France: We run projects for vulnerable populations, homeless and migrants, in Paris region, with mobile clinics and support to screening. MSF mobile teams continue to provide medical support in emergency shelters and various other collective accommodation facilities, with specific attention to COVID-19 detection and management. A hotline set up with MSF nurses to provide advice to managers of these facilities and flag the most concerning situation to medical mobile teams. We also provide general consultations near food distribution sites, five days a week.
In total, and as of 1st of June 2020, we have conducted almost 1800 consultations since the beginning of our COVID-19 response in Paris region. 193 people seen in our consultations had COVID-19 symptoms, 109 people were tested of which 35 were positive. Since the beginning of our operations, 57 people were admitted in COVID+ Centres where MSF is working (set up to isolate and accommodate migrants and homeless population infected with COVID-19). Our medical work in COVID+ Centres ended with the closing of the centre in Chatenay-Malabry (on 8 May), where a total of 31 people were admitted and the other in Aulnay-sous-Bois on 21st of May, where 27 people were admitted. Our support to hospitals has come to an end with the current decline of COVID-19 infected patients – we no longer work in Henri Mondor Hospital in Créteil.
In Marseille, through our screening, counselling and testing activities in support of health centres in some of the city’s impoverished neighbourhoods (13e and 15e arrondissements), around 1000 tests were performed from mid-April to end of May, both in the two MSF-supported diagnostic and counselling centres (900) and through mobile teams reaching people living in precarious conditions (e.g. squats). After six weeks of operation and due to the decrease in the number of cases, the counselling and testing centres run by MSF were handed over to the originally supported health centres on 31st of May. We continue our support to mobile interventions towards people living in extremely precarious situations, away from health care circuits and often without health coverage.
Medical activities and technical support in EHPADs (care homes for the elderly) are still ongoing – we work in Hauts-de-Seine and Seine-Saint-Denis Départements, near Paris, and are also proposing psychosocial support to Ehpad staff over the following weeks. Since the beginning of its intervention, 30 EHPAD more than 2,000 elderly people in the Paris region have opened their doors to MSF.
Germany: An MSF team is supporting the authorities in the federal state of Saxony-Anhalt in a centre for asylum seekers in the city of Halberstadt, in which hundreds of inhabitants are under quarantine and where some inhabitants were earlier infected with COVID-19. Our teams are carrying out health education activities, including infection prevention and control (IPC) and providing psychological support in the centre. In addition, in different parts of Germany, MSF is advising organisations, volunteer groups and state institutions working with the homeless, migrants and other vulnerable groups on IPC measures, to enable them to continue their services. Those we are supporting include a network of volunteer organisations distributing food to the homeless in Berlin, and a variety of social support provided by the Protestant Church of Germany.
Greece: More than 17,500 people still live in overcrowded tents or containers on the Greek islands with limited access to running water and sanitation services. So far there is no positive case of COVID-19 in any of the Greek reception centers (RICs) but medical actors, including MSF, are coordinating with national authorities to respond in case the virus reaches the centers. In Lesbos, MSF teams have started to operate an inpatient medical unit near Moria RICs for patients who present symptoms similar to COVID-19 and potential positive cases that might be detected. In its first week of activity, six patients with mild symptoms were tested and provided with appropriate care. None of the tested cases were positive. The center will ensure the early detection of suspected or positive COVID-19 cases, their isolation in a safe space, their medical monitoring and the treatment of those with mild symptoms. MSF teams are also providing support and training on the triage system of the National Public Health Organisation (NPHO), which is responsible for the COVID-19 triage and case management. In Samos and Lesbos, we have adapted our facilities and procedures in order to ensure the safety of our patients and our staff. MSF is doing health promotion with the camp residents and we are increasing the provision of water and sanitation services in the camp and scaling up our operations with the recruitment of extra medical, paramedical, support staff and the acquisition of the necessary equipment.
Italy: Following three months of intervention in Italy, we closed our projects in the Lodi area and Marche region. More than 50 MSF were involved and responded in three hospitals and close to 50 elderly homes. Several other activities were carried out such as telemedicine, to ensure only the critical cases where sent to hospital. MSF teams trained more than 500 health workers on IPC procedures and conducted sessions of psychosocial support.
MSF’ intervention continues in several detention centres in Lombardy, Piedmont and Liguria to protect detainees, jail workers and police officers. In Rome, activities are ongoing with the most vulnerable communities in the suburbs, and in Sicily (Catania province) we are supporting the epidemiological surveillance service that identifies and records new cases and their contacts.
The Netherlands We are providing mental health support to frontline workers. This includes a short video with a highly experienced and well-known MSF clinical and health psychologist (also providing psychosocial support to MSF staff responding to the coronavirus pandemic and other emergencies) that has been widely shared in hospitals and nursing homes across the country.
Portugal: MSF teams have started visiting nursing homes and supporting authorities and management teams in order to train staff and set-up basic IPC measures.
Spain: The latest figures (01.06.2020) show 239,638 confirmed cases and 27,127 people died in total. MSF’s final reports are being finalised. The MSF specialised website (https://msfcovid19.org/) for health administrators, supervisory and training teams, medical and healthcare staff looking after people affected by COVID-19 will remain online. So far it received 61,856 visitors and 38 webinars were organised. On 2 June, MSF Spain’s GD took part in a hearing at the Health Commission of the Congress to highlight the consequences of Covid-19 on health professionals. According to the latest data provided by medical associations, more than 51,000 health professionals have contracted Covid-19 and 76 died. Spain has the highest incidence of positive cases within health professionals in the world with 24%.
United Kingdom: MSF staff are providing nursing and logistics support at the London COVID CARE Centre, in partnership with the University College London Hospital (UCLH) Find & Treat team. The project provides rapid testing, accommodation in which to self-isolate, and medical care for members of the homeless community with suspected or confirmed COVID-19.
COVID-19 highlights on preparedness:
Belarus: MSF is maintaining the continuity of care for DR-TB patients by providing essential consultations and counselling using smartphone-enabled technologies. Our patient support team developed and shared mental health support materials for patients and healthcare workers providing guidance on how to deal with stress in the times of pandemic.
Ukraine: We are focusing on supporting healthcare workers, awareness raising about COVID-19 and continuity of care for our regular patients. In Mariinka, Donetsk region, we have two mobile teams collaborating with the MoH to provide contact tracing, screening and home-based care for people with mild symptoms in order to prevent health structures from being overwhelmed. We have provided infection control trainings at Central District Hospital in Krasnogorívka. We are also running a hotline for psychological support available for Mariinka and Volnovakha Rayons. In Zhytomyr region, together with TB Dispensary, we continue to enrol patients in our regular programme that is an operational research on all-oral short regimen to treat MDR-TB and we are continuing to provide mental health support by phone. Following an agreement signed with health authorities, we started COVID-19 activities by providing trainings on proper use of protection equipment, infection control, flow of patients – triage, screening and isolation – as well as waste management started this week and will cover four health facilities and an elderly house. We also launched hotlines for psychological support of healthcare workers and COVID-19 patients. As the country has been under quarantine since 12 March, we have adapted approach according to the needs and delivered medication to assure continuity of care for our patients on treatment for tuberculosis in Zhytomyr and hepatitis C in Mykolaiv. All of them, as well our staff, received information on how to prevent the virus. We increased infection control measures at our project locations and in our offices. In Sievierodonetsk, Luhansk region, we keep donating medicines to the HIV programme to treat a sort of infections.
Iraq: MSF is supporting Ibn El Khateeb Hospital, a MoH hospital in Baghdad, identified as one of the three main hospitals for COVID-19 in the city, with technical training on patient triage and infection protection and control. In Mosul, MSF has donated beds to furnish a 50-room building (run by the MoH) in Al Salam hospital complex, for the isolation of patients. Another hospital, Al Shifaa, is located in this same complex. The new Al Shifaa was built by MSF in 2019 and is now used as the main referral point for suspected COVID-19 patients in the Ninawa province. MSF is supporting Al Shifaa and has put in place 40 isolation rooms and 30 beds for mild and moderate cases in its centre for post-operative care. MSF works jointly with local health authorities to facilitate their treatment.
MSF has also been helping local health facilities in Erbil by providing technical support, logistic support and training for their staff on infection prevention and control (IPC). Triage started in Laylan camp (Kirkuk) and in Abbasi in Hawijah. We also started triage in Hawijah PHCC if there is a need to respond to any outbreak in the area. We continue trainings for driver and non-medical staff about PPE and sterilization. Two COVID-19 caravans are being built (10 beds capacity each) and will be pre-positioned for COVID-19 intervention to treat mild cases. MSF’s existing projects in Ninawa, Diyala, Kirkuk and Baghdad have also been reinforcing their capacity to triage, support infection and prevention control, and refer cases to MoH hospitals; according to the protocol established by health authorities. MSF will continue monitoring the situation and discussing support possibilities with the MoH.
Lebanon: In Zahle, MSF restarted its regular pediatric activities on 18 April in Elias Hraoui Governmental Hospital through a two-flow emergency room in tents set up outside the premises. Children have been admitted in the IPD and in the intensive care unit, but no COVID-19 positive cases so far. Confirmed cases, if any, will be managed in the emergency room of the COVID-19 zone and referred for hospitalization or home isolation. The thalassemia unit was moved to a separate area to protect thalassemia affected children from exposure to COVID-19. MSF supported the EH Hospital by setting up a COVID-19 emergency room outside the premises for triage and screening of adult patients. The ER for adults was opened on April 18.
In Bar Elias, MSF’s elective surgeries hospital, usually handling elective surgeries and wound-care activities, was being prepared to host potential influx of COVID-19 patients. MSF had temporarily suspended the elective surgeries, but wound care activities were still running. COVID-19 activities planned in Bar Elias are now on stand-by and elective surgeries have resumed. We’ve also been in contact with several governmental hospitals (in Hermel, Saida, and Tripoli) to support them with different logistic services and medical supplies and increasing their medical capacities through training staff members.
MSF also deployed a medical team to UNRWA’s Siblin training centre (near Saida), which has been turned into an isolation site. Our team trained the staff there on IPC and biosafety. The activities target patients as well as vulnerable communities living in the four corners of Lebanon.
In Dora, a northern suburb of Beirut, MSF has created a medical helpline in partnership with a local organisation called Anti-Racism Movement, in order to provide medical support and assistance to the migrant communities and especially women domestic workers during the lockdown.
MSF also launched a new pilot programme, consisting of training and assisting families in South Beirut and the Bekaa Valley with the practice of shielding. Shielding is a voluntary process that can provide additional protection to people at higher risk of contracting COVID-19, such as the elderly or people living with chronic diseases. Meanwhile, a massive awareness campaign targeting frontline workers also took place in these two areas. MSF health promotion teams targeted individuals who are in daily contact with the community (such as taxi drivers, internal security forces, food distributors and waiters) to IPC measures, to avoid potential transmission of the virus when they do their work. Awareness campaigns have also been conducted by the MSF teams from Akkar to Tripoli, South Beirut, Bekaa. There, we engaged with community leaders and partner NGOs to spread awareness about general protective measures especially in crowded refugee camps and informal tented settlements.
On 23 May, MSF also launched a quick response unit in Ras Al Nabaa and Basta neighbourhoods in Beirut to support vulnerable people, where 70 COVID-19 positive cases had been previously identified. MSF provided information to suspected and confirmed COVID-19 patients on their health condition. Our teams also provided general health awareness sessions and mental health support. Over the course of 10 days our teams took more than 200 swabs samples of suspected cases in the Basta area.
COVID-19 highlights on preparedness:
Jordan: At the beginning of the COVID-19 outbreak in Jordan we suspended admissions to our reconstructive surgery hospital and reduced activities there to the minimum. We have now restarted surgeries and have also identified 30 patients from Jordan who are ready for admission in June. We currently have 146 patients in the hospital; in previous weeks we were able to organise the return of around 40 patients to Iraq, Gaza and Yemen. During the outbreak we provided trainings and other support to the Jordan Medical Association, a union of doctors, to assist them with their response to the pandemic. In Irbid and Mafraq we are preparing for the resumption of face-to-face consultations in our mental health project but will continue remote consultations for patients who are not able or willing to come. We are delivering medication on a daily basis for our non-communicable diseases (NCD) patients in both Irbid and Ramtha cities. We have also assessed the needs in Zaatari camp and started preparing a case management facility in the camp should the needs arise and the authorities require more support.
Libya: MSF activities in Libya have been severely impacted by the restrictions imposed by the COVID-19 response and the escalation of armed conflict, while these same factors increase humanitarian needs in the country. In Tripoli, MSF continues providing medical and humanitarian assistance to migrants and refugees in one detention centre, while other facilities have been emptied or closed under COVID-19 outbreak threat and escalating conflict. While curfew and lockdown measures had a severe impact on migrants and refugees’ access to basic services, MSF participated in interagency food distributions, offering medical and humanitarian assistance to migrants and refugees living in urban settings. Beyond Tripoli, MSF continues working in three detention centres (in Khoms, Zliten, Zintan), providing primary healthcare and referrals to migrants in Bani Walid and running a tuberculosis (TB) programme (16-bed TB unit + lab support) in Misrata. We are also providing COVID-19 related trainings to medical staff in Tripoli, Zliten, Misrata, Khoms, Yefren and Bani Walid, as well as and reinforcing IPC and prevention measures in detention centres (handwashing points, distribution of soaps and cloth masks, health promotion with migrants and refugees arbitrarily detained and guards). We delivered trainings on infection control & case management to nurses & doctors in hospitals in Tripoli.
Northeast Syria: Across northeast Syria, MSF takes part in the COVID-19 humanitarian taskforce, chaired by the local health authorities. We are providing training and preparedness measures in Al Hassakeh National Hospital and in Al Hol camp. This includes creating a 48-bed isolation ward, introducing surveillance measures, case identification and management, and patient flow and triage processes, along with infection prevention and control (IPC) and personal protective equipment (PPE) usage training. MSF is also providing logistical support for preparedness of facilities for receiving patients (e.g. rehabilitating wards). The isolation ward is ready to receive patients. In the past couple of days we received four patients with COVID-19 symptoms, three of them tested negative and one still pending test results. The testing is handled by the Kurdish self-administration.
MSF continues to support the Raqqa National hospital, Raqqa outpatient department clinic and Kobane Maternity Hospital. In Al Hol camp, where 94 percent of inhabitants are women and children, we continue to run an inpatient nutrition centre and a tent-based wound care programme for those who cannot reach the clinics, while also providing water and sanitation support in the camp. We have also started mapping vulnerable people who are more likely to develop severe illnesses as a result of COVID-19. We share targeted health awareness messages and hygiene kits accordingly. We are preparing to use the inpatient therapeutic feeding centre (ITFC) for case management - if needed - in the camp. In Al Hassakeh, MSF provides water trucking to the most vulnerable communities. In May, MSF flew two charter flights landing in Erbil, Iraq, which brought in 46 tonnes of essential medical supplies and 14 MSF staff to support medical activities and the COVId-19 response in northeast Syria.
Northwest Syria: More than 700 COVID-19 tests have been performed in Northwest Syria so far, all of which have come back negative. The laboratory in Idlib city has a capacity of 100 tests per day. Between 17 and 30 May, there were 69 suspect cases tested in Idlib, from which 56 were received in the isolation ward at the Idlib National Hospital (INH), a unit designed with MSF support and whose staff was trained by MSF team. To keep its burn unit running in Atmeh, MSF has organized the triage of burn patients, implemented infection prevention and control measures, trained the staff and set up an isolation ward in the hospital.
In the hospitals and health centres that we support in different locations, we have reviewed the triage systems and patient flow to ensure fast detection of suspect COVID-19 cases and isolation from the rest of the patients. In some of them, we have also set-up Hygiene Committees, reinforced them with additional staff, and made donations of protective equipment when needed. We have strengthened the infection prevention and control measures in the facilities we support, and equipped MSF staff with the needed protective equipment.
In the camps we intervene in, we are spreading awareness messages and distributing non-food items and hygiene kits. In Idlib governorate, MSF community health workers provided COVID prevention health promotion to 20,000 families in Harem and Salqen camps. In Deir Hassan area, we distributed hygiene kits to more than 6800 families living in IDPs camp. We adapted NFI distribution to prevent crowding and to reduce the risk of transmission. After adapting the triage system and implementing social distancing measures, in May we resumed the two mobile clinics in 7 sites in Deir Hassan camps and we continued to support a local NGO running two mobile clinics in 10 sites in Afrin area. In Adana district, the two mobile clinics run for patients with non-communicable diseases are taking place every two weeks outside the health centres to allow a safe distribution of drugs to the patients.
Palestine: MSF teams are monitoring closely the spread of COVID-19 and liaising with the MoH in Gaza and Ramallah and with WHO to follow up the situation. In Gaza we have so far observed a small number of confirmed cases, though we are still concerned about the ability of the health system to face an outbreak that stretched even the health systems of rich, high-resource countries to their limits (Gaza has been under blockade for 13 years). MSF is still in touch with the MoH to discuss possible support for patient care, depending on the developments of the outbreak.
In the West Bank, MSF teams adapted the activities to continue to provide psychological support by phone to the population in need. In Hebron the MSF team launched a hotline service to provide remote counselling in support to some of the people most affected by the COVID 19 outbreak such as patients and their families, medical personnel and other first responders, and families of detainees. Meanwhile, the team is distributing hygiene kits to remote villages and food parcels to families that need it as a result of the outbreak control related movement restrictions and loss of income.
Yemen: MSF has put in place measures to keep staff and patients safe in our existing projects across 13 governorates, while ensuring the continuation of life-saving activities in the existing hospitals we work in and helping prepare hospitals to receive COVID-19 cases. In Sanaa, we are supporting two hospitals. At al-Kuwait we are offering a full package of hands on support to the Ministry of Health, including treating the most severely ill patients in the 15-bed intensive care unit, as well as the large inpatient department. At the Sheikh Zayyed Hospital, along with providing training to the MOH staff for screening set up, triage and infection control, MSF has donated hygiene and cleaning supplies, drugs, oxygen and fuel, and continue to monitor the situation.
In Aden, MSF is now running the COVID-19 treatment centre at al Amal hospital following discussions with the authorities. The local health authorities remain in charge of the overall COVID-19 response in Aden, e.g. testing & running rapid response teams. Due to the sharp increase of suspected and confirmed cases in Aden and after discussions with the Ministry of Public Health and Population and Al Ghanouria hospital management, MSF reached an agreement with both entities to provide immediate support to the hospital and to have a COVID-19 treatment centre there. MSF emergency team is already on the ground and started to provide immediate medical and logistical support to the hospital.
In Haydan and Khamer we have set up COVID-19 treatment centres to take care of moderate cases and have begun admitting small numbers of patients with symptoms that resemble those of COVID-19.
In Hajjah Governorate, we are helping with preventive measures in hospitals, including the set-up of screening points for patients, an isolation unit in Abs hospital with a capacity of 11 beds and improving IPC measures (hand washing points, reinforcing waste management protocols) as well as training of MSF and MOH staff on symptoms and case definition, case management and IPC. More than 20 patients have been admitted to the isolation unit in Abs Hospital but so far there have been no confirmed cases for COVID-19. MSF has been supporting with COVID-19 preparedness, providing training and setting up the isolation unit. MSF supported the authorities in setting-up a 30-bed triage area in the COVID-19 unit that is now officially part of Al Gumhouri Hospital, the referral hospital for COVID-19 for Hajjah governorate. In Al Gumhouri hospital, together with the MoH, we maintain essential lifesaving activities such as ER, ICU, OT (life-saving surgeries) IPD male and female, mental health services and emergency referrals to Sana’a. One of our Abs team members showed mild symptoms aligned with the case definition of COVID-19 and he was immediately isolated and later transferred to Sanaa as precautionary measure. In Abs, we are working with communities, to understand more about perceptions and knowledge of COVID-19 within the community, including ‘shielding’ measures (concept of moving vulnerable people to be together in a ‘green zone’ to ‘shield’ them from potential infection). We are also training staff in 3 health facilities and helping them in setting-up screening points, patient flow circuits and preventions measures.
In Ibb governorate we have been supporting local authorities to set up the main COVID-19 treatment centre in the governorate. The team assists with technical support, triage/screening set up, facility management including workforce planning, waste management. The teams put in place infection, prevention and control (IPC) measures and provided training sessions, including for health promotion, for MoH and MSF staff, and for private carers. So far our teams have conducted sessions to more than 500 healthcare workers and cleaners in 8 MoH health facilities and 7 private hospitals.
In Hodeidah we have conducted training in different hospitals and set up an isolation unit in Al Salakhana Hospital in collaboration with local health authorities. We are also conducting trainings and implementing IPC measures in the mother and child hospital in Taiz Houban. Moreover, in Ibb and Hodeidah ours team provided HP, IPC measures and case management training to MoH. In Taiz city, we are providing training on IPC and provided HP materials in the three hospitals we support, as well as setting up triage, screening and identification for potential cases. In Marib, we have trained a large group of community health workers in COVID-19 health promotion and we have been providing for 42 Health Promotion Supervisors of the GHO in Marib (in collaboration with the GHO) on COVID-19 messaging.
Burkina Faso: In Ouagadougou, MSF has finalised the construction/rehabilitation of a 50-bed treatment centre for the care of COVID-19 patients. The opening officially took place on 26th May and 11 patients are admitted to date. Our teams are also providing assistance to health structures in three other districts (Baskuy, Sig-Noghin and Pissy) of the capital; this includes capacity building of medical personnel from the Ministry of Health, with more than 100 staff already trained on infection prevention control and cases management, setting up of isolation units and contributing to establish adequate triage systems. Sensitization activities are also led in the community: our health promotion teams have reached more than 3400 people to inform them on the disease and preventative measures to adopt.
MSF is also working in Bobo-Dioulasso, western Burkina Faso, where the second-most severe epicentre of the outbreak is located. We have been providing care for COVID-19 patients in a dedicated facility since the beginning of April, in collaboration with health authorities, and an oxygen generator which can provide oxygen to several tens of people at once has just been installed. Furthermore, we continue reinforcing other facilities’ capacities in terms of triage, isolation, protection equipment and infection prevention and control measures: at the University Hospital Centre, and at the Medical Centres with Surgical Antennas of Do and Dafra. We are also strengthening epidemiological surveillance at the community level, we are providing psychosocial support to patients, their families and contacts, we are distributing protection kits to vulnerable people, and we are stepping up sensitization activities through media and other social mobilization tools.
In the Eastern area, we have rehabilitated a 20-bed provisional treatment site at the regional health centre in Fada and identified isolation units in all medical structures supported by MSF in the area. We continue to train health workers on prevention measures and adapt patient circuit and triage at the facilities we assist and implement WASH to minimize the risk of infections. We are pursuing awareness-raising efforts as well, through sensitization activities on radios and community health workers. In the projects in Titao, Djibo, Kaya and Barsalogho, not yet affected by COVID-19 either, we are following up epidemiological situation as concerns remain high with the number of displaced people in the northern, central and eastern parts of the country. Over the last weeks, we have adapted triage and infection prevention and control measures in the health structures we are supporting, we have set up isolation units, and trained staff on prevention and case management.
Cameroon: In Yaounde, MSF is treating moderate covid-19 patients in the Djoungolo health facility, where we increased the capacity in building four rooms with 20 beds each. Capacity is now up to 110 beds. For now, 90 patients are hospitalized (12 suspected cases and 72 confirmed).
We also support the Hôpital Général in triage, safer patient flow, infection prevention and control measures, and set up a systematic triage service at the Jamot Hospital.
In North West and South West regions, MSF has set up isolation and treatment wards (16 and 20 beds) in Bamenda and Buea regional hospitals for suspected and confirmed COVID-19 patients, and has trained medical and non-medical staff who will run the units. MSF has also strengthened measures to prevent the spread of the new coronavirus in the health facilities we support in Bamenda, Kumba, Muyuka, Mamfe, and Widikum and is giving logistical and training support to Tiko District hospital. The procedures for our ambulance service have been adapted to the Covid-19 response. Health promotion has been strengthened at community level, especially targeting people affected and displaced by violence – using community health workers and nurses, as well as radio messages.
In Douala, Cameroon´s second-most affected city, we have trained staff at Hospital General and 2 other hospitals.
In the Far North, patient flow and infection prevention and control measures have been adapted in both the regional hospital of Maroua and in the Mora hospital, where we have been present since 2015. We also set up a triage and isolation circuit for alert cases in 9 health centers in the city of Maroua, train the teams on standard hygiene rules and infection prevention and donated some material. In Mora, the team constructed an 8-bed isolation ward in the district hospital and similar support has now started in neighbouring health centres. We also trained community health workers and reinforced the Covid-19 screening at the entrance of the Mora district hospital.
Ivory Coast: In Abidjan, MSF WaCA and Ministry of health medical teams are now treating moderate covid-19 patients in the treatment centre of Vitib, in Grand Bassam, one hour far from Abidjan. The capacity here is up to 76 beds. So far, 258 patients have been admitted since the beginning of the activities and 213 have been discharged after being confirmed negative. Three patients with severe complications were referred to an MoH facility. Psychosocial support has been increased in Vitib, with the presence of 2 psychologists recruited by MSF. With the ease of the restrictions measures in the country, surveillance in Bouake has increased, as it’s a big travel corridor, between Abidjan and Burkina Faso. MSF is now ready to accelerate activities in Bouake. Training, health promotion activities are still on-going, as well as WASH activities and support to the screening at the different entry points to the city and the six supported health centers in order to identify suspect cases of Covid and refer them to the Covid care unit. MSF also produced 1 million cloth masks in partnership with UNIWAX and other civil society organisations. Their distribution to the vulnerable population started 2 weeks ago in Abidjan and will continue with other sites to be confirmed jointly with the partnering civil society organisation. MSF, through local associations, is also distributing cloth masks to patients suffering from kidney failure, as well as to diabetics and people with high blood pressure.
DRC: Since April 27, MSF teams have been treating COVID-19 patients at Saint-Joseph hospital in Limete, Kinshasa, in support of the Diocesan Medical Office, the Ministry of Health and in coordination with the COVID-19 national response team. The structure can accommodate up to 25 patients and will be expanded to 50 beds if necessary, according to the admission criteria defined for each municipality by the Ministry of Health. MSF mobile teams also support 50 health structures in four health zones in Kinshasa to strengthen hygiene measures, equip them with masks and handwashers, train medical staff and community relays on prevention and infection control in health centers and within families. In Lubumbashi, MSF is preparing to support a dedicated COVID-19 structure, with 20-bed capacity, which has been constructed in the area around the airport. In Goma, MSF is preparing to support the MoH to manage the COVID-19 Treatment Centre, previously used as an Ebola Treatment Centre in Munigi. Also in Kinshasa and Goma, MSF has started production of tens of thousands of reusable masks. These masks were manufactured to protect patients and their carers in the structures that MSF supports, as well as its non-medical staff. They are not surgical masks used by nursing staff in contact with patients. In Ituri Province, MSF has implemented infection prevention and control measures to prevent the spread of COVID-19 in the health structures we support (community health sites, health centers and hospitals). The teams have trained health workers in the region about COVID-19 and are strengthening the hospitals of Nizi, Drodro and Angumu with medical equipment, human resources, and preparing the isolation and care structures within these hospitals. Additionally in South Kivu, MSF is establishing isolation centres in Baraka hospital, Kimbi hospital and Nyange Heath Centre for suspected COVID 19 patients, with 80 beds in total as capacity and mental health support for the patients.
Guinea: Since 30 April, MSF is caring for COVID-19 patients in the Nongo Epidemic Treatment Center in Conakry. MSF had set up this structure in 2015 as part of its response to the Ebola epidemic, before handing it over to the authorities. In April 2020, MSF teams have rehabilitated a large area of the centre to bring it up to standard and to provide care for patients with mild symptoms of the disease but who need to be admitted to hospital according to national policy. Rehabilitating and expanding Nongo treatment centre was urgent given the rapid overcrowding of Donka hospital, the only health facility designated to receive COVID-19 patients in the first weeks of the crisis. The new isolation and care centre can accommodate 75 stable patients. Depending on the evolution of the pandemic and bed capacities in the city, an increase in the number of beds will be considered, as well as the medical management of more severe cases requiring treatment in hospital. Our teams are also disinfecting the homes of patients admitted to hospital, providing psychosocial support, and tracing and following up on their contacts. Given the very fragile health system in Guinea, the continuity of our medical services and projects in Guinea is a priority. In the cities of Conakry and Kankan, we continue to provide free care for children with measles in two facilities. Our malaria and malnutrition projects in Kouroussa prefecture, and the provision of care for patients living with HIV in Conakry, are also ongoing and our teams have adapted to the new pandemic by helping health facilities and communities to protect themselves from the virus.
Kenya: The number of confirmed cases of COVID-19 has been growing exponentially in Kenya over the last two weeks, with the current figures standing at 2,093 confirmed cases, with 71 deaths. MSF is supporting several health facilities in Nairobi, Kiambu, Dadaab and Mombasa Counties in conducting health awareness, case management trainings to staff, providing logistics support, boosting Infection Prevention and Control and triage. In Mathare informal settlements, teams are providing mental health consultations to survivors of sexual and gender-based violence by phone to continue providing adequate care throughout the pandemic. There is an increase in the obstetric calls at MSF’s emergency call centre, as many pregnant mothers find it difficult to reach medical facilities at night due to a nationwide dusk-to-dawn curfew. MSF also conducted an assessment in western Kenyan counties following the flooding of most of the areas. MSF will support with malaria drugs and treated mosquito nets. MSF’s intervention is largely limited by COVID-19.
As a mitigation measure for COVID-19 spread, patients with Non-Communicable Diseases (NCDs) have been provided medicine for three months in Embu County where MSF is supporting the county level five hospital with triage and screening of patients and boosting IPC in 11 health facilities. To ensure continuity of care for people who use drugs, MSF has set up triage system and an isolation room at Karuri Hospital in Kiambu County. In Homa Bay County, MSF has provided three months of ARV treatments to patients to avoid their exposure to and at the hospital. MSF assisted the MoH in the design of a facility for managing confirmed cases of COVID-19 in Malela. In Dagahaley camp, in Dadaab, Kenya’s largest refugee camp, MSF has set up an isolation unit with 10 beds for COVID-19 positive patients. Unit has a capacity to expand up to 40 beds. MSF has set up isolation rooms, at Mrima health centre in Likoni subcounty, Mombasa, which will allow women who have COVID-19 to give birth safely.
Liberia: There are 288 confirmed cases of COVID-19 in the country, and 27 people have died. MSF completed a month-long COVID-19 hygiene awareness and soap distribution campaign in April, reaching more than 78,000 households in four of Monrovia’s most vulnerable neighborhoods and continues to provide technical support at the city’s Military Hospital, run by the Ministry of Health, where COVID-19 patients are being treated. MSF is carrying out on-going awareness activities on prevention measures in communities in an around Monrovia. MSF is now operating its’ mental health project remotely, talking to patients on the phone and providing two-months drug supplies when necessary.
Mali: In Bamako, MSF supports the COVID-19 treatment unit, within the grounds of the hospital where it runs its oncology programme (‘Point G’ hospital). The 100-bed unit is set up and managed by the MoH and run with MSF and MoH staff. MSF supported the rehabilitation of the hospital’s oxygen distribution network and provides medical, nursing and hygiene control staff as well as logistical and technical support. We also helped with IPC, watsan, training of staff, and revision of patient flows in two other hospitals in Bamako receiving COVID-19 patients (Hôpital Dermatologique and Hôpital du Mali). We also engage on COVID-19 related HP/sensitization with local actors, health workers and members of civil society organisations, such as people living with diabetes and members of patients’ associations. In link with MoH community-level and contact tracing activities in Bamako, we set up handwashing stations and provide locally-produced cloth masks and soaps in most at risk locations, ie where a case has been confirmed. In the Center (Ségou, Niono, Tenenkou, Ansongo, Douentza, Koro), in the South (Koutiala) and North (Kidal and Ansongo) of the country, we strengthened hygiene and IPC measures and set up isolation areas in the supported hospitals and health centres. We also support MoH activities such as case management, raising awareness among the population, improving prevention and setting up isolation structures for patients. Technical advice and support has been provided to the hospitals of Gao and Sévaré. This week a team is being dispatched to Timbuktu in order to assess more closely the ongoing situation with COVID-19.
Niger: We finished the semi-permanent construction – a 50 bed treatment centre opened – located close to the Amirou Boubacar Diallo National Hospital, and trained health workers on COVID-19. The treatment centre is now operational and should receive its first patients in the next days. MSF and MoH’s health workers will receive suspected cases with complications and confirmed cases requiring hospitalisation. We are also supporting the emergency medical service’s call centre (24/7), and the response teams in five communes of the city in order to strengthen response capacity of the MoH, at community level. The teams provide technical support in the verification of alerts and organise the triage at the call centre’s level. We provide psychological support. A response team composed of MSF and MoH are monitoring simple COVID-19 cases at home. Serious cases are referred to health structures, and soon to the new treatment centre of Lamordé.
Nigeria: across the seven states where MSF works in Nigeria, we are providing technical support to the MoH and Nigeria Center for Disease Control (NCDC) as they set up isolation centres for patients who present symptoms of COVID-19, as well as with contact tracing, community-based health promotion activities, and setting up hand washing points and isolation areas in local communities and IDP camps.
Senegal: In Dakar, we are supporting the health authorities in the Hopital Dalal Jamm, in the northern part of the city, where we trained staff and supported water and sanitation activities, logistics and also helped the simplification of triage, waste management and other protocols. The treatment centre has now 187 patients admitted (capacity being up to 200 beds) and we are working on preparedness for complex cases (oxygen therapy). In a Northern suburb of Dakar, support activities in Guediawaye district, on epidemiological surveillance, community engagement and IPC standards at health facilities are progressing.
Sierra Leone: MSF is part of the case management and surveillance pillars at the national Emergency Operations Centre (EOC) and district level EOCs in Kenema, Tonkolili and Bombali Districts. In Freetown, MSF has completed refurbishments at a government facility, Hastings CTC, that has been converted into a 120-bed centre for COVID-19 patients. MSF WATSAN and construction engineers built systems to treat waste water, and a structure for patient reception and donning and doffing areas for health workers. The facility was handed over to the Sierra Leone Emergency Operations Centre on 13 May. MSF also carried out training in the correct use of personal protective equipment for around 140 workers who will manage the facility.
In Kenema District, MSF completed in 12 working days rehabilitation works at a Lassa Fever isolation unit at Kenema government hospital so that it is ready to become a COVID-19 treatment centre with a current capacity for 25 beds. The facility began receiving patients on 18 May. MSF established the facility’s water supply, repaired the existing plumbing and sewage systems and installed 11 hand washing stations. MSF repaired and improved the existing electrical infrastructure and installed a new generator and an uninterruptible power supply to guarantee the supply of electricity to oxygen concentrators during power outages. MSF also built a new drying area, installed new mosquito mesh and carried out indoor residual spraying in all patient rooms.
South Africa: MSF has re-purposed existing project staff from all 4 projects to COVID-19 responses in Gauteng, KwaZulu-Natal and Western Cape provinces. MSF staff have assisted with limiting infection spread by: contact tracing (physical and telephonic); the development and dissemination of health promotion materials; decanting of healthcare facilities through screening/triage points outside facilities and ensuring HIV/TB patients get medicine refills delivered at home. TB screening and testing as well as voluntary HIV testing is now included in shelter-based activities in Tshwane and Johannesburg. In these cities, MSF has also started methadone distribution to opiate dependent patients as part of the package of primary healthcare services, and mental health services are currently offered in 15 highveld shelters. In Eshowe, MSF is driving a strategy to set up 35 medicine pick up points in communities, meaning at-risk people living with HIV, TB and non-communicable diseases like diabetes will make fewer non-essential visits to healthcare facilities. The team is also developing additional COVID-19 case management capacity for healthcare facilities in Eshowe and Mbongolwane. In Rustenburg, MSF has supported COVID-19 patient flow at several hospitals and community health centres, and has helped to ensure the continuation of services for victims of sexual violence, as well as helping to ensure that choice of termination of pregnancy is maintained as an essential service during this time. In Khayelitsha, a COVID-19 Field hospital opened on June 1st, in partnership with the South African Department of health. It also has 60 oxygen concentrators to support COVID-19 patient care. Khayelitsha is the sub-district with the highest number of cases in the country.
South Sudan (see also preparedness below): Cases of COVID-19 continue to increase with 994 confirmed patients in the country (as of 2 June), including in MSF facilities and project areas in Agok, Yei, Lankien and Bentiu Protection of Civilians (PoC) site, as well as in Malakal Town and Aweil. In Bentiu PoC, UNMISS had granted permission to MSF to run a “holding/transit” facility wherein COVID-19 patients can be kept until they are transferred to the “isolation/treatment” facility in Bentiu town. Unfortunately, external actors have not yet pledged sufficient support for the rehabilitation of the facility. MSF continues to reach out to UNMISS and awaits a formal response.
In Agok, MSF has modified an ambulance to be used to transport confirmed and suspected COVID-19 cases. In Juba, MSF teams are carrying out community assessments and community engagement, as well as installation of handwashing points in the following locations: Konyo Konyo market, Juba Cemetery area, Mangateen Primary Health Care Unit, Gumbo Primary Health Care Centre, Don Bosco Health Centre and an Internally Displaced Persons (IDP) camp in Gumbo. Handwashing points were donated to the Juba Teaching Hospital and to the Military Hospital, 14 handwashing points are now running in Konyo Konyo and Cemetery, and 51 healthcare workers were trained on infection and prevention control (IPC) and triage related to COVID-19, in six health facilities including in three free-of-charge MoH-supported health facilities and three private clinics.
Sudan: MSF teams across Sudan are conducting health promotion and awareness sessions with patients and the local community, or at non-MSF primary healthcare centres. MSF provides daily trainings to health workers including bedside trainings and mentoring, in the health facilities we support. MSF also runs a mobile COVID-19 unit that supports other facilities and works on early detection and prevention of the spread of the disease.
COVID-19 highlights on preparedness:
CAR: While COVID-19 confirmed cases keep rising (1173 as of 1 June according to the MoH), MSF remains committed to provide care in our 13 projects, to ensure that all needed supplies and medications are available for both our patients and staff. IPC measures, pre-triage and triage mechanisms, and isolation wards have been set up in all our projects around the country, and MSF projects teams are working to improve them. We are also working to adapt the way we care for people who are the most at risk of developing severe forms of COVID-19 if infected, such as malnourished children and people living with HIV and TB. Last week the intersectional taskforce for COVID-19 received the authorization to go ahead with the construction of an MSF COVID-19 treatment center (COVID TC) in Bangui, with an initial capacity of 24 places, to be scaled up to 50. The COVID TC will treat severe patients through oxygen therapy and offer palliative care. On surveillance, MSF supports the MoH in Bangui for contact tracing and sample collection activities on the testing site. We continue our engagement with the communities to explain what COVID-19 is and work together to promote and adapt prevention measures to their daily realities. Overall MSF is supporting the MoH through technical advice and active participation to the COVID Riposte (response) mechanism. Out of the capital, in projects in the provinces, we are running several measles vaccination campaigns for children until 15 years old (ages range varies for each campaign), in Bossangoa, Carnot (where teams are also testing children under 5 for PCV13, and identifying those who suffer from severe and acute malnutrition and referring them) and Bangassou, which are becoming more and more challenging because of the need of implementing COVID-19 prevention measures : in order to limit as much as possible the risk of transmission, the general strategy adopted is to avoid big vaccination sites and to divide the areas we cover in small departments, running vaccination activities on a longer period.
DRC: MSF is supporting the MoH with training of healthcare workers in infection prevention and control (IPC) measures as well as pre-triage, triage, screening and isolation for people with symptoms consistent with COVID-19, in all structures where we work. In some of the country’s hospitals and healthcare centres where MSF is already present, we are building isolation circuits within the structures and setting up additional beds for the isolation and care of potential COVID-19 patients. We are also carrying out health promotion activities. In South Kivu, MSF is also supporting with laboratory and sample analysis and in Bukavu, with the dignified and secure burial of patients who die from COVID-19.
Eswatini: We are providing support to the MoH by assisting with infection control and triage at health facilities. We are also part of technical advisory groups to the MoH and are implementing adjusted models of care for patients living with HIV, TB and non-communicable diseases in order to reduce their risk of infection. Teams are doing health education in the communities on a daily basis.
Guinea Bissau: In Bissau, at the National Hospital Siamo Mendes (HNSM), we provided many different trainings: COVID-19 preparedness jointly with MoH, IPC, water&sanitation and hygienist support, waste management (we rehabilitated the incinerator). An epidemiologic surveillance reinforcement was offered. To support triage and suspected cases, we prepped 5 tents given by UNICEF. MSF trained staff - including MoH - on case management and we expect to train staff from other provinces. MSF is also supporting the local call centre and the mobile response team who are doing case detection, alert confirmation and contact tracing. Health promotion and community engagement work is ongoing in the HNSM and also with various communities in different area of the city and SAB (sector autonomo de Bissau). Since 1 May, Guinea Bissau has become one of the most affected countries in Africa in terms of confirmed cases per capita. Following a dramatic exponential increase in confirmed cases, including more than 45 medical staff at the HNSM, MSF called publicly and bilaterally at many levels for a scale-up of the response and a better coordination between all actors involved (Ministry of Heath, UN system, International intuitions). https://allafrica.com/stories/202005160066.html
Malawi: A low number of COVID-19 cases has so far been reported in the country. We adapted our activities to help contain the spread of the virus. Adjustments include installation of handwashing points, health promotion actions as well as clinical screening/triaging of potential COVID-19 cases.
Our HIV programmes in Nsanje and Chiradzulu have are increasing efforts to provide ARV refill supplies for our patients, to reduce the frequency of their visits and decongest health care facilities.
In Dedza and Zalewa, we are working to ensure continuity of care for one-stop HIV and sexual and reproductive health services at facilities. Physical distancing measures led to a temporary suspension of the “Teen Clubs” in Chiradzulu, where HIV-positive children and teenagers can access counselling, consultations and testing in a dedicated environment featuring recreational activities. Our cervical cancer activities in Blantyre have also been limited to admitting the more urgent cases.
Mozambique: Across all our projects, we have worked on preventative measures like infection control, triage and surveillance. We have also adapted our models of care to reduce the risk of infection for vulnerable patients. In Maputo, we have started supporting the main COVID-19 referral hospital Polana Caniço. An MSF team works full-time inside the hospital, supporting the MoH staff with infection control, training, patient flows and protocols. In Pemba we helped local health authorities to install an isolation centre. We participate in the Mozambican COVID-19 coordination meetings and technical groups providing advice for the shaping of the response in the country.
Niger : Our teams have put in place COVID-19 preparedness measures in all our projects in the regions of Zinder (Zinder and Magaria), Maradi (Maradi and Madarounfa), Agadez, Diffa. We adapted and implemented triage, isolation room, and infection prevention control measures and health promotion activities in our supported health structures (hospitals, centres de santé and cases de santé) and references from remote areas to health structures. We also have COVID-19 activities on some external axis, where we run preventive decentralised care. In some regions, we also support the MoH in the transport of samples.
Borno state: MSF continues to provide technical and material support to the MoH COVID-19 isolation centre in Maiduguri, with staff training, the establishment of a patient flow system, and the management of certain infection prevention protocols, including the laundry system for the centre. In Gwange, the MSF-run hospital continues to run comprehensive paediatric secondary healthcare services, and in Fori, our inpatient therapeutic feeding centre both with reinforced IPC and adapted triage and patient flow systems. In Ngala MSF's hospital has ceased 24-hour services but continues to provide primary healthcare services during the day, as well as community-based health promotion services. In Pulka the MSF-run hospital continues to provide comprehensive primary and secondary healthcare, community engagement activities (including health promotion and education on COVID-19), outpatient care and vaccinations. A 24-bed isolation ward has also been established. In Rann, MSF continues to provide community-based health promotion services and will commence round-trip visits for medical consultations.
Outside Borno: In Ebonyi state, MSF is supporting the MoH and Nigerian CDC in setting up the state’s first COVID-19 testing centre. In Sokoto we have supported the MoH in renovating a 32-bed isolation and treatment centre, handed over to the MoH in early May. In Zamfara, ongoing community engagement with IDPs in and around Anka town, includes HP and installing water points and soap and hygiene product distributions and the setting up of a holding centre for potential COVID-19 patients, before transfer to the MoH in Gussau. MSF continues to provide paediatric care in Anka general hospital (but has changed criteria to reduce inpatient services to only those for whom it is essential) and is providing technical support in the hospital to establish isolation zones, IPC protocols and adapted triage and patient flow systems. A malaria contingency plan is in place to ensure continuity of malaria treatment during the upcoming season and minimise the load in the hospital. Together with the state health authorities, we are conducting a large-scale community sensitisation campaign on COVID-19. So far, we have visited 240 of the planned 370 settlements. In Jigawa, MSF teams continue to provide support to the MoH isolation facility, maintain reinforced IPC and adapted triage in the MSF-run maternity hospital in Jahun, and provide IPC training to hospitals. In Port Harcourt - MSF continues to provide medical and psychological care for victims of sexual violence in Port Harcourt. MSF has adapted its triage and patient flow systems and added more stringent infection prevention protocols. In Benue MSF-run clinics (in collaboration with MoH) have adapted triage, and screening, reinforced IPC and worked to ensure staff safety and use of PPE, as well as HP and water and sanitation activities with IDPs.
Sierra Leone: As psychosocial care is a gap in Sierra Leone, one member of the mental health team for the TB project is currently in Freetown to support provision of mental health services for COVID-19, focusing on training but may also provide psychological support to COVID-19 patients. We will see how we can cascade that training to the districts, but first we will start in Freetown. The coordination team is trying to work with the District Medical Officer of Freetown Area to start doing health promotion and sensitization in a slum area. We will also look at the WATSAN situation and could do a limited hygiene kit distribution to the area in the coming weeks. MSF supported the setup of the Bombali district’s first treatment centre in Makeni. Completed this week, already 6 of the 12 beds are occupied. While we are continuing our essential TB activities in collaboration with the MoHS we are also looking at how we can support in opening a 30 bed COVID-19 treatment centre. MSF did a quick qualitative assessment on the perceptions of key community leaders toward the implementation and impact on their and community lives of COVID-19 control measures. The findings from this assessment will feed into a co-design with community adapted control measures and improved messaging and outreach strategies implemented by MSF and local MoHS. In Tonkolili District, MSF has set up isolation wards in Magburaka Hospital and Hinistas community health centre. The team is working to support some logistical and WATSAN gaps for the case management centre.
Somalia and Somaliland: Over the last weeks, MSF, WHO and other actors have been coordinating with the health authorities of Somalia and Somaliland at project and national level. The already fragile health system is overburdened with COVID-19. Due to the measures put in place to prevent the spread of the infection, regular programs are getting affected, like routine immunization and nutrition programs. In Las Anod, Galkayo and Baidoa, where we were already running medical activities, we have put in place hygiene measures and preventive measures to protect our frontline staff. This includes infection prevention and control (IPC) trainings and trainings to be able to identify COVID-19 symptoms and triage suspected cases. We are also stepping up health promotion activities and providing technical advice or logistic support to set up isolation structures in some places. In Hargeisa, as part of a task force composed by different NGOs, we are providing support to the MoH of Somaliland to set up a COVID-19 centre. MSF´s support has included light donation of IPC materials, training of Emergency Room staff and ambulance drivers, and a Training of trainers for regional medical staff on issues like IPC measures.
South Sudan: In addition to trainings, MSF is working on preparedness for COVID-19 in all project locations across the country, as well as on preventive measures, to be able to isolate and treat suspected patients of COVID-19 who may eventually approach our health facilities. These measures include setting up additional washing points equipped with either chlorinated water or soap and reinforcing the existing ones, training staff on triage and infection prevention and control (including the use of PPE), identifying and establishing isolation areas or pre-screening areas for suspected COVID-19 patients and conducting. Most recently, in Mundri we have handed over the old ER facility to Doctors With Africa (CUAMM) to support COVID-19 case management. In Yambio we have distributed COVID-19 dignity kits to national staff. In Yei the Ministry of Health has requested support in the running of the COVID-19 isolation facility, given constraints in staffing and supply. In Malakal, we are in consultation with UNMISS who have started the rehabilitation of the Malakal teaching and referral hospital to renovate two wards to be used for COVID-19 critical care centre. The centre would serve Malakal town population and population in the Malakal Protection of Civilians site. In Agok, preparations are underway for an In Patient Department (IPD) for COVID-19 patients, and in Old Fangak – where we were working on setting up a 10-bed COVID-19 centre – activities have been temporarily suspended due to insecurity.
Sudan (also see activities above): In MSF projects across Sudan, we have put in place safety and hygiene measures to avoid the emergence of cases among our staff. We have also developed quarantine procedures for those who develop symptoms, to ensure that our staff can continue to safely treat patients. In collaboration with WHO and the Sudanese health authorities, MSF provided Trainings of Trainers (ToTs) to key medical staff of 90 major (public and private) hospitals in Khartoum, including the two COVID-19 isolation centres identified by the Government. Subsequently, the WHO and the MoH rolled out ToTs in nine states. The objectives of the trainings were to increase capacity of the health facilities in being prepared to respond to patients, suspected or confirmed to have COVID-19, to reinforce IPC knowledge and standards and rationalise the circuit of the health facilities depending on the level of exposure. MSF teams are in touch with the federal MOH and support the preparedness of a response including infection prevention control measures, setting up treatment centre, trainings for MSF and MoH staff, HP and basic logistics. At the Omdurman Teaching hospital, the largest hospital in Sudan, we are working closely with the MoH in the emergency department and preparedness to cope with COVID-19. We are also supporting the MoH to set up and manage isolation centres in East Darfur, South Kordofan and Gedaref states. Our teams are working on COVID-19 preparedness and preventive measures in all our projects, in order to safely isolate and treat suspected patients who may seek treatment in our health facilities.
Tanzania: MSF is the sole healthcare provider at Nduta refugee camp, which hosts 75,000 Burundian refugees. In preparation for a COVID-19 outbreak in the camp, MSF has built four triage/isolation areas at each of its health clinics at Nduta refugee camp, and has completed preparation for a main isolation centre at the MSF hospital, where suspect cases of COVID-19 will be referred. Currently we have 10 beds with the possibility to connect 10 oxygen concentrators, and are in the process of constructing an additional 50 beds, with options to scale up to 100 if needed. More than 250 MSF staff have so far been trained for COVID-19 response, with a focus on case definition, triage, screening, infection prevention and control, safe transportation of suspect cases, isolation, use of PPE, and case management. All patients are now screened for COVID-19 at the entrance of our health clinics and hospital. In April, seven suspect cases were admitted to MSF’s isolation facility. All of them tested negative for COVID-19. Meanwhile, our health promotion team in Nduta camp are working to sensitise and educate the community on hygiene and best health practices, to improve preparedness for COVID-19 within the camp.
Uganda: Uganda has reported a low number of cases and no COVID-19 deaths so far. MSF teams have reinforced measures to prevent and control infections, have worked to raise awareness and improve triage in all the sites of activity. In Adjumani district, in the North, MSF teams have visited transit centers being used to isolate COVID-19 contact cases – an intervention is being planned to improve living conditions in these overcrowded facilities. The HIV programme has been adapted to reduce the frequency of patient visits by increasing anti-retroviral treatment supplies, follow up is limited to urgent cases. Recreational activities for HIV-positive teenagers are on standby. Physical and mental health care for victims of sexual violence continues in the Yumbe refugee camps, with measures to avoid infection.
Zimbabwe: The MSF migration project in Beitbridge is working with the government and other partners supporting the repatriation of Zimbabwean residents. With more residents expected to return from neighboring countries, MSF is providing support for COVID-19 screening, sample collection for testing and providing non-COVID-19 healthcare services and health promotion. We are supporting case management of COVID-19 cases who are in isolation in Harare and upgrading facility capacity to 164 beds, while WASH team provides additional support in communities. MSF has trained more than 415 healthcare workers on COVID-19 case management, laboratory surveillance, IPC, WASH in facilities, epidemic surveillance, contact tracing, data management, as well as safe transport of people testing positive for COVID-19.
CENTRAL & SOUTH EAST ASIA
Afghanistan: The COVID-19 response team in Herat is planning to set-up a COVID-19 centre and launch outreach activities in the IDPs camps. So far COVID-19 patients are admitted to an MoPH hospital turned into a COVID-19 center supported by an NGO. And most of them are not severe. Kabul has surpassed Herat as the epicentre of the outbreak in Afghanistan, but little is known as to the true scale of confirmed cases in other locations as testing capacity is still limited. After the attack on Dasht-e-Barchi, the support to the Afghan-Japanese COVID-19 referral centre in Kabul has been stopped. In Lashkar Gah, the MSF team is providing technical support for the management of the COVID-19 facility set up in Malika Suraya hospital. In all projects, MSF has put in place all necessary preventative measures to mitigate the risk of our facilities becoming part of the chain of transmission. In Kunduz, the wound care clinic activities have been temporarily suspended, as have the MSF activities in the small stabilisation clinic in Chardara district, west of the city. Some construction activities in our various projects have also been put on-hold.
Bangladesh: MSF is treating a number of patients who are COVID-19 positive, as well as monitoring others with suspected COVID-19, in isolation wards in our facilities in Cox’s Bazar. Our focus is currently on treating all of our patients and ensuring we can give the best possible quality of care for COVID-19 and other medical problems, as well as continuing to work together with the Bangladeshi authorities, WHO and other health actors to limit the spread of the virus. Our teams are also carrying out HP activities in the camps. Regular activities in the Rohingya refugee camp in Cox’s Bazaar are ongoing.
Cambodia: Staff in six hospitals in four provinces in Cambodia – Pailin, Bantey Meanchey, Oddar Meanchey and Pursat– have received training and logistic support for triage setup. MSF has also contributed to the development on national treatment protocols and infection control and prevention SOP. MSF teams have resumed hepatitis C care in Phnom Penh, taking the necessary precautionary measures against COVID-19 for patients and MSF team into consideration.
Hong Kong: In the past weeks, the local outbreak has been under control. Therefore, Hong Kong has started to relax its COVID-19 measures. The MSF project has shifted its focus from health education to mental health support. As the outbreak has lasted for months, the team is now preparing a website providing information and tips to address mental stress caused by prolonged exposure to uncertainty whilst face-to-face sessions targeting the most vulnerable people are also ongoing.
Japan: An outbreak of COVID-19 among crew members on a cruise ship docked for repairs in Nagasaki, in western Japan, led to 149 out of 623 staff on board testing positive for COVID-19. MSF launched onshore medical assistance. The team of one doctor and two nurses assessed patients and assisted with referrals depending on the condition of the patients and the urgency of medical care.
Pakistan: In Timergara, the team is screening more than 1,000 people (sometimes more than 2,000) every day for symptoms of COVID-19 and undertaking consultations for suspect cases. We have increased the bed capacity of the isolation ward from 15 to 24 beds for mild and moderate cases and referring serious patients to the tertiary structures in Peshawar. In Baluchistan, while cutaneous leishmaniasis activities remain suspended, we have started our support to the Killa Abdullah District Hospital Isolation Ward, preparing donations of PPE, hiring support staff, and providing watsan, logistics and trainings to the health authorities. We continue to see hepatitis C patients in Karachi twice a week but we have provided most with enough drugs to cover their treatment and avoid frequent clinic visits. MSF is looking at how to further support the most vulnerable in the Machar Colony community. MSF is also conducting extensive awareness-raising activities on ways for people to protect themselves and prevent spreading the virus, and we have added protective COVID-19 measures and isolation areas in most of the facilities we support across Pakistan.
Philippines: Regular activities have been put on hold, both in Manila and Marawi. In Manila, the team supports our partner organisation Likhaan with health promotion activities. In Marawi, in the south of the country, a "mobile information drive" to pass health promotion messages to vulnerable populations has been launched and medication, hygiene kits and leaflets about COVID-19 have been delivered to patients suffering from diabetes or hypertension.
Papua New Guinea: In Papua New Guinea, our teams continue to provide training to the health care staff in health facilities designated to receive COVID-19 patients, particularly in the Gulf province, where one of MSF’s tuberculosis projects is based. Regular TB activities have resumed.
COVID-19 highlights on preparedness:
India: MSF's team in Patna, Bihar continues to set up a facility for mild to moderate COVID-19 patients, converting a sports hall, to support the Nalanda Medical College Hospital. Expecting to start treating patients from 10 June. Community health promotion and education activities will also be taking place. Maharashtra state has reported the highest number of COVID-19 cases in the country (26% approximately) of which nearly 66% have been from Mumbai. Mumbai is reported as one of the hot spots for the spread of COVID-19 cases in India. MSF will scale up training among staff, screening, triage, IPC measures, testing and establish an appropriate referral mechanism for presumptive cases for treatment and isolation in targeting 28 informal settlements within Mumbai. With outpatient departments at all hospitals in Kashmir, including MSF mental health clinics, closed for the time being, MSF teams now provide psychological support via mobile phone consultations. In Manipur MSF is starting a food distribution intervention for homeless people and intravenous drug users, and continues to run its HIV/TB clinics, albeit with reduced opening time, and is working to ensure all patients have a three-month supply of medicine.
Indonesia: MSF continues its support related to the COVID-19 preparedness in Labuan and Carita sub-districts in Banten Province as well as the health education activities. As well, the support in task force surveillance at sub-district up to the village levels. At the coordination level, the MSF team visited the primary healthcare facilities in Jakarta to discuss challenges and identify areas of possible MSF support. As the mission has added COVID-19 Watsan staff to the team in Banten, MSF is going to reinforce the medical COVID-19 team in the coming weeks with staff to support with training and support to primary healthcare facilities.
Kyrgyzstan: In Kyrgyzstan, we are working closely with the Ministry of Health, and offering technical advice for Covid preparedness planning and logistics support for contact tracing with a specific focus on our areas of operation in Kadamjay Rayon and Batken Oblast. We have also provided the Ministry of Health with personal protective gears including N-95 masks and gloves, thermometers, chlorine tablets and alcohol pads.
Malaysia: We are ready to increase support to the national MoH and district authorities for contact tracing and testing. We have also issued a call to the Malaysian government to repeal a circular, obliging public health facilities to report irregular migrants, including refugees and asylum seekers.
In Penang, we are providing COVID-19 health education in different languages, including Rohingya and Burmese, and translations in hospitals. We’ve had to suspend mobile clinics, but patients reach us through our phone hotline. We have donated food supplements to 100 vulnerable families.
Myanmar: Our teams have implemented e-prep plans in each project including: IPC and PPE training, additional handwashing points, establishing quarantine options for staff and designing rotating work schedules. We also provided extra drugs to HIV and NCD patients. The MSF Myanmar Facebook page has started an awareness and engagement campaign, focusing on the dissemination of COVID-19 prevention and health promotion messages, reaching 1.7 million clicks in the last month. MSF is also closely collaborating with the MOHS, providing technical trainings, translations and other assistance to MOHS staff and donating various items such as surgical masks, hand sanitizer, soap and health education billboards.
Tajikistan: On 30 April, the first COVID-19 cases were reported after weeks of the government citing a “pneumonia” outbreak. As of 1 June, there are 4013 confirmed cases and 47 deaths. MSF is prioritising 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 existing MSF programmes focused on diagnosis, treatment and contact tracing. We developed a TB+COVID health education leaflet in collaboration with the MoHSPP which has been disseminated by the National Tuberculosis Program (NTP) to TB facilities. In districts where we work, we are prioritising TB patients, their families and their communities as well as the staff to explain how to prevent the transmission and infection of COVID-19. Medical guidelines for treatment of TB+COVID co-infection were drafted in collaboration with the NTP and are under review. MSF is planning to ensure clean water supply to Rudaki TB dispensary and hospital to strengthen IPC measures such as handwashing.
Uzbekistan: MSF is maintaining key TB and HIV programmes while engaging in interagency cooperation for COVID-19 response. We have supported the drafting of the infection control chapter of the National COVID-19 guidelines and support the translation of health education documents upon request. MSF is posting health education messages through social media channels, supporting health education for individuals with TB in Karakalpakstan and shared COVID+TB messaging with the Ministry of Health and UN risk communications for wider reach. Most recently in Karakalpakstan, MSF has used the local radio and television channels to promote prevention messages around COVID-19. We are conducting infection prevention and control (IPC) assessments in healthcare facilities in Karakalpakstan. For each facility assessed, MSF provides recommendations, IPC education materials, relevant punctual training for health care workers and material support if feasible. MSF’s guidance for individuals with TB was adapted into posts and shared with social media groups of TB facilities for use during their regular sessions with patients. Training videos for Ministry of Health nurses and caretakers have been produced and will be put to use this month on the Family-Directly Observed Treatment treatment model for TB patients.
Brazil: We expanded activities in São Paulo and are now running medical activities at two isolation centres for vulnerable patients (homeless people, drug users and the elderly) with mild COVID-19; a total of 140 beds. There activities screening the homeless population and other vulnerable groups for COVID-19 are ongoing; also health promotion, mostly in sites in the city’s central region where they gather to receive meals. Screening and HP expanded to downtown area where heavy drug users gather (“crackland”). Activities started in Rio, also with screening and HP with homeless, but with limited scope for now due to difficulties to do patient referral because hospitals are overcrowded. Manaus team continued training local health professionals on infection and prevention control, and meetings are ongoing with local authorities regarding medical activities for severe COVID-19 cases. There are also plans being drawn up for MSF to support healthcare in indigenous areas, where the case numbers are increasing. In Boa Vista, in Roraima state, the team visited informal shelters where migrants and refugees from Venezuela have gathered, providing hygiene and physical distancing guidance to residents. The team has also assisted in expanding access to water in formal and informal shelters and has distributed hygiene kits.
Colombia: MSF is working closely with health authorities in La Guajira, Norte de Santander, Arauca, Buenaventura and Tumaco to support the local response. We expanded our field teams and reoriented part of our services to respond to the disease. We are currently participating in outpatient triage and supporting the area for patients with respiratory symptoms at the Tibú hospital. In Buenaventura we adapted and expanded our Psychological Care Line #335 for the early identification of potential patients with symptoms of COVID-19 and mental health support for people affected by the virus. In Tumaco we started medical and mental health activities in the two public hospitals in the city. In Arauca we provide technical advice to the hospitals and mental health support to the health staff. In each of these places we are also focusing a large part of our efforts on promotion and prevention activities in towns, villages and neighbourhoods through different community strategies and the media. Likewise, in all our projects we continue to follow up on patients with chronic diseases, and we have maintained our mental health and sexual and reproductive health activities with Venezuelan and Colombian populations without access to the health system, as well as emergency attention for sexual violence and pregnancy termination.
El Salvador: MSF has strengthened its ambulances services in areas that are difficult to reach due to violence, in order to alleviate the workload of the emergency system that is dedicated to the transport of COVID-19 patients. MSF continues mobile clinics in communities of San Salvador and Soyapango affected by violence. The health centres have suspended outpatient consultations and only serve people with suspected COVID-19 and emergencies. We continue in health promotion and prevention interventions. MSF has started working in mental health care in an isolation centre dedicated solely to deported people (from Mexico and the US), while evaluating others for possible intervention.
Haiti: There are 2226 confirmed cases of COVID-19 and 45 deaths reported. 81% of the cases and 62% of the deaths have been reported in Port-au-Prince, the epicenter of the pandemic. The age group most affected is that of 20-44 with 60% of cases followed by that of 45-65 years with 27% so the mortality is 9.4% in those 65 and over. Several health facilities have had to close their doors due to lack of protective equipment and contamination of staff, making access to obstetric, pediatric and trauma care very difficult. Since opening on 16 May, the MSF Drouillard COVID treatment center has received more than 150 patients, 75% spontaneously and 25% referred from the Ministry of Health and other health facilities. 59 patients have been treated in hospital and the remaining patients are being treated on an outpatient basis. Unfortunately, we recorded 14 deaths due to late arrival. Health promotion teams continue to work in the community to raise awareness with people presenting symptoms to seek treatment. The installation of an early detection circuit for suspected COVID-19 cases and the installation of a 10-bed isolation unit have been completed at the Immaculate Conception Hospital in Les Cayes. Staff training and PPE donations take place this week. Community awareness and mobilization activities are continuing, in particular through the training of other NGOs and community organizations. In Martissant, MSF is receiving a growing number of COVID-19 suspect cases in its isolation area (5 beds). Sadly, 3 suspected COVID-19 cases died within hours after their arrival at the emergency center.
Honduras: In Tegucigalpa, MSF is preparing an intervention for severe COVID-19 patients to avoid the city’s hospitals from overcrowding. The hotline dedicated to mental health and sexual violence has recorded an increase in MH consultations. Our health centre on the outskirt of the city is still functional and is prepared to detect COVID-19 cases. In Choloma, the sexual and reproductive health project is still working. This is the only maternal clinic in the city, so all the references for deliveries and prenatal care consultations are taking place there. The project also donated an ambulance to transport COVID-19 patients to the isolation centres established by the government.
Mexico: MSF teams have started attending COVID-19 patients in an auxiliary hospital unit in Tijuana, in the north-western corner of Mexico. The center is located in the Zonkies basketball stadium, refurbished as a medical center with a capacity to care for up to 50 beds (all of them equipped with oxygen supplies) with mild and moderate forms of COVID-19. MSF's response to the pandemic in this space is coordinated with the Baja California state Secretary of Health and a civil society organisation Apoyemos Tijuana (Let's Support Tijuana). The objective of the project is to relieve the hospital burden in the city, which concentrates the largest number of accumulated cases in the State of Baja California and is one of the urban areas with the highest number of deaths from this disease in the entire country. 50 patients have already been discharged so far. In Tenosique (Tabasco), based in La 72 shelter, MSF continues to offer comprehensive primary healthcare (medical and psychological support) to the migrants of Tenosique. MSF team supported La 72 shelter in implementing the IPC protocols and to be prepared if a COVID case would be reported inside the shelter. In Mexico, the CAI (a specialised centre for those who have suffered torture or extreme violence) continues to integrate new cases referred by our partners from Mexico City, in addition to the patients who were already following the program before the confinement. MSF assessed and implemented IPC in migrant shelters across Mexico City.
USA: In response to the outbreak of COVID-19 in the United States, MSF is working in key sites around the country with local authorities and partner organizations serving vulnerable communities who often lack access to health care, including migrants and people experiencing homelessness. In New York City, MSF is helping reduce the spread of the novel coronavirus by partnering with local organizations to improve infection prevention and control (IPC) measures for at-risk groups. MSF has opened temporary relief stations in Manhattan, offering free showers, toiletries, clean socks and underwear, and information on additional services to people who currently lack access to hygiene facilities. So far we have provided more than 1300 showers. MSF has also donated over 160 handwashing stations to places like soup kitchens and supportive housing facilities, and we are distributing 1,000 mobile phones to vulnerable New Yorkers who lack the essential technology needed to contact emergency and support services.
In Immokalee, Florida, where approximately 15,000-20,0000 migrant farmworkers have continued to labor during the pandemic with minimal access to health care and testing, we are working closely with Coalition of Immokalee Workers (CIW), the Department of Health (DoH) and the Health Care Network. Together, we are implementing a multi-faceted COVID-19 response plan. MSF is running a public health education campaign and mobile ‘virtual’ clinics, which provide COVID-19 testing and remote medical consultations for COVID-19 and other health issues. We will also start supporting the DoH with contact tracing.
In the Southwest, an MSF team is working with local officials, health care providers and organizations that are directly addressing needs related to COVID-19 in Native American communities. We are supporting local and federal agencies and medical professionals by providing infection prevention and control trainings and guidance. We started this work in community facilities in Pueblos in New Mexico and have begun to offer similar trainings and technical support in correctional facilities, congregate living spaces (such as nursing homes and group homes), emergency services and other spaces in the Navajo Nation. We are also working with local organizations to expand public health information and education about COVID-19 at the community level.
In Puerto Rico, MSF is focusing on providing support to health care workers and organizations assisting vulnerable groups, including people who are experiencing homelessness, the elderly, people with substance abuse disorders and communities that have been affected by recent earthquakes. MSF is distributing essential supplies, like items of personal protective equipment (PPE) and hygiene kits, and conducting IPC trainings to help essential workers, patients and others stay safe. So far, MSF has delivered 1,300 hygiene kits to vulnerable groups and over 4,000 masks and 14,500 face shields to 21 health care facilities across the island. MSF teams have conducted nine IPC trainings for over 70 health staff and volunteers from community-based organizations.
Venezuela: MSF’s response plan includes assisting with medical supplies and staff recruitment, as well as strengthening triage, diagnosis, treatment, infection control and peri-hospital system services in the projects in Amazonas, Anzoátegui, Bolívar, Sucre and the Capital District (in Vargas Hospital in Libertador and at the Hospital Perez de León II in Petare). In Caracas, COVID-19 activities will be carried out in Pérez de León II Hospital in Petare (Miranda), where teams rehabilitated the infrastructure, adapted the patient flow, established IPC measures and trained staff to receive COVID-19 patients for hospitalisation and ICU care. Teams started receiving patients as of last week. MSF is also supporting with staff recruitment, treatment and peri-hospital system services in Vargas Hospital of Caracas.
COVID-19 highlights on preparedness:
Argentina: In Argentina, MSF is offering technical support and advice to several health authorities such as the design of protocols, circuits and infection prevention and control measures in health structures and/or in alternative treatment structures, and in supporting the staff of homes for the elderly. In Córdoba, MSF provides specific technical support to the province's Emergency Operations Committee working group for enclosed structures (which includes homes for the elderly, hemodialysis units and prisons), and participates in training for the staff. In Buenos Aires, MSF is collaborating with the secretariats in charge of the response to COVID-19 in the city’s vulnerable neighbourhoods, where cases are increasing rapidly, with regard to possible intervention strategies, definition of priorities, and in the training of teams.
Mexico: In the Mexican northern border project, in Matamoros and Reynosa, MSF increased and adapted its activities in a shelter and an asylum seekers camp. So far, COVID-19 patients have not been detected.