cased have been discharged and 4 were referred.

We are in the process of reassessing the needs, as the number of cases is decreasing, while the reopening of borders and needs for massive testing capacities are creating new challenges for the national authorities and partners involved in the response.

We are also supporting the emergency medical service’s call centre (24/7), and the response teams in five communes of the city to strengthen response capacity of the MoH. The teams provide technical support on alert verifications and organise the triage of patients at the call centre’s level. We provide psychological support. Serious cases are referred to health structures.

Nigeria

We continue to support health promotion and provide local authorities, hospitals and healthcare centres with technical support, staff training and IPC in all our projects. 

In addition: in Borno state, we support the Ministry of Health COVID-19 isolation centre in the state capital, Maiduguri, with training and IPC, including managing the laundry. Our teams have prepared 20 beds in Gwoza and 7 in Pulka, should isolation facilities be needed.  In Ebonyi state, we are supporting the MoH and Nigerian CDC with testing, in the state’s first COVID-19 testing centre, and are supporting a 25-bed MoH facility with treatment for COVID-19. In Sokoto, we have supported the MoH to renovate a 32-bed isolation and treatment centre. 

With the local authorities we helped to conduct a large community sensitisation campaign on COVID-19, reaching 370 settlements. We have supported communities with health promotion and installed water points and distributed soap and hygiene products to displaced communities in Benue and Zamfara.  
 
In Kano state, we are supporting primary healthcare, in response to the closure of healthcare structures because of COVID-19. We have seen nearly 3,300 patients so far, around 50 per cent for malaria. We monitor conditions that could make patients more vulnerable to COVID-19, including hypertension, heart disease, diabetes, and respiratory diseases. To date, our teams have referred five patients with COVID-19 symptoms, but not test was confirmed.

Senegal

In Dakar, we support activities in Guediawaye district (northern suburb of Dakar Region), with a special focus on community surveillance  support /analysis, community engagement, improving IPC standards, continuity of care and, since the change of the national strategy, on home-based care for simple COVID-19 cases. Besides, we continue our work at the Hospital of Dalal Jamm where we support case-management of moderate and severe cases.

Sierra Leone

MSF is part of the case management and surveillance pillars at the national Emergency Operations Centre (EOC) and district level EOCs in Kenema, Tonkolili and Bombali Districts.  Since July, we work with 10 Community Health Workers (CHW) from the Thompson Bay slum in Freetown delivering COVID-19 prevention messages across the whole slum area. In the coming months we will distribute 8-15 handwashing stations, with soap, in strategic places and pass additional messaging on malaria, pneumonia, and diarrhoea. 

We are also working with the CHWs to identify the poorest families in the slum and provide them with a small hygiene kit of soap and buckets with a tap and a bucket, and masks for the adults.  The CHWs have distributed large COVID-19 banners and also have put up COVID-19 posters about social distancing, how to wear a mask, and proper hand hygiene.  We also donated 700 small posters to the Freetown district health management team (DHMT) to distribute in other slum areas and key areas within Freetown.  

In addition to refurbishing a government facility on the outskirts of Freetown into a 120-bed centre for COVID-19 patients, the team carried out PPE training for around 140 workers. The Lassa Fever isolation unit in the Kenema government hospital has been rehabilitated into a COVID-19 treatment centre with an initial capacity of 25 beds.

Somalia and Somaliland

There is a lot of stigma surrounding COVID-19 so people who feel sick are reluctant to go to a health centres out of fear of discrimination. The testing capacity is also extremely low due to shortage of testing kits and lack of funding. 

MSF has stopped its support to treatment centres in Galcayo, Las Anod and Baidoa as there are no patients; screening at hospital gates continue for now.

In Somaliland, we are starting a round of trainings on prevention of COVID-19 for members of the MoH rapid response teams. Due to infection prevention and control measures put in place to prevent the spread of the infection, regular programmes are affected, like routine immunisation and nutrition programmes. 

South Africa

Case numbers are dropping in all South African provinces, although national borders remain closed. MSF continues to support secondary care interventions in two hospitals in uMlalazi district, KwaZulu-Natal.

In rural Mbongolwane District Hospital, MSF established a patient flow system, including a “flu clinic” in which all patients presenting or claiming COVID-19 symptoms are screened by an MSF nurse and seen by an MSF doctor for triage and testing.

In Eshowe District Hospital, an MSF doctor supports care for patients under investigation awaiting test results. Approximately 1500 asymptomatic patients with chronic conditions in this project area have been enrolled in a programme that sees their medication delivered to pick up points in communities, saving a trip to the clinic.

In Khayelitsha, the health promotion team continues to provide neighborhood groups with COVID-19 training, with over 170 groups trained to date.

South Sudan

Cases of COVID-19 continue to increase including confirmed or suspected cases in MSF facilities and project areas in Aweil, Lankien, Leer, Old Fangak, Bentiu Protection of Civilians (PoC) site, as well as in Bentiu Town. Overall, we are seeing a decrease in hospital admission across several project sites. The extremely limited testing capacity across the country and thus possible community transmission remains a concern.  

Across the country, our project teams are working on awareness raising and health promotion activities, as well as preventive measures such as setting up additional washing points equipped with either chlorinated water or soap and reinforcing the existing ones, training staff on triage and infection prevention and control (including the use of PPE), and establishing isolation areas or pre-screening areas for suspected COVID-19 patients.

In Juba, we reduced the number of handwashing points from 12 to 4 as more humanitarian actors and business owners installed their own handwashing stations. MSF continues to provide technical support to the MoH, the National Public Health Laboratory and Juba Teaching Hospital.  Further, 117 community leaders have enrolled in the community mortality surveillance system, which covers 52 neighborhoods in Juba. SMS-based community mortality system for Juba has been set up using REDCap/Twilio (collects data in realtime). Health promotion messages have shifted to explain how hygiene and sanitation affects health and relates to COVID-19.

In Yei, with the population afraid of visiting health facilities, MSF started mobile clinics in three different locations within Yei town where about 140 consultations are conducted on a daily basis, with referral to MSF clinic. 

Sudan

We are supporting three main public hospitals in Khartoum to strengthen their screening and triage system, expanding the isolation area in one of the hospitals. The objective is to protect or reopen lifesaving services and to reinstate confidence among health workers. MSF teams are supporting with trainings, reinforcement of infection prevention and control (IPC) measures, weekly donations of PPE. We also trained staff from 10 primary healthcare centres, donated IPC items and provided technical on-site support, which continues in different facilities in Khartoum. 

In August our teams opened a temporary COVID-19 treatment centre in Omdurman teaching hospital in Khartoum, in partnership with the hospital and the Ministry of Health. The 18-bed centre has the capacity to expand to 40 beds, if needed, and provides medical care to patients with moderate to severe COVID-19 symptoms.

We are also supporting the MoH to manage isolation centres in East Darfur and South Kordofan states.

Tanzania

MSF is the sole healthcare provider in Nduta refugee camp, which hosts 75,000 Burundian refugees. In preparation for a COVID-19 outbreak in the camp, MSF built four triage/isolation areas at each of its health clinics and completed preparation for a main isolation centre at the MSF hospital, where suspect cases of COVID-19 will be referred. Currently, we have 10 beds with the possibility to connect 10 oxygen concentrators, and are in the process of constructing an additional 50 beds, with options to scale up to 100 if needed.

Over 250 MSF staff have been trained on COVID-19 response, with a focus on case definition, triage, screening, infection prevention and control, safe transportation of suspect cases, isolation, use of PPE and case management. All patients are now screened for COVID-19 at the entrance of our health clinics and hospital. Training is ongoing in our hospital in Nduta refugee camp.

Meanwhile, our health promotion team in Nduta camp is working to sensitise and educate the community on hygiene and best health practices, to improve preparedness for COVID-19 within the camp.

Uganda

Uganda has reported a low number of confirmed cases and no COVID-19 deaths so far. MSF teams have helped with logistics and hygiene measures in 3 MoH isolation units in Arua and Kasese.

We are raising awareness among the communities where we and distribute masks to patients and staff in MSF-supported health structures, as well as protective equipment to medical staff working with COVID-19 patients. In Adjumani district, in the North, an MSF team intervened to improve living conditions in a transit centre used to quarantine and test refugees, where conditions were particularly poor. 

Zimbabwe

While COVID cases and fatalities in Zimbabwe have remained relatively low (7116 total cases, 208 fatalities and 5373 recoveries on 6 September), we remain on standby to provide support. 

Our WASH team continues to support community activities for COVID-19 prevention such as mask and soap distribution, access to water, health promotion and sensitisation.  We are supporting case management, laboratory surveillance, IPC, WASH in healthcare facilities, epidemic surveillance, contact tracing, as well as safe transport of people testing positive for COVID-19.  With more residents returning from neighboring countries, MSF is providing support for COVID-19 screening, sample collection for testing and providing non-COVID-19 healthcare services and health promotion at the Beitbridge Border post.

Americas

Argentina

Activities closed

Between April and July, MSF offered technical support and advice to health authorities in the provinces of Buenos Aires and Córdoba. We helped to design protocols, circuits and infection prevention and control measures in health structures, alternative treatment structures, and nursing homes.

In Córdoba, we provided technical support to the province’s Emergency Operations Committee working group for enclosed structures (which includes nursing homes, haemodialysis units and prisons), and participated in training the staff.

In Buenos Aires, we collaborated with the secretariats in charge of the response to COVID-19 in the city’s vulnerable neighbourhoods on possible intervention strategies, definition of priorities, and in the trainings.

Overall, MSF teams provided direct training (in person and online) to more than 550 people who work with some of the most at-risk groups: staff from nursing homes, organisations for people with disabilities, homes for children and adolescents, and community representatives from vulnerable neighbourhoods. MSF also worked with the National Penitentiary Office, providing advice on general aspects of the disease, prevention measures in detention centres, psychosocial aspects and promotion of mental health.

Bolivia

A team assessed needs in the Beni region, a rural Amazonia-basin area in the northeast of the country.

Brazil

In the state of Mato Grosso do Sul, we are running mobile clinics in indigenous areas near the towns of Aquidauana and Anastacio. There are also doing mobile clinics in the Aquidauana urban area and we are supporting the activities at the local hospital.

In Sao Paulo, we run an 8-bed ICU at Tide Setubal hospital. Also in Sao Paulo, we have regularly visited two communities and have carried out tests on family members and people close to patients who have already tested positive for COVID-19. MSF is developing health promotion activities, in addition to installing handwashing points and distributing hygiene kits to residents, in partnership with local leaders. 

In Boa Vista, the number of COVID-19 cases is decreasing. MSF is supporting the field hospital with doctors treating moderate cases. We are expected to finish activities at the field hospital on mid-September.

Canada

Activities closed

MSF used its expertise in emergency outbreak response to provide valuable guidance to medical organisations, government agencies and remote indigenous communities to prevent and manage COVID-19 outbreaks. Teams created and shared two eBriefings related to COVID-19, one on infection prevention and control (IPC) and another on adapting and developing medical facilities. MSF also facilitated experienced field staff in Canada to other front-line organisations. MSF teams conducted several IPC assessments in shelters in Toronto for people experiencing homelessness and long-term care facilities in Montreal, providing recommendations to improve staff and clients’ overall safety. 

The Canadian COVID-19 emergency highlighted systemic health inequalities in Canada that existed before the pandemic. Those living in remote locations continue to experience challenges in accessing secondary and tertiary levels of health care. Many communities still face challenges accessing primary health care and necessities, such as clean water. The economic barriers and unstable employment confronting too many Canadians before COVID-19 have been worsened. Canadians facing difficulties accessing medical care, because of insecure, inadequate, or nonexistent housing conditions, or geographic isolation remain vulnerable. The tragedies in Quebec and Ontario’s long- term care facilities highlighted the province’s catastrophic failure to care for a segment of Canada’s elderly population.

Despite existing and exasperated disparities in Canada, there is no need for MSF’s specific expertise currently. Although slow to start, generally, Canada's healthcare systems have not been overwhelmed by COVID-19. With lessons learned from the pandemic's first wave, systems and organisations should be better positioned to prevent and respond to future COVID-19 outbreaks in Canada. MSF Canada's COVID-19 activities ended on July 15, 2020.

Colombia

MSF is working closely with health authorities in Norte de Santander and Tumaco to support the local response. We are currently participating in outpatient triage and supporting the area for patients with respiratory symptoms at the Tibú hospital.

In Tumaco we are carrying out medical and mental health activities in the two public hospitals in the city. In each of these places we are also focusing a large part of our efforts on promotion and prevention activities in towns, villages and neighbourhoods through different community strategies and the media. 

In Norte de Santander we continue to follow up on patients with chronic diseases, and we have maintained our mental health and sexual and reproductive health activities with Venezuelan and Colombian populations without access to the health system, as well as emergency attention for sexual violence and termination of pregnancy.

We have deployed a small technical team, the Flying COVID Team, which has been supporting local hospitals in Atlantico, one of the regions most affected by COVID-19. The team’s work, which is now supporting Erasmo Meoz Hospital in Cúcuta, has focused on rapid assessment, technical training, mental health care for health staff, and donations of medicines and supplies to help health facilities keep COVID-19 services safe at the peak of the outbreak. 

Ecuador

A testing campaign was launched in Quito. MSF is supporting the health centres, to make sure they can follow-up on positive tests. MSF gives training and support for IPC, health promotion and mental health to mobile teams and to health posts.

In the Temporary Attention Center (CAT) in Quito, MSF will provide palliative care from mid-September, and train staff in this field. This is a pioneering project for whole country and will be implemented gradually.

The interventions in nursing homes and shelters for homeless people continue, with on-site support and trainings on IPC, mental health and health promotion.

El Salvador

MSF has strengthened its ambulances services in areas that are difficult to reach due to violence, in order to alleviate the workload of the emergency system that is dedicated to the transport of COVID-19 patients.

MSF continues mobile clinics in communities of San Salvador and Soyapango affected by violence. We resumed health promotion activities with community leaders and health committees.

After the reopening of the health units, we have facilitated the access of Ministry of Health personnel to the communities of San Salvador and Soyapango to carry out child vaccination campaigns. During the COVID-19 emergency, we worked on mental health care in isolation centres dedicated exclusively to deported people (from Mexico and the United States).

Haiti

After the initial steady increase of admissions at MSF's Drouillard COVID-19 treatment centre in Cité Soleil, Port-au-Prince, the number of hospitalised patients stabilised and decreased in July. A similar situation was observed in other COVID-19 centres managed by the Ministry of Health or other organisations in Haiti.  From its opening in mid-May to its closure on 9 August, MSF teams in Drouillard centre screened 333 people and provided care to 192 patients who were hospitalised with severe symptoms.

MSF's emergency centre in the Martissant neighbourhood has also screened 69 people for COVID-19 since the epidemic was declared in March, referring patients to Drouillard when needed. A total of 66 deaths have been recorded by MSF (59 at Drouillard and 7 in Martissant) while more than 100 COVID-19 patients were discharged from Drouillard. Since 27 August, Drouillard hospital has reopened to treat patients with severe burns, which was its focus prior to COVID-19.


In several neighbourhoods of Port-au-Prince, community awareness and mobilisation activities on prevention measures and timely admissions continue through door-to-door health promotion, radio spots and training for community organisations and leaders. In Port-au-Prince, Les Cayes, Port-à-Piment and Port-Salut, our teams have also supported several hospitals and medical facilities in implementing infection prevention and control measures, triage and isolation. 

Honduras

In Tegucigalpa, MSF has started medical activities in an adapted centre for severe COVID-19 patients with the objective to help the metropolitan health system to keep the hospitals from being overwhelmed. We have so far cared for 44 patients.

A mental health phone line for violence and sexual violence survivors has been put in place. An increase in mental health consultations has been recorded by the psychologists. MSF manages a health centre in a neighborhood at the outskirts of the city which is prepared to detect COVID-19 cases.

In Choloma, the sexual and reproductive health project is still working but with some limitations. This is the only maternal clinic in the city, so all references for deliveries and prenatal care consultations are sent there. The project also donated an ambulance to transport COVID-19 patients to the isolation centres established by the government.

Mexico

An MSF COVID-19 team - in coordination with the state health authorities - provides  technical IPC support in different hospitals and health centres in different states. 


A second MSF team is focused on migrant shelters. The objective is to help shelters and migrant centres to adapt their structures to the pandemic response. Many migrant shelters had to close or reduce activities, as they lacked resources, space or information on how to prevent infection and how to act in case of suspected COVID cases.  


In Guerrero, MSF teams resumed the mobile clinics providing primary healthcare and psychosocial support to population victims of violence. 


A hotline and WhatsApp number has been set up for MSF psychologists to provide psychological care remotely to migrants and refugees as well as to the population isolated by violence in Guerrero and migrants and refuges across the country.


In the Mexican northern border project, in Matamoros and Reynosa, MSF increased and adapted its activities, a shelter and an asylum seekers camp. Also in both cities, MSF has started medical activities in two adapted centres for severe COVID-19 patients. In both centres MSF is caring for mild and suspected patients, and severe patients that need oxygen. A psychological care phone line started activities for patients who are victims of violence or are coping with the COVID-19 pandemic. 

PAEC-LAT Project (‘Proyecto de Asesoramiento Estratégico ante el COVID-19 en Latinoamérica’)

Due to the difficulties in responding to the pandemic with the traditional approach, and as a way to overcome the restrictions for face-to-face work and staff movements, MSF created a free online strategic and technical support service aimed at institutions and staff that are at the frontline of the pandemic in Latin America.

This innovative digital solution takes advantage of the possibilities of virtual visits and online trainings to reach multiple countries, regions and different audiences, including health professionals, administrative staff, cleaning staff, community agents and indigenous health teams, mainly in remote communities and areas with limited access to healthcare services.

Since May, the PAEC-LAT has responded to more than 1,500 requests from health personnel working against COVID-19 in 14 countries in the region (Mexico, Guatemala, Honduras, Nicaragua, Costa Rica, Colombia, Venezuela, Peru, Uruguay, Argentina, Chile, Ecuador, Bolivia and Puerto Rico), and conducted 130 trainings and 35 virtual visits followed by recommendations reports.

Peru

In Peru, MSF launched a 3-months intervention to support the Ministry of Health’s COVID-19 activities in the Amazon region. This intervention should end at the end of September.

In cooperation with a team of the Basque health authorities in Spain we are treating severely ill patients in the hospitals of Tarapoto, Huánuco and Tingo María while also providing support to primary health centres in the provinces of Datem de Marañón and Condorcanqui through donations and training.

United States

In collaboration with local authorities and/or partner organisations, MSF teams worked with migrant farm workers in Florida; people experiencing homelessness in New York; Native Americans –particularly Navajo Nation and Pueblo peoples– in the southwestern states of New Mexico and Arizona; clinical and non-clinical staff in nursing homes in Michigan and Texas; and a range of people and communities in need in Puerto Rico.

MSF has completed its programmes in Florida, New York, Michigan, and the Southwest. Medical programmes continue in Puerto Rico until the end of September. In Texas, the team will continue to offer on-site infection-control and mental health support to nursing homes until October. 

In Puerto Rico, since May, MSF helped support medical facilities with the immediate needs for personal protective equipment (PPE), provided training on infection prevention and control (IPC) measures to health care workers. MSF is continuing to provide hand hygiene and COVID-19 health education workshops to high-risk groups.

MSF also currently works in close collaboration with local partners to provide primary care consultations in homes and at ‘pop-up’ clinics to people suffering from chronic health conditions who had been unable to or fearful of going to health care facilities due to COVID-19. The team also monitors the symptoms of COVID-19 patients or people who test positive, but are asymptomatic. MSF works across the island in and around San Juan or travel to remote areas in the East, West, South and the third largest island Vieques. 

In August, MSF took its infection-control training and wellness support model for nursing homes to Texas. Nursing home deaths make up more than 30 percent of the state’s total coronavirus fatalities since March. MSF is also providing its infection prevention and control (IPC) training tool kit and staff wellness model to schools of nursing so students can develop this expertise.

Venezuela

MSF’s response plan includes assisting with medical supplies and staff recruitment, as well as strengthening triage, diagnosis, treatment, infection control and peri-hospital system services in the projects in Amazonas, Anzoátegui, Bolívar, Sucre, Táchira and the Caracas.

In Caracas, COVID-19 activities will be carried out in Pérez de León II Hospital in Petare (Miranda), where teams rehabilitated the infrastructure, adapted the patient flow, established IPC measures and trained staff to receive COVID-19 patients for hospitalisation and ICU care. MSF is also supporting with staff recruitment, treatment and peri-hospital system services in Vargas Hospital of Caracas.

Asia

Afghanistan

In June, we opened a 32-bed COVID-19 treatment centre in Herat for the treatment of patients in need of oxygen therapy. We aim at raising the level of care for severe COVID-19 patients and relieve the pressure on the existing COVID-19 management centres – Shaidayee and Liberty Hospitals – which are increasingly overwhelmed. 

In Lashkar Gah, MSF is providing support to Malika Suraya Hospital – the main dedicated COVID-19 facility in Helmand, meanwhile in Boost Hospital, screening and stabilisation areas and a referral mechanism have been established for suspected COVID-19 patients. In Kandahar, the team is supporting both the provincial TB centre and MSF TB centre and isolation units have been set up for the admission and treatment of DRTB patients who are COVID-19 positive or suspected. The logistics team is also speeding up the construction of the new TB Hospital.

In Kunduz, the wound care clinic activities have been temporarily suspended, as have MSF activities in the small stabilisation clinic in Chardara district, west of the city. We are collaborating with Kunduz Regional Hospital to provide IPC training to ensure better protection of their front line medical and support staff. Some construction activities in our various projects have also been put on-hold. In all projects, MSF has put in place all necessary preventative measures to mitigate the risk of our facilities becoming part of the chain of transmission

Bangladesh

MSF has created isolation wards in all our medical facilities in Cox’s Bazar and is preparing two dedicated treatment centres. Currently our teams are treating a number of patients with COVID-19, as well as monitoring patients with suspected COVID-19.

Our focus is currently on treating all of our patients and ensuring we can give the best possible quality of care for COVID-19 and other medical problems, as well as continuing to work together with the Bangladeshi authorities, WHO and other health actors to limit the spread of the virus. Our teams are also carrying out HP activities in the camps. In Kamrangirchar urban slum, MSF has reduced regular activities to focus resources on our main clinic, where we continue to provide sexual and reproductive health services and SGBV, as well as health promotion for COVID-19. We are also supporting the local health facilities with IPC training.

Cambodia

Activities closed

Last spring, MSF teams implemented triage infrastructures in six hospitals bordering Thailand. They also participated in training 300 staff of the ministry of Health in IPC and case management. 

Hong Kong

As Hong Kong is currently facing its most severe local outbreak since July, MSF has extended its COVID-19 emergency response from health education activities to providing emergency shelter and basic medical consultations to the homeless people. Homeless people in Hong Kong are particularly affected by the closure of publicly accessible facilities and suspension of services by local service providers or organisations.

Our emergency team is working with Impact HK, a local NGO, that has been supporting the homeless for some years already. The teams visit the homeless people twice a week in various streets of Hong Kong. Apart from distributing food, drinking water and hygiene kits, our caseworkers also follow up on individuals’ needs. Since June, the team has conducted 25 medical consultations and has arranged temporary shelter for 15 vulnerable individuals.

The COVID-19 outbreak lasts since January. Prolonged exposure to uncertainty can cause stress and anxiety. Therefore, aside from conducting anxiety and stress management workshops for vulnerable groups for several months, we have created a website for the general public offering tips and tools to help cope with the situation: https://howareyou.msf.hk/en/.

India

In Patna, Bihar, MSF works in a facility for mild to moderate COVID-19 patients in a converted sports hall, to support the Nalanda Medical College Hospital. Community health promotion and education activities are also taking place. 

In Mumbai, MSF continues to scale up COVID-19 training among its DRTB-HIV and COVID-19 projects staff and have established IPC measures at all its work sites. MSF is also carrying out COVID-19 screening of the DRTB and HIV patients in its private independent clinic and in an OPD co-managed with national TB Program. MSF is supporting an existing fever clinic and scaling up capacity for treatment of mild to moderate cases of COVID-19 in a newly built hospital of 1100 beds (MoH). MSF is carrying out health promotion in the slum, distributing mask and soap distribution to at-high-risk TB/DRTB patients, patients on ARVs and street vendors. WASH & disinfection activities in 8 community toilets at hotspot pockets in M-east ward.  

In Chhattisgarh’s Bijapur district mobile clinics were disrupted because of flooding, with the district showing a trend of increasing COVID-19 cases. Increasing cases in Moreh, Manipur has delayed opening of one-stop centre for HIV, TB, HCV, OST. 

MSF’s 24/7 mental health telephone hotline in India is available in English & Hindi and in Nepal in Nepali. Jahangirpuri, the Umeed Ki Kiran (UKK) clinic and its catchment area in Delhi, continues to be a hotspot zone for COVID-19. UKK clinic continued to remain open with gradual rise in uptake of the services. 

Facilities-based counselling remain suspended in Kashmir. Phone counselling continues with improvement in the uptake of the services mainly for follow ups and new consultations referred by psychiatrist. Findings from a health and humanitarian needs assessment in Kashmir showed increasing need for mental health awareness raising and counselling services. No specific needs related to COVID-19 were found during the assessment. 

A new intervention for COVID-19 & TB screening of homeless population in northeast Delhi, and their referral for testing and treatment, is planned for mid-September.

Indonesia

MSF teams are conducting workshops and trainings for community health workers in Jakarta and Banten Province who are involved in the management of suspected COVID-19 cases and those observing home-isolation.

To date, 17 training sessions have been completed, with more than 200 people trained. Health promotion sessions are still ongoing, with MSF teams now also conducting training-of-trainers (ToT) targeting specific community members to ensure increased coverage and sustainability

Japan

Activities closed

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 assessed patients and assisted with referrals to further health facilities, depending on patients’ condition and the urgency of medical care. In Suginami, a district of Tokyo, MSF teams provided epidemiological analysis, supporting local health authorities.

Kyrgyzstan

Cases have risen in recent weeks. We are reinforcing our response by providing home-based care for mild and moderate cases. In Chuy Oblast which has some of the highest cases of COVID-19 in the country, our teams are addressing a critical gap by reinforcing home-based care, while supporting a COVID-19 hotline that ensures people are informed and directed to appropriate care pathways. Our teams manage mild and moderate cases, frequently organising home visits to ensure patients receive adequate follow-up care and medications in line with national protocols. 

We also ensure psychosocial support for those receiving home-based treatment and support families in infection-proofing their homes. We have also adapted our regular activities in Kadamjay Rayon and Batken Oblast, increasing the frequency of home visits for neonatal and pediatric consultations in order to avoid a high concentration of people in health centres. 

We are working closely with the Ministry of Health, and offering technical advice, providing logistics assistance and supporting health promotion initiatives while also assisting in epidemiological surveillance through data collection. We focus on our areas of operation in Kadamjay Rayon and Batken Oblast.

More specifically, we are working to infection-proof four main hospitals in Kadamjay rayon, not only through advice and training in line with robust infection prevention guidelines, but also by providing disinfectants and personal protective equipment for health staff. We are also managing the logistics of all four mobile teams, providing them with vehicles and fuel, and equipping medical teams with protective gear. And we have distributed over 4,500 masks to protect patients with NCDs and existing complications in the region. We have also provided the Ministry of Health with personal protective gears including N-95 masks and gloves, thermometers, chlorine tablets and alcohol pads.

Malaysia

In Penang, we are providing COVID-19 health education in different languages, including Rohingya and Burmese, and translations in hospitals. Based on input from the community, MSF has started a COVID-19 health promotion campaign with R-vision, an online Rohingya news network. Our advocacy has focused on a more inclusive COVID-19 response, calling on the government to halt targeting migrants and refugees in immigration raids, which could risk further spread of COVID-19 in detention centres. 

Myanmar

The MSF Myanmar Facebook page has started an awareness COVID-19 prevention and health promotion messages.

Pakistan

In Timergara, MSF has reduced the capacity of the COVID-19 isolation ward in the District Headquarters (DHQ) hospital from 30 to 14 beds based on the epidemiological data showing a significant decrease in the cases. We are discussing the handover of the activities to Ministry of Health (MoH) by end of September if the situation remains stable. The team is screening on average 950 people every day for symptoms of COVID-19 and undertaking consultations for suspect cases. We are referring seriously ill patients to the tertiary structures in Peshawar or other cities in Malakand division.

In Balochistan, we supported the setting up of an isolation unit of 32 beds in the Killa Abdullah New DHQ Hospital in Chaman. It is currently used for isolation and treatment of the patients of COVID-19 virus but can be used for other infectious diseases in the future if needed. A screening and triage setup has also been installed by MSF at the main entrance of the hospital, where the team is screening about 300 people daily who come for the MoH outpatient services. 

We are also conducting extensive awareness-raising activities on ways for people to protect themselves and prevent spreading the virus, and we have added protective COVID-19 measures and isolation areas in most of the facilities we support across Pakistan. 

Papua New Guinea

In Papua New Guinea, staff in health facilities have received training on infection prevention control, and 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.

Philippines

In Manila, the team is supporting its partner organisation Likhaan with health promotion activities. Teams are also supporting with contact tracing and COVID-19 prevention activities at community level and helping to implement IPC measures in the health facilities that are caring for COVID-19 patients. We distributed ‘quarantine kits’ – including hygiene materials - to 726 COVID-19 patients and contacts between early July and mid-August. 

In June, we started supporting the COVID-19 ward and the hospital laboratory at San Lazaro hospital, in Manila, with PPE, biomed equipment and pharmacy. The MSF medical team now counts 25 staff members who provide patient care on the COVID-19 ward since July. Our team is seeing a steady increase of COVID-19 patients.

In Marawi, the team continues health promotion activities and has trained the local health teams in 60 of the 72 communities in charge of COVID-19 surveillance and contact tracing. 

Tajikistan

We prioritise the continuity of quality care for essential services for children and adults with TB, in collaboration with the Ministry of Health and Social Protection of the Population (MoHSPP) via existing MSF programmes focused on diagnosis, treatment and contact tracing.

Our team completed the first assessment of the Republican Centre TB dispensary. The objective is to decrease the risk of transmission of COVID-19 between individuals seeking care and the staff working there. We will help develop triage questions, improve patient flow and offer health promotion for individuals awaiting their examination.

Additionally, a separate outdoor open space waiting area with shade protection will be built for individuals with suspected COVID-19. This is the first time such a triaging approach will be implemented in NTP facilities. If the pilot is successful, MSF will introduce similar triage systems in other TB dispensaries across the country. The proposal has been discussed and approved by NTP.

Uzbekistan

We continue to support IPC measures across the primary healthcare system and more recently also in COVID treatment facilities. Additionally, we coordinate with the MoH regarding the treatment of co-infected COVID+TB patients. 

Europe

Belgium

Over the summer, MSF did qualitative research on the mental wellbeing of residents of care homes. The preliminary results are being shared with partner organisations and health authorities. One mobile team continues to support care homes, with IPC measures, organisation of care, and psychosocial support for both residents and staff. These activities are being handed over to local authorities and MSF will end its intervention at the end of September.

Support for COVID-19-related needs in MSF’s project for people living in the streets in Brussels continues.

France

In the past months, MSF’s intervention dedicated to COVID-19 significantly decreased following the general downward epidemiological trend across the country. We still provide general medical care, along with COVID-19 screening and testing capacities, for people living in the streets and precarious settings in Paris region via mobile clinics.

After an intervention in nursing homes between April and June 2020 (medical consultations, health promotion, technical support and donations), MSF teams started a new programme in these facilities (21 as of today) in order to offer psychological support to staff and residents.  

Germany

Activities closed

In Germany, MSF advised organisations, volunteer groups and state institutions working with the homeless, migrants and other vulnerable groups on IPC measures, to enable them to continue their services.

An MSF team had supported the authorities in the federal state of Saxony-Anhalt in a centre for asylum seekers in the city of Halberstadt, in which hundreds of inhabitants were under quarantine, with health education activities and psychological support. Activities in Germany ended by 8 May.

Greece

In Athens, we collaborate with the 3rd Clinic of Internal Medicine of Athens University (NKUA-EKPA) by providing psychological support to frontline health workers, COVID-19 patients and their relatives.

We also made PPE donations (gloves, masks, face shields, antiseptic fluids) to vulnerable social groups, including elderly, refugees, homeless, women/victims of gender-based violence, detainees, people with mental health problems as well as to the airlifting department of the National Emergency Aid Center.

Italy

In Italy, which had been an epicentre of the pandemic, our teams continue to work in Rome, where we working in informal settlements and squats. In these settlements, we aim to strengthen COVID-19 surveillance among marginalised urban communities through the creation of COVID community health committees. We are training the committees on improving infection prevention and control measures in their structures and communities, and on identifying suspect cases and how to alert the authorities and medical staff through COVID-19 kits. A dedicated phone helpline has been set up to serve these communities are being staffed by doctors and intercultural mediators, who provide counselling, and supports community health needs.

On the island of Sicily, we are providing training on IPC measures and on health promotion to civil society working in the most marginalised and vulnerable areas of Palermo.

The Netherlands

Activities closed

In the Netherlands, we provided mental health support to frontline workers. This included a short video with a highly experienced and well-known MSF clinical and health psychologist which had been widely shared in hospitals and nursing homes across the country.

Norway

Activities closed

In Norway, MSF provided strategic advice and IPC support to a hospital close to Oslo which was located in one of the main clusters of cases in the country.

Portugal

Activities closed

MSF teams in Portugal visited nursing homes, and supported authorities and management teams to train staff and establish basic IPC measures. Our work in Portugal came to an end on 22 May.

Russia

By the end of July, we aim to start the distribution of food packages and hygiene kits to MDR/XDR-TB patients who are currently on treatment in Arkhangelsk Region, north Russia. During the distribution, basic health education on precautions against COVID-19 will be conducted by Ministry of Health nurses using informational materials on TB and COVID-19 developed by MSF.

Spain

Activities closed

Elderly and aged care homes have been hit particularly hard in Spain, and we focused many of our activities on aged care homes. Our teams 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 worked with steering committees that manage aged care homes, to help protect the elderly through patient care and infection prevention and control measures. These activities were undertaken in Madrid, the Catalonia region (including Barcelona), the Basque country, Castilla y Leon, in Andalucia, Tarragona, Palencia and Asturias.

MSF had set up two health units to support hospitals around Madrid, with a total capacity of 200 beds. The units received patients with moderate cases, helping decongest the hospitals’ emergency and intensive care services, and were run by hospital staff, while our teams are provided them with logistical and infection prevention and control advice to protect healthcare workers and patients.

MSF also advised hospitals on staff and patient flow to manage infection control in Barcelona and the Catalonia region.

All MSF COVID-19 operations in Spain had ended, closed or been handed over by 22 May.

Switzerland

Activities closed

In Geneva, where MSF's international headquarters are located, our staff had provided logistical and sanitation support to areas where vulnerable people are living – reaching 1,300 families in the canton (administrative division) of Geneva – and provided training for staff and volunteers working with these groups. A logistician also supervised a weekly food distribution organised by different NGOs to 2,500 people.

We exchanged medical expertise with Hôpitaux Universitaires de Genève (HUG), the university teaching hospital in Geneva. MSF medical staff detached to HUG focused on patient care and managing medical teams. In partnership with HUG, our teams are tested people for free based on their symptoms, and we also undertook contact tracing among vulnerable groups of people who have confirmed cases of COVID-19. We also provided recommendations to public and private mortuary services on procedures to avoid any post-mortem transmission of the disease.

In neighbouring canton Vaud, we undertook IPC and health promotion activities with staff working in structures that support vulnerable groups, such as the homeless, in Lausanne, Vevey and Yverdon-les-Bains.

All MSF activities in Switzerland came to an end by 16 May.

Ukraine

MSF is supporting the Ministry of Health to respond to COVID-19 in Donetsk and Zhytomyr regions.

In Mariinka Rayon, Donetsk region, MSF runs one mobile team providing screening and home-based care for people suspected of having COVID-19 and those with mild symptoms in order to prevent health facilities from being overwhelmed.

MSF is also providing psychological support through phone hotlines to residents of Mariinka and Volnovakha Rayons. 

In Zhytomyr region, MSF is focused on strengthening the capacities of health workers by providing training and psychological support. MSF has visited around one third of the facilities designated to treat COVID-19 patients in Zhytomyr region, and has launched telephone hotlines to provide psychological support for both health workers and COVID-19 patients.

Almost 200 health workers across Donetsk and Zhytomyr regions have already received training on the use of protective equipment, infection control, flow of patients as well as waste management.

United Kingdom

Activities closed

Our staff provided nursing and logistics support at the London COVID Care Centre, in partnership with the University College London Hospital Find & Treat team. The project provided rapid testing, accommodation in which to self-isolate, and medical care for homeless people with suspected or confirmed COVID-19; with the decline in new cases, MSF staff ended their support on 8 June.

Middle East and North Africa

Iraq

The COVID-19 pandemic has become a full-scale emergency in Iraq, with the country currently reporting close to 4,000 new cases every day and around 500 deaths per week.

Baghdad, the capital, is the worst-hit city, with more than 28% of the country’s reported cases of COVID-19.  There, MSF is supporting Al Kindi hospital, one of the facilities that are receiving a large number of severe and critical COVID-19 patients. Our teams are helping out in their respiratory care unit (RCU) by providing training for their staff on treatment for COVID-19, administering ventilation and conducting disinfection procedures.

In Mosul, MSF’s post-operative care centre was transformed in the early stage of the pandemic into a COVID-19 facility. MSF works jointly with local health authorities to facilitate the treatment of mild and moderate COVID-19 cases. Over 860 patients have been admitted in the facility since the beginning of the pandemic.  

We have also been helping local health facilities in Erbil and Dohuk by providing technical support, logistic support and training for their staff on infection prevention and control (IPC).

In Laylan camp (Kirkuk governorate), MSF has mobilized a 20-bed isolation and treatment facility in a container structure and continues to implement triage measures for suspected COVID-19 patients. MSF did a distribution of reusable cloth masks to Alwand and Laylan camp residents and raised awareness about prevention measures there.

To promote health awareness around COVID-19, our teams also carried out a digital health awareness campaign targeting the city of Mosul and is starting another campaign in Sinjar area.

Iran

Activities closed

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.

After the Iranian Ministry of Health rescinded the approval for our intervention in Isfahan, MSF was asked to participate in the response dedicated to foreign nationals in the northeast of the country. A team went to assess the possibility of setting up our inflatable medical unit in places located between Mashhad and the Afghan border, but after discussion with local authorities, it appeared there was no location in this area where our medical unit could be sent in support of an existing medical facility, as planned in the original design of our intervention.

In early April, when it became clear that we would not launch activities to respond to the COVID-19 outbreak in Iran, the international team who had arrived to start activities left the country. In mid-June, the inflatable medical unit and the medical supplies which we had sent to Tehran for the response were shipped to Afghanistan. They are being used in Herat, in the COVID-19 treatment hospital which MSF has opened.

Regular MSF activities in Iran are continuing in South Tehran and Mashhad.

Jordan

MSF built a COVID-19 treatment centre in Zaatari camp and we are on standby in case of confirmed cases. Epidemiological surveillance is ongoing.

Lebanon

In the Beqaa Valley, MSF has set up tents outside the Elias Hraoui Governmental Hospital in Zahle, for triage and screening of children. Suspected cases are admitted in a tent and if the tests are positive, patients are transferred to governmental hospitals.  The MSF hospital in Bar Elias is being equipped and prepared to admit and treat COVID-19 patients soon. 

In Siblin (south Lebanon), the training centre of the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) that had been turned into an isolation site in partnership with MSF, is still open to welcome patients who test positive for COVID-19. The centre admits vulnerable people of all nationalities, who cannot home isolate due to overcrowded living settings. 
 
Since May 2020, MSF has deployed a Medical Response Teams (MRT) to support the Ministry of Public Health in its COVID-19 testing strategy across Lebanon. The teams are taking swab samples in fixed points designated by the Ministry of Health, based on contact tracing. The collected samples (so far over 8 000) are then sent for testing. In addition, the MRT conduct assessments as well as providing guidance and support to medical teams and positive patients in isolation sites.

Alongside the MRT, MSF’s project-based Rapid Response Teams (part of the UN-led multi-sectoral emergency scheme) have also been part of the testing campaign in their project areas, notably in Tripoli and the Bekaa Valley.

Libya

MSF activities in Libya continue to be impacted by the restrictions imposed by the COVID-19 response – notably in terms of staff movements - while these same factors increase humanitarian needs in the country. 

We continue to work in six detention centres (in Tripoli, Khoms, Zliten, Zintan, Zuwara and Zawiya), to provide first aid to people disembarked in Libya (in Misrata and Khoms mainly) and primary healthcare and referrals to migrants and refugees in Bani Walid. 

We provided COVID-19-related trainings to medical staff in all project locations, reinforced IPC and prevention measures in detention centres - as far as possible given the inhumane conditions;  held a training for the Medics and Paramedics at Abusalim Autism Centre in Tripoli; donated PPE to health workers in Bani Walid;  and supported the Rapid Response Teams who perform testing and contact tracing in Misrata. 

Palestine

In Gaza, the number of COVID-19 cases has been increasing lately. We are monitoring the spread of COVID-19 and liaising the MoH to discuss possible support for patient care, depending on the developments of the outbreak.

In the West Bank, MSF teams adapted the activities to continue to provide psychological support by phone to the population in need. In Hebron district, the 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 families of detainees. Meanwhile, the team is distributing hygiene kits to affected households and carrying out health promotion and mental health promotion activities. 

Syria

(North-East) Nearly a fifth of the COVID-19 cases we’re seeing in northeast Syria are among health workers. Although testing is still limited, half of them turn out to be positive. This suggests that transmission rates are high and that much more testing is needed. 

As part of the COVID-19 humanitarian taskforce chaired by the local health authorities, MSF has provided training across the region and helped renovate a 48-bed isolation ward in Hassakeh National Hospital, the largest general hospital in the region. We are also working with the Kurdish Red Crescent in supporting the only dedicated COVID-19 hospital in northeast Syria, on the outskirts of Hassakeh city, which also has some intensive care capacity. 

(Al Hol Camp) Across the camp, our teams have identified 1,900 people who will be particularly vulnerable to COVID-19, many of whom have non-communicable diseases, such as diabetes, hypertension, asthma or heart conditions. We are supporting them as much as possible with the medicines they need, as well as with soap and other essential items. Our teams are also providing targeted health awareness messages inside the camp.  

(North-West) Our teams in Idlib National Hospital’s COVID-19 treatment centre were reinforced after the first confirmed cases. We started setting-up an additional isolation centre in the town of Salqin, in case there would be a sharp increase of cases. So far, this has not been the case and this centre remains closed at the moment.  

In Atmeh, we have set up an isolation ward for suspected cases in our burn unit.

In some of the hospitals and health centres that we support or co-manage in different locations, we have also set-up Hygiene Committees, reinforced them with additional staff, and made donations of protective equipment when needed. 

In the camps where we work in north Idlib, we are spreading awareness messages and distributing non-food items and hygiene kits.

Yemen

In Sanaa, we continue to support Al-Kuwait hospital, where we are treating people with severe cases of COVID-19 in the 15-bed intensive care unit, as well as running the large inpatient department. 

In Haydan and Khamer, we have set up COVID-19 treatment centres to care for moderate cases and have begun admitting a small number of patients with symptoms that resemble those of COVID-19.

In Abs Hospital and Al Ghomouri Hospital in Hajja governorate, MSF continues with the screening point at the entrances, as well as referrals for suspected COVID-19 cases. In Hajja City MSF is supporting the referrals from AGH to the Isolation centre Al Rahadi, as well as the triage area of the centre.

We adapted our work to keep our regular programmes running in the General Rural Hospital of Dhi As Sufal district (informally called ‘Kilo’ hospital), set-up an isolation ward for the suspected cases and our teams also do referrals to the MSF-supported Al Sahul COVID19 treatment centre in Ibb city.
 
As part of our commitment to provide the best care for people with COVID-19, we support local health authorities to run the Al-Sahul COVID-19 centre which has been receiving patients since June. The centre has 18 intensive care unit (ICU) beds and 70 inpatient (IPD) beds.

Our teams continue their support by coaching and monitoring the staff in the centre. We provide medication, medical supplies - including personal protective equipment (PPE) - and assist to put in place all infection prevention and control (IPC) measures, and hygiene equipment and materials. We also provide health promotion training sessions to both MoH staff and private carers.
 
Within MSF response to COVID-19 pandemic we have conducted trainings in various districts in Al Hudaydah and have implemented IPC measures in hospitals across Al Hudaydah. Our teams also assisted to set up an isolation unit in Al-Salakhana hospital and supporting the isolation centre with drugs and PPE.

MSF and COVID-19

What is the new coronavirus disease?

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.

How is MSF responding? 

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 most countries where we have programmes, such as in Colombia, Iraq, and Nigeria, we have been opening dedicated wards inside hospitals and health structures to help separate COVID-19 patients from non-COVID-19 patients and to extend the hospitals’ capacity to provide care.

Helping people 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.

To help people protect themselves, MSF teams are running health promotion activities 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.

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. 

Across the world, our 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.

What needs to be done?

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.

Ensuring trust

We know from our experience that trust in the response and 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: 
 

  • prevent patents and monopolies from limiting production and affordable access;
  • guarantee access to repurposed drugs for patients suffering from disease;
  • prioritise the availability of the medical tools for the protection and treatment of frontline healthcare workers; and  
  • improve transparency and coordination, making sure an evidence-based approach is put in place to continuously monitor the risk of the potential supply chain vulnerability on essential medical tools

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We must do everything to prevent and delay further spreading of the virus. We know from our experience that trust in the response and health authorities is an essential component for outbreak control.

Clear, timely and honest communication and guidance is needed. People need to be empowered to protect themselves.

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