Preventing and containing outbreaks

MSF nurse Persa Dimitsaki vaccinates a child during an emergency measles vaccination campaign in Moria camp on the Greek island of Lesvos, where thousands of refugee men, women, and children live in squalid, overcrowded conditions without sufficient access to health care. "Moria camp is both unsafe and wholly unhealthy, especially for children," said Declan Barry, MSF medical coordinator. "Every day we treat many hygiene-related conditions such as vomiting and diarrhea, skin infections, and other infectious diseases, and we must then return these people to the same risky living conditions. It's an unbearable vicious circle." In May, MSF called on Greek authorities to transfer people from Lesvos to the Greek mainland and scale up provision of health care on the island.
GREECE 2018 © Julia Kourafa
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This article is part of the Winter 2018 issue of Alert—2018: The Year in Photos—featuring some of the most striking images and stories from our work around the world.

Over the past year, Doctors Without Borders/Médecins Sans Frontières (MSF) teams responded to manifold disease outbreaks in diverse contexts, from tackling malaria in Niger, to vaccinating refugee children in Greece against measles. In Bangladesh, where more than 800,000 Rohingya Muslim refugees have settled since fleeing targeted violence and persecution in neighboring Myanmar, our teams mobilized quickly to help contain a major outbreak of diphtheria.

MSF also responded to the largest outbreak of Ebola ever recorded in Democratic Republic of Congo (DRC), opening treatment and transit centers in the small town of Mangina, North Kivu, where the outbreak began, and in the larger city of Beni when it began to spread. The outbreak is proving especially difficult to curtail, with active conflict in the region hampering containment efforts. This area also sees a lot of transit and trade, and some communities straddle the border with Uganda to the east. It is quite common for people to travel back and forth, raising risks of transmission across the border and the possibility the virus could spread further in the region.

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Hygienists disinfect personal protective equipment used by medical staff in an Ebola treatment center
MSF is stepping up its response to the worst outbreak of Ebola ever recorded in DRC. Declared in August, the outbreak began in the small town of Mangina in DRC's eastern North Kivu Province. It has since moved to the larger city of Beni, where numbers of new and suspected cases of the deadly virus have been rising for weeks. MSF is on the forefront of the response, caring for patients and health workers alike. Here, hygienists disinfect personal protective equipment used by medical staff in the Ebola treatment centers, a crucial part of curbing the spread of the disease.
DEMOCRATIC REPUBLIC OF CONGO 2018 © Carl Theunis/MSF
MSF nurse dons personal protective equipment as she prepares to enter the Ebola treatment center
MSF nurse Seraphine dons her personal protective equipment as she prepares to enter the high-risk zone of the Mangina Ebola treatment center. Born and raised in North Kivu, she has worked with MSF in the region for several years. “My aunt always complained that people working in hospitals never smiled. That’s why she didn’t feel comfortable there,” she said. “She literally asked me to become a nurse so she would encounter at least one person with a smile in the hospital. So that’s what I do now—treat people in the best way I can, [and] give them a big smile!”
DEMOCRATIC REPUBLIC OF CONGO © Carl Theunis/MSF
An MSF team member prepares to enter the high risk zone of the Ebola treatment center in Mangina, DRC.
MSF hygienist Roger prepares to enter the high-risk zone of the Ebola treatment center in Mangina. The personal protective equipment worn by health workers inside the treatment centers is hot, heavy, and makes breathing difficult, which means that they can only remain inside for a maximum of one hour.
DEMOCRATIC REPUBLIC OF CONGO 2018 © Carl Theunis/MSF

A seasonal "peak" in malaria cases occurs annually in the Zinder region of Niger, but the 2018 season brought extremely high levels of mortality in children under five years old. In response, MSF sent 243 experienced medical staff from across Niger and around the world to ensure patients received the best possible care inside the hospital and in the community, where a team ran mobile clinics to care for children closer to home.

MSF team cares for pediatric patient in Niger
An MSF team sets up an intravenous catheter on a pediatric patient at the district hospital in Niger's Zinder region in September. "We have never seen anything like this before, and we fear it's just the tip of the iceberg," said Dr. Dorian Job, MSF's Niger program manager. "Every year, at this time, we expect a peak in malaria infections, as well as an incidence of malnutrition above emergency thresholds, but we haven't seen patients overwhelming the hospital in such numbers before."
NIGER © Laurence Hoenig/MSF

In early 2018 an outbreak of diphtheria raged in the refugee camps in Cox's Bazar, where hundreds of thousands of Rohingya people settled after fleeing Myanmar, where they had extremely limited access to health care. Though diphtheria is covered by the most basic vaccine packages, the deadly childhood disease spread quickly through the camps in Bangladesh, where most children had not been immunized.

Diphtheria intervention in Cox's Bazar
An MSF doctor cares for a patient suffering from diphtheria at an MSF clinic near Cox’s Bazar, Bangladesh. “We should not be seeing cases of diphtheria anymore,” said MSF doctor Rosie Burton in January. “So when it appears it shows there has been a fundamental breakdown in vaccination programs.”
BANGLADESH 2018 © Sara Creta/MSF