Our COVID-19 response focuses on three main priorities:
Across our projects, MSF teams have been improving infection prevention and control measures to protect patients and staff, and prevent further spread of the new coronavirus. It is absolutely crucial to prevent health facilities from amplifying the pandemic or being forced to close their doors.
We started our first activities in our response to the COVID-19 pandemic in January 2020. As the new coronavirus spread, touching virtually every country in the world, MSF adapted or scaled up our ongoing activities and started new activities in many countries over the course of the first six months of 2020.
We committed substantial resources to developing dedicated COVID-19 projects, maintaining essential healthcare in our existing programmes, and accompanying ministries of health in preparing and/or facing the pandemic. This support was often in the form of training in infection prevention and control, health promotion and organisation of healthcare services.
Since the middle of 2020, this training has largely concluded. Most COVID-19-related activities have been integrated in our regular projects, although we are maintaining some COVID-19-focused projects. Over the last six months, our COVID-19-specific activities have been opened (or reopened) and closed as the second wave of infections determines the need to scale up. Where we are doing so is very much dependent on the context: the local epidemiological situation, the local health needs, and our own resources.
It is still difficult to provide a global narrative on our operations, as the pandemic is affecting every country in the world, with different consequences, in different places. Therefore, our approach can also be very different from country to country or even from project to project.
On the ground, around the world, our emergency teams are experts at fighting epidemics. With your support, we will help beat the new coronavirus pandemic.
Activities closed. MSF teams in Ouagadougou, the capital of Burkina Faso, are working in the city’s COVID-19 treatment centre, at the request of the Ministry of Health (MoH). Teams are undertaking the follow-up of outpatients and health promotion activities in the community.
In Bobo-Dioulasso, in the country’s west, a team has been sent for six weeks to support to the local health authorities. We continue to follow 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.
MSF teams had also been responding in Fada and Dafra.
In Burundi, we launched our first dedicated COVID-19 activities in the country, following an increase in cases in July. Our teams are working in Kinyinya district, Ruiygi province, where we are reinforcing preventive activities through health promotion with community members and leaders. We are also providing medical training in health centres and at the district hospital to guarantee the quality of care and support patients with a nutritional programme.
We have restarted activities in Cameroon, where we provide home-based care and follow up of COVID-19 patients, contact tracing at Buea Regional hospital. We are also constructing a new laboratory to improve the capacity for testing.
Activities closed. In Central African Republic, teams worked with people living with HIV in four outpatient treatment centres across Bangui, benefiting 9,000 people, on the practice of shielding.* A similar strategy, which included the distribution of soap and masks, providing food support and awareness raising sessions, was implemented in Paoua and Carnot, and targeted around 4,000 patients and their families.
Also in Bangui, our teams supported the MoH with surveillance activities, including contact tracing and sample collection. We engaged with the communities to explain what COVID-19 is and work together to promote and adapt prevention measures to their daily realities.
MSF built a COVID-19 treatment centre in Bangui, with a capacity of 24 beds, but given the low number of severe cases, the centre did not open; it remains ready to be used.
*Shielding consists of creating ‘green zones’, or safe zones, where individuals more susceptible to COVID-19 are kept protected from any potential source of infection. The areas where they stay can either be inside the household or in separate locations, in the neighbourhood. During the shielding phase, these people should have minimal physical interactions with their relatives and other community members.
In Chad, MSF teams worked in Farcha hospital, in the capital, N’Djamena, where people with severe cases of COVID-19 are being cared for. We provided clinical training to the staff, reinforced lab and testing capacity, and installed an oxygen generator. With the low number of severe cases, our support was no longer needed. Also in N’Djamena, our teams supported laboratory activities at central level to draw up biosecurity procedures.
Elsewhere in N’Djamena, we provided support for surveillance, contact tracing, and home-based care for people with mild forms of the disease. We also undertook health promotion and community engagement, including with marginalised groups who have less access to health information such as nomadic people on the outskirts of the city. We strengthened IPC measures across communities, including having installed handwashing stations.
In Côte d’Ivoire, MSF teams are working on a telemedicine project to help diagnose illnesses that could lead to complications with COVID-19.
Democratic Republic of Congo
In South Kivu province, eastern Democratic Republic of Congo (DRC), we are working at the Clinique Universitaire de Bukavu to provide training, additional staff, and improvement of infection prevention and control measures, including an isolation circuit. We also ensure the availability of tests and treatment at the hospital.
MSF teams work at the Hôpital Provincial de Reference and Kyeshero Hospital in Goma, North Kivu province, where we provide health promotion and IPC technical support.
MSF teams have also responded to the pandemic in the capital, Kinshasa, and in Ituri province.
In Gambella region, Ethiopia, MSF has set up a 20-bed COVID-19 isolation centre and another one with a capacity of 10 beds in two camps for South Sudanese refugees (Kule and Tierkidi). In Gambella town, a team provides support to the COVID-19 triage and temporary isolation centre in Gambella hospital.
Since May, a team in Addis Ababa has been providing mental health support to migrants who have returned mainly from Saudi Arabia, Kuwait and Lebanon, and have been placed in three COVID-19 quarantine centres in the capital. MSF is supporting the MoH’s medical and non-medical staff who work in the quarantine centres by training them on migrants’ mental health needs.
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.
In Eswatini, we have provided treatment to critical patients sick with COVID-19 in a home-based care approach, where patients with comorbidities are visited at home to ensure continuity of care. With health facilities being overwhelmed with high numbers of sick patients during the current third wave, there has been an extension of the COVID-19 ward at the Nhlangano health centre, which has now been fully equipped with oxygen concentrators.
In Guinea, we support the Ministry of Health to provide care to patients with COVID-19 at the Gbessia Epidemic Treatment centre, on the outskirts of the capital Conakry, with a specific focus on people coinfected with HIV/TB.
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.
In the city of Homa Bay, in Kenya’s southwest, we follow up COVID-19 patients after their discharge from Homa Bay county hospital. At the hospital we also continue to test suspect patients in the outpatient and adult inpatient wards.
In Dadaab, we continue to maintain a COVID-19 isolation ward.
MSF teams in Kenya have also responded to COVID-19 in Embu, Nairobi, Kiambu, Dadaab and Mombasa counties.
In Lesotho, following a recent acute shortage of nursing staff for COVID-19 wards, we are supporting Jhpiego, an international partner, to implement the ward attendant programme that we first implemented in the country during the second wave.
Activities closed. In Liberia, our teams are undertaking health promotion activities on prevention measures in and around Monrovia, the capital.
In Malawi, we have reopened our field hospital of 60 beds in Blantyre, following the start of the third wave in June. We provide medical staff, staff trained in infection prevention and control measures, manage patient flow, treat severely ill patients and provide oxygen supply. At the Blantyre Youth Centre, we provide logistics support for vaccination efforts.
At the South Yunzu health centre, we conduct COVID-19 testing and provide logistic and medical supplies.
MSF has also responded in Neno, Dedza and Nsanje districts in Malawi.
In the capital of Mali, Bamako, we provide human, financial and technical support to the MoH’s inpatient COVID-19 unit in Hôpital du Mali.
We run outpatient activities in three communes of Bamako, such as improving dedicated COVID-19 patient flow, testing and triage areas in health centres, medical follow up of COVID-19 positive patients at home, health promotion sessions and targeted distribution of prevention kits.
Activities closed. In Mozambique, we have scaled up our national response following an increase in cases. In Maputo, we set up two tents able to accommodate 16 people with moderate or severe symptoms in Mavalane Hospital. We installed GeneXpert machines to improve testing and diagnosis and provided technical support for the organisation of the new COVID-19 treatment centre and IPC training to local front-line health workers.
In Montepuez, we continue to support the local hospital, setting up pre-triage points there and in three health centres. We’re also providing training for health staff to open a COVID-19 treatment centre.
We assist the MoH in Beira with triage in two health facilities and at Central Hospital. We are also supporting the isolation centre with 20 beds and are providing IPC and treatment training to MoH front-line health workers. The capacity of health staff was also scaled up with one doctor, five nurses, six health promoters and 14 cleaners.
MSF teams in Mozambique had also responded to COVID-19 in Pemba.
In Niger, our teams support with logistics and human resources in Lamordé hospital in Niamey, where people with moderate cases are treated.
We are also supporting health centres in Magaria, Dungass and Tillaberi with water and sanitation activities, distributing masks, organising the triage of patients, and helping the investigation and response team.
MSF teams in Niger also worked on the COVID-19 response in Zinder, Maradi and Madarounfa.
In Ebonyi state, southeastern Nigeria, we are supporting the MoH and Nigerian disease control centre with testing, in the state’s first COVID-19 testing centre.
Our teams have set-up isolation units in Gwoza and Pulka where suspected and confirmed cases of COVID-19 are treated. The capacity of the unit has been reduced to five beds in each facility. In Ngala, we have increased epidemiological surveillance and are implementing IPC measures and running health promotion activities.
Across Nigeria, we have responded in Ngala, Sokoto, Maiduguri, Benue, and Zamfara.
Activities closed. In Dakar, the capital of Senegal, we supported the treatment of people with moderate and severe cases of COVID-19 in the Hospital Dalal Jamm. Here we also provided training as well as support for water and sanitation activities, and simplified triage protocols.
We provided support in Guediawaye district, in Dakar’s northern suburbs. Our teams supported the MoH on community engagement, case surveillance, testing mechanisms and improving IPC measures and continuity of care.
MSF teams support the ministry of health in Sierra Leone with treatment, surveillance, IPC measures and testing strategies. We are part of an oxygen technical working group at the national Emergency Operations Centre, as well as district level operations centres in Kenema, Tonkolili and Bombali districts.
In Tonkolili district, our team is supporting the district health authorities with cold chain support and logistics for COVID-19 vaccinations.
In Freetown, the capital, we have started rehabilitation work in Connaught Hospital to increase treatment capacity, as well as installing an oxygen production plant to support the treatment of moderate and severe COVID-19 patients.
In Somalia, a specialised biomedical engineer is assisting all Somaliland MoH COVID-19 centres with the repair and maintenance of specialised biomed equipment, such as oxygen concentrators. The engineer also provides training on how to service, maintain and operate them.
Our teams in the country have also worked in Hargeisa, Galcayo, Las Anod and Baidoa.
In South Africa, MSF is supporting public hospitals in KwaZulu-Natal and Eastern Cape provinces with the placement of extra doctors and nurses, in Ngwelezane hospital and Livingstone hospital, respectively.
In Eshowe in KwaZulu-Natal, where MSF has a long-term HIV/TB project, we have a community-based activity that aims to identify individuals at high risk of severe COVID-19. People enrolled in the programme self-monitor using a pulse oximeter, reporting daily to MSF. We also launched a task shifting intervention in Ngwelezane hospital in KwaZulu-Natal and in Livingstone hospital in Eastern Cape, recruiting and training enrolled nurse aides to cover basic care tasks, taking pressure off nurses and ensuring that the lifesaving basics get done.
In Khayelitsha in the Western Cape, a team of MSF health promoters supports a mobile vaccination site in collaboration with the City of Cape Town Health Department.
In addition to previous projects in KwaZulu-Natal and Western Cape provinces, MSF teams have also worked in Port Elizabeth, Johannesburg, and in Gauteng and North West provinces.
In Juba, the capital city of South Sudan, MSF teams are providing technical support to the MoH, with a laboratory supervisor based at the National Public Health Laboratory.
Outside of Juba, four MSF facilities in Agok, Bentiu, Lankien and Malakal run COVID-19 testing.
In addition, in all projects across the country we continue to isolate and treat patients with suspected or confirmed COVID-19.
In places where MSF is the only health partner, such as in Ulang in Upper Nile State, we are supporting the MoH in the rollout of vaccination activities.
MSF teams previously responded to the coronavirus in Yei, Old Fangak, and in Doro refugee camp in Maban.
Just over the Nile River from Khartoum, Sudan’s capital, MSF is supporting the Ministry of Health with screening, testing, triage and IPC support for COVID-19 in Omdurman Teaching hospital. We rehabilitated the hospital’s laboratory and provided furniture.
Our teams also responded in East Darfur and South Kordofan states.
In Tanzania, our health promotion team in Nduta refugee camp, is undertaking health promotion activities, raising awareness among the community on hygiene and best health practices. MSF has built four triage/isolation areas at each of our health clinics at Nduta refugee camp, and a main isolation centre at our hospital, with a 100-bed capacity, where people suspected of having COVID-19 are referred.
Following an explosion of cases, we started working in Tunisia in July 2021, to support the MoH with the opening of a field hospital in Beja Governorate, in the country’s west. Our medical staff support the hospital with patient treatment, and we improve oxygen capacity through training on maintenance and quality.
We’re also helping to transfer patients from the regional hospital and other health facilities in the area to this new facility, to reduce the burden on those structures. We also provide training, so staff members are prepared if a new wave occurs. Additionally, we’ve started supporting the MoH’s COVID-19 vaccination campaign in Beja and in Manouba Governorate (close to the capital city, Tunis).
In Uganda, MSF has been supporting the intensive care unit at the 140-bed Entebbe hospital, managing the triage and patient flow, ensuring oxygen supplies, while training staff in infection and prevention control measures.
In the Arua District, we also run a 35-bed COVID-19 treatment unit, which conducts testing and treatment for the Arua Regional Referral hospital.
In the Kasese district, MSF has set up a 24-hour ambulance service for the transfer of critically ill patients between Kasese and the Regional Referral Hospital in Fort Portal.
The number of new COVID-19 cases continues to decrease in Zimbabwe, while few patients are hospitalised. As a result, we have scaled down our intervention at Beitbridge’s Screening and Referral Unit, our isolation ward and quarantine centre, but continue to provide support to Beitbridge hospital.
Activities Closed. In Argentina, 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. Activities in Argentina ended in July.
In Brazil, MSF is working in north Amazonas, in Atalaia do Norte and Benjamin Constant municipalities, where we prepare local health staff in case a new wave of cases strikes the area. Our teams are working on patient flow, rapid testing, mental health and health promotion, with a focus on prevention training in clinics and hospitals.
MSF launched a COVID-19 intervention in Bolivia in March 2021. Our activities consist of infection prevention and control measures in health structures, mental health services (for patients and medical staff), and capacity building for frontline workers.
We have also developed health promotion activities in several districts of the country, sharing information with the communities on health practices and preventive measures. Since the beginning of our intervention in the country, the team has organised more than 800 awareness sessions on COVID-19.
In Canada, we used our expertise in emergency outbreak response to provide valuable guidance to medical organisations, government agencies and remote Indigenous communities on how to prevent and manage COVID-19 outbreaks. Teams created and shared two e-briefings related to COVID-19; one on infection prevention and control (IPC) and another on adapting and developing medical facilities.
MSF facilitated experienced field staff in Canada to join 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 residents’ overall safety. After three months of activities, all MSF COVID-19 projects in Canada had closed by 15 July.
Activities closed. Our teams supported patients with respiratory symptoms at Tibú hospital, in Colombia’s north. In Buenaventura, we adapted and expanded our psychological care Line #335 for the early identification of potential patients with symptoms of COVID-19.
In Arauca, we provided technical advice to hospitals and mental health support to medical staff. MSF teams also engaged people on health promotion and IPC activities in towns, villages and neighbourhoods throughout the northeast, through different community strategies and the media.
MSF worked closely with health authorities in Norte de Santander and Tumaco to support the local response. We participated in outpatient triage and supporting the area for patients with respiratory symptoms at the Tibú hospital. In Tumaco, we carried out medical and mental health activities in the two public hospitals in the city. In each of these places, we also focused a large part of our efforts on promotion and prevention activities in towns, villages and neighbourhoods through different community strategies and the media.
We deployed a small technical team, the Flying COVID Team, which supported local hospitals in Atlantico, one of the regions most affected by COVID-19. The team’s work, which was supporting Erasmo Meoz Hospital in Cúcuta, 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.
Activities closed. In Ecuador’s capital, Quito, MSF supported health centres, in the wake of a launch of a testing campaign, in the follow-up on positive tests. We also provided training and support for IPC, health promotion and mental health to mobile teams and to health posts.
In the city’s Temporary Attention Centre, we provided palliative care and trained staff in this field; the initiative was a pioneering project for the country.
MSF teams also provided on-site support and training on IPC, mental health and health promotion in nursing homes and shelters for homeless people across the country.
In the Guayaquil region, which was the first area in Ecuador to be hit hard by COVID-19, a small team assisted health centres and nursing/care homes with infection prevention and control measures. An MSF team worked in the coastal Esmeraldas Province in the northwest. All projects in Ecuador had been handed over or ended by October.
Activities closed. In Port-au-Prince, Haiti’s capital, MSF reorganised our Emergency Centre in the Martissant neighbourhood of Port-au-Prince to isolate and refer COVID-19 suspect cases. In city’s Drouillard area, we had converted our burns hospital to a field hospital to treat COVID-19 patients; we screened over 330 people and treated nearly 200 for COVID-19 before the centre closed at the beginning of August, and reconverted back to our burns hospital. Our teams also visited the Chancrelles hospital in Port-au-Prince’s Cité Soleil district, and supported them in implementing IPC measures, including triage and isolation.
MSF teams carried out health promotion activities in communities all over the country, via mass media such as radio and social networks but also through training health workers and community leaders, and in health institutions.
In Haiti’s south, MSF supported several public health facilities across Port-à-Piment and Port Salut for the set-up of triage systems, isolation beds, referral systems and training of medical staff.
In Les Cayes, also in the country’s south, our team set up a triage and an isolation unit in the departmental referral hospital. Medical staff were trained on early detection of suspected cases and IPC standards. Support staff, such as hygienists and health officers, were trained in IPC standards and in the maintenance of the water and sanitation infrastructure installed by MSF. Our activities in Haiti ended in August.
In Tegucigalpa, the capital of Honduras, we support five health centres with a mobile team, including a nurse, psychologist and health promoters, who provide psychosocial support to the community and in two hospitals with COVID-19 units. Our teams also reinforce health promotion activities in the hospitals.
In Mexico, MSF teams have incorporated COVID-19 prevention measures and testing into our regular activities in the shelters we work in across the migration route.
MSF teams have also responded to the pandemic in Oaxaca, Chiapas, Tabasco, Veracruz, Nuevo Laredo, Nuevo Léon, Coahuila, Tamaulipas, and Guerrero states.
Activities closed. MSF developed the PAEC-LAT (‘Proyecto de Asesoramiento Estratégico ante el COVID-19 en Latinoamérica’, or Strategic Advisory Project for COVID-19 in Latin America) project, as a way to overcome the restrictions for face-to-face work and staff movements. We 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 took 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.
Between May and November, PAEC-LAT 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.
In Peru, our activities have shifted to setting up vaccination sites in Cusco City and in Arequipa to scale-up vaccination efforts, as the Delta variant is circulating widely and rapidly. We are also supporting the Ministry of Health’s vaccination campaigns by providing data-entry staff materials for reporting. These activities will come to an end in early/mid-October.
Activities closed. In the United States, MSF worked in key sites around the country with local authorities and partner organisations serving vulnerable communities who often lack access to healthcare. Our teams also helped residents and staff at long-term healthcare facilities reduce and stop the spread of the coronavirus. The last of our activities in the US ended on 15 October.
Our response in the US started in New York in March. During our activities, we donated over 160 handwashing stations to key locations, including soup kitchens and supportive housing facilities in the city. We also distributed 1,000 mobile phones to vulnerable New Yorkers who lack the essential technology needed to contact emergency and support services, including telemedicine providers. MSF teams opened a shower trailer in Manhattan to give people who are homeless or housing insecure a place to bathe while public restrooms and facilities are closed due to COVID-19. We also supported New York City authorities with webinar training on IPC practices.
MSF teams worked in nursing homes across the country, including in Michigan and in Texas. In Michigan, in the country’s northeast, our team worked in nursing homes which needed assistance, including general guidance to improve infection prevention and control practices; technical on-site support and training; and mental health workshops to address the high level of stress and grief that the frontline staff face every day. Our activities in Michigan came to a close at the end of July. Starting in August, two MSF teams, comprised of nurses and a wellness specialist, worked in nursing homes across Texas. Each team conducted in-person IPC trainings and created tailored IPC action plans for both medical and non-medical staff. They also provided technical support and wellness sessions to staff and residents. Our support to facilities in Texas ended in mid-October.
On the island of Puerto Rico, MSF teams worked across the island, in and around San Juan, or travelled to remote areas in the east, west, south and the third-largest island, Vieques. Teams distributed essential supplies, such as masks, face shields and hygiene kits to healthcare facilities and vulnerable groups of people on the island. We also provided training on IPC measures. We collaborated with local partners on the island and provided 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 monitored the symptoms of COVID-19 patients or people who tested positive, but were asymptomatic.
In Immokalee, Florida, where approximately 15,000-20,0000 migrant farmworkers have been working during the pandemic with minimal access to healthcare and testing, we worked closely with Coalition of Immokalee Workers (CIW), the Department of Health and local organisations and healthcare providers. MSF ran a public health education campaign and mobile ‘virtual’ clinics, which provided COVID-19 testing and remote medical consultations for COVID-19 and other health issues. The clinics have been handed over to the Department of Health who will continue this work.
In southwestern USA, especially in the states of New Mexico and Arizona, an MSF team worked with local officials, healthcare workers from the Navajo Nation and Pueblo peoples, and organisations that directly address needs related to COVID-19 in Native American communities. We provided infection prevention and control technical guidance to healthcare facilities and communities, including to prisons and communal living facilities, such as nursing homes.
COVID-19 cases remain high in Venezuela, and vaccination coverage remains low. MSF’s response plan includes assisting with medical supplies and staff recruitment, as well as strengthening triage, diagnosis, treatment, infection prevention and control, and secondary care services in Amazonas, Anzoátegui, Bolívar, Sucre, Táchira and Caracas.
In Vargas hospital in Caracas we are supporting a unit of 24 beds (including four for ICU) and 36 beds in Hospital Lidice in the west of the city, where we are seeing an increase in patients. We already scaled up our intervention in Bolivar state, in response to the outbreak of COVID-19 in the state.
In Herat, in northwestern Afghanistan, we are undertaking testing and triage activities in Herat regional hospital.
In Lashkar Gah, Helmand province, the team is referring people with suspected COVID-19 to the province’s main COVID-19 hospital, Malika Suraya hospital. We are also treating COVID-19 patients with four identified risk factors: those with tuberculosis, surgical patients, children and pregnant women.
In Kandahar, our teams treat DR-TB patients infected with COVID-19 in the MSF DR-TB centre.
MSF teams have also responded to the pandemic in a number of areas across Afghanistan, including in Khost, and Kabul.
During July and August, an alarming surge in infections and deaths occurred in Bangladesh. In response, MSF teams set up isolation and treatment wards in eight medical facilities in the Cox’s Bazar area for Rohingya refugees and the Bangladeshi host community. We also prepared two standalone intensive care centres, opening one with 16 beds ready to admit patients with moderate or severe symptoms referred from other facilities.
We provide testing at all of our hospitals and basic healthcare centres, including at a specialised clinic. As of June, around 12,000 COVID-19 samples have been collected and more than 600 patients have received COVID-19 care.
In Kamrangirchar, a crowded slum area in the capital, Dhaka, we support the government hospital with logistics and train staff in infection prevention and control measures.
Activities closed. MSF provided staff in health facilities in three provinces in Cambodia – Pailin, Bantey Meanchey and Oddar Meanchey – with training and technical support, which included implementing triage infrastructure in six hospitals bordering Thailand. More than 300 staff members of the Ministry of Health were trained on the new guidelines and protocols concerning COVID-19, among them ambulance drivers, cleaners, laboratory technicians, doctors and nurses, on IPC measures and the treatment of people with suspected or confirmed cases of COVID-19. MSF also contributed to the development on national treatment protocols.
Activities closed. One of the first activities in MSF’s global COVID-19 response was in Hong Kong, when at the end of January, we started providing face-to-face, and later virtual, health promotion sessions with vulnerable people less likely to be able to access information, such as refugees, and those on the front line, such as street cleaners.
Given the prolonged crisis and exposure to uncertainty in the city-state, which can cause stress and anxiety, our teams focused on managing people’s mental health and conducted workshops on how to manage stress and anxiety for vulnerable people. We also created a website for the general public which offers tips and tools to cope with stress and worry; https://howareyou.msf.hk/en/.
Our emergency team had been working with Impact HK, a local NGO, that has been supporting the homeless for some years. Our teams visited homeless people twice a week in various streets of Hong Kong, and distributed food, drinking water and hygiene kits; our caseworkers also followed up on individuals’ needs. Between June and when the project was handed over in mid-September, the team conducted 51 free medical consultations and arranged temporary shelter for 35 vulnerable individuals.
Our activities in Hong Kong had ended by November.
Activities closed. After activities in India were wound down in February, MSF teams are responding to COVID-19 once again following a massive surge in new cases in Mumbai, Maharashtra
MSF restarts emergency response amid a surging second wave of COVID-19 in Mumbai in Maharashtra state. Our teams are actively identifying cases, conducting screening and appropriate triage for infection prevention and control for TB/DR-TB patients at Shatabdi hospital and the MSF independent clinic. Patients coinfected with COVID-19 and tuberculosis are being referred for inpatient management and treatment to Sewri hospital. MSF is further providing prevention kits, counseling and phone follow-up to high risk patients, including TB/DR-TB, Diabetes melitus patients and the elderly. To ensure continuity of care, MSF continues to support four health centers in MEW.
As of Saturday, April 17, MSF started shielding, digital health promotion, water and sanitation activities in the M-East Ward (MEW) of Mumbai. Activities will be further extended to five more health facilities.
MSF is supporting two units within a Jumbo hospital in Mumbai. The divisions include two sets of tents with about 1000 intensive care unit bed capacity in each. Additional medical doctors and nurses have been recruited to strengthen the response.
MSF continues to provide medical and technical support with oxygen supplies and therapy.
Our teams in Patna, Bihar state, eastern India, provided health promotion, mental health, and psychological first aid activities to healthcare workers in government hospitals across the state. Community health promotion and education activities are also taking place in the area.
In Mumbai, teams provided training and are screening in TB projects. We also undertook a digital health promotion campaign through Facebook in the city’s M-East Ward, with messages focusing on COVID-19 prevention and the reduction of stigma within the community.
Activities closed. In Indonesia, MSF teams are conducting workshops and training of trainers for doctors and community health workers in Jakarta, who treat suspected COVID-19 cases and those observing home-isolation. Training sessions are on topics including IPC measures, contact tracing and health promotion.
MSF provides COVID-19 mental health and psychosocial support activities in Banten province and in Jakarta.
MSF teams in Indonesia had also responded to the pandemic in the West Java province.
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.
Activities closed. In Kyrgyzstan, we are working closely with the MoH in Chuy and Batken oblasts (provinces), where teams provide home-based care for moderate and mild COVID-19 patients to prevent hospitals from being overwhelmed.
Our teams are also supporting health centres in Kadamjay raion (district) to reinforce COVID-19 preparedness measures, while offering technical advice, providing logistics assistance, supporting health promotion initiatives, and assisting in epidemiological surveillance through data collection.
In Penang, northwest Malaysia, we are providing health education in different languages for vulnerable people, including Rohingya and Burmese, and translations in hospitals. We have started a COVID-19 health promotion campaign for Rohingya refugees via an online Rohingya news network.
Activities closed. In Nepal, MSF staff operated a 24/7 mental health telephone hotline in Nepali, an extension of the same service our teams operated in India.
In Pakistan, MSF provides cold chain management and maintenance to support the local health department’s COVID-19 vaccination campaign in Kemari district, Karachi.
In Balochistan province, we also support the COVID-19 unit of the Department of Health’s (DoH) centralised Fatima Jinnah hospitals with nurses and a lab technician in Quetta.
MSF provides sample transfers from the districts of Dera Murad Jamali, Jaffarabad and Chaman, to the provincial laboratory in Quetta. We support the DoH with information, educational and communication material for COVID-19 awareness and prevention, which is being disseminated in government facilities.
Since early March, the number of confirmed infections in Papua New Guinea has increased drastically.
We support the Rita Flynn hospital in the capital, Port Morseby, with one lab technician and cartridges to analyse samples of PCR tests for coronavirus infections. We also carry out patient education and counselling sessions, as a lot of stigma and misinformation is reported from the communities.
Activities closed. In Manila, capital of the Philippines, the MSF team supported our partner organisation Likhaan with health promotion activities. Teams also supported with contact tracing and COVID-19 prevention activities at the community level, plus helped to implement IPC measures in the health facilities that were caring for COVID-19 patients.
In Marawi, a “mobile information drive” to passes health promotion messages to vulnerable people and the team trained the local health teams in 60 of the 72 communities in charge of COVID-19 surveillance and contact tracing.
In Manila between early July and mid-August, MSF teams distributed ‘quarantine kits’ – including hygiene materials – to 726 COVID-19 patients and contacts.
In June, we started supporting the COVID-19 ward and the hospital laboratory at San Lazaro hospital, in Manila, with human resources, PPE, biomed equipment and pharmacy. Following a decrease in the number of cases, we ended our activities at the hospital at the end of October.
Activities closed. In Tajikistan, we have developed a tuberculosis+COVID health education leaflet and shared the document with the health ministry to ensure accurate information is disseminated. In Dushanbe, we are working with TB patients, their families and their communities to explain how to prevent the transmission and infection of COVID-19.
At the Republican Centre TB dispensary, we are developing improved triage protocols and patient flow, and offering health promotion for people awaiting their consultation.
In Uzbekistan, we support the implementation of IPC measures across the primary healthcare system. Additionally, we coordinate with the MoH for the treatment of patients co-infected with COVID-19 and tuberculosis (TB).
In Belgium, an outreach team provides support to people who are staying in unauthorised places (e.g. squats) in Brussels, offering screening and medical follow-up in collaboration with two other NGOs. This team also provides health promotion, infection prevention and control, contact tracing and psychological support.
Activities closed. In November, MSF started a small project in nursing homes in the Czech Republic, in partnership with the Ministry of Labour and Social Affairs. Even though the staff of these facilities was not obliged to have a formal medical education, they were on the front line of the COVID-19 response, treating one of the most vulnerable groups. In the first-ever MSF intervention in the country, two small mobile teams provided assessments and training on IPC measures in nursing homes.
Working in facilities in the regions of Plzensky, South Moravian, Zlinsky and Central Bohemian, all located outside the country’s capital, Prague, the teams visited almost 40 nursing homes in the first three weeks. Our teams provided training either on-site or through a Czech version of a website developed by MSF’s Barcelona section for their similar activities earlier this year – https://msfcovid19.org/. We also received requests to provide support from other regions as well.
In France, since early June, MSF mobile teams have been providing COVID-19 vaccinations for people living on the streets or in precarious settings in Paris, and in the neighbouring departements of Seine-Saint Denis, Val-de-Marne and Yvelines. We also provide vaccinations at a dedicated site at Porte de la Villette in Paris. Our Paris-based mobile clinics provide COVID-19 antigen tests and carry out basic healthcare consultations.
In France, MSF teams have worked extensively in previous projects – especially in nursing homes – across Paris and the Île-de-France region, plus in Marseille, Reims, the regions of Provence-Alpes-Cote d’Azur and Occitanie, and in the département of Haute-Savoie, in the country’s east.
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; this support had finished by the end of June.
Until early May, 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.
In Athens, Greece, 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.
MSF teams have also responded to the pandemic on the islands of Samos and Lesbos.
In Rome, Italy, we are working in collaboration with the Ministry of Health to reach undocumented people and facilitate their access to vaccination programmes.
We previously responded to the pandemic in several areas in Italy, including on the islands of Lampedusa and Sicily.
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.
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.
In Portugal, our teams are providing health promotion in five areas of Lisbon and Vale do Tejo, which have a majority of people of Roma and African descent. We supplement the support of these groups of people on an ad hoc basis, through training and donations of hygiene materials, including soap and masks.
In Russia, MSF is distributing information leaflets on TB and COVID-19, which we developed for multidrug-resistant and extensively drug-resistant TB patients in Arkhangelsk region, in the country’s north. We are distributing food and hygiene packages during the patient visits.
In addition, we partner with two community-based NGOs in Moscow and St Petersburg to support vulnerable people, where PPE (masks, gloves and hydroalcoholic gel) have been distributed with information on COVID-19, TB and HIV.
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.
Activities closed. In Switzerland, MSF is working in collaboration with the health authorities and charities in the cantons (states) of Geneva and Vaud and in neighbouring Haute-Savoie, France, where we are caring for vulnerable people and the elderly in nursing homes.
MSF teams in Switzerland responded to the pandemic in a number of different projects across cantons Geneva, Vaud and Jura.
In Ukraine, MSF teams are raising awareness about COVID-19 vaccination among communities and monitoring the situation as the country prepares for a third wave.
Activities closed. In the United Kingdom, our staff are 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.
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.
In June 2021, a third wave of COVID-19 outbreak was declared in Iraq. With a peak of confirmed infections reaching over 13,000 a day on 28 July – the highest recorded daily infections in the country since the beginning of the pandemic – and a daily death toll exceeding 50 deaths per day during the last week of July and first week of August, the country’s already-weakened health system has been hit harder than in previous waves.
MSF teams are continuing to work in hard-hit Baghdad, where we provide intensive care to severely and critically ill COVID-19 patients. We run the COVID-19 intensive care unit in Al-Kindi hospital, which is constantly full, with new COVID-19 patients often having to wait in the emergency room for a bed to become free.
In Sinjar, in Nineveh governorate, we provide care to people in a seven-bed unit of Sinuni General Hospital dedicated to observing and stabilising suspected COVID-19 patients.
Elsewhere in Iraq, our teams have also responded in Mosul, Erbil, Dohuk and in Laylan camp.
Activities closed. MSF, in collaboration with the MoH of health in Jordan, and other organisations, has opened a dedicated 30-bed COVID-19 treatment centre in Zaatari refugee camp. We treat confirmed and suspect COVID-19 patients in the treatment centre; our care includes providing psychosocial support. In a dedicated ‘transition area’ of the camp, MSF teams also carry out daily screenings for asymptomatic COVID-19 patients (confirmed cases and/or people who were close contacts of cases), transferring patients in need of medical attention to our COVID- 19 treatment centre.
We had also partly converted our reconstructive surgery hospital in Amman to a 40-bed dedicated COVID-19 treatment centre; the treatment centre has now closed and reconverted back to surgical activities.
Across Lebanon, MSF’s Medical Response Teams (MRT) support the Ministry of Public Health in its COVID-19 testing strategy – taking PCR samples based on the contact-tracing scheme of the authorities. Our Rapid Response Teams have also been part of the testing campaign, notably in Tripoli and in the Bekaa Valley. The MRT also supports home isolation assessments and provides follow up for confirmed COVID-19 patients in home isolation.
We also support the Ministry of Public Health on the COVID-19 vaccination roll out, where we are currently vaccinating people in a COVID-19 vaccination centre in Bar Elias.
In Lebanon, MSF teams have worked in a number of neighbourhoods across Beirut, plus in Hermel, Saida, Zahle, and Tripoli, among other places.
In Libya, we continue to support the Ministry of Health in one COVID-19 testing site in Tripoli, as well as providing COVID-19-related training to medical and healthcare staff. We also continue to reinforce IPC measures in detention centres (in Tripoli, Zliten, Zintan) – as much as possible given the inhumane conditions there.
To help combat COVID-19 misinformation in Palestine, MSF has been running a Facebook campaign, where we share accurate COVID-19 health messages across Gaza.
In the West Bank, we operate a hotline offering remote counselling to medical staff and other first responders affected by the COVID-19 pandemic. We carry out COVID-19 health promotion activities to affected communities.
In Nablus, we support a Palestinian Red Crescent Society hospital with medical staff, and medical and logistic supplies. In Hebron, we work in Dura hospital on infection prevention and control measures, triage, support the intensive care unit, and assist with water and sanitation services.
In northwest Syria, MSF continues to provide care for patients with moderate and severe COVID-19 in Idlib National Hospital’s 30-bed COVID-19 treatment centre. We also run a 30-bed COVID-19 isolation unit in the vicinity of one of our co-managed hospitals in Idlib governorate, where rapid diagnostic testing is also conducted. In the camps where we work in northwest Syria, our teams conduct rapid diagnostic testing, spread awareness messages about COVID-19 and the vaccines, and distribute hygiene kits to displaced families.
In the Afrin area, we support a 34-bed community COVID-19 treatment centre and a mobile surveillance clinic run by a local organisation; we also run a respiratory clinic within a basic healthcare centre run by a local partner. In Al-Bab, MSF is in charge of another 30-bed treatment centre. In all these health facilities, we treat patients with mild, moderate and severe COVID-19 symptoms and provide oxygen support to the patients who need it.
In Syria’s northeast, in Al-Hol detention camp, both the number of cases and proportion of people tested who return a positive result have risen since the second half of August. We are concerned that this could potentially signal the beginning of another wave of COVID-19. In the camp, we offer home-based care for people with confirmed or suspected COVID-19, who are mildly or moderately ill. This allows people to be treated and followed up while isolating in their tent.
MSF teams in Syria have also responded to the pandemic in Raqqa and Hassakeh, in the northeast.
In response to the current COVID-19 outbreak in Yemen, we support the 67-bed COVID-19 treatment centre at Al-Kuwait hospital and the 40-bed COVID-19 centre in Al-Jumhouri hospital, both in Sana’a, by providing oxygen therapy, other essential care and IPC measures. These two centres continue to receive patients on a daily basis; most cases come from far away, including other governorates like Hajjah and Al-Baydaa.
In Al-Sahul hospital in Ibb governorate, our teams support local health authorities at the COVID-19 treatment centre. We provide treatment, nursing care, support in provision of medications, health promotion, training on personal protection equipment use, and infection prevention and control measures in the hospital, which cares for both admitted patients and those in intensive care.
In Hajjah Governorate, we work in Abs hospital, where a team undertakes screening and refers people with suspected COVID-19 to treatment centres.
In Aden, MSF is running Al-Sadaqa COVID-19 treatment centre. It remains the only functional facility to treat COVID-19 patients in Aden, with a bed capacity of 21 admitted patients and 9 in intensive care.
In Khamer (Amran governorate), our COVID-19 treatment unit, in which we treat patients with respiratory infections and suspected moderate cases of COVID-19, is still regularly receiving patients.
In Haydan (Saada Governate), we continue to treat people with moderate cases of COVID-19.
MSF teams have also worked in Abyan, Hodeidah, Lahj, and Taiz governorates.
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.
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:
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.