Battered health systems brace for impact of the coronavirus

By Jonathan Whittall, Doctors Without Borders/Médecins Sans Frontières (MSF) head of humanitarian analysis

Inside Moria camp on the Greek island of Lesbos, these relatives sit in the tent they share with four other refugee families.
Greece 2019 © Anna Pantelia/MSF
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How are you supposed to wash your hands regularly if you have no running water or soap? How can you implement “social distancing” if you live in a slum or a refugee camp? How are you supposed to stop crossing borders if you are fleeing from war? How are those with pre-existing health conditions going to take extra precautions if they already can’t afford or access the treatment they need?

Everyone is affected by the coronavirus pandemic, but the impact may be felt by some more than others.


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COVID-19 is demonstrating how policy decisions of social exclusion, reduced access to free health care, and increased inequality will now be felt by all of us. These policies are the enemy of our collective health.

The spread of novel coronavirus and the disease it causes, known as COVID-19, will continue to expose the inequalities that exist in our health systems. It will expose the exclusion of certain groups from accessing care, either because of their legal status or because of other factors that make them a target of the state. It will expose the under-investment in free public health care for all, which means that access to quality care will for some be based on purchasing power and not medical need. It will expose the failure of governments—not just health services—to plan for and deliver services that meet the needs of everyone. It will expose the life-threatening vulnerabilities caused by displacement, violence, poverty, and war.

The people who will especially suffer will be those already neglected, due to government austerity measures, because they have fled conflict, or because they don’t have access to treatment for existing conditions under privatized health care. This pandemic will also disproportionately affect those who can’t stock up on food because they already can’t afford a meal every night of the week; those who are underpaid, overworked, and deprived of sick leave, or unable to work from home; and those trapped in conflict zones under bombing and siege.


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And how are you supposed to treat patients without all the materials that you need? Many health systems bracing for the impact of COVID-19 have already been hammered to the breaking point by war, political mismanagement, under-resourcing, corruption, austerity, and sanctions. They are already barely able to cope with normal patient loads.

As MSF scales up its response to the pandemic, we will focus on the most vulnerable and neglected. We started working with at-risk communities in Hong Kong earlier this year in response to the first cases of the virus, and we now have medical teams deployed to respond in the heart of the pandemic in Italy. We will continue to scale up as much as is feasible as this crisis spreads.

However, there are decisions that can be taken now that can ease the impending disaster that many communities may soon face. The congested camps for refugees and asylum seekers on the Greek islands need to be evacuated.

MSF Field Trauma Clinic, South of Mosul, Iraq
MSF head of humanitarian analysis Jonathan Whittall talks on the phone at the MSF field trauma clinic south of Mosul, Iraq.
Iraq 2017 © Alice Martins

That doesn’t mean sending people back to Syria, where war still rages. It means finding a way to integrate people into communities where they will be able to practice safety measures such as social distancing and self-isolation.

In addition to this, supplies must be shared across borders according to where the needs are greatest. This must start with states in Europe sharing their supplies with Italy. It will soon need to extend to other regions that will be hit by this pandemic and whose ability to cope is already compromised.

As MSF, we also need to manage the gaps we will face in staffing our other ongoing emergency projects. Our response to the measles epidemic in Democratic Republic of Congo needs to continue. So too does our response to the emergency needs of war-affected communities in Cameroon and Central African Republic. These are just some of the communities we cannot afford to let down. For them, COVID-19 is yet another assault on their survival.

This pandemic is exposing our collective vulnerability. The powerlessness felt by many of us today, the cracks in our feeling of safety, the doubts about the future. These are all the fears and concerns felt by so many in society who have been excluded, neglected, or even targeted by those in positions of power.

I hope COVID-19 does more than teach us to wash our hands. I hope it makes governments understand that health care must be for all.