International Activity Report 2020 > Keeping pace with the pandemic: MSF’s global COVID-19 response

The rapid spread of the novel coronavirus SARS-CoV-2 (COVID-19), and recurring waves of high infection and hospitalisation rates, posed enormous challenges for healthcare systems around the world, pushing some to the brink of collapse. From early 2020, in more than 300 existing projects and dedicated COVID-19 interventions in 70 countries, Médecins Sans Frontières (MSF) raced to scale up a global emergency response.

Our teams worked in both low- and high-resource countries throughout the year, and continued to deliver humanitarian medical assistance in hard-to-reach crisis and conflict settings. Global shortages of protective and medical equipment, and disrupted transport and supply networks, meant teams had to make extraordinary efforts – and tough choices – to assist the people most in need of care.

Protecting healthcare facilities and medical personnel

In around 780 health facilities and 983 retirement and long-term care homes, MSF focused on ramping up infection prevention and control measures. Specialists provided staff training, set up patient flow and triage zones, and installed handwashing stations. Overall, we distributed more than 3.2 million masks, gowns, gloves and other personal protective equipment (PPE) to shield health workers and patients. In over 40 per cent of our COVID-19 interventions, we also offered mental health counselling and psychosocial support to health workers, as well as patients and their families.

Early in the pandemic, as a preventive measure, MSF teams installed isolation wards in 10 health centres in the world’s largest refugee camp, in Cox’s Bazar in Bangladesh. Despite severe access constraints, almost 23,000 suspected COVID-19 patients were seen in our facilities in the camp between March and December. In addition, health promotion teams reached more than 266,000 families with door-to-door information campaigns on preventing infection, and distributed around 290,000 masks and other PPE items.

In South Africa, continuing care and ensuring protection for people living with diseases such as HIV and tuberculosis called for a flexible, community-centred approach. In 13 remote health facilities in Eshowe, KwaZulu-Natal province, we extended a network of easy-to-reach medication pickup points for stable patients with chronic conditions. To reduce fear and stigma around COVID-19, we supported the local health department to establish help desks and triage points outside several clinics.

Treating COVID-19 patients in crisis and conflict settings

During the year, MSF medical teams admitted 15,400 suspected and confirmed COVID-19 patients to 156 dedicated treatment centres and hospitals. Some 6,000 of these patients presented with severe symptoms and required oxygen support. Providing such specialised care was particularly challenging in conflict zones and countries affected by humanitarian crises.

In Yemen, where the health system has been shattered by five years of war, we admitted almost 2,000 COVID-19 patients, more than half of whom had developed severe symptoms. In three COVID-19 treatment centres in Aden and Sana’a, critical medication, equipment for respiratory support and oxygen were constantly in short supply, and had to be flown in on humanitarian charter planes.

Many critically ill patients were treated in regular or improvised wards, and intensive care concepts, such as ventilation management or intubated prone positioning, had to be taught on the job.

In Venezuela, the political and socio-economic crises largely paralysed the national COVID-19 response. With international staff and supplies denied access to the country, MSF teams struggled to care for the 1,400 patients admitted to five supported treatment centres. The situation was particularly worrying in the capital, Caracas, where around 700 severe patients were admitted between March and December. Due to the lack of qualified staff, drugs and medical equipment, MSF was forced to withdraw from one of the hospitals over concerns of no longer being able to ensure the quality of care.

Reaching remote communities and vulnerable people

Providing medical assistance to communities with no access to healthcare, and to migrants and refugees excluded from national health systems, continued to be a focus of our activities during the pandemic.

In May, reports of the catastrophic health situation in Brazil’s vast Amazonas state prompted us to shift the centre of operations from coastal cities to areas along the Amazon River. After supporting hospitals in Manaus and in the hard-hit town of Tefé, a team continued by boat upriver to deliver medical services to small communities further inland.

Several thousand kilometres to the south, in Mato Grosso do Sul state, our teams helped prevent, diagnose and treat COVID-19 in indigenous communities, where the high prevalence of chronic diseases such as diabetes and hypertension makes people particularly vulnerable to the virus. During the year, MSF ran 12 projects supporting close to 60 health facilities, including eight intensive care units or treatment centres, all over Brazil.

From March, our teams in and around Paris, France, operated a mobile clinic for homeless people, migrants, refugees, asylum seekers and unaccompanied minors living in emergency shelters, makeshift camps or on the streets. Through the mobile clinic and two dedicated treatment centres, we carried out consultations with more than 2,000 people with suspected COVID-19. In early October, an MSF study conducted in emergency shelters, food distribution points and workers’ hostels found up to 94 per cent of people had been exposed to COVID-19 infection, with overcrowded living conditions and shared facilities likely accelerating transmission.

Staffing and supplying a global emergency response

The global shortage of medical and protective equipment and disrupted transport networks posed complex logistical challenges. With most commercial flights suspended for long periods, staff relied largely on humanitarian charter flights in the first half of the year. Close to 4,000 international staff were nonetheless able to reach MSF projects between April and December, only about 25 per cent less than during the same period in 2019.

From late February to the end of the year, our three global supply centres packed close to 125 million items for the global COVID-19 response, including PPE, medical devices, medication, testing material and specialised laboratory equipment. Most of these items were shipped to our projects in humanitarian crisis and conflict settings with limited local procurement options, such as Central African Republic (CAR), the Democratic Republic of Congo, Yemen, South Sudan, Bangladesh and Afghanistan.

In Syria, Yemen, Venezuela and Bangladesh, where importing medical supplies was already difficult before the pandemic, COVID-19-related restrictions or blockades caused further complications and delays.

In some countries where case numbers remained lower than projected, such as Burkina Faso, Niger and CAR, the treatment centres built by MSF were not used to full capacity. These facilities were handed over to local health authorities. Unused PPE was either reallocated regionally, donated to partners, or stored in health facilities to strengthen preparedness.