Global Response on COVID-19
The COVID-19 pandemic is an unprecedented global emergency—its rapid spread has overwhelmed healthcare systems, disrupted economies, and altered social life in many parts of the world. In human terms, the disease's toll is almost unfathomable: COVID-19 has killed more than 4 million people since it was first reported by the World Health Organization (WHO). There have been more than 200 million cases reported so far—and many more go undocumented.
Doctors Without Borders/Médecins Sans Frontières' (MSF) teams are responding to the pandemic in more than 70 countries. Our teams are caring for patients, offering health education and mental health support, providing training for vital infection prevention control measures in health facilities, donating personal protective equipment (PPE) and supporting response efforts by local authorities around the world. A key priority is to keep our other essential medical programs in our projects running amid this new emergency.
Everywhere we work, we see how this pandemic hurts already vulnerable and marginalised communities. This is obvious in many countries with the highest death tolls—including in the United States, India, Brazil, and Mexico. We are also responding to the growing needs in countries where we run some of our largest medical projects, such as Iraq and Yemen.
Doctors Without Borders/Médecins Sans Frontières teams doing COVID-19 triage in Brussels. © Kristof Vadino
Coronavirus patient Alba Ramos is treated by Doctors Without Borders/Médecins Sans Frontières health workers in the intensive care unit inside of the COVID-19 unit operated by Doctors Without Borders in collaboration with Pérez de León II Hospital in Caracas, Venezuela. © Carlos Becerra
Medical personnel support the COVID-19 response at the San Lazaro Hospital, Manila, Philippines. © Veejay Villafranca
Nader Owidat (Counselor Educator) is conducting a COVID-19 health promotion activity with children in Masafer Yatta, a collection of 19 Palestinian hamlets in the Hebron Governorate (West Bank). © MSF
The COVID-19 Crisis Continues
The COVID-19 pandemic continues to rage on as new strains of the virus emerge and spread across the world. Doctors Without Borders has scaled up its intervention and started a new project in many different countries. The increasing number of people with COVID-19 has devastated the health care system and overwhelmed frontline workers.
The demand is just so huge. Imagine a thousand-bed hospital, there’s 28 wards as well as the emergency, casualty and triage areas. It’s a makeshift hospital in a huge metal tent. Walking into it the first time was a surreal experience; I’ve never seen anything like it.Gautam Harigovind, Mumbai, India
- Southeast Asia
Doctors Without Borders responded to the COVID-19 surge that started at the end of June. We increased our donation of PPE to health facilities and included rapid antigen tests for COVID-19 in the package.
In Banten, our team did another round of COVID-19 refresher training in all 19 villages in Labuan and Carita Sub-districts and distributed new awareness-raising materials related to the health protocols. The team also conducted health promotion on vaccination in the targeted schools.
Meanwhile, in Jakarta, the team worked on training modules for monitoring COVID-19 patients in home isolation and for the safe transport of COVID-19 patients. The team also started discussions and planning with Muhammadiyah – a national faith-based organisation – on possible support for an isolation facility for COVID-19 patients with mild to moderate symptoms. In addition, the assessment was also ongoing to establish handwashing facilities in Koja village and the health centre personnel.
Finally, in August, Doctors Without Borders wrote to the MoH about promoting the inclusion of refugees in the Indonesian national vaccination programme.
In Penang, we provide COVID-19 health education in different languages including Rohingya and Burmese, and translations in hospitals. Based on input from the community, Doctors Without Borders developed a COVID-19 health promotion campaign with R-vision, an online Rohingya news network. The videos produced reached the Rohingya in Malaysia, Myanmar, Saudi Arabia, India, the camps in Bangladesh and elsewhere.
As Malaysia entered another Movement Control Order (MCO) or lockdown in June 2021, the teams scaled-up support for people who can't access their livelihoods and use digital information campaigns based on earlier two rounds of MCO. Our advocacy continues to focus on a more inclusive COVID-19 response, calling on the government to halt targeting migrants and refugees in immigration raids, which could risk the further spread of COVID-19 in detention
A surge of infections in March 2021 in Tondo, a district of the capital, Manila, the capital, led us to monitor the situation again after we had previously ended our activities at the end of 2020. Tondo is one of the districts most affected by local community transmission. We support the health facilities where we used to work with patient kits (masks, alcohol, and thermometers) and PPE.
- South Asia
Doctors Without Borders maintains activities at the COVID-19 triage unit in the Herat Regional Hospital to continue close surveillance and monitoring of the epidemiological situation. In Helmand province, Doctors Without Borders is continuing to refer suspected COVID-19 patients to Malika Suraya Hospital. In addition, Doctors Without Borders agreed with the Ministry of Public Health to provide treatment and hospital care for four categories of patients infected with COVID-19 (TB, surgical, paediatric and maternity patients).
In our DR-TB centre in Kandahar, we care for DR-TB patients infected with COVID-19.
An alarming surge in infections and deaths occurred in Bangladesh during July and August, with more than 1.36 million people recorded as being infected and 22,897 deaths recorded by 20 August. In response, Doctors Without Borders set up isolation and treatment wards in eight medical facilities in Cox’s Bazar area for Rohingya refugees and the Bangladeshi host community. We also prepared two standalone intensive care centres, opening one with 16 beds ready to admit patients with moderate or severe symptoms referred from other facilities.
Doctors Without Borders provides screening at all of our hospitals and basic healthcare centres, including a specialised clinic. As of June, around 12,000 COVID-19 samples have been collected, and more than 600 patients have received COVID-19 care.
In Kamrangirchar, a crowded slum area in the capital city of Dhaka, Doctors Without Borders supports the government hospital with logistics and trains staff in infection prevention and control measures.
When the second wave of COVID-19 hit India, Doctors Without Borders started to support the BKC Jumbo COVID-19 hospital in Mumbai, managing 168 oxygen-supported beds in six wards of the 2,000-bed hospital. We also launched a health promotion intervention targeting vulnerable people in one of the slum areas of the city.
By the end of May, the numbers in Mumbai had decreased sharply, but the number of COVID-19-related deaths in India remained very high.
The western coast of India, including Mumbai, was brutally hit by Cyclone Tauktae on 17 May 2021. As soon as the Disaster Management Authorities issued the cyclone warning, the Municipal Corporation of Greater Mumbai (MCGM) safely relocated all the COVID-19 patients from BKC to other peripheral facilities. The BKC Jumbo vaccine centre was partially damaged due to strong winds, but no injuries were reported. MCGM has immediately started the repairing work of the facility.
The community, where Doctors Without Borders is engaged in health promotion and shielding the vulnerable population, did not experience any major impact of the cyclone, except for the water logging in low-lying areas. However, the heavy rains, floods and strong winds have led to the interruption of services, including trains, airports and electrical lines. Doctors Without Borders activities in Mumbai was handed over in July. We monitor the situation and context and prepare emergency plans in case there’s a third wave of disease in the city.
Doctors Without Borders supports extending the mass COVID-19 vaccination campaign of the Kemari district health department, Karachi, with cold chain management and maintenance. Doctor Without Border also plans to launch COVID-19 vaccination mobile units for Kemari district and a COVID-19 vaccination support unit at the Doctor Without Border Hepatitis C clinic in Machar Colony, Karachi.
In Balochistan province, Doctors Without Borders also supports the COVID-19 unit of the Department of Health’s (DoH) centralised Fatima Jinnah hospitals with nurses and a lab technician in Quetta. In addition, we have provided training to the department of health on COVID-19 patient transfer.
Doctors Without Borders also provides support with sample transfers from the districts of Dera Murad Jamali, Jaffarabad and Chaman to the provincial laboratory in Quetta. In addition, we support the DoH with information, educational and communication material for COVID-19 awareness and prevention. The material will be handed over to the health department for further dissemination in government facilities.
In August, Doctors Without Borders donated PPE, including isolation gowns, oxygen masks and examination gloves, to the DoH to support the Balochistan government’s COVID-19 response.
- Central Asia
We prioritise the continuity of quality care for essential services for children and adults with TB, in collaboration with the Ministry of Health and Social Protection of the Population (MoHSPP) via our existing programmes focused on diagnosis, treatment and contact tracing.
We have helped the MoHSPP establish a new triage approach in several TB facilities in Dushanbe and neighbouring areas to decrease the risk of transmission of COVID-19 between patients and staff. We also built outdoor waiting areas and provided training to the staff. With these measures in place, our teams have observed a remarkable decrease in the number of patients waiting in corridors and improved infection control in the TB dispensaries.
In August 2021, we conducted a community assessment in Dushanbe to explore community perceptions of COVID-19 impact on TB patients and caretakers.
We continue to support IPC measures across the primary healthcare system. Additionally, we coordinated with the MoH for the treatment of patients co-infected with COVID-19 and TB.
- Asia Pacific
PAPUA NEW GUINEA
Since early March, the number of confirmed infections in Papua New Guinea has increased drastically. Doctors Without Borders recruited and trained a new team of healthcare staff to work in a dedicated COVID-19 ward in Rita Flynn care centre in Port Moresby. Most people testing positive are asymptomatic and don’t seek medical care. With admissions decreasing, the authorities closed the ward. Patients are now referred to two other facilities.
We continue to support the Rita Flynn hospital in Port Moresby with one lab technician and cartridges to analyse samples of PCR tests for SARS-CoV-2 infections. We also continue to carry outpatient education and counselling sessions, as many stigma and misinformation are reported from the communities.
CLOSED COUNTRIES: In Asia, Doctors Without Borders teams responded to the pandemic in Bangladesh, Cambodia, China, Hong Kong, India, Japan, Nepal, and the Philippines.
The remaining COVID-19 activities in Belgium can be divided into two groups, both operating in the capital, Brussels:
Firstly, there’s a mobile team for COVID-19 vaccination. They focus on homeless people, migrants, undocumented people and day/night centres for the people. The team is composed of 8 people from 4 NGOs, including Doctors Without Borders. Between May and August, they administered vaccines in 53 different locations. These activities ended on September 15 (and were handed over to the authorities).
Secondly, in collaboration with the NGOs Médecins du Monde and Samusocial, an outreach support team continues its activities with testing, contact tracing, and support for non-official squats. The team is in contact with Doctors Without Borders’ team at the humanitarian hub in Brussels and the other structures we work
Since early June, we started COVID-19 vaccination activities for people living in the streets or precarious settings. Our mobile teams have administered more than 8,700 doses in over 30 facilities in Paris and the departments of Seine-Saint Denis, Val-de-Marne and Yvelines. Doctors Without Borders also set up a dedicated vaccination site at Porte de la Villette in Paris. Our mobile clinics also provide COVID-19 antigen tests and carry out basic healthcare consultations.
In Athens, we collaborate with the 3rd Clinic of Internal Medicine of Athens University (NKUA-EKPA) by providing psychological support to frontline health workers, COVID-19 patients and their relatives. We also donated PPE items (gloves, masks, face shields, antiseptic fluids) to vulnerable social groups, including the elderly, refugees, homeless people, victims of gender-based violence, detainees, people with mental health issues, as well as to the air ambulance department of the National Emergency Aid Centre.
In August, Doctors Without Borders provided cultural mediation during four vaccination days for undocumented people in Rome, organised by the MoH. In Lazio, undocumented people still don’t have full access to vaccination programmes. In addition, many are experiencing difficulties getting the green pass once they are vaccinated.
In Rome, we are implementing a new project collaborating with the MoH’s local health unit to reach undocumented people and facilitate their access to vaccination programmes. The project will start at the end of September,
In June, Doctors Without Borders started an intervention in Lampedusa to support migrants’ medical and humanitarian needs at the landings on the island. Our team is involved in triage activities and providing initial assistance, from testing people for COVID-19 screening to identifying people in need of emergency care. These activities ended in mid-September.
Until April 2021, the Palermo project was busy with infection and prevention control and WASH activities in the provincial migration centres. Then, as the number of cases receded, the project slowly resumed its activities to promote services and health care.
We have ongoing health promotion activities through community workers with five local associations in Lisbon and Vale do Tejo, which have most people of Roma and African descent. These activities were complemented with donations of IPC materials and hygiene kits, including masks, soap, bleach, and hydroalcoholic gel. In addition, the creation of a music video about preventive measures and health promotion helped with community engagement.
We also expanded our ad hoc support and health promotion activities to vulnerable people within the metropolitan region of Lisbon and in other areas in the south and the north of the country, with training and donations. When possible, Doctors Without Borders has also provided training on COVID-19 through face-to-face and online platforms during these activities.
We also undertake mental health activities, focusing on prevention with a community approach, with a team of four psychologists and one technical supervisor. We launched the development of a referral network linked with associations. During the whole period of activities, regular supervision sessions were held between psychologists and community health workers.
We continue to support the MoH in providing health education about infection prevention of tuberculosis (TB) and COVID-19, including distributing information to all patients visiting the Arkhangelsk TB dispensary on how to use face masks. In addition, Doctors Without Borders distributed hygiene kits and food parcels to multidrug-resistant and extensively drug-resistant TB patients in the northern region of Arkhangelsk. These patients also receive health education from MoH nurses.
In Moscow and St. Petersburg, Doctors Without Borders continues the partnership with two community-based NGOs that support vulnerable people and people.
Doctors Without Borders provided training to medical and paramedical staff of our partner organisations on TB/HIV co-infection, COVID-19 and basic counselling. Doctors Without Borders also donates PPE (masks, gloves and hydro alcoholic gel) for the people accessing the services of the organisations. We have developed health information materials on COVID-19 infection prevention, TB and HIV that are being distributed
Between March 2020 and May 2021, Doctors Without Borders supported the MoH’s COVID-19 response. In the Zhytomyr region, Doctors Without Borders provided training and support on IPC for the regional TB hospital, donated Gene Xpert cartridges, and strengthened patient support to ensure continuity of care for DR-TB patients. Based on this experience, the team developed good practice guidelines for treating TB, HIV and hepatitis C during the COVID-19 pandemic.
In the Donetsk region, our mobile teams provided diagnosis and home-based care for almost 3,500 patients to decongest hospitals and allow people to recover at home. Teams also transported samples for testing and introduced antigen rapid diagnostic tests. Doctors Without Borders also supported the provision of care in Krasnohorivka hospital by training the staff and providing equipment, oxygen and medicines. In addition, in both regions, we offered psychological support to patients and healthcare workers through hotlines, training, and in-person consultations.
Our teams are now raising awareness about COVID-19 vaccinations and monitoring the situation as Ukraine prepares for a third wave, likely in September or October. We will assess the needs and respond as necessary, depending on the scale and severity of this COVID-19 wave.
- Middle East
In June 2021, a third wave of the COVID-19 outbreak was declared by the Iraqi authorities. With a peak of confirmed infections reaching over 13,000 on 28 July - the highest recorded daily infections in the country since the beginning of the pandemic - and a daily death toll exceeding 50 deaths per day during the last week of July and the first week of August, the country’s already-weakened health system has been hit harder than in previous waves.
As of August 2021, more than 2.5 million COVID-19 vaccine doses were already administered to the Iraqi people. More batches of vaccines are expected to arrive in the country, but the situation remains concerning.
Doctors Without Borders continues supporting the health authorities in Baghdad, where the highest number of confirmed cases in the country has been recorded. Our teams continue to run the COVID-19 intensive care unit in Al-Kindi Hospital, where they directly provide lifesaving intensive care to severely and critically ill COVID-19 patients. Unfortunately, the unit is running at full capacity, and arriving COVID-19 patients often have to wait in the emergency room for a bed to become free.
In Sinjar, at the Sinuni General Hospital, where we provide emergency, maternity, neonatal and mental healthcare services, our teams also offer care in a seven-bed unit dedicated to observing and stabilising suspected COVID-19 patients.
In the Bekaa Valley, Doctors Without Borders supported the Elias Hraoui Governmental Hospital with the triage and screening of children. Doctors Without Borders’ Medical Response Teams (MRT) also support the Ministry of Public Health in its COVID-19 testing strategy across the country. The teams are taking PCR samples based on the contact-tracing scheme of the authorities. Alongside the MRT, MSF’s project-based Rapid Response Teams have also been part of the testing campaign in their project areas, notably in Tripoli and the Bekaa Valley. The MRT also supports home isolation assessments and providing follow up for confirmed COVID-19 patients in home isolation.
From September 2020 until June 2021, Doctors Without Borders’ hospital in Bar Elias was adapted to receive confirmed positive COVID-19 patients in need of hospitalisation.
Doctors Without Borders has also been supporting the Ministry of Public Health on the COVID-19 vaccination rollout. From March to July 2021, our mobile teams visited nursing homes and prisons to conduct vaccination activities. We focused on people with no or difficult access to COVID-19 vaccination. In June 2021, Doctors Without Borders also opened two COVID-19 vaccination centres, one in Bar Elias, which is still operational, and another one in the northern city of Tripoli, which closed at the end of August 2021.
Since its opening, the centre in Tripoli faced high vaccine hesitancy leading to a very low vaccination rate. We put health promotion teams in place to work specifically on this hesitancy and inform people about the vaccine and how to get registered. We are also reaching out to people with no or difficult access to COVID-19 vaccination. In that regard, Doctors Without Borders recently organised, in collaboration with the Ministry of Public Health, a COVID-19 vaccination drive for migrant workers on 24 and 25 August 2021.
In Libya, we continue to support the MoH in one COVID-19 testing site in Tripoli, as well as providing COVID-19-related training to medical and healthcare staff. We also continue to reinforce IPC measures in detention centres (in Tripoli, Zliten, Zintan) - as much as possible given the inhumane conditions there.
In Gaza, we have provided technical advice and hands-on training in IPC, including proper waste management and cleaning processes, oxygen therapy, and how to use PPE correctly. Doctors Without Borders has also donated essential drugs, PPE, medical equipment, and consumables such as oxygen masks, tubing and other devices and tools.
To help combat COVID-19 misinformation, Doctors Without Borders has been running a Facebook campaign to share accurate COVID-19 health messages across all of Gaza. This campaign reached nearly a million people in April.
In the West Bank, Doctors Without Borders operates a hotline offering remote counselling to mental health patients and their families and medical staff and other first responders affected by the COVID-19 outbreak. In addition, we carry out COVID-19 health promotion and mental health promotion activities to affected communities. In Nablus, we support a Palestinian Red Crescent Society hospital with skilled human resources, medical and logistic supplies. In Hebron, we work in Dura hospital on infection prevention and control measures and triage, support the intensive care unit and assist water and sanitation services.
Additionally, we provided hygiene, water and sanitation training to staff at Al-Mohtassab Hospital and basic life support and first aid training to various basic healthcare facilities in and around Hebron.
In northwest Syria, Doctors Without Borders continues to run a 30-bed COVID-19 isolation unit in the vicinity of one of its co-managed hospitals in Idlib governorate, where Rapid Diagnostic Testing (RDT) is also conducted. In addition, in the same area, we provide care for patients with moderate and severe COVID-19 symptoms within Idlib National Hospital’s 30-bed COVID-19 treatment centre.
In the camps where we work in northwest Syria, our teams also conduct RDT, spread awareness messages about COVID-19 and the vaccines, and distribute hygiene kits to displaced families. In the Afrin area, Doctors Without Borders supports a 34-bed community COVID-19 treatment centre and a mobile surveillance clinic run by a local organisation called Al-Ameen. We also run a respiratory clinic within a basic healthcare centre run by a local partner, in the frame of our COVID-19 response.
In the Al-Bab area, Doctors Without Borders is in charge of another 30-bed treatment centre. In all these health facilities, we treat patients with mild, moderate and severe COVID-19 symptoms and provide oxygen support to the patients who need it.
In northeast Syria, in the Al-Hol detention camp, Doctors Without Borders offers home-based care for people with confirmed or suspected COVID-19 who are mildly or moderately ill. This allows people to be treated and followed up while isolating in their tent. Unfortunately, the number of cases and proportion of people tested who return a positive result have begun to rise over the second half of August. We are concerned that this could potentially signal the beginning of another wave of COVID-19. In Raqqa and Hassakeh, we remain on standby, ready to support a spike in cases.
In Khamer (Amran Governorate), our COVID-19 treatment unit, in which we treat patients with respiratory infections and suspected moderate cases of COVID-19, is still receiving patients regularly. The number of patients has increased since April 2021. In Haydan (Saada Governate), we keep receiving suspected moderate cases of COVID-19 (based on the clinical examination).
In Aden, Doctors Without Borders has been running the Al-Sadaqa COVID-19 treatment centre since the beginning of April 2021. It remains the only functional facility to treat COVID-19 patients in Aden, with a bed capacity of 21 admitted patients and nine in intensive care.
In Sana'a, Doctors Without Borders is supporting a COVID-19 treatment centre at Al-Kuwait hospital, with a bed capacity of eight beds for triage, 44 for admitted patients and 15 for intensive care. We also support the COVID-19 centre at Al-Jumhouri hospital, with a 25-bed capacity and 15 beds in intensive care. These two centres continue to receive patients daily; most cases come from far away, including other governorates like Hajjah and Al-Baydaa.
In Ibb, Doctors Without Borders supports local health authorities at Al-Sahul COVID-19 centre in managing intensive care and admitted patients. We provide treatment, nursing care, support in the provision of medications, health promotion, training on personal protection equipment use and infection prevention and control measures, in addition to paying incentives for health workers.
In Abs Hospital (Hajja governorate), Doctors Without Borders continues screening activities and referrals for suspected COVID-19 cases.
Following an increase in COVID-19 cases in July, Doctors Without Borders decided to launch a dedicated COVID-19 intervention in the Kinyinya district in the Ruiygi province, where we are already running a large-scale malaria intervention. Through this COVID-19 intervention, we reinforced preventive activities in the district through health promotion with community members and leaders. We also provide medical training in health centres and at the district hospital to guarantee the quality of care and support patients with a nutritional programme. Other components of the medical response – such as providing drugs, biomed materials or ambulance service – are also incorporated in this response.
Currently, Doctors Without Borders takes part in weekly national epidemiological meetings. In partnership with Africa CDC, we launched a study on the seroprevalence of COVID-19 throughout Cameroon, which is currently underway. Our teams donated medication and supplies for inpatient and outpatient COVID-19 cases at the Buea Regional Hospital in the Southwest Region. We also provide mental and psychosocial support to those in need. A home-based care and follow up of patients, contact tracing, was also introduced at the regional hospital of Buea. The construction of a new lab for testing is underway.
We restarted our telemedicine project in partnership with a local NGO. Based in a testing centre in Abidjan, the team is now helping diagnose illnesses that could lead to complications with the COVID-19 vaccines.
DEMOCRATIC REPUBLIC OF CONGO (DRC)
Our teams are working on awareness-raising and health promotion and implementing preventive measures, such as providing masks and handwashing stations, setting up triage and isolation areas, and contact tracing and training staff.
With a new and virulent outbreak of COVID-19 starting in June, the Doctors Without Borders team in Kinshasa decided to intervene in the health zone of Nsele, a poor and remote area on the outskirts of Kinshasa. Teams provided support to the COVID-19 treatment centre in Kinkole and training healthcare personnel, including the treatment of severe cases. Early September, the handover of care provision in Kinkole to the MoH was on its way.
Our teams in Kinshasa have also supported the treatment centre of the Vijana clinic, where patients living with advanced HIV and in need of specific COVID-19 care are referred. A dedicated structure was built, fully equipped with beds.
In South Kivu, east of DRC, we started working with the Clinique Universitaire de Bukavu (CUB Muhanzi) to provide training and additional staff. We also help improve IPC measures, including an isolation circuit, and ensure the availability of tests and treatment at the hospital. Doctors Without Borders started supporting the Hôpital Provincial de Reference and Kyeshero Hospital in Goma, North Kivu, at the end of July. This intervention was phased out in early September. Health promotion and IPC technical support will continue.
In the Gambella region, in two camps for South Sudanese refugees (Kule and Tierkidi), Doctors Without Borders set up a 20-bed COVID-19 isolation centre and another one with a capacity of 10 beds. In addition, in Gambella town, a team supports the COVID-19 triage and temporary isolation centre in Gambella Hospital.
Since May, a team in Addis Ababa has provided mental health support to more than 5,000 migrants who returned from Saudi Arabia, Kuwait and Lebanon and placed in three COVID-19 quarantine centres in the capital. In addition, Doctors Without Borders supports the MoH medical and non-medical staff who work in the quarantine centres by training them on migrants’ mental health needs.
Our teams support the regional health authorities in our different project locations in Amhara and Somali Region in isolation and treatment centres and health promotion. We have also been working on preparedness in all our projects putting in place preventive and hygiene measures.
During the third wave, the country recorded its highest number of patients. The home-based care team visited the most critical patients at home for continuity of care and treatment. With the health facilities being overwhelmed with high numbers of sick patients, there has been an extension of the COVID-19 ward at the Nhlangano Health Centre, now fully equipped with oxygen concentrators.
In May 2021, we signed an agreement with the MoH to provide care to patients with COVID-19 at the Gbessia Epidemic Treatment centre, on the outskirts of the capital Conakry, with a specific focus on those coinfected with HIV/TB. Doctors Without Borders medical staff assisted the MoH team in providing care and follow-up of patients with COVID-19. The team also supported the maintenance of the ICU biomedical equipment, mainly ensuring the proper oxygen provision and maintenance, and reinforced the overall COVID-19 related waste management system, including constructing a new waste zone.
Since the start of the pandemic in Homa Bay, Doctors Without Borders has progressively ramped up our support to the Homa Bay County Hospital. During the last surge from May to July 2021, the initial 10-bed COVID-19 High Dependency Unit (HDU) set-up for severe cases was supplemented by an emergency response to increase the total capacity to 32 beds to care for the 350 patients admitted during that peak period. Our team consisted of 60 staff to support a comprehensive programme of testing, treatment, nutritional and psychosocial care, and assuring the supply of commodities, oxygen and electricity. With a decline in hospitalisations since August, Doctors Without Borders closed the extra capacity HDU. Still, our team continues our COVID response with regular follow-up of patients after their discharge, daily support supervision of remaining patients, and continued testing of suspect patients in the outpatient department and adult internal medicine wards. In Dadaab, we maintain a COVID-19 isolation ward.
New COVID-19 cases peaked in July. As the two main COVID-19 treatment centres in Berea and Mafeteng resumed normal services in August, they experienced an acute shortage of nursing staff for COVID-19 wards. We are supporting Jhpiego, an international partner based in Lesotho, to implement the Ward Attendant Programme that we first implemented in the country during the second COVID-19 wave.
Following the third wave in June, we reopened our field hospital of 60 beds in Blantyre. We provide human resources, trained staff in infection prevention and control, manage patient flow, treat severely ill patients and provide oxygen. At the Blantyre Youth Centre, we provide logistics support for vaccination efforts. At the South Yunzu Health Centre, we conduct COVID-19 screening and provide logistic and medical supplies.
In Bamako, we’ve been providing human, financial and technical support to the MoH’s inpatient COVID-19 unit (emergency, intensive and inpatient care) in Hôpital du Mali since April. In addition, we run outpatient activities in three communes of Bamako, such as improving dedicated COVID-19 patient flow, testing and triage areas in health centres, medical follow up of COVID-19 positive patients at home (258 patients currently, near 2,000 in total), health promotion sessions and targeted distribution of prevention kits.
Following a third wave of cases and strict restrictions in June and July, COVID-19 cases in Mozambique have decreased and stabilised in August. Doctors Without Borders responded to the third wave in Beira by supporting the government’s COVID-19 treatment centre with one doctor to follow advanced HIV patients and eight cleaners and two health promoters at the Central Hospital triage area. We also donated material for handwashing points and provided infection prevention and control training at a Doctors Without Borders -supported clinic. In Maputo, Doctors Without Borders continues to donate medical material, drugs and equipment on an as-needs basis and follow the vaccination rollout.
We support logistics and human resources in Lamorde hospital in Niamey, where people with moderate cases are treated. We also support health centres in Magaria, Dungass and Tillaberi with water and sanitation activities, distribution of masks, organising the triage of patients and helping the investigation and response team.
We continue the epidemiological surveillance and community awareness. In Diffa and Agadez, we have set up isolation centres in our facilities.
We continue to support health promotion and provide local authorities, hospitals and healthcare centres with technical support, staff training and IPC measures in all projects. Our teams have set up isolation units in Gwoza and Pulka where suspected, and confirmed cases of COVID-19 are treated. The capacity of the unit has been reduced to 5 beds in each facility. In Ngala, we have increased epidemiological surveillance and started to implement IPC measures and health promotion activities.
In Ebonyi State, we support the MoH and Nigerian CDC with testing in the state’s first COVID-19 testing centre. In addition, we are currently supporting the re-opening of a 25-bed MoH facility in preparation for the second wave of COVID-19 in the state.
In Sokoto, we have supported the MoH to renovate a 32-bed isolation and treatment centre. With the local authorities, we helped conduct a community awareness campaign on COVID-19, reaching 370 settlements. In addition, we have carried out health promotion, installed water points and distributed soap to displaced communities in Benue and Zamfara.
Doctor Without Border supports the MoH in Sierra Leone with treatment, surveillance, IPC measures and testing strategies. In addition, we are part of an oxygen technical working group at the national Emergency Operations Centre (EOC) and district level EOCs in Kenema, Tonkolili and Bombali districts.
In Tonkolili district, our team supports the district health authorities with cold chain support and logistics for COVID-19 vaccination.
In Freetown, Doctor Without Border started rehabilitation work in Connaught Hospital to increase treatment capacity and install an oxygen production plant to support the treatment of moderate and severe COVID-19 patients. Doctor Without Border is also rehabilitating the current waste zone area to manage COVID-19 and general hospital medical waste. In Freetown's Thompson and Susan Bay slums, we are conducting a COVID-19 vaccination perception study and exploring further options of supporting the ministry of health's COVID-19 vaccination. We also finished an assessment of Military 34 hospital in Freetown and will start rehabilitation work and provide logistical support. Our team also conducted biomedical training.
SOMALIA AND SOMALILAND
In Somaliland a specialised biomedical engineer assists all MoH COVID-19 centres with the repair and maintenance of specialised biomed equipment, such as oxygen concentrators. He also provides training on how to service, maintain and operate them. The number of COVID patients has again significantly increased in Las Anood and Galkayo north and south. We helped improve the isolation capacity there and supported the MoH with supplies and incentives for MoH staff.
In South Africa, Doctors Without Borders has supported public hospitals in three provinces in the third wave with the placement of doctors and nurses. As admissions continue to rise in KwaZulu-Natal and Eastern Cape, we will extend the support of our human resources in Ngwelezane Hospital and Livingstone Hospital, respectively, for most of September.
In Eshowe in KwaZulu-Natal, where Doctors Without Borders has a long-term HIV/TB project, we launched a community-based intervention in July, aiming to identify individuals at high risk of severe COVID-19. Individuals enrolled in the programme self-monitor using a pulse oximeter, reporting daily to Doctors Without Borders. In addition, we launched a task-shifting intervention in Ngwelezane Hospital in KwaZulu-Natal in July. We recruited and trained 15 enrolled nurse aides to cover basic care tasks, taking pressure off nurses and ensuring that the lifesaving basics get done. The programme was also rolled out in Livingstone Hospital in Eastern Cape in August.
Doctors Without Borders initiated rapid deployment training at Greys Hospital in KwaZulu-Natal province at the end of July. The flash visit and training focused on how clinical staff can improve patient care and use limited resources through a systematic approach to work on COVID-19 wards.
In Khayelitsha in the Western Cape, a team of our health promoters has supported a mobile vaccination site in collaboration with the City of Cape Town Health Department since July. Since August, a team of Doctors Without Borders health promoters has supported the Eastern Cape Department of Health in Gqeberha with training on how to run a digital vaccination campaign and have trained government health promoters on outreach vaccination activities.
We handed over IPC measures and COVID-19 screening activities to the MoH in Juba Teaching Hospital at the end of April. We continue to support the National Public Health Laboratory (NPHL, the main testing facility in the country), including with a Doctors Without Borders Laboratory Supervisor. In June 2021, we finished technical support to the NPHL warehouse to help ensure improved and efficient stock management for COVID-19 testing.
Outside of Juba, there are four MSF testing facilities in Lankien, Agok, Bentiu IDP camp and Malakal town, which add to the 30 facilities country-wide.
In addition, in all projects across the country, we continue to isolate and treat patients with suspected or confirmed COVID-19. However, the numbers of confirmed patients remain low. We also support and implement preventive measures, including screening and reinforcing IPC, awareness-raising and health promotion, and training. Moreover, in the project locations across the country where Doctors Without Borders is the only health partner, such as in Ulang in Upper Nile State, we have supported the MoH in rollout vaccination activities.
Doctors Without Borders has received approval to conduct a seroprevalence survey in Omdurman. We are discussing with the MoH to begin a home-based support system for COVID-19 patients, covering the same area.
We support four main public hospitals in Khartoum to strengthen their screening and triage systems and isolation areas. The objective is to protect or reopen lifesaving services and to reinstate confidence among health workers.
Doctors Without Borders teams support training, reinforcement of infection prevention and control (IPC) measures, and weekly donations of PPE. We also trained staff from 10 basic healthcare centres, donated IPC items, and provided on-site technical support in different Khartoum facilities. We are also supporting the MoH to manage isolation centres in East Darfur and South Kordofan states.
Doctors Without Borders is the sole healthcare provider in the Nduta refugee camp, which hosts some 70,000 Burundian refugees. More than 250 Doctors Without Borders staff have been trained on COVID-19 preparedness and response measures to respond to a potential outbreak. Our teams continue to organise simulation exercises to maintain rapid response capacity. We continue to have triage structures in the four health posts, including 100 beds in the main hospital.
Our community health educators in the Nduta camp regularly raise awareness in the community on hygiene and best health practices. We also continue with temperature screening at the triage of the main camp gate and maintain handwashing points.
We started working in Tunisia in July 2021 to support the MoH with the opening of a field hospital in Beja Governorate, in the country’s west. Our medical staff support the hospital on patient treatment, and we improve oxygen capacity through training on maintenance and quality. We’re also helping to transfer patients from the regional hospital and other health facilities in the area to this new facility to reduce the burden on those structures. With fewer cases in August, we started training, so the staff is prepared if a new wave occurs. We’ve also begun supporting the MoH’s COVID-19 vaccination campaign in Beja and Manouba Governorate (close to the capital city Tunis).
The second wave in Uganda started in mid-May 2021 and lasted until late August. Doctors Without Borders has been supporting the intensive care unit at the 140-bed Entebbe hospital, managing the triage and patient flow, ensuring oxygen supplies, and providing staff, along with training them in infection and prevention control measures. In the Arua District, Doctors Without Borders is also running a 35-bed COVID-19 treatment unit that conducts screening and treatment for the Arua Regional Referral Hospital. In the Kasese district, Doctors Without Borders has set up a 24-hour ambulance service to transfer critically ill patients between Kasese and the Regional Referral Hospital in Fort Portal.
The number of new COVID-19 cases continues to decrease in Zimbabwe, and only a small number of patients is hospitalised. The government is relaxing lockdown measures with the re-opening of learning institutions and has procured the vaccine. There is a considerable uptake of the vaccine.
Doctors Without Borders has scaled down our intervention at Beitbridge’s Screening and Referral Unit, our isolation ward and quarantine centre. More support is now given to Beitbridge hospital, where COVID-19 patients are admitted. Our short-term intervention at Wilkins Infectious Clinic ended on 29 August.
Doctors Without Borders is working in north Amazonas, in Atalaia do Norte and Benjamin Constant municipalities. The project's focus is to prepare local health staff in case a new wave of cases strikes the area. MSF teams are working on patient flow, rapid testing, mental health and health promotion, focusing on prevention training in clinics and hospitals.
In June, Fortaleza, Ceara, Doctors Without Borders undertook a project focused on mobile clinics with rapid testing for COVID-19 and health promotion activities. In July, in Patos, Paraiba, the teams established a project to support the health system with IPC training and rapid testing points.
From June to August, Doctors Without Borders ran a project in Bahia to prepare the local staff in Xique-Xique, Cocos and Riachão das Neves, focusing on rapid testing training. In Portel, Pará, our teams provided IPC measures and rapid testing for local health staff and mobile clinics in hard to reach communities.
Doctors Without Borders launched a COVID-19 intervention in Bolivia in March 2021. Our activities include infection prevention and control measures in health structures, mental health services (for patients and medical staff), and capacity building for frontline workers. Our teams have been working until the end of August in the region of Cochabamba, where there is a high incidence of cases; the health system was on the brink of collapse with no mental health services available.
Another component of Doctors Without Borders' intervention in Bolivia is the development of health promotion activities in several country districts by sharing information with the communities on health practices and preventive measures. Since the beginning of our intervention in the country, the team has organised more than 800 awareness sessions on COVID-19.
In Tegucigalpa, Doctors Without Borders started COVID-19 activities in April due to increasing cases in the city. These activities have three different phases. Its objective is to support the health system with comprehensive care in the communities, primary health centres, and hospitals.
Doctors Without Borders also supports five health centres with a mobile team with a nurse, psychologist, and health promoters at the community level. The team does psychosocial support to the community through psychoeducation and individual telephone psychological support. We also reinforced biosecurity measures in the health centres. At the hospital level, Doctors Without Borders provided psychosocial support in two hospitals with COVID-19 units. The support is for patients and families with psychological support and social support if needed. Also, Doctors Without Borders is going to reinforce the health promotion activities in the hospitals. The third phase consists in donating two ambulances with drivers and nurses at the six triage centres in the city. The ambulances will help the health system transferring patients to hospitals and isolation areas.
In Guerrero state, we have integrated our COVID-19 response in the regular migrant project and our mobile clinics. In the migrant shelter projects, in different shelters and traveller points across the country where Doctors Without Borders intervenes, teams have incorporated COVID prevention and COVID detection into our regular activities.
In Reynosa, we supported the General Hospital with extra staff to care for COVID-19 patients with mild and moderate cases. This activity was completed at the end of March. The teams in Reynosa and Matamoros continue to monitor the COVID-19 situation in both cities and conduct health promotion activities.
As hospitalizations declined, Doctors Without Borders completed its medical activities at hospitals in Huacho and Cusco. They shifted to prevention activities by setting up vaccination sites in Cusco City and Arequipa to scale up vaccination efforts as the Delta variant is circulating widely and rapidly. Doctors Without Borders also supports the MoH's vaccination campaigns by providing data entry staff, access to Wi-Fi, and computer tablets for reporting. These activities will come to an end in early/mid-October.
In April, we began supporting efforts led by the local health organisation Puerto Rico Salud to bring COVID-19 vaccines to be vulnerable and hard-to-reach communities on the island. Puerto Rico Salud grew out of Doctors Without Borders’ work in 2020 to provide home-based care and monitoring for people with COVID-19 in remote or marginalised communities. Puerto Rican members of the Doctors Without Borders team went on to form an independent organisation to continue to provide vital health services to underserved groups.
People who already had inadequate health services have lagged in receiving COVID-19 vaccinations through the health system. Puerto Rico Salud took a new approach, sending mobile teams to vaccinate people in remote or marginalised communities and people who are homeless or living with chronic diseases. Doctors Without Borders supported Puerto Rico Salud’s efforts until June 2021.
COVID-19 cases remain high in the country, and vaccination coverage remains low. Doctors Without Borders’ response plan includes assisting with medical supplies and staff recruitment and strengthening triage, diagnosis, treatment, infection prevention and control, and secondary care services in Amazonas, Anzoátegui, Bolívar, Sucre, Táchira and Caracas. In Vargas hospital in Caracas, we are supporting a unit of 24 beds (including four for ICU) and 36 beds in Hospital Lidice in the west of the city, where we are seeing an increase in patients. We already scaled up our intervention in Bolivar state in response to the outbreak of COVID-19 located in the state.
Doctors Without Borders COVID-19 response around the world
No Patents, No Monopolies in this Pandemic
While developed countries achieve significant COVID-19 vaccination milestones, the developing world is witnessing a frightening rise in infections and deaths from COVID-19, with Brazil's and India's healthcare systems reaching breaking point. Southeast Asian countries have not been spared as new COVID-19 infection surges are being reported. Numbers have never been so large anywhere in the world before.
Vaccines to protect the vulnerable are just not available in sufficient quantities to meet the needs of the COVAX (COVID-19 Vaccines Global Access) facility and developing countries that would like to vaccinate their people in advance of an outbreak. Indonesia and Philippines, two countries in the region that have consistently registered the highest number of infections, have had a slow start to their vaccination programmes due to access issues.
Doctors Without Borders medical mobile teams vaccinating elderly people and frontline Healthcare workers in a nursing home in Tripoli, Lebanon. @Mohamad Cheblak/MSF
It is for this reason that Doctors Without Borders, through the Access Campaign, is actively advocating for removing technology and intellectual property (IP) barriers to open up the manufacture of vaccines, medicines, and other health products and tools needed to fight this pandemic.
Doctors Without Borders has first-hand witnessed Norway, EU, UK, Canada, and Japan stalling negotiations on the proposal to ease IP barriers to expand the number of manufacturers in different regions to meet the developing world and make potential treatments available to all countries. The US finally agreed this month to participate in the negotiations and may convince others to follow.
This is the first step. Member countries like the US will now face intense pressure by the pharmaceutical industry to water down the waiver proposal at the World Trade Organization. Governments must join the negotiations actively to ensure the waiver applies not just to vaccines but also for all COVID-19 related technologies.
Challenges of the COVID-19 Response
Doctors Without Borders/Médecins Sans Frontières (MSF) started its first activities in response to the COVID-19 pandemic in January 2020, by adapting and scaling up our ongoing activities and starting new activities in many countries. We committed substantial resources to developing dedicated COVID-19 projects, maintaining essential healthcare in our existing programmes, and accompanying ministries of health in preparing and/or facing the pandemic. This support was often in the form of training in infection prevention and control(IPC), health promotion and organisation of healthcare services.
Most COVID-19-related activities have been integrated into our regular projects while maintaining some COVID-19-focused projects. What we are doing so is very much dependent on the context: the local epidemiological situation, the local health needs, and our resources. It is still difficult to provide a global narrative on our operations, as the pandemic affects every country around the world with different consequences in different places. Therefore, our approach can also be very different from country to country, or even from project to project.
We advocate strongly for access to essential medical tools to all, at an affordable cost. To fight the new virus and disease, there is a need for the new tools, such as drugs, tests and vaccines. It is important that there should be no profiteering on any emerging medical tools used for this pandemic; a COVID-19 vaccine, for example, should be available to everyone around the world. High prices and monopolies of tools will only result in rationing and certain people missing out, which will prolong the pandemic.
Governments, pharmaceutical corporations, and research organisations need to take the necessary measures to ensure that medical tools urgently needed for COVID-19 are accessible, affordable, and available to all. Learn more about MSF's response in our Responding to COVID-19: MSF Global Accountability Report.
- What is COVID-19?
COVID-19 is a disease caused by a new coronavirus known as SARS-CoV-2, because of its similarities to the virus that causes SARS. On March 11, the WHO declared that the global spread of this previously unknown disease is a pandemic. By February 4, COVID-19 had killed more than one million people. There were more than 104.4 million cases of coronavirus around the world.
- How is coronavirus transmitted?
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 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.
- How dangerous is the coronavirus?
The latest estimates are that 80 per cent of the people infected with the coronavirus will experience a mild or moderate form of the disease. Roughly 15 per cent will develop a severe form of the disease requiring hospitalisation. Some five per cent will become critically ill. Sophisticated healthcare systems may be able to cure some critically ill patients. Still, the danger is that even the most advanced systems may be overwhelmed by the large numbers of people who will need to be hospitalised.
The high level of supportive and intensive care required to treat patients with COVID-19 places real challenges to even the most advanced healthcare systems. MSF is very concerned about the potential consequences in countries with weak or fragile healthcare systems.
The virus is more dangerous for older 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.
- How can I prevent myself from being infected?
It’s important to protect yourself and protect others too. As with other coronaviruses, droplet infection seems to be the primary mode of transmission. The virus enters the human body through the mouth or nose. This can happen by breathing in infected droplets or touching with your hands on 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 essential 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 PPE, the needs of health care staff should be prioritized.