A new coronavirus was first reported in Wuhan, China, on December 31, 2019. This new virus presents particular dangers: there is no known pre-immunity, no vaccine, and no specific treatment. The virus is contagious, and everyone is presumed to be susceptible. Doctors Without Borders/Médecins Sans Frontières (MSF) teams are working in projects around the world to fight the spread of coronavirus, and to sustain other lifesaving medical aid for communities who are further threatened by this pandemic.
Coronaviruses are a large family of viruses, most of which are harmless for humans. Four types are known to cause colds, and two other types can cause severe lung infections: Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The novel coronavirus is now known as SARS-CoV-2, because of its similarities to the virus that causes SARS.
This new coronavirus 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, for instance by coughing.
On February 11, the World Health Organization named the disease caused by the new coronavirus: COVID-19. Both the virus and the disease were unknown before the outbreak began in Wuhan. The overwhelming majority of cases were initially concentrated in China, however the disease has now spread worldwide. On March 11, the WHO declared the COVID-19 outbreak a pandemic. As of August 3, there were more than 17,965,128 cases of the coronavirus in 213 countries, territories, or areas, and 689,370 people have lost their lives. There are more cases in the United States (4,749,138) than in any other country.
Our understanding of this new coronavirus and COVID-19 is still evolving. The virus can spread from person to person, including by people who appear to have no symptoms. This makes it much harder to get a good picture of the way it’s spreading.
The WHO notes that coronavirus can be transmitted through small droplets from the nose or mouth which are spread when an infected person coughs or exhales. People can catch COVID-19 by touching objects or surfaces contaminated with the virus, and then touching their eyes, nose, or mouth. People can also be infected if they breathe in droplets from a person with coronavirus who coughs out or exhales droplets. The WHO recommends staying more than three feet away from a person who is sick.
The latest estimates are that 80 percent of the people who get infected with the new coronavirus will experience a mild or moderate form of disease. Roughly 15 percent will develop a severe form of the disease requiring hospitalization. Some 5 percent will become critically ill. Sophisticated health care systems may be able to cure some critically ill patients, but the danger is that even the most advanced systems may be overwhelmed by the large numbers of people who will need to be hospitalized.
The high level of supportive and intensive care required to treat patients with COVID-19 places real challenges to even the most advanced health care systems. MSF is very concerned about the potential consequences in countries with weak or fragile health care systems.
COVID-19 is more dangerous for elderly people or people suffering from other infections or ailments. Children so far seem to be less affected by the disease. The mortality rates vary significantly from place to place.
Public health measures such as isolation, quarantine, and social distancing are generally put in place to limit community transmission, reduce the number of new cases and severely ill patients, protect the most vulnerable people, and manage health resources.
It’s important to protect yourself and protect others too. As with other coronaviruses, droplet infection seems to be the main mode of transmission. The virus enters the human body through the mouth or nose. This can happen by breathing in infected droplets, or by touching with your hands a surface on which droplets have landed, and then touching your eyes, nose, or mouth later.
Simple infection control measures such as good handwashing and proper cough and sneeze etiquette are effective and important for prevention.
Hand hygiene is paramount, so wash your hands often with soap and water. Use enough soap, and make sure all parts of both your hands are washed. Spend at least 20 seconds washing your hands. If there is no visible dirt on your hands, an alcohol-based gel is also a good option.
Stay home when you are sick, and avoid contact with other people. If you cough or sneeze, cover your mouth and nose with a tissue or with the inside of your elbow. Throw used tissues into a wastebasket immediately and wash your hands.
Social distancing is advised in places with community transmission of the virus. Avoid crowded places and large gatherings, and generally keep some physical distance between you and other people.
Given the current problems with the supply of masks, gloves, and other personal protective equipment, the needs of health care staff should be prioritized.
Our teams are responding to the coronavirus emergency on multiple fronts—caring for patients, offering health education and mental health support, and providing training for vital infection control measures in health facilities around the world. MSF is working with local authorities in many of the countries where we have medical projects to help prepare for the impact of COVID-19. A key priority is to keep our regular medical programs running for the tens of thousands of patients and extremely vulnerable communities we help support. This pandemic threatens the lives of people around the world, and presents even greater risks in countries with weak or fragile health systems.
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Note: MSF teams are responding to the coronavirus pandemic in the more than 70 countries where we run existing programs, as well as opening projects in other countries that have become outbreak hotspots.This is a selective list of projects specifically related to MSF’s COVID-19 response, as of May 7, 2020. Our activities are evolving on a daily basis, and teams are working on epidemic preparedness in practically all our medical projects. Preparedness may include a range of activities, such as how we reorganize triage and waiting areas; strengthen infection prevention and control (IPC) measures; and provide technical advice and training on IPC to other health workers and national ministries of health staff.
MSF projects responding to COVID-19
Highlights of our global response so far include:
- In Hong Kong, MSF sent one metric ton of personal protective equipment and is running a project to provide health information and mental health support to vulnerable communities. We also sent 3.5 metric tons of protective equipment to China’s Wuhan Jinyintan hospital—which was at the forefront of treating patients with COVID-19.
- In Italy—the epicenter of the pandemic in Europe—MSF supported three hospitals in northern Italy to strengthen IPC measures. We have started activities in central Italy, where the number of cases is increasing. We also support a network of nursing homes in several cities to prevent cases from spreading in these vulnerable facilities.
- In Greece, MSF is providing medical aid on the islands of Samos and Lesbos, including support for people under isolation with mild to moderate cases of COVID-19. We are also calling for the immediate evacuation of refugees and asylum seekers trapped in squalid camps, high-risk environments for COVID-19 transmission.
- In Syria, teams are providing training and technical assistance in MSF-supported facilities in Azaz and Idlib, including help with the identification and set-up of isolation areas and the management of patient flow.
- In South Africa, the epicenter of the pandemic in Africa, teams from all four of our medical projects are now supporting the COVID-19 response in Gauteng, KwaZulu-Natal, and Western Cape provinces. Staff are assisting with contact tracing and the development and dissemination of health promotion materials.
MSF is still running the COVID-19 treatment center in Ouagadougou. From May 26 when the facility opened to July 14 33 patients were admitted. Our teams have concluded technical and infrastructure assistance to health facilities in three other districts of the capital (Baskuy, Sig-Noghin, and Pissy). Our health promotion teams reached about 10,000 people with sensitization activities led in the community. By the end of July all COVID-19 related activities will be handed over to the MoH.
We’re also working in Bobo-Dioulasso, western Burkina Faso, where the second-most severe epicenter of the outbreak is located. We have been providing care for COVID-19 patients in a dedicated facility since the beginning of April in collaboration with health authorities, and an oxygen generator was installed. After reinforcing triage, isolation, protection equipment, and IPC capacity at the University Hospital Center and the Medical Centers with Surgical Antennas of Do and Dafra MSF decided to phase out all activities from July 15 to focus on displaced people in the northern part of the country.
In the east we rehabilitated an 18-bed provisional treatment site at the regional health center in Fada and identified isolation units in all MSF-supported medical structures in the area. We continue to train frontline health workers on prevention measures, detection of cases, and case management (including mental health).
We also organized 21 training sessions for 453 health staff and 104 community health workers in collaboration with the MoH. We adapted the patient circuit and triage at the facilities we assist and implemented water and sanitation services to minimize the risk of infections. We continue to pursue awareness-raising efforts as well through sensitization activities on the radio and community health workers and we conducted a survey of knowledge, attitude, practice, belief, and emotions of the population with regard to COVID-19. We will continue reinforcing health promotion activities and the investigations of new cases of fever in health facilities and in the community, as we expect more cases.
In the projects in Titao, Djibo, Kaya, and Barsalogho—not yet affected by COVID-19—we are following up on the epidemiological situation as concerns remain high with the number of displaced people in the northern, central, and eastern parts of the country. Over the last weeks we have adapted triage and infection prevention and control measures in the health structures we are supporting, set up isolation units, and trained staff on prevention and case management.
In Yaounde, MSF is treating moderate COVID-19 patients in the Djoungolo health facility, where we increased the capacity by building four rooms with 20 beds each. Capacity is now up to 110 beds and on July 16 14 patients were hospitalized (two suspected cases and 41 confirmed).
We have also started operational research activities relating to the clinical evaluation of diagnostic tests, and provided training, equipment, and support to the teams, particularly in terms of mental health and health promotion. We support the Hôpital Général in triage, safer patient flow, and IPC, and set up a systematic triage service at Jamot Hospital.
In Douala, Cameroon’s second-most affected city, we have trained staff in infection prevention and control measures at the three main hospitals in charge of COVID-19 case management (Yasa, Laquintinie, and General Hospital).
Central African Republic:
While the number of confirmed COVID-19 cases keeps rising (there were 4,485 as of July 18, according to the MoH), MSF remains committed to ensuring the continuity of care in our 13 projects and ensuring that all needed supplies and medications are available for both patients and staff.
IPC measures, pre-triage and triage mechanisms, and isolation wards were set up in all our projects. MSF has started to build a COVID-19 treatment center in Bangui. The process is in its final stage and we are collaborating with the MoH to finalize the last operating details before the opening. The center will treat severe patients through oxygen therapy and offer palliative care.
In addition to the overall support and technical advice given to the national COVID-19 response mechanism, we continue COVID-19-related health promotion work and we are currently discussing how to support the MoH decentralization and community integration process by reinforcing surveillance and early detection of cases.
In Bangui MSF has also launched shielding activities for people living with HIV in four outpatient treatment centers, targeting at least 7,500 people. A similar strategy including soap and mask distribution, food support, and awareness raising sessions has been implemented in Paoua and Carnot in collaboration with UNICEF and WFP, targeting around 4,000 patients and their families.
In projects in the provinces, we continue to run several measles vaccination campaigns for children until 15 years old (at the moment in Bangassou, Carnot, Bossangoa). In Bossangoa, a targeted distribution of prophylactic treatment for malaria is in full preparation. Vaccination and distribution campaigns are challenging to implement given prevention measures in place against COVID-19. In order to limit the risk of transmission, the general strategy adopted is to avoid big vaccination sites and to divide the target areas into smaller zones, running activities on a longer timeframe.
MSF opened a new COVID-19 project at Farcha hospital in N’Djamena to care for patients suffering severe cases of COVID-19. This hospital was designated by the MoH as the referral facility for COVID-19 treatment.
We provided clinical training to the staff, reinforced lab and testing capacity, and we stand ready to support with case management. We installed an oxygen generator, which is essential to provide adequate care to patients with severe respiratory disease.
Activities in N’Djamena also include support for surveillance, contact tracing, home-based care for patients with simple forms of COVID-19, and health promotion and community engagement across the capital, including with marginalized groups with limited access to health information such as nomadic people in the outskirts of the city.
We have added COVID-19 related health promotion, medical screening, and distribution of soap and locally produced cloth masks (with a specific focus towards those most at risk of developing severe forms of the disease, such as the elderly and people living with HIV) to our community-based activities in the three districts where we run a malnutrition program. This includes the distribution of supplies to community leaders to install handwashing stations at main markets and health centers, resulting in a total of 145 new handwashing stations.
We continue strengthening prevention and control measures in Moïssala district, in southern Chad, where we run a woman and child health care program. We have obtained a greenlight from public health authorities to run malaria chemoprevention campaigns in the district this year. As we get ready to enter the seasonal malaria peak, our priority is now to lay the groundwork for these campaigns, which will have to be carried out in accordance with COVID-19 prevention measures (door-to-door when possible, and with strict IPC measures when it’s not).
In the Far North, patient flow and infection prevention and control measures have been adapted in both the regional hospital of Maroua and in the Mora hospital, where MSF has been present since 2015. We also set up a triage and isolation circuit for alert cases in nine health centers in the city of Maroua, trained teams on standard hygiene rules and IPC, and donated materials. In Mora, an MSF team constructed an eight-bed isolation ward in the district hospital and similar support has now started in neighboring health centers. We also trained community health workers and reinforced COVID-19 screening at the entrance of the Mora district hospital.
In te North West and South West regions, MSF has set up isolation and treatment wards in Bamenda, Kumba (16 beds), and Buea (20 beds) regional hospitals for suspected and confirmed COVID-19 patients and trained medical and non-medical staff who will run the units.
We have also strengthened measures to prevent the spread of COVID-19 in the health facilities we support in Bamenda, Kumba, Muyuka, Mamfe, and Widikum and are providing logistical and training support to the main hospital in Tiko (District hospital), Limbe (Regional and District hospital) and Buea (Buea regional hospital and Mount Mary hospital). In Bamenda, we provided additional training on PPE and IPC and support the teams with oxygen for severe cases.
The procedures for our ambulance service have been adapted to the COVID-19 response. Health promotion has been strengthened at the community level—especially targeting people affected and displaced by violence—using community health workers and nurses as well as radio messages.
Democratic Republic of Congo
Since April 27 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. From early May to early June, the 40-bed treatment center hospitalized 30 patients per day on average, of whom almost 20 percent were on oxygen therapy.
At the Kabinda Hospital Center in Kinshasa, where MSF supports HIV/AIDS patients, we have set up an isolation/stabilization unit with 20 beds which is used before transferring patients to health facilities identified by the MoH. In addition, MSF mobile teams supported 50 health structures in four health zones in Kinshasa to reinforce hygiene measures, provide masks and handwashing stations, and train medical staff and community relays on infection prevention and control.
In Masisi, in North Kivu, we set up an isolation circuit at the Nyabiondo Reference Health Center and a 20-bed isolation unit at the Masisi General Reference Hospital. MSF teams are raising awareness on the ground via health promoters and through community radio.
In Lubumbashi, MSF maintains a dedicated COVID-19 structure with a 20-bed capacity, which was constructed near the airport. In Goma, we ended support of the COVID-19 treatment center in Munigi, previously used as an Ebola Treatment Centre, and handed over its activities to MoH teams. In South Kivu, MSF established isolation centers in Baraka hospital, Kimbi hospital, and Nyange Heath Center for suspected COVID-19 patients, with a total capacity of 80 beds and mental health support for patients.
MSF is supporting the MoH in training health care workers in IPC measures as well as pre-triage, triage, screening, and isolation for people with symptoms consistent with COVID-19 in all structures where we work. In some of the country’s hospitals and health care centers where MSF is already present we are building isolation circuits and setting up additional beds for the isolation and care of potential COVID-19 patients. We are also carrying out health promotion activities.
We are supporting the MoH by assisting with infection control and triage at health facilities. We are also participating in technical advisory groups for the MoH and are implementing adjusted models of care for patients living with HIV, TB, and noncommunicable diseases in order to reduce their risk of infection with COVID-19. Teams are also doing health education in communities on a daily basis.
Since April 30 MSF has cared for COVID-19 patients in the Nongo Epidemic Treatment Center in Conakry. We set up this structure in 2015 as part of our response to the Ebola epidemic before handing it over to authorities. In April 2020, MSF teams rehabilitated a large area of the center to bring it up to standard for a 75-bed COVID-19 isolation and treatment unit to care for patients with mild symptoms of the disease and patients in need of oxygen therapy.
Beyond the provision of care, our teams are also disinfecting the homes of patients admitted to hospital, providing psychosocial support, and tracing and following up on their contacts. Our regular projects in Kouroussa prefecture (malaria and malnutrition), and Conakry (provision of care for patients living with HIV) are ongoing and our teams have adapted to the pandemic by helping health facilities and communities to protect themselves from COVID-19.
MSF teams first supported the MoH to screen passengers at Abidjan airport and refer those with coronavirus symptoms. Following this, MSF medical teams supported the MoH to treat moderate COVID-19 patients in the Vitib treatment center in Grand Bassam, one hour from Abidjan.
During the 12-week intervention, more than 350 patients were admitted to the 76-bed center. MSF also provided psychosocial support with two psychologists. The team has now reduced its presence, as needs are covered by the MoH, and have redirected effort to the Yopougon treatment center for a pilot telemedicine project in partnership with a local nongovernmental organization and the MoH.
Two MSF teams comprising doctors, nurses, and caregivers provide consultations to COVID-19 patients at the Yopougon site to detect co-morbidities (diabetes, hypertension, respiratory failure, and cardiovascular diseases) using an electronic platform to connect to specialists such as an internist doctor and a cardiologist in order to confirm diagnoses.
One million cloth masks were produced in partnership with local organizations and distributed to the population in Abidjan. Masks were also distributed to patients suffering from kidney failure, as well as to diabetics and people with high blood pressure.
In Bouaké, the country's second largest city, MSF teams continue to provide training and health promotion in collaboration with local civil society organizations. The association has supported screening and awareness raising activities at different entry points in the city and in six health centers where COVID-19 cases can be referred to the dedicated care unit.
About 5,000 masks produced by local artisans were distributed to people identified as vulnerable to COVID-19 (people suffering from diabetes, hypertension, and kidney failure). Masks were also distributed to patients in prayer camps, where mentally ill people and others are left. Mobile clinics have been set up in these camps and more than 700 consultations have been conducted. No COVID-19 cases were detected.
MSF is supporting several health facilities in Nairobi, Kiambu, Garissa, and Mombasa Counties. In the Mathare informal settlements, teams are providing mental health consultations to survivors of sexual and gender-based violence by phone to continue providing adequate care throughout the pandemic. Many patients picked up by MSF ambulances in Mathare have tested positive for COVID-19, even those who did not initially meet the case definition for the disease.
As a mitigation measure for the spread of COVID-19, patients with NCDs have been provided medicine for three months in Embu county, where MSF supports the five county-level hospitals with triage and screening of patients and boosting IPC in 11 health facilities. To ensure continuity of care for people who use drugs we set up a triage system and an isolation room at Karuri hospital in Kiambu County.
In Homa Bay county MSF has provided three months of antiretroviral treatments to patients to limit travel and exposure at hospitals. MSF assisted the MoH in the design of a facility for managing confirmed cases of COVID-19 in Malela. In Dagahaley camp, in Dadaab, Kenya’s largest refugee camp, MSF has set up an isolation unit with 10 beds for COVID-19-positive patients, expandable up to 40 beds. In nearby Wajir county, our teams have organized training for health care workers. MSF also set up isolation rooms at Mrima health center in Likoni subcounty, Mombasa, which will allow women who have COVID-19 to give birth safely.
There are 1,070 confirmed cases of COVID-19 in the country, and 58 people have died as of July 15 MSF continues to provide technical support at the city’s Military Hospital, run by the MoH, where COVID-19 patients are being treated. We are carrying out ongoing awareness activities on prevention measures in communities in an around Monrovia. MSF is now operating its mental health project remotely, talking to patients on the phone and providing two-month drug supplies when necessary. Our pediatric hospital in Monrovia (BJH) has been adapted with IPC measures. Its activities have continued since the start of COVID-19 with the exception of pediatric surgery, which was suspended due to the challenges associated with sending surgical teams that require regular rotations during the global pandemic.
The number of cases is increasing in the country (2,430 as of July 15, with 39 deaths). We adapted our activities to help contain the spread of the virus. Adjustments include installation of handwashing points, health promotion activities, clinical screening and triage of potential COVID-19 cases, and logistic support. We provided training and technical advice to the MoH in setting up isolation units in Boma hospital in Chiradzulu and in Blantyre.
Our HIV activities in Nsanje and Chiradzulu are scaling up to ensure the availability of ARV refills for patients in order to reduce the frequency of their visits to health centers and decongest health care facilities. We also reorganized patient flow and implemented pre-screening, triage, waiting, and consultation areas.
In Dedza, Zalewa, and Nsanje we are working to ensure continuity of care in the community and for one-stop HIV and sexual and reproductive health services for female sex workers. We are also supporting COVID-19 preparedness and prevention activities and inmate and visitor flow in Chichiri prison in Blantyre.
Physical distancing measures led to a temporary suspension of the “Teen Clubs” in Chiradzulu, where HIV-positive children and teenagers had access to counseling, consultations, drug refills, and testing and social support in a dedicated environment featuring recreational activities. Direct nutritional support to vulnerable HIV-positive people is even more crucial during the COVID-19 outbreak. Our cervical cancer program in Blantyre has also been limited to admitting urgent cases. Non-urgent surgery is on standby due to the epidemic—we are advocating to restart surgery for cancer patients as soon as possible. Screening activities are resuming this week, after a long suspension due to COVID-related restrictions and a lack of protective gear.
In Bamako, MSF supports the MoH’s 100-bed COVID-19 treatment unit within the grounds of the hospital where it runs its oncology program (“Point G” hospital). MSF supported the rehabilitation of the hospital’s oxygen network and provides medical, nursing, and hygiene control staff as well as logistical and technical support.
Over 400 patients have been admitted to this unit so far, including 44 to the intensive care unit. Twenty patients have died in total. We are progressively reducing our support. We also engage on COVID-19 related health promotion/sensitization with local actors, health workers, and members of civil society organizations.
Together with MoH community-level and contact tracing activities in Bamako, we set up handwashing stations and provide locally produced cloth masks and soap in the most at-risk locations (where a case has been confirmed, for example). 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 MSF-supported hospitals and health centers. We also support MoH activities such as case management, awareness raising, improving IPC, and setting up isolation structures for patients. New activities with a focus on COVID-19 are currently underway in Timbuktu.
Across all our projects, we have worked on preventative measures like IPC, triage, and surveillance, and adapted our models of care to reduce the risk of infection for vulnerable patients while ensuring access to health care.
In Maputo we support the main COVID-19 referral hospital Polana Caniço. An MSF team provided on-the-job training to the MoH staff with a focus on IPC, patient flows, and triage protocols. Our harm reduction services in Maputo have been adapted to reduce the risk of exposure to COVID-19 for our patients, notably by providing methadone in take-home doses.
In Pemba we helped local health authorities install two isolation centers, 18 de Outubro (30 beds) and Decimo Congresso (100 beds). We also did health promotion in two IDP centers in Metuge. In Beira we assisted in the installation of two isolation centers, 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 helping with patient flow and triage of suspected COVID-19 patients in four health centers. We participate in the Mozambica Government COVID-19 coordination meetings and technical groups providing advice on the response in the country and facilitating access to updated evidence for the latest COVID-19 protocols.
Close to the Amirou Boubacar Diallo National hospital in Niamey, MSF and MoH staff receive confirmed cases and suspected ones with complications. As of July 21, the COVID-19 treatment center had admitted 34 patients (30 confirmed and 4 suspected). Twenty-six confirmed cased have been discharged and four were referred. We are in the process of reassessing the needs, as the number of cases is decreasing, while the reopening of borders and a need for massive testing capacity are creating new challenges for national authorities and partners involved in the response.
We are also supporting the emergency medical service’s 24/7 call center and response teams in five communes of the city to strengthen the MoH’s response capacity. The teams provide technical support on alert verifications and organize the triage of patients at the call center’s level. We also provide psychological support. Serious cases are referred to health structures.
Our teams have implemented COVID-19 preparedness measures in all our projects in the regions of Zinder (Zinder and Magaria), Maradi (Maradi and Madarounfa), Agadez, and Diffa. We adapted and implemented triage, isolation room, and IPC measures and health promotion activities in our supported health structures (hospitals, centres de santé, and cases de santé) and referrals from remote areas to health structures. In some regions, we also support the MoH in the transport of samples.
Across the seven states where MSF works in Nigeria we are providing technical support to the MoH and Nigeria Center for Disease Control (NCDC) as they set up isolation centers for patients who present symptoms of COVID-19, as well as with contact tracing, community-based health promotion activities, and setting up handwashing points and isolation areas in local communities and IDP camps.
In Borno state, MSF continues to provide technical and material support to the MoH COVID-19 isolation center in Maiduguri with staff training, the establishment of a patient flow system, and the management of certain IPC protocols, including the laundry system. In Gwange, the MSF-run hospital continues to provide comprehensive pediatric secondary health care services. And in Fori, our inpatient therapeutic feeding center continues to operate, both with reinforced IPC and adapted triage and patient flow systems.
In Ngala MSF's hospital has ceased 24-hour services but continues to provide primary health care services during the day as well as community-based health promotion services. In Pulka the MSF-run hospital continues to provide comprehensive primary and secondary health care, community engagement activities (including health promotion and education on COVID-19), outpatient care, and vaccinations. A 24-bed isolation ward has also been established. In Rann, MSF continues to provide community-based health promotion services and will start round-trip visits for medical consultations.
In Ebonyi state, MSF supports the MoH and Nigerian CDC in setting up the state’s first COVID-19 testing center. In Sokoto we have supported the MoH in renovating a 32-bed isolation and treatment center, handed over to the MoH in early May. In Zamfara, ongoing community engagement with IDPs in and around Anka town includes health promotion. We also installed water points, distributed soap and hygiene products, and set up a holding center for potential COVID-19 patients before transfer to the MoH in Gussau. MSF continues to provide pediatric care in Anka general hospital (with new criteria to reduce services to essential cases only) and is providing technical support in the hospital to establish isolation zones, IPC protocols, and adapted triage and patient flow systems.
A malaria contingency plan is in place to ensure continuity of malaria treatment during the upcoming season and minimize the impact on the hospital. Together with state health authorities, we are conducting a large-scale community sensitization campaign on COVID-19. So far, we have visited 240 of the planned 370 settlements.
In Jigawa, MSF teams continue to provide support to the MoH isolation facility, maintain reinforced IPC and adapted triage in the MSF-run maternity hospital in Jahun, and provide IPC training to hospitals. In Port Harcourt MSF continues to provide medical and psychological care for victims of sexual violence in. We have adapted triage and patient flow systems and added more stringent IPC protocols. In Benue, MSF-run clinics have adapted triage and screening, reinforced IPC, worked to ensure staff safety and use of PPE, and undertaken health promotion and water and sanitation activities with IDPs in collaboration with the MoH.
In Dakar we are supporting health authorities at the Hopital Dalal Jamm for the past six weeks. We have trained staff and supported water and sanitation efforts, and helped with simplification of triage and other protocols. The Ministry of Health recently increased the hospital's capacity by 200 beds and we are helping prepare to care for more severe cases of COVID-19. We also started support activities in Guediawaye district, a northern suburb of Dakar, on surveillance, community engagement, and IPC standards at health facilities.
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. In Freetown, MSF refurbished a government facility, Hastings CTC, which was converted into a 120-bed center for COVID-19 patients. We also carried out PPE training for around 140 workers who will manage the facility.
In Kenema district, MSF completed the rehabilitation of a Lassa fever isolation unit in the Kenema government hospital to turn it into a COVID-19 treatment center with a capacity of 25 beds.
There is a gap in psychosocial care in Sierra Leone. Following a successful week of training of health staff in Freetown, we are working with the MoH’s psychosocial lead to ensure the knowledge is shared in all the districts of the country.
A health sensitization intervention in Thompson Bay Slum area in Freetown will start mid-July, focusing on disseminating COVID-19 prevention messages and other basic health messages as the pandemic has resulted in a drop in regular consultations. MSF will be collaborating closely with community health workers who are working in Thompson Bay and are known to the community.
The Bombali COVID-19 treatment center in Makeni Regional Hospital is operational, with MSF providing logistical support for the initial setup. We are pushing for the construction of another treatment center outside the Regional Hospital. In Tonkolili, we provided water and sanitation support to the Masanga Treatment center.
Somalia and Somaliland
The already fragile health system is now overburdened with COVID-19. The measures implemented to prevent the spread of the virus are affecting regular health services like routine immunization and nutrition programs. In Las Anod, Galkayo, and Baidoa, where MSF was already running medical activities, we have put in place hygiene and preventive measures to protect our frontline staff, including trainings on IPC, triage, and identification of COVID-19 symptoms. We are also stepping up health promotion activities and providing technical advice or logistical support to set up isolation structures.
In Hargeisa, as part of a task force of NGOs, we are providing support to the MoH of Somaliland to set up a COVID-19 center. MSF´s support has included donations of IPC materials, training of emergency room staff and ambulance drivers, and a “training of trainers” for regional medical staff on issues like IPC measures.
We re-assigned existing staff from all four MSF projects to COVID-19 responses in Gauteng, KwaZulu-Natal, and Western Cape provinces. MSF staff have assisted with limiting infection spread through contact tracing (physical and telephonic), the development and dissemination of health promotion materials, and by implementing various strategies for decongesting health care facilities.
In partnership with local health authorities in Eshowe, we set up 35 medicine pickup points in communities. This means that at-risk people living with HIV, TB, and noncommunicable diseases like diabetes will make fewer non-essential visits to health care facilities. The team is also developing additional COVID-19 case management capacity for health care facilities in Eshowe and Mbongolwane.
In Khayelitsha, a COVID-19 field hospital opened on June 1 in partnership with the South African Department of Health. On July 17 a decision was made to decrease capacity from 60 beds to 30 beds due to progressively lower admission numbers both in our partner hospital and across the Western Cape province. The plan is for field hospital resources to be sent to other sites within the country, where the peak of the epidemic is imminent or already happening. As of July 27 the field hospital had treated 213 COVID-19 patients and there have been 30 deaths. One-hundred fifty-eight patients have been discharged and there are 210 patients in the facility.
Cases of COVID-19 continue to increase, with over 2,100 confirmed patients in the country as of July 10, including in MSF facilities and project areas in Yambio, Agok, Yei, Lankien, and the Bentiu and Malakal protection of civilians (PoC) sites, as well as in Malakal town. In Juba, MSF teams are carrying out community assessments and community engagement, as well as installation of handwashing points in several locations.
Additionally, more than 50 health care workers have been trained IPC and triage related to COVID-19 in six health facilities (both MoH-supported and private clinics). We are also helping with laboratory support in Juba, with MSF co-facilitating trainings for staff of different institutions. In Malakal PoC, following the announcement of the confirmed case on June 23, UN agencies have implemented stringent measures and restrictions of movement from the PoC into the Humanitarian Hub.
In Bentiu PoC, UNMISS had granted permission to MSF to run a “holding/transit” facility wherein COVID-19 patients could be kept until being transferred to the “isolation/treatment” facility in Bentiu town. Rehabilitation efforts for the isolation area in the MSF hospital continue despite the presence of COVID-19 patients under treatment.
In Lankien, renovations have been completed to the COVID-19 isolation area tent and construction of a mortuary and a maternity delivery room in the COVID-19 isolation areas is ongoing. In Doro refugee camp in Maban, the MSF team works with community leaders to do door-to-door health promotion and awareness raising. The teams also conduct sessions with women’s groups, youth groups, watch groups, and sheikhs in the camp. In Agok, MSF modified an ambulance to be used to transport confirmed and suspected COVID-19 cases and work on an isolation ward is ongoing.
In addition to trainings, MSF is working on preparedness for COVID-19 in all project locations across the country, as well as on preventive measures to be able to isolate and treat suspected patients who may eventually reach our health facilities. These measures include setting up additional washing points equipped with either chlorinated water or soap and reinforcing existing ones, training staff on triage and IPC, and identifying and establishing isolation areas or pre-screening areas for suspected COVID-19 patients.
MSF teams across Sudan are conducting health promotion and awareness sessions with patients and the local community or at non-MSF primary health care centers. We provide daily trainings to health workers including bedside trainings and mentoring in the health facilities we support. MSF also runs a mobile COVID-19 unit that supports other facilities and works on early detection and prevention of the spread of the disease.
In MSF projects across Sudan, we have implemented safety and hygiene measures to avoid the emergence of cases among our staff. We have also developed quarantine procedures for those who develop symptoms to ensure that our staff can continue to safely treat patients.
In collaboration with the WHO and the Sudanese health authorities, MSF provided “trainings of trainers” to key medical staff of 90 major (public and private) hospitals in Khartoum, including the two COVID-19 isolation centers identified by the government. Subsequently, the WHO and the MoH rolled out trainings in nine states.
The objectives of the trainings was to increase the preparation of health facilities to respond to suspected or confirmed COVID-19 cases, to reinforce IPC knowledge and standards, and adapt patient flow depending on the level of exposure. MSF teams are in touch with the federal MoH and support the preparedness of a response including infection prevention control measures, setting up treatment center, trainings for MSF and MoH staff, health promotion, and basic logistics.
At the Omdurman Teaching hospital, the largest hospital in Sudan, we are working closely with the MoH in the emergency department and preparedness to cope with COVID-19. We are also supporting the MoH to set up and manage isolation centers in East Darfur, South Kordofan, and Gedaref states. Our teams are working on COVID-19 preparedness and preventive measures in all our projects, in order to safely isolate and treat suspected patients who may seek treatment in our health facilities.
MSF is the sole health care provider in Nduta refugee camp, which hosts 75,000 Burundian refugees. In preparation for a potential 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 center at the MSF hospital, where suspected 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, IPC, safe transportation of suspected 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.
In April, seven suspected cases were admitted to MSF’s isolation facility. All of them tested negative for COVID-19. Training is ongoing in our hospital in Nduta refugee camp. Meanwhile, our health promotion team in the camp is working to sensitize and educate the community on hygiene and best health practices to improve preparedness for COVID-19.
In spite of its community testing strategy (more than 200,000 people tested) Uganda has reported a low number of confirmed cases (1,043 as of July 14) and no COVID-19 deaths. MSF teams have reinforced measures to prevent and control infections and also helped with logistics and hygiene measures in three MoH isolation units in Arua and Kasese.
In addition, we are raising awareness among communities where we work (Omugo refugee settlement, HIV peer groups in Arua, youth communities in Kasese, and fishing communities near lake George) and distribute masks to patients and staff in MSF-supported health structures and PPE 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 center used to quarantine and test refugees, where conditions were particularly poor.
Our HIV program as well as mental health activities have been adapted to reduce the frequency of patients’ visits by increasing ARV and mental health treatment supplies. Follow-up is limited to urgent cases. Recreational activities for HIV-positive and negative teenagers in Arua and in Kasese are on standby. Physical and mental health care for victims of sexual violence continues in the Arua district’s refugee camps, with measures to avoid infection.
Given the sharp increase of COVID-19 cases in recent weeks (1,611 as of July 19), MSF stepped up its support to the MoH and Child Care. In Harare, MSF is preparing to open a community facility that will be used as a COVID-19 isolation center by people who cannot self-isolate at home. We will provide technical and material support, staff and training, the establishment of a patient flow system, and the management of certain infection prevention protocols, including the laundry system for the center.
Following a significant reduction of cases, MSF activities in Manaus have ended.
We have begun operations in the remote Amazonian towns of São Gabriel da Cachoeira and Tefé, several hours by plane from Manaus. In Tefe we continue trainings at the town’s main hospital and will continue monitoring the epidemic situation in more rural villages in case a response is needed. In São Gabriel da Cachoeira, MSF runs a 10-bed inpatient department for moderate COVID-19 cases.
In São Paulo, we opened an eight-bed intensive care unit at Tide Setubal hospital in an eastern suburb of the city, where there is a mixture of patients from the neighborhood and from areas outside the city. We are also starting (and hoping to expand) an outreach strategy in the area to perform active case finding and contact tracing in the households of patients admitted to the ICU, as well as health promotion and outreach activities in slum districts in the neighborhood.
We are finalizing an agreement for the handover of two isolation centers in the city center where we have been providing medical services in municipality-run facilities.
In Rio, our activities have ended.
In Boa Vista, in Roraima state, MSF runs an ICU unit and a ward for moderate to severe cases in the COVID-dedicated field hospital managed by the authorities’ disaster-response entity. Meanwhile, the team kept working at informal shelters where migrants and refugees from Venezuela have gathered, providing hygiene and physical distancing guidance to residents. The team has also assisted in expanding access to water in both formal and informal shelters and has distributed hygiene kits.
MSF is working closely with health authorities in Norte de Santander, and Tumaco to support the local response. We expanded our field teams and reoriented part of our services to respond to COVID-19. 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 city’s two public hospitals.
In each of these places we are also focusing a large part of our efforts on health promotion and prevention activities in towns, villages, and neighborhoods through different community strategies and the media. In all our projects 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 living without access to the health system, as well as emergency attention for sexual violence and termination of pregnancy.
We have ended our activities assisting health centers and nursing/care homes in the Guayaquil region, which was the first area in Ecuador to be hit hard by COVID-19. The team has moved to the coastal Esmeraldas province in the northwest, where cases are rapidly rising.
We have been asked by city authorities in the capital Quito to assist in nursing homes, and an MSF team there has confirmed that the situation there is distinctly alarming.
MSF has strengthened its ambulance 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. We continue to run mobile clinics in communities of San Salvador and Soyapango affected by violence. The health centers have suspended outpatient consultations and only serve people with suspected COVID-19 and emergencies.
We continue our health promotion and prevention interventions. MSF is providing mental health care in an isolation center dedicated solely to people deported from Mexico and the US while evaluating others for possible intervention.
In total 7,063 COVID-19 cases and 146 deaths have been reported in Haiti as of July 18, mostly in the Ouest department, which includes the capital Port-au-Prince, but cases have been confirmed in all of the country's departments. With limited testing, these figures are only confirmed cases and deaths and do not reveal the full extent of the epidemic, which is difficult to estimate.
Since opening in mid-May, MSF's Drouillard COVID-19 treatment center in Cité Soleil, Port-au-Prince, has screened 327 people and provided care to 178 patients who were hospitalized with severe symptoms. MSF's emergency center in the Martissant neighborhood has also screened 58 people for COVID-19 since the epidemic was declared in March, referring patients to Drouillard when needed.
After the initial steady increase of admissions at Drouillard, the number of hospitalized patients stabilized and has now sharply decreased in the last two weeks. A similar situation is observed in other COVID-19 centers managed by the MoH or other organizations in Haiti.
A total of 66 deaths have been recorded by MSF (59 at Drouillard and seven in Martissant) while more than 100 COVID-19 patients have been discharged from Drouillard.
In several neighborhoods of Port-au-Prince, community awareness and mobilization activities on prevention measures and timely admissions continue through door-to-door health promotion, radio spots, and training for community organizations and leaders.
In Port-au-Prince, our teams have also supported the Chancrelles hospital in Cité Soleil, the Saint Michel health center in Martissant, and the State University hospital of Haiti in implementing IPC measures, triage, and isolation. In the Sud department we have provided this support to Immaculate Conception hospital in Les Cayes, the Port-à-Piment health center, and the community hospital of Port-Salut, as well as support for patient referrals.
MSF has visited several hospitals in Port-au-Prince that were forced to close their services, totally or partially, due to COVID-19, with the goal of assessing what support we can provide and to reduce the impact of the epidemic on other medical needs.
In Tegucigalpa, MSF has started medical activities in an adapted center for severe COVID-19 patients with the aim of helping the metropolitan health system keep hospitals from overcrowding.So far MSF has cared for 44 patients. We also run a mental health phone line for survivors of violence and sexual violence. An MSF-managed health center in a neighborhood on the outskirts of the city is still operating and is prepared to detect COVID-19 cases. In Choloma, the sexual and reproductive health project is still open, with some limitations. It is the only maternal clinic in the city, so all patients are referred there for deliveries and prenatal care consultations. The project donated an ambulance to transport COVID-19 patients to the isolation centers established by the government.
In Guerrero, MSF teams resumed mobile clinics providing primary health care and psychosocial support to victims of violence. We have coordinated with state health authorities to provide technical IPC support where needed. The team has visited several state hospitals, including the Ciudad Altamirano health center, Arcelia Community hospital, and the Teloloapan Community hospital, where we carry out trainings for health staff and provide support in setting up circuits for staff and patients. MSF concluded activities in the general hospital of Coyuca de Catalán (Guerrero) and Renacimiento hospital (Acapulco), which included including trainings and implementation of patient circuits as well as psychosocial work with families.
In Mexico City, the CAI (a specialized center for people who have suffered torture or extreme violence) continues to integrate new cases referred by our partners from Mexico City, in addition to the patients who were already following the program before the pandemic began. MSF assessed and implemented IPC in migrant shelters across Mexico City and in shelters in Tijuana, Baja California; Ciudad Juarez, Chihuahua; Tapachula, Chiapas; Tierra Blanca, Coatzacoalcos, and Oluta, Veracruz; Huehuetoca, State of Mexico; and in Monterrey, Nuevo Leon, Saltillo, Ciudad Acuña, Coahuila, Piedras Negras, Sonora, Tenosique, and Nuevo Laredo. In addition, we have provided support at the Samuel Rodríguez Moreno psychiatric hospital in Mexico City, the Renacimiento general hospital in Acapulco, and the Chilpancingo general hospital in Guerrero.
In the northern border project, in Matamoros and Reynosa, MSF increased and adapted activities at a shelter and a camp for asylum seekers. In both cities we have started medical activities in two adapted centers for severe COVID-19 patients. In both facilities MSF cares for mild and suspected cases and severe patients that need oxygen. So far we have treated 75 patients.
In Matamoros and Reynosa a psychological care phone line has launched for people who are victims of violence or who are coping with the COVID-19 pandemic.
Also at the northern border, MSF continue its intervention in Nuevo Laredo by assessing and implementing IPC in all migrant shelters, where more than 200 people are staying in confinement. Psychosocial support is provided to shelter staff and also to members of the surrounding communities. MSF continues to monitor the flow of Mexicans repatriated by US authorities and deported non-Mexican migrants.
A hotline and WhatsApp number has been set up so that MSF psychologists can provide psychological care remotely to migrants and refugees as well as to people isolated by violence in Guerrero and migrants and refugees across the country.
In response to the outbreak of COVID-19 in the United States, MSF works with local authorities and partner organizations serving vulnerable communities who often lack access to health care and helps residents and staff at long-term health care facilities to control the spread of the virus.
In New York City, MSF partnered with local organizations to improve IPC measures for at-risk groups. We opened temporary relief stations in Manhattan, offering free showers, toiletries, socks and underwear, and information on additional services for people who currently lack access to hygiene facilities. The project provided more than 2,000 showers. We also donated more than 160 handwashing stations to places like soup kitchens and supportive housing facilities, and distributed 1,000 mobile phones to vulnerable New Yorkers who lack the essential technology needed to contact emergency and support services.
Michigan has 84,000 confirmed cases of COVID-19 and over 6,300 deaths. Nursing home residents account for 7,500 of the cases and 2,000 deaths. Additionally, more than 3,700 staff working in long-term care facilities have fallen ill. MSF coordinates with the Michigan Department of Health and Human Services and the Detroit Health Department to quickly identify which nursing homes and adult foster care facilities are in need of IPC measures. Our teams offers three sets of activities to help protect residents and staff: assessments and general guidance to improve IPC practices, technical on-site support and training, and mental health workshops to address the high level of stress and grief that frontline staff face every day. We’re also carrying out digital health promotion activities in certain communities to ensure that people have information about testing and protecting themselves from COVID-19.
In Immokalee, Florida, where approximately 15,000–20,0000 migrant farmworkers have labored during the pandemic with minimal access to health care and testing, we work closely with the Coalition of Immokalee Workers (CIW), the Department of Health (DoH) and the Health Care Network. Together, we implemented a multi-faceted COVID-19 response plan. MSF ran a public health education campaign and mobile COVID-19 testing sites in partnership with the DoH and the Health Care Network. We handed over our testing clinics to the DoH, which will continue this work.
In the Southwest, MSF worked in partnership with local officials, community leaders, service organizations, and health care workers from the Navajo Nation and Pueblo peoples in the states of New Mexico and Arizona that are directly addressing needs related to COVID-19. The MSF team provided guidance and trainings on IPC measures at a variety of medical and non-medical facilities, from nursing and group homes to correctional facilities with Emergency Medical Services (EMS) units, and with new police recruits, and worked closely with local partners to expand public health information and education about COVID-19 at the community level. As other community sectors requested IPC trainings, MSF trained staff from Community Outreach and Patient Empowerment (COPE) to ensure as many groups as possible will continue to have access to critical IPC workshops. The team deliver
ed six “Training the Teachers” workshops to more than 700 employees of the Social Services Department.
In Puerto Rico, MSF supports vulnerable groups including people who are experiencing homelessness, the elderly, people with substance abuse disorders, and communities that have been affected by recent earthquakes. We offer medical consultations in and around San Juan and in remote locations where access to care is limited by the pandemic. These services include both home visits and planned on-site clinics for communities. MSF has provided medical consultations to almost 300 patients since mid-June. Next week, the team will start new activities in Ponce in Belgica and Arecibo. Last week, MSF distributed 2,000 face masks and 700 face shields to detention centers, colleges of nursing, and a nursing home. The team continues to carry out health promotion and conducted 41 hand hygiene demonstrations and education sessions. Early in the response, MSF distributed more than 2,700 hygiene kits, donated almost 30,000 PPE items to 22 health facilities, and conducted 11 IPC trainings to help essential workers, patients, and others stay safe.
Our COVID-19 response plan includes assisting with medical supplies and staff recruitment as well as strengthening triage, diagnosis, treatment, IPC, and more in Amazonas, Anzoátegui, Bolívar, Sucre, and the Capital District. At the Hospital Perez de León II in Petare, MSF teams have begun rehabilitating infrastructure, adapting patient flow, establishing IPC measures, and training staff.
ASIA & PACIFIC
On June 28, MSF opened a 32-bed COVID-19 treatment center in Herat for the treatment of patients in need of oxygen therapy. Our objective is to significantly raise the level of care for severe COVID-19 patients and relieve the pressure on the existing COVID-19 management center—Shaidayee and Liberty hospitals—which are increasingly overwhelmed.
Kabul has surpassed Herat as the epicenter of the outbreak in Afghanistan, but little is known about the true scale of confirmed cases in other locations as testing capacity remains limited. After the attack on Dasht-e-Barchi, the support to the Afghan-Japanese COVID-19 referral center in Kabul was been stopped.
In Lashkar Gah, MSF supports Malika Suraya hospital, the main dedicated COVID-19 facility in Helmand. Meanwhile, in Boost hospital, screening and stabilization areas and a referral mechanism have been established for suspected COVID-19 patients. In Kandahar, our team is supporting both the provincial TB center and the MSF TB center, and isolation units have been set up for the admission and treatment of DR-TB patients who are COVID-19 positive or suspected. The logistics team is also speeding up the construction of a new TB Hospital.
In Kunduz, wound care clinic activities have been temporarily suspended, as have MSF activities in the small stabilization 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 frontline 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
MSF has added isolation wards to all of our medical facilities in Cox’s Bazar and is preparing two dedicated COVID-19 treatment centers. Currently our teams are treating a number of patients with COVID-19, as well as monitoring patients with suspected cases. 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.
We are also carrying out health promotion 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 care for victims of sexual and gender-based violence, as well as health promotion for COVID-19. We also support local health facilities with IPC training.
From mid-March, MSF shifted its operational priorities to help draft IPC and clinical care management guidelines. The team also implemented triage infrastructure in six hospitals bordering Thailand. Over a period of about three weeks, more than 300 MoH staff members were trained on the new guidelines and protocols concerning COVID-19, among them ambulance drivers, cleaners, laboratory technicians, doctors, and nurses. They learned about the appropriate infection prevention measures and management of suspected or confirmed cases of COVID-19.
In the past weeks, the local outbreak has been under control. Therefore, Hong Kong has started to relax its COVID-19 measures. The MSF project has shifted its focus from health education to mental health support. As the outbreak has lasted for months, the team is now preparing a website providing information and tips to address stress caused by prolonged exposure to uncertainty while face-to-face sessions targeting the most vulnerable people are also ongoing.
We continue to support the COVID-19 response in the Banten project, and in Jakarta our team is scaling up trainings and workshops with community leaders and health workers who are responsible for COVID-19 surveillance, tracing, and reporting at sub-district and village levels. Additionally, workshops have been held with hospitals in Jakarta on integrating COVID-19 activities into existing health structures and services. To date, 10 training sessions have been completed, with 140 people trained.
In Kyrgyzstan, we are working closely with the MoH and offering technical advice, providing logistics assistance, and supporting health promotion initiatives in addition to assisting in epidemiological surveillance through data collection with a specific 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 PPE 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 MoH with PPE, including N-95 masks and gloves, thermometers, chlorine tablets, and alcohol pads.
We are ready to increase support to the national MoH and district authorities for contact tracing and testing. We have also issued a call to the Malaysian government to repeal a circular obliging public health facilities to report irregular migrants, including refugees and asylum seekers.
In Penang, we are providing COVID-19 health education in different languages, including Rohingya and Burmese, and translations in hospitals. We had to suspend mobile clinics, but patients can still reach us through our phone hotline. We have donated food supplements to 100 vulnerable families.
Our teams have implemented emergency preparedness plans in each project, including IPC and PPE training, additional handwashing points, establishing quarantine options for staff, and designing rotating work schedules. We also provided extra drugs to HIV and NCD patients. The MSF Myanmar Facebook page has started an awareness and engagement campaign, focusing on the dissemination of COVID-19 prevention and health promotion messages, reaching 1.7 million clicks in the last month. MSF is also closely collaborating with the MOHS, providing technical trainings, translations, and other assistance to MOHS staff and donating various items such as surgical masks, hand sanitizer, soap, and health education billboards.
In Timergara, an MSF team is screening more than 1,000 people every day for COVID-19 symptoms and providing consultations for suspected cases. We run a 15-bed isolation ward for mild and moderate cases and refer serious patients to tertiary structures. As the number of cases continues to increase we are expanding the isolation ward to 24 beds. MSF is also bringing COVID-19-positive patients in Lower Dir district to the isolation ward by ambulance, but only under certain conditions. In Balochistan and Khyber Pakhtunkhwa we have suspended cutaneous leishmaniasis consultations and are reducing or suspending activities in some projects as a temporary measure to protect against COVID-19 exposure. We're also conducting extensive awareness-raising activities on how people can protect themselves and prevent the spread of the virus, and we've added COVID-19 protection measures and isolation areas in most of the facilities we support across the country.
Papua New Guinea
MSF teams continue to train health care staff in facilities designated to receive COVID-19 patients, particularly in the Gul province, where one of our tuberculosis projects is based. Regular tuberculosis activities have been suspended.
Regular MSF activities have been suspended in both Manila and Marawi. In Manila we support our partner organization, Likhaan, with health promotion activities. In Marawi a mobile information drive has been launched to communicate health promotion messaging to vulnerable populations.
MSF is prioritizing continuity of quality care for essential services for children and adults with TB, in collaboration with the MoH and Social Protection of the Population (MoHSPP) via existing MSF programs focused on diagnosis, treatment, and contact tracing. Our team completed the first assessment of the Republican Center 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 waiting area with shade protection will be built for people with suspected COVID-19, the first time such a triage 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.
MSF is maintaining key TB and HIV programs while engaging in interagency cooperation for COVID-19 response. We are posting health education messages through social media channels and supporting health education for individuals with TB in Karakalpakstan and shared COVID-19 and TB messaging with the MoH and the UN to increase the reach.
Most recently in Karakalpakstan, MSF has used local radio and television channels to promote COVID-19 prevention messaging. We continue to support IPC measures across the primary health care system and, more recently, in COVID treatment facilities. Additionally, we coordinate with the MoH on the treatment of patients co-infected with COVID-18 and TB.
MSF’s guidance for people with TB was adapted into posts and shared with social media groups of TB facilities for use during their regular sessions with patients. Training videos for MoH nurses and caretakers have been produced and are used to instruct MoH health care workers on the Family-Directly Observed Treatment (FDOT) model for TB patients.
MSF is maintaining continuity of care for drug-resistant tuberculosis (TB) patients while gradually resuming face-to-face treatment. Our medical and patient support teams began visits to the inpatient department of the Republican TB Institute and the Second TB Dispensary in Minsk and the Volkovichi TB hospital.
On the island of Lesbos, MSF operates an inpatient medical unit near the Moria reception center for patients who present symptoms similar to COVID-19 and potential positive cases, with the aim of detecting cases, safely isolating patients, and monitoring the medical condition and treatment of mild cases. We also provide support and training on the triage system of the National Public Health Organization, which is responsible for COVID-19 triage and case management. In Samos and Lesbos, we adapted our facilities and procedures to ensure the safety of patients and our staff. MSF is also doing health promotion in camps for migrants and asylum seekers and increasing the provision of water and sanitation services.
In Athens, we collaborate with the Third Clinic of Internal Medicine of Athens University by providing psychological support to frontline health workers and COVID-19 patients and their relatives. We also donated personal protective equipment (PPE) donations to vulnerable social groups, including elderly people, refugees, homeless people, victims of gender-based violence, detainees, and people with mental illness, as well as to the airlifting department of the National Emergency Aid Center.
We have now closed our projects in the Lodi area and Marche region, where we supported three hospitals and 44 homes for elderly people and provided remote monitoring of non-critical COVID-19 patients at home to ensure that only severe cases where sent to the hospital. MSF teams trained more than 500 health workers on IPC procedures and conducted psychosocial support sessions.
We have also ended our intervention in detention centers in Lombardy, Piedmont, and Liguria,
where we conducted IPC and health promotion activities in 15 prisons and improved protocols and procedures for isolation of suspected cases and contact tracing activities.
In Rome we are creating COVID Community Health Committees in informal settlements with the aim of strengthening the COVID-19 surveillance system in marginalized urban communities. We train these committees on improving IPC and identifying suspected cases, how to alert the authorities, and how to act as first responders through the use of COVID-19 kits. We also manage a phoneline with medical staff and cultural mediators to provide information and orientation services as well access to care for both COVID and non-COVID patients.
In Sicily we have supported the epidemiological surveillance service in Catania and Enna provinces and we are providing IPC and health promotion training for civil society groups in the most marginalized and vulnerable areas of Palermo.
By the end of July, MSF aims to start the distribution of food packages and hygiene kits to multidrug and extensively drug-resistant TB patients currently on treatment in the Arkhangelsk Region in northern Russia. During the distribution, basic health education on precautions against COVID-19 will be conducted by MoH nurses using informational materials on TB and COVID-19 developed by MSF
MSF Spain is preparing an accountability report regarding its intervention in Spain. This report will be shared primarily with our donors and supporters. Two advocacy reports focusing on Home Care for Elderly and Protection of Healthcare Workers are also in preparation and will be shared with relevant stakeholders and the wider MSF movement in early August.
In Geneva, MSF is sharing medical expertise with the University Teaching Hospital (HUG), focusing on COVID-19 case management and management of medical teams. We're also providing free COVID-19 tests based on symptoms in partnership with the HUG. IPC support activities have begun in Lausanne, and we are also visiting nursing homes on the French side of the border. In Vaud, MSF teams are supporting groups helping vulnerable people in the region, and in Haute-Savoie we are supporting nursing homes with IPC and medical sensitization sessions. Since April 25 an MSF logistician has been supervising food distributions organized by nongovernmental organizations for 2,500 people.
MSF supports the MoH in the response to COVID-19 in the Donetsk and Zhytomyr regions. In Mariinka Rayon, Donetsk region, an MSF mobile team provides 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. We also provide psychological support through phone hotlines to residents of Mariinka and Volnovakha Rayons. In the Zhytomyr region, MSF is provides training and psychological support to health care workers. We have visited around one-third of the facilities designated to treat COVID-19 patients in Zhytomyr and have 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 PPE, infection control, patient flows, and waste management.
MIDDLE EAST AND NORTH AFRICA
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 when authorities unexpectedly revoked permission. Activities are currently on hold, but we remain willing and able to respond if asked.
In Baghdad, MSF supports two hospitals run by the MoH (Ibn Al Khateeb & Al Kindi) with IPC support and other services and treats COVID-19 patients.
In Mosul, we have turned our post-operative care center into a temporary COVID-19 facility, where we works with local health authorities to facilitate the treatment of mild and moderate cases. Approximately 500 patients have been admitted in the facility since the beginning of the pandemic.
MSF has also been helping local health facilities in Erbil and Dohuk with technical and logistical support and staff training on IPC. In Laylan camp, Kirkuk governorate, we are mobilizing a 20-bed caravan isolation and treatment facility and continue to implement triage measures for any suspected COVID-19 patients and raise awareness about prevention measures.
Our existing projects in Ninewa, Diyala, Kirkuk, and Baghdad have also reinforced their triage capacity and continue to support ICP and refer cases to MoH hospitals according to the protocol established by health authorities.
At the beginning of the COVID-19 outbreak in Jordan we suspended admissions to our reconstructive surgery hospital and minimized activities. We have now restarted surgeries.
During the outbreak we provided trainings and other support to the Jordan Medical Association, a union of doctors, to assist them with their response to the pandemic. In Mafraq we are preparing for the resumption of face-to-face consultations in our mental health project but will continue remote consultations for patients who are not able or willing to come.
On June 1 we opened both of our noncommunicable diseases (NCDs) clinics in Irbid and Ramtha, providing NCD medication and medical consultation face-to-face for unstable patients who require follow-up while maintaining IPC measures. Phone consultations are also available. The construction of the Zaatari COVID-19 treatment center has been completed, and MSF is on standby until there is a confirmed COVID-19 case in the camp. Epidemiological surveillance is ongoing.
In Zahle, MSF set up tents outside the Elias Hraoui Governmental Hospital for triage and screening of children. Suspected cases of COVID-19 are admitted in a tent and if the positive cases are transferred to government hospitals in the area.
At the MSF hospital in Bar Elias, COVID-19 activities are still on stand-by and elective surgeries have resumed. In Siblin, in southern Lebanon, MSF is runs the medical services of the UNRWA’s Siblin Isolation Site.
In South Beirut, in the Bekaa valley, and in Baalbek-Hermel, our teams are training and assisting families on the practice of shielding, a voluntary process that can provide additional protection to people at heightened risk of contracting COVID-19.
Meanwhile, across the country MSF teams are providing intensive COVID-19 awareness sessions to vulnerable communities. Other campaigns aim to train frontline workers (such as bus drivers, internal security forces, and community-based organizations,) on IPC measures and precautions to help them reduce the risks of viral transmission in their day-to-day activities.
In Dora, a northern suburb of Beirut, MSF launched a medical helpline to provide medical support and assistance to migrant communities. We’ve also been in contact with several governmental hospitals across Lebanon to support them with different logistical services, provide them with medical supplies, and build their staff members’ capacities. In late May 2020 MSF deployed medical response teams (MRT) to support the Ministry of Public Health in its COVID-19 testing strategy across Lebanon. These teams take samples for PCR testing of contacts that have been traced and deemed related to active clusters. They also conduct assessments and provide guidance and support to medical teams and positive patients in isolation sites. Alongside the MRTs, MSF’s project-based Rapid Response Teams (part of the UN-led multi-sectoral emergency scheme) are also part of the testing campaign in their project areas, notably in Tripoli and the Bekaa Valley.
MSF activities in Libya have been impacted by restrictions imposed by the COVID-19 response, which have also increased humanitarian needs in the country. In Tripoli, MSF continues providing medical and humanitarian assistance to migrants and refugees in one detention center, while other facilities have been emptied or closed.
While curfew and lockdown measures further reduce the already extremely limited ability of migrants and refugees to access basic services, MSF participated in interagency food distributions in Tripoli and offered medical and humanitarian assistance to migrants and refugees living in urban settings.
Beyond Tripoli, we continue to work in four detention centers (in Khoms, Zliten, Zintan, and Zuwara) to provide first aid to people disembarked in Libya and primary health care and referrals to migrants and refugees in Bani Walid. A TB program is in place in both Misrata and Tripoli.
We provided COVID-19-related trainings to medical staff in all project locations. As the number of people held in official detention centers has risen to more than 2,300 in the last two months with more people transferred there upon disembarkation by the Libyan coast guards, we are reinforcing IPC and prevention measures in these facilities as much as possible given the dire conditions.
We are monitoring the spread of COVID-19 and liaising with the MoH in Gaza and Ramallah and with the WHO to follow up on the situation. In Gaza we have so far observed a small number of confirmed cases, though we are still concerned about the ability of the health system to manage an outbreak. MSF is still in touch with the MoH to discuss possible support for patient care if needed.
In the West Bank, MSF teams adapted activities to continue providing psychological support by phone. In Hebron we launched a hotline service to provide remote counseling to people most affected by the COVID-19 outbreak, such as patients and their families, medical personnel and other first responders, and families of detainees. The team is also distributing hygiene kits to remote villages and food parcels to families in need.
Northeastern Syria: MSF is part of the COVID-19 humanitarian taskforce chaired by local health authorities in northeastern Syria. We have provided training and preparedness measures in Al Hassakeh National Hospital and Al Hol camp, including creating a 48-bed isolation ward, introducing surveillance measures, case identification and management, and patient flow and triage processes, along with IPC and training on PPE.
So far, the COVID-19 situation in northeastern Syria has notdeteriorated at the rate we initially feared. Following a consultation with the community and authorities we handed over our COVID-19 activities in Hassekeh National Hospital, including the isolation ward, to local health authorities. MSF remains on standby, ready to support health authorities if a rise in COVID-19 cases occurs.
In Al Hol, where 94 percent of inhabitants are women and children, we continue to run our inpatient nutrition center and a tent-based wound care program for people who cannot reach clinics. MSF also provides water trucking in the camp, as the quantity and quality of water doesn’t meet the needs. Teams are mapping people most vulnerable to severe illnesses as a result of COVID-19 and sharing targeted health awareness messages.
We also continue to support emergency, surgical, and inpatient activities at Raqqa National Hospital and a separate outpatient clinic inside Raqqa city. Ongoing support related to routine vaccinations continues in Kobane. We are also assessing health and humanitarian needs in the region to evaluate the needs of people living in informal settlements or other camp settings.
Northwestern Syria: The first COVID-19 case in an area outside of government control was reported on July 9, and, as of July 19, 18 cases have been confirmed in these areas and 30 more in Aleppo. Our teams in Idlib National Hospital’s COVID treatment center were reinforced after the first confirmed cases.
In our burn unit in Atmeh, MSF has adapted the triage of patients, implemented IPC measures, trained the staff, and set up an isolation ward.
In the other MSF-supported or co-managed hospitals and health centers we have reviewed triage systems and patient flows to ensure fast detection of suspected COVID-19 cases and isolation from the rest of the patients. In some we have also set up hygiene committees, provided additional staff, and made donations of PPE when needed. We have strengthened IPC measures in these facilities and equipped MSF staff with the needed protective equipment.
In the camps where we intervene we are spreading awareness messages and distributing non-food items and hygiene kits. We have started a wide-scale distribution of hygiene products that targets 8,000 families in IDP camps in north Idlib.
We implemented measures to keep staff and patients safe in our existing projects across 13 Yemeni governorates while ensuring the continuation of lifesaving activities in the existing hospitals where we work and helping prepare hospitals to receive COVID-19 cases.
In Sana’a we support two hospitals. At the Sheikh Zayyed Hospital, where we were already providing training and donations, we have now started triage, an inpatient department (20 beds, expandable) and an intensive care unit (6 beds, expandable). At Al-Kuwait we offer a full package of hands-on support to the MoH, including treating the most severely ill patients in the 15-bed intensive care unit and in the large inpatient department.
In Aden, MSF was running COVID-19 treatment centers at Al Amal and Al Gamhuriah hospitals. In light of the continuing reduction in the number of admissions to the two MSF COVID-19 treatment centers in Aden, we have decided to combine activities in Al Gamhuriah hospital. Local health authorities remain in charge of the overall COVID-19 response in Aden.
In HaydanandKhamerwe have set up COVID-19 treatment centers to take care of moderate cases and have begun admitting small numbers of patients with symptoms resembling those of COVID-19.
In Hajjah governorate we are helping with preventive measures in hospitals, including the set-up of screening points for patients and support to set up an isolation unit in Abs hospital, as well as training of staff on symptoms and case definition, case management, and IPC. In the MSF-supported Al Gumhouri Hospital (Hajjah city), the referral facility for the governorate, our teams supported the setup of a COVID-19 isolation center.
In Ibbgovernorate MSF supported the MoH in Al Sahul COVID-19 treatment center, which opened on June 11 and began receiving patients on June 13. Our team conducted a five-day training for 234 medical and non-medical staff in the facility, and assists with technical support, setup of triage and screening, facility management including workforce planning, and waste management. The teams implemented IPC measures and provided training sessions, including for health promotion, for both MoH and MSF staff and private caregivers.
In Hajjah governorate’s Al Gumhouri hospital we work with the MoH to maintain essential lifesaving activities such as the emergency room, intensive care unit, operating theater, inpatient department, mental health services, and emergency referrals to Sana’a.
In Abs, in addition to supporting authorities in managing the key departments of the hospital and implementing IPC measures to protect staff and patients, we are also working with communities to understand more about perceptions and knowledge of COVID-19.
In Hodeidahwe have provided health promotion, IPC measures, and case management training in different hospitals and set up an isolation unit in Al Salakhana Hospital in collaboration with local health authorities. In Ibb and Hodeidah our teams provided health promotion, IPC measures, and case management training to the MoH.
In Taiz governate we have adapted IPC measures and patient and triage flows to protect staff and patients in our Mother and Child hospital in Taiz Houban. We continue trainings and health education sessions on infection prevention, case management, and proper use of PPE for staff and patients and caretakers. An MSF team has supported the MoH with two assessments of potential COVID-19 isolation centers and has advised on layout, patient flows, human resources, and supply needs. In Taiz city,we continue to support lifesaving activities in three hospitals in addition to providing training on IPC, screening, triage, and identification of COVID-19 cases. We’re also providing health and safety promotion to patients and caretakers in the health facilities we support, as well as to pregnant women from the city and surrounding communities.
In Marib, we trained a large group of community health workers in COVID-19 health promotion and have been providing for 42 health promotion supervisors of the Governorate Health Office in Marib on COVID-19 messaging. We also set up IPC measures and patient and triage flows to protect staff and beneficiaries in facilities run and supported by MSF. We’ve also carried out trainings on infection prevention and PPE use for all staff. Health Promotion on infection prevention is also given to all patients and caretakers at the facilities in Arabic, Oromo, and Amharic.
MSF’s international medical programs are impacted by the current travel restrictions, which limit our ability to move staff between countries. We also are dealing with the consequences of global shortages of medical supplies, in particular personal protective equipment for health care staff. Our regular health care programs are also preparing to deal with potential cases of COVID-19, especially making sure infection prevention measures are respected. We must be able to receive people with COVID-19, while making sure that no one is consequently infected in our structures, including other patients as well as staff.
We need to ensure that we can continue to provide lifesaving medical care in our ongoing projects. So far, teams are able to continue medical activities, but securing future supplies of key items—such as surgical masks, swabs, gloves, and chemicals used to diagnose COVID-19—is a matter of concern. There is also a risk of supply shortages due to a lack of production of generic drugs and difficulties to import essential drugs due to lockdowns, reduced production of basic products, exportation stops, or the repurposing and stocking of drugs and material for COVID-19.
MSF also seeks to ensure that any new treatments or vaccines developed to respond to COVID-19 are accessible, affordable, and available to all.
Teams are also preparing for potential cases of COVID-19 in our projects. Protecting patients and health care workers affected by the pandemic is essential. In places where there is a higher chance of cases, this means ensuring that infection prevention and control measures are in place, setting up screening at triage, maintaining isolation areas, and providing health education. In most countries where MSF works, we are coordinating with the WHO and the respective Ministries of Health to see how MSF could help in case of a high load of COVID-19 patients. We are also providing training on infection control for health facilities
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