India: Responding to the COVID-19 crisis and other urgent needs

Vulnerable groups need access to health care

Access to health care overall is difficult. In Mumbai, COVID-19 care is organized in dedicated hospitals, but non-COVID-19 care is under severe stress during this crisis.

The virus has crippled some of the most advanced health systems in countries that have a social safety net, where most people have access to running water and space to self-isolate. This is simply not possible for many people in India and other countries where we typically work. In particular, people living in large settlements, in overcrowded conditions, with poor sanitation services, and limited access to health care can face huge risks.

MSF is undertaking precautionary measures to ensure continuity of care to 1,287 people with drug-resistant tuberculosis (DR-TB) at the Shatabdi Hospital outpatient department and at the MSF Independent Clinic. We are scaling up screening, shielding, testing, and referral activities at the hospital, community, and nine health posts. Shielding is mainly focused on protecting vulnerable groups living in informal settlements as well as people with diabetes, elderly people, TB and DR-TB patients, and patients on antiretroviral therapy (ART).

Another priority is to reach migrant workers who come to Mumbai, and the M-East Ward (MEW) in particular, to look for work. During the first wave of the pandemic, when strict lockdown measures were in place, daily wage workers were hit particularly hard. Many lost their jobs and were forced to return to their home towns and villages. For people with DR-TB, this meant interruptions to their critical treatment, as the drugs they require are often not available in smaller cities and rural areas.

This year, in order to ensure continuity of care, we are proactively reaching out to migrant workers in our patient population. We are asking them to contact us if they have to leave and to let us know where they are going. This enables our teams to send a supply of medications to their local health centers and get in touch with their local medical teams. We are also offering telephone counseling to try and help with other problems they may face, including the loss of work or difficulties obtaining their daily ration support.

We have restarted health promotion efforts as well as water and sanitation activities in the densely populated settlements of Mumbai’s M-East Ward. Health promotion at the community level is critical to preventing the most vulnerable from getting infected.

MSF is offering mental health support to help COVID-19 patients manage anxiety and worries while in isolation. We are also providing psychosocial support for our staff. Health workers are faced with the difficult situation of not just responding on the frontlines of the pandemic, but also taking care of their own families and loved ones.

Maintaining other essential health care services

Reaching people in rural areas

COVID-19 is also affecting rural areas in India. Through our clinics in Churachandpur, Chakpikarong, Moreh, and Chakpikarong, near the Myanmar border, our teams offer screening, diagnosis, and treatment, as well as counseling and health education for TB, HIV, and hepatitis C in Manipur. To help minimize the impact of COVID-19, our teams are coordinating with local health facilities and have provided hygiene supplies to refugees fleeing the crisis in Myanmar.

In Jammu and Kashmir, where years of conflict have taken a severe psychological toll on residents, counselors are providing phone-support in order to maintain counseling services. We are planning to provide support in other parts of India through an MSF Info Line as part of our emergency response.

Our teams continue to conduct mobile clinics to take primary health care to people living in remote villages in Chhattisgarh, where it is extremely difficult for people to access medical care. Our teams provide free treatment for malaria, respiratory infections, pneumonia, and skin diseases among other conditions.