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 May 27, there were more than 5,591,067 cases of coronavirus in 213 countries, territories, or areas, and 350,458 people have lost their lives. There are now more cases in the United States (1,716,612) 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.
- Burkina Faso: In Ouagadougou, MSF teams continue the construction of a 50-bed hospital center for the care of COVID-19 patients. The facility should be ready to receive patients by May 15. We've also recruited nearly 70 new staff members including nurses, medical doctors, and logisticians. We've also launched awareness-raising activities and meetings with community leaders in the Boulmiogou commune. MSF is working in Bobo-Dioulasso, in western Burkina Faso, the country's second-most severe outbreak epicenter. We are caring for COVID-19 patients in a dedicated facility in collaboration with health authorities and reinforcing triage, isolation, and IPC measures in other facilities. We are also strengthening epidemiological surveillance at the community level; providing psychosocial support to patients, families, and contacts; distributing protection kits to vulnerable people; and stepping up sensitization activities. In the Eastern area, we have rehabilitated a provisional isolation site at the regional health center in Fada. We are also training health workers, identifying isolation sites, and adapting patient flow and triage at structures we support, in addition to implementing water and sanitation to minimize risk of infection. In the projects in Titao, Djibo, Kaya, and Barsalogho—which have not yet been affected by the pandemic—we have adapted triage and IPC measures in the health structures we support, set up isolation units, and trained staff.
- Cameroon: In Yaounde, MSF started receiving moderate COVID-19 patients in the Djoungolo health facility, where we built four 20-bed rooms, increasing capacity to 110 beds. We also supported the Hôpital Général in triage, patient flow, and IPC measures, and set up a systematic triage service at Jamot hospital. In northwestern and southwestern Cameroon, MSF is supporting regional hospitals in Bamenda and Buea with case management of COVID-19 patients. We have set up pre-screening points at the entrances of these facilities, supported the implementation of COVID-19 isolation and treatment wards, and trained medical and nonmedical staff. MSF has also strengthened measures to prevent the spread of coronavirus in the health facilities we support in Bamenda, Kumba, Muyuka, Mamfe, and Widikum. We are also providing logistical and training support to Tiko District hospital. Community health workers have also been trained to provide information on COVID-19 and identify potential patients. In Douala, Cameroon's second-most affected city, we trained staff at the general hospital and will train more at two other facilities next week. In the Far North, patient flow and IPC measures have been adapted in both Maroua regional hospital and Mora hospital.
- Democratic Republic of Congo: MSF has set up a 20-bed isolation ward in North Kivu's Masisi General Reference hospital. In Kinshasa we support St. Joseph hospital, one of six identified by the Ministry of Health for COVID-19 case management. As of April 30 there were 20 patients hospitalized. Training of medical staff on COVID-19 detection and prevention has begun, and the team is working on installing a 40-bed isolation tent. In Goma, MSF is preparing to support the Ministry of Health in managing a COVID-19 treatment center, previously used as an Ebola treatment center, in Munigi. In Lubumbashi, we are preparing to support a 20-bed dedicated COVID-19 structure constructed near the airport.
- Eswatini: We are supporting the Ministry of Health with IPC measures and triage at health facilities. We are also implementing adjusted models of care for patients living with HIV, tuberculosis, and noncommunicable diseases in order to reduce their risk of coronavirus infection.
- Guinea: Since April 30 MSF has been caring for COVID-19 patients in the Nongo Epidemic Treatment Center in Conakry. We set up this facility in 2015 as part of the response to the Ebola epidemic in the region, and it was later handed over to authorities. In recent weeks MSF has rehabilitated the structure to bring it up to standards and increase capacity. We will initially be able to care for 75 patients with mild COVID-19 symptoms, with the possibility of expansion. About 60 patients have already been hospitalized.
- Guinea-Bissau: MSF provided training on clinical management and IPC for Ministry of Health staff, Red Cross volunteers, civil protection, and police. We also trained health promoters and support a 24/7 national call center.
- Ivory Coast: Outside Abidjan, MSF and Ministry of Health medical teams are now caring for moderate COVID-19 patients in the treatment center of Grand Bassam, which currently has a 76-bed capacity. We also produced one million tissue masks to be distributed to the general population in Abidjan and Bouake, where we run activities. In Bouake there have been no new COVID-19 cases in two weeks. We continue to train health workers and support screenings at the different entry points to the city. MSF is also implementing water and sanitation activities.
- Kenya: MSF supports several health facilities in Nairobi, Kiambu, Dadaab, and Mombasa counties in conducting health awareness education, providing case management training and logistical support, and boosting IPC and triage. In Kibera, Kenya's largest informal settlement in Nairobi, a team is screening and referring suspected COVID-19 patients to Mbagathi hospital. In an effort to mitigate the spread of COVID-19, patients with noncommunicable diseases have received medications for three months in Embu county, where MSF supports five hospitals with triage and screening and is supporting IPC in 11 health facilities. In Homa Bay county, we have provided three months of ARV treatments to patients to avoid their exposure to COVID-19 at the hospital. We also assisted the Ministry of Health with 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 potential COVID-19 patients, with the capacity to expand to 40 beds. We've also set up isolation rooms at Mrima health center in Likoni subcounty, Mombasa, which will allow women with COVID-19 to give birth safely.
- Liberia: There are 166 confirmed cases of COVID-19 in the country, and 18 people have died. MSF completed a month-long COVID-19 hygiene awareness and soap distribution campaign reaching more than 78,000 households in four of Monrovia's most vulnerable neighborhoods, and continues to provide technical support at the city's Military Hospital, where COVID-19 patients are being treated. MSF is carrying out awareness activities on COVID-19 prevention in and around Monrovia. We continue to operate our mental health project remotely, talking to patients on the phone and providing two-month supplies of drugs when necessary. Earlier this month we were forced to suspend pediatric surgeries due to staffing shortages resulting from travel restrictions.
- Mali: MSF is supporting the management of a COVID-19 unit in a hospital in Bamako, where we already run an oncology program ("Point G hospital") with a capacity of up to 100 beds. Eighty patients have been admitted so far. We're also helping with IPC, water and sanitation, training of staff, and revision of patient flow in two other Bamako hospitals receiving COVID-19 patients. We're working on health promotion with local actors and reinforcing Ministry of Health community outreach and contact tracing activities in Bamako, set up 60 handwashing stations, and provided 18,000 locally produced cloth masks in at-risk locations. In the center (Niono, Tenenkou, Ansongo, Douentza, Koro) south (Koutiala) and north (Kidal and Ansongo) of the country we have strengthened hygiene and IPC measures and set up isolation areas in supported hospitals and health centers. We're also supporting Ministry of Health activities such as case management, awareness raising, and improving prevention and setting up isolation structures. Technical advice and support has been provided to hospitals in Gao and Sévaré.
- Mozambique: MSF teams are integrating surveillance for COVID-19 into all project activities, with an emphasis on high-risk populations. We've donated four tents to the main Maputo Central hospital, and have adapted our models of care to implement physical distancing. Our teams are also working with local health authorities to improve patient flow at two referral hospitals in Maputo.
- Niger: A semi-permanent treatment center with a 50- to 100-bed capacity should be ready in early May near the Hôpital National Lamordé in Niamey, where MSF and Ministry of Health workers will manage moderate COVID-19 patients. We are also supporting the emergency medical service's 24/7 call center and response teams in the city. A response team comprising MSF and Ministry of Healths staff are monitoring simple COVID-19 cases at home, referring serious cases to health structures.
- Nigeria: MSF is working to maintain its operations in Nigeria while also establishing isolation facilities, adapting triage processes, launching additional community-based health promotion activities, and setting up handwashing points and isolation areas in local communities and camps for internally displaced people. In Ngala, MSF teams are focusing on reinforcing IPC. On April 18 an MSF nurse anesthetist who passed away in Maiduguri tested positive for the coronavirus. We are supporting the Ministry of Health with contact tracing.
- Senegal: 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.
- Sierra Leone: MSF is part of the case management and surveillance pillars at the national Emergency Operations Center. As part of our partnership with health authorities, MSF regularly carries out assessments at facilities that are being considered for conversion into COVID-19 treatment centers. In Freetown, MSF water and sanitation and construction specialists have begun work on repurposing a government facility into a 120-bed COVID-19 treatment center. In Kenema district, MSF carried out an assessment at Kenema Government hospital, where we had been engaged to assist in opening a COVID-19 treatment center. In Makeni Regional hospital, Magburaka hospital, and Hinistas Community Health center, MSF has set up isolation wards. In Freetown, an MSF epidemiologist is assisting with surveillance activities, and MSF epidemiologists are also working in Tonkolili and Bombali districts. Also in Kenema, MSF projects in Kenema, Gorama Mende, and Wandor provide regular donations of IPC supplies to health facilities as part of standard operations in an area where Lassa fever is endemic. The MSF project in Kenema has donated handwashing stations to 42 villages after meeting with community representatives.
- South Africa: MSF has sent staff from all four of our projects to help support the COVID-19 response in Gauteng, KwaZulu-Natal, and Western Cape provinces. Staff are assisting with contact tracing, both in person and over the telephone; the development and dissemination of health promotion materials; and the decanting of health care facilities; and we're working to ensure HIV and tuberculosis patients get medication refills delivered to their homes. In Tshwane, we're providing care for vulnerable asylum seekers and elderly homeless people to mitigate the impact of the extended national lockdown. In Johannesburg a mobile team conducts primary health care consultations and COVID-19 screening in three homeless shelters, with links to an MSF testing and tracing team. In Eshowe and Rustenburg, MSF set up triage tents and handwashing points at supported facilities, and health promotion continues.
- Sudan: In our projects across Sudan MSF is implementing safety and hygiene measures to avoid cases of COVID-19 among our staff. In collaboration with WHO and Sudanese health authorities MSF has 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 authorities. MSF teams are in contact with the Ministry of Health to support preparedness, including IPC measures, setting up treatment centers, training MSF and Ministry of Health staff, and logistics. At Omdurman Teaching hospital, the largest in the country, an MSF team of more than 60 staff works closely with the Ministry of Health in the emergency department and on preparedness for COVID-19. We are also supporting health authorities in setting up and managing isolation centers in two towns in east Darfur and South Kordofan states.
- South Sudan: MSF is assisting the Ministry of Health with the training of health care workers in IPC and triage for patients exhibiting symptoms consistent with COVID-19. In Juba, MSF teams are installing handwashing points in several locations with high concentrations of people, including around hospitals and health care centers and in and around Konyo Konyo, the main market area.
- Tanzania: MSF is the sole health care provider in Nduta refugee camp, which hosts 75,000 Burundian refugees. In preparation for a COVID-19 outbreak in the camp we have built four triage/isolation areas in each of the health clinics where we work in the camp. We completed preparation of an isolation center at the MSF hospital, where suspected cases of COVID-19 will be referred. We currently have a 10-bed capacity with the possibility to connect 10 oxygen concentrators and are in the process of constructing an additional 50, with the option to scale up to 100 if needed. One-hundred sixteen MSF staff have been trained on COVID-19 response with a focus on case definition, triage, screening, IPC, and case management. Training is ongoing in our hospital in Nduta camp. Our health promotion team in the camp is working to educate the community on hygiene and best health practices to improve COVID-19 preparedness.
- Zimbabwe: MSF is supporting management of COVID-19 cases in isolation in Harare and upgrading capacity to 164 beds while water and sanitation teams provide additional support in communities. We've trained more than 145 health care workers on COVID-19 case management, laboratory and epidemic surveillance, IPC, water and sanitation in facilities, contact tracing, data management, and safe transport of people who test positive for coronavirus.
USA: In response of the outbreak of COVID-19 in the United States, we are working with local authorities in key locations around the country and partner organizations that serve vulnerable populations that are normally excluded from healthcare, such as migrants and the homeless, and communities that are especially likely to be left behind during a health emergency. Learn more.
- Brazil: We have begun activities in São Paulo, screening homeless people and other vulnerable groups for coronavirus and conducting health promotion. Infection rates seem very high. Teams have also been visiting shelters to provide health and basic IPC education to health professionals. In Boa Vista, Roraima state, an MSF team visited informal shelters where migrants and refugees from Venezuela have gathered, providing hygiene and physical distancing education, expanding access to water, and distributing hygiene kits.
- El Salvador: MSF has strengthened ambulance services in difficult-to-reach areas to alleviate the workload of the emergency system that is dedicated to the transport of COVID-19 patients. Teams have assessed isolation centers where people arriving in the country are quarantined for 30 days, and has begun providing mental health care to people in isolation after being deported from Mexico and the US.
- Haiti: In Haiti there are now 100 confirmed cases of COVID-19 and there have been 11 deaths. MSF has installed 14 isolation beds in its emergency care facility in the Martissant district of Port-au-Prince, and in two Ministry of Health facilities we support in Port-á-Piment and Port Salut. In all of these structures MSF has implemented triage, IPC training, and early detection of suspected COVID-19 cases, in addition to handwashing points, latrines, and emergency showers. We've also provided PPE to staff. A referral system with dedicated ambulance for suspected COVID-19 cases has also been implemented, and we are carrying out health promotion activities via mass media and social networks. The burn center in Drouillard has suspended admissions as it reorients to implement a COVID-19 treatment center. On May 4 we began setting up a triage and isolation unit in the departmental referral hospital (HIC des Cayes).
- Mexico: In Matamoros and Reynosa MSF has increased and adapted activities in a shelter and a camp for asylum seekers. So far, no cases of COVID-19 have been detected. The team has identified a hospital in Mexico City and a decongestion center in Tijuana where we've begun trainings and established a patient circuit, with the aim of alleviating the hospital's burden by caring for moderate patients. Recruitment of staff to support hospitals in the management of 150 beds has begun, and teams are assessing hostels for vulnerable people in Mexico City, Tijuana, and Mexicali.
- Venezuela: 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
- Afghanistan: MSF COVID-19 response teams arrived in Herat and Kabul last week and are now carrying out assessments to explore what additional support can be provided to the Ministry of Public Health. In Lashkargah an MSF team is providing technical support for the management of a COVID-19 facility set up in Malika Suraya hospital. In all of our projects in Afghanistan MSF has implemented preventive measures to mitigate the risk of our facilities becoming part of the chain of transmission. In Kunduz, wound care clinic activities have been temporarily suspended, as has our work in the small stabilization clinic in Chardara district, west of the city. Some construction activities in our various projects have also been put on hold.
- Bangladesh: In addition to maintaining regular medical activities in the Rohingya refugee camps, teams are organizing dedicated waiting areas for people with symptoms of COVID-19. In MSF hospitals we have built dedicated COVID-19 wards and isolation rooms, with the goal of reaching a 300-bed capacity. Our teams are also carrying out health promotion activities in the camps.
- Cambodia: MSF provided training for staff in health facilities and is contributing to the development of national guidelines for IPC and clinical care for COVID-19 patients.
- Hong Kong: The local outbreak in Hong Kong seems to be under control, and COVID-19 measures are being relaxed. The MSF project has shifted its focus from health education to mental health support.
- Indonesia: MSF is supporting COVID-19 preparedness of two health centers in Labuan and Carita sub-districts in Banten province. In Labuan, we are supporting sluice area cleaning, improving ventilation of the isolation room, and conducting training on PPE. We're also supporting technical training, establishing standard operating procedures, reinforcing IPC and supervision, and providing logistical support. Health education continues, and we've set up handwashing points in Labuan and Carita. We're also providing surveillance, contact tracing, and home quarantine support to the COVID-19 task force sub districts. With the lifting of government suspension on adolescent health activities, MSF has now resumed regular home visits to provide medical care, observing COVID-19 prevention and precautionary measures in line with national guidelines.
- Kyrgyzstan: MSF is working closely with the Ministry of Health to support COVID-19 preparedness planning, with a specific focus on our operations in Kadamjay Rayon and Batken Oblast. We have also provided the Ministry of Health with personal protective equipment, including N-95 masks, gloves, thermometers, and sanitization supplies.
- Malaysia: We are prepared to increase support to the Ministry of Health and district authorities with contact tracing and testing. We have also called on the Malaysian government to repeal a directive that public health facilities report "irregular migrants," including refugees and asylum seekers. In Penang we are providing COVID-19 health education in multiple languages, including Rohingya and Burmese, and translation services in hospitals. Though we've had to suspend mobile clinics, patients can still reach our teams via a phone hotline.
- Myanmar: Our teams have implemented emergency preparation plans in each of our projcets, including IPC and PPE training, additional handwashing points, and quarantine options for staff. WE've also provided extra drugs to HIV and noncommunicable disease patients. We're closely collaborating with the Ministry of Health, providing technical trainings, translations, and other assistance and donating supplies.
- Pakistan: 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.
- Phillippines: 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.
- Tajikistan: On April 30 the first COVID-19 cases were reported, and there were 128 confirmed cases and two deaths as of May 4. We are prioritizing continuity of care for essential services for tuberculosis patients and developed a tuberculosis and COVID-19 health education leaflet.
- Uzbekistan: In Karakalpakstan, MSF has launched a Karakalpak-language health promotion campaign directed at people living with tuberculosis to educate them about the risks of the coronavirus.
- Belgium: In Belgium MSF's COVID-19 response focuses on nursing homes for the elderly and disabled and homeless people and migrants. Our eight mobile teams have visited 115 nursing homes and we have conducted multiple webinars for nursing home staff. We are adapting our existing isolation medical structure in Brussels to meet the new needs as more testing has resulted in growing numbers of confirmed COVID-19 cases, reducing available space for suspected cases. So far, 96 patients have received care in this facility, and 52 have been discharged. An outreach team continues to support facilities sheltering vulnerable people.
- France: Teams are running medical projects for vulnerable groups, including homeless people and migrants, in Paris and surrounding areas. We are working in emergency shelters set up to accommodate people living on the streets during lockdown, providing medical support, evaluating health status, and identifying potential COVID-19 cases. A new hotline has been set up to provide advice to managers of these facilities. We're also offering general consultations near food distribution sites and providing medical assistance in two "COVID centers" set up to isolate and accommodate migrants and homeless people suffering from COVID-19 in Châtenay-Malabry and Aulnay-sous-Bois. On April 4 we wet up inflatable tents in Reims hospital to temporarily increase ICU capacity. On April 8 a new intervention was launched in Henri-Mondor hospital in Créteil to increase capacity for patients suffering from severe COVID-19. MSF also provides organizational and technical support and staff to manage a new 10-bed care ward. Screening, counseling, and testing have begun in vulnerable neighborhoods of Marseille. Our teams are also intervening in nursing homes around Paris.
- Germany: An MSF team supports authorities in the federal state of Saxony-Anhalt in a center for asylum seekers in the city of Halberstadt, where COVID-19 cases were confirmed and hundreds of people are currently quarantined. We provide health education including IPC and psychological support. Elsewhere in Germany MSF advises organizations, volunteer groups, and state institutions, including some working with homeless people, migrants, and other vulnerable groups, to implement IPC measures.
- Greece: MSF is providing support on the islands of Samos and Lesbos. We are currently doing health promotion for residents of the camps and have procedures in place to support referral of patients that might present symptoms of COVID-19. For the moment there have been no reported cases in the camps. At the same time we have adapted our facilities and procedures in order to ensure the safety of both patients and staff, increased provision of water and sanitation services in the camps, and scaled up operations with recruitment of more medical, paramedical, and support staff. We are in discussions with the Ministry of Health to coordinate further action and support in case the virus reaches the camps. We continue to call for the immediate evacuation of refugees and asylum seekers trapped in squalid camps, high-risk environments for the transmission of COVID-19.
- Italy: MSF supported three hospitals at the epicenter of the outbreak in Europe, in the Lombardia region in northern Italy, to strengthen infection prevention and control measures and provide additional doctors. Outside the hospitals we are conducting outreach activities to reach vulnerable people, supporting family doctors and health care workers, and assisting people living under home isolation with a telemedicine program. In the Marche region, MSF teams increased support in 30 retirement homes, providing IPC and staff training. In Rome, we launched an emergency intervention at Selam Palace, a building hosting more than 500 refugees, that includes a clinic and health promotion services. There are currently about 50 full-time MSF staff responding to COVID-19 in Italy.
- Netherlands: We are providing mental health support to frontline health workers, including a video that has been widely shared in hospitals and nursing homes across the country.
- Portugal: MSF teams are visiting nursing homes and supporting authorities to train staff and set up IPC measures.
- Spain: Since mid-March MSF has supported nearly 350 Spanish nursing homes, some 300 of which were visited by an MSF team. Activities in Madrid and Barcelona have entered the handover phase, while work in other areas such as Tarragona, Palencia, and Asturias is beginning. We are winding down activities, with a full closure of operations expected in two to three weeks.
- Switzerland: 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.
- Ukraine: We have expanded health education activities for all patients and staff and are increasing IPC measures at our projects and offices. Psychological support for patients is available by phone. We have also launched a psychological support hotline in eastern Ukraine, covering Mariinka and Volnovakha Rayons in the Donetsk region, in order to help people living near conflict cope with the additional stress of COVID-19.
- United Kingdom: MSF staff provide nursing and logistics support at the London COVID CARE Centre in partnership with the University College London Hospital (UCLH) Find & Treat team. The project provides rapid testing, accommodation for self-isolation, and medical care for homeless people with suspected or confirmed cases of COVID-19.
MIDDLE EAST AND NORTH AFRICA
- 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 when authorities unexpectedly revoked permission. Activities are currently on hold, but we remain willing and able to respond if asked.
- Iraq: We are supporting Baghdad's Ibn al-Khatib hospital, one of the main hospitals treating COVID-19 patients in the city. Teams provide technical training on patient triage and IPC. In Mosul, MSF has equipped a 50-room building run by the Ministry of Health in Al Salam hospital complex to ensure the isolation of patients. Al Shifaa, another hospital in the complex, was built by MSF in 2019 and now serves as the main COVID-19 referral point for patients in Nineveh province. MSF is supporting the hospital by setting up 40 isolation rooms and 30 beds for mild and moderate cases in its center for post-operative care. Twenty-six isolation rooms are already occupied by patients suspected of having COVID-19. MSF will work with local health authorities to facilitate their treatment. We're also helping local health facilities in Erbil with technical and logistical support and IPC training. Our existing projects in Nineveh, Diyala, Kirkuk, and Baghdad continue to provide lifesaving health care while reinforcing capacity to identify COVID-19 patients, support IPC, and refer patients to Ministry of Health hospitals in accordance with established protocols.
- Jordan: MSF has adapted operations in Jordan to ensure continuity of care while assisting Jordanian authorities with COVID-19 response. In Amman we have stopped admissions to our reconstructive surgery hospital but continue to care for 170 patients there. We have reorganized the hospital to care for COVID-19 patients should authorities ask us to intervene. We've also provided training and other support to the Jordan Medical Association and are exploring further collaboration with them and the MoH. In Irbid, remote mental health consultations continue, and we are delivering medications daily for patients suffering from noncommunicable diseases in both Irbid and Ramtha. MSF has also assessed the needs of Syrian refugees in Zaatari camp and are prepared to intervene if need be.
- Lebanon: In Zahle, where MSF runs a pediatric ward in the Elias Hraoui Governmental hospital (now a COVID-19 referral hospital), our teams are supporting hospital staff by managing a triage zone for children in tents outside the premises and management of suspected cases in the inpatient department and pediatric intensive care unit. There are no positive COVID-19 cases at this time. We've also set up a COVID-19 emergency room outside the hospital for triage and screening of adult patients. In Bar Elias, where MSF's elective surgeries hospital was being prepared to manage a potential influx of COVID-19 patients, surgeries have been temporarily suspended and COVID-19 activities are on standby. We've also been in contact with several governmental hospitals in Hermel, Saida, and Tripoli to support them with logistics services, medical supplies, and training. MSF also deployed a medical team to the UNRWA's Siblin training center near Saida, which has been converted into an isolation site. We trained staff on IPC and biosafety. In Dora, a suburb north of Beirut, MSF has launched a medical helpline in partnership with a local organization called Anti-Racism Movement to provide medical support and assistance to migrant communities, especially female domestic workers. MSF awareness campaigns have also been conducted from Akkar to Tripoli, South Beirut, and Bekaa. We are engaging with community leaders and partner organizations to spread awareness about protective measures, especially in crowded refugee camps and informal tent settlements.
- Libya: MSF is training medical staff in Zliten, Misrata, Khoms, Yefren, and Bani Walid and reinforcing IPC measures in detention centers.
- Palestinian Territories: MSF teams are closely monitoring the spread of COVID-19 and liaising with the Ministry of Health in Gaza and Ramallah and with the WHO to follow up. In Gaza we have observed a small number of confirmed cases, though we are still concerned about the health system's ability to respond to the outbreak. In the West Bank, MSF teams adapted activities to continue providing psychological support over the phone to people in need. In Hebron, we launched a hotline service to provide remote counseling to people affected by the pandemic, such as patients and their families, medical personnel and other first responders, and families of detainees. Meanwhile, a team is distributing hygiene kits to remote villages and food parcels to families in need.
- Syria: In northeastern Syria MSF is part of the COVID-19 humanitarian task force chaired by local health authorities. We provide training and preparedness measures in Al Hassakeh National hospital and in the Al Hol camp for displaced people, including a 48-bed isolation ward, disease surveillance measures, case identification and management, and patient flow and triage processes, in addition to IPC and PPE training. We're also providing logistical support to prepare health facilities to receive COVID-19 patients and have also started mapping vulnerable people who are more likely to develop severe illness as a result of COVID-19 and sharing targeted health awareness messages and hygiene kits accordingly. We are preparing to use the camp's inpatient therapeutic feeding center for case management if needed. In northwestern Syria there were 38 suspected cases of COVID-19 in Idlib as of May 1. All were admitted to the Idlib National Hospital's COVID isolation unit, where 18 were tested with negative results. We reviewed triage systems and patient flows in some of the hospitals we support in the region to ensure quick detection of potential COVID-19 cases. We have also set up hygiene committees and reinforced them with additional staff, strengthened IPC measures in our facilities, and equipped our staff with PPE and donated more to facility staff in preparation for an increased number of consultations. We are raising awareness about the pandemic in displacement camps where we work and have implemented physical distancing measures and reviewed protocols in order to continue distribution of non-food items and health care services. In the Deir Hassan area we distributed thousands of hygiene kits in camps for internally displaced people. Services for people with noncommunicable diseases resumed in Adana district, and two mobile clinics are now providing safe distribution of drugs outside health centers. In Idlib governorate, MSF community health workers provided COVID-19 prevention education during a non-food item distribution to 20,000 families carried out by Relief Aid in the Harem and Salqen camps. We also supported the Idlib National hospital with the design of a COVID-19 isolation unit. Medical and logistical supply donations were delivered to the hospital's quarantine department, and preparation of the isolation ward is ongoing. Isolation staff were trained in COVID-19 case management. In Al Salamah hospital in Azaz, MSF has set up a COVID-19 triage tent, though no suspected cases have been registered yet. Patients with noncommunicable diseases have been given two months of treatment to reduce the risk of infection during hospital visits. In order to keep our burn unit running in Atmeh, MSF has organized the triage and screening of burn patients and implemented IPC measures. We've also trained medical and logistics staff and prepared a COVID-19 isolation ward in the hospital.
- Yemen: MSF has implemented measures to keep staff and patients safe in our existing projects across 13 governorates in Yemen. We're ensuring continuation of lifesaving activities in the hospitals where we work while helping them prepare to receive COVID-19 cases. In Aden we assisted with setting up COVID-19 treatment centers and supported the Ministry of Health in opening an isolation facility. In Hajjah governorate, we've rolled out preventive measures in both Abs and Al Jambouri hospitals, including a screening point for patients entering the facilities, isolation capacity, and improved IPC measures, in addition to training both MSF and MoH staff on symptoms and case definition, case management, and IPC. An MSF supported COVID-19 isolation center is now officially part of the hospital, and will be the referral hospital for COVID-19 in the governorate. Six suspected COVID-19 patients have been admitted to the isolation unit in Abs hospital, but so far all have tested negative for the disease. In Al Jambouri hospital we maintain essential services such as the emergency room, intensive care unit, operating theater, inpatient wards, mental health care, and emergency referrals to Sana'a. In Abs we also work with communities, including by holding focus group discussions in Al Khudish camp, to better understand perceptions and knowledge of COVID-19. In Sanaa we support hospitals, including Sheikh Zayyed hospital, one of the city's designated COVID-19 treatment centers. Along with technical expertise for screening, triage, and IPC, MSF has donated hygiene and cleaning supplies and is planning to provide medicines to support the treatment of COVID-19 cases if the need arises. In Ibb governorate we supported local authorities with the construction of a COVID-19 treatment center, implemented IPC measures, and provided health promotion training for both Ministry of Health and MSF staff and private caregivers. In Hodeidah we conducted trainings in hospitals and set up a second isolation unit in Al Salakhana hospital. We are also conducting trainings and implementing IPC measures in the mother-and-child hospital in Taiz Houban. In Hodeidah we have conducted trainings in hospitals and set up an isolation unit in Al Salakhana hospital. We are also conducting trainings and implementing IPC measures in the mother-and-child hospital in Taiz Houban. In Ibb and Hodeidah our teams provided health promotion, IPC, and case management training to the Ministry of Health. In Taiz city we are providing training on IPC and health promotion materials in the three hospitals we support, in addition to setting up triage, screening, and identification of potential COVID-19 cases. In Marib we have trained a large group of community health workers.
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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