Brazil: MSF’s COVID-19 response provides care to vulnerable people

MSF evaluates and screens homeless people for COVID-19 in shelters in downtown São Paulo, where infection rates seem very high. Teams also visit shelters to provide health and basic IPC education to health professionals.
Brazil 2020 © Diogo Galvão
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NEW YORK, APRIL 23, 2020—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is working with homeless people and Venezuelan migrants and asylum seekers as part of its COVID-19 response in Brazil. Teams have started working in the nation’s largest city, São Paulo, and Boa Vista in the north of Brazil.

In São Paulo, which has the highest number of COVID-19 cases, MSF has begun working with homeless people, migrants and refugees, drug users, and the elderly—groups that were already especially vulnerable even before the pandemic.

Teams here are providing medical consultations and screening for COVID-19, referring patients in more serious conditions to hospitals, training health professionals on the use of protective equipment, and visiting shelters, government-run subsidized restaurants, and food distribution sites for the homeless. Staff are also working in partnership with local authorities and organizations to educate people living on the streets about proper hygiene measures to help prevent the spread of COVID-19.

“If we are unable to identify them early enough, patients in more serious condition that are on the street will die on the street,” said Ana Letícia Nery, MSF's project coordinator in São Paulo.

In Boa Vista, in Roraima state, where MSF has been supporting the local health system since 2018 by providing physical and mental health care, teams are working with Venezuelan migrants and asylum seekers who live in precarious conditions, often in close quarters and without regular access to water.

“Even before the arrival of the pandemic, Roraima's health system was already fragile, and this situation has made things worse,” said Michael Parker, MSF project cordinator in Boa Vista. “We are working to try to lighten the burden on the local system, both in relation to COVID-19 and other diseases.”

MSF is working in coordination with local authorities and other organizations in Boa Vista as part of “Operação Acolhida,” an initiative of Brazilian authorities and the United Nations Refugee Agency to assist Venezuelan migrants arriving in Brazil.

Paying special attention to people with pre-existing diseases that make them more susceptible to COVID-19 in this part of the country, MSF teams are regularly visiting informal shelters, where a considerable number of migrants live, to provide hygiene and physical distancing guidance, water, and hygiene kits. The capacity of official shelters, where housing and hygiene conditions are reasonably maintained, is about 7,000 people. But there are tens of thousands for whom there is no space in these shelters and who instead live in makeshift settlements, which are usually overcrowded, lacking access to clean water, sewerage, and electricity. Other migrants are living on the street.

In addition to the complexity of the pandemic itself, in Brazil there has been a great deal of conflict between different levels of government in relation to physical distancing, with contradictory views.

“The experience of other countries, where the pandemic arrived before Brazil, has shown the importance of adopting physical distancing measures,” said Ana de Lemos, executive director of MSF-Brazil. “It is important that we slow down the rate of contagion as much as possible so that we can reduce the number of serious cases that reach the hospitals at the same time. At times like this, it is crucial to have a clear orientation, but unfortunately, we have witnessed the diffusion of contradictory guidelines that hinder compliance with the necessary measures."

In addition to these two projects, MSF is making final arrangements to start working with vulnerable populations in Rio de Janeiro. A team was also sent to the Amazonian city of Manaus to evaluate how MSF can contribute to the local efforts against COVID-19.