People's Stories Advocates

Vulnerable communities are bracing for impact of COVID-19
by Medicins sans Frontieres (MSF)
Doctors Without Borders
20 Mar. 2020
How are you supposed to wash your hands regularly if you have no running water or soap? How can you implement ‘social distancing’ if you live in a slum or a refugee camp? How are you supposed to stop crossing borders if you are fleeing from war? How are those with pre-existing health conditions going to take extra precautions if they already can’t afford or access the treatment they need?
Everyone is affected by the COVID-19 pandemic, but the impact may be felt by some more than others.
As coronavirus disease COVID-19 spreads further, it will continue to expose the inequalities that exist in our health systems.
It will expose the exclusion of certain groups from accessing care, either because of their legal status or because of other factors that make them a target of the state.
It will expose the under-investment in free public healthcare for all, which means that access to quality care will for some be based on purchasing power and not medical need.
It will expose the failure of governments - not just health services - to plan for and deliver services that meet the needs of everyone.
It will expose the life-threatening vulnerabilities caused by displacement, violence, poverty and war.
The people who will especially suffer will be those already neglected - due to austerity measures, who have fled because of war, who don’t have access to treatment for existing conditions because of privatised healthcare.
And it will also be those who can’t stock up on food because they already can’t afford a meal every night of the week, who are underpaid, overworked and deprived of sick leave, unable to work from home - and those trapped in conflict zones under bombing and siege.
And how are you supposed to treat patients without all the material that you need? Many health systems bracing for the impact of the COVID-19 pandemic have already been hammered to breaking point by war, political mismanagement, under-resourcing, corruption, austerity and sanctions. They are already barely able to cope with normal patient loads.
COVID-19 is demonstrating how policy decisions of social exclusion, reduced access to free healthcare, and increased inequality will now be felt by all of us. These policies are the enemy of our collective health.
As MSF scales up our response to the coronavirus COVID-19 pandemic, we will focus on the most vulnerable and neglected.
We started working in Hong Kong earlier this year in response to the first cases of COVID-19, and we now have medical teams deployed to respond in the heart of the pandemic in Italy. We will continue to scale up as much as is feasible as this crisis spreads.
However, there are decisions that can be taken now that will already ease the impending disaster that many communities may soon face. For example, the congested camps on the Greek islands need to be evacuated. That doesn’t mean sending people back to Syria where war still rages. It means finding a way to integrate people into communities where they will be able to practice safety measures such as social distancing and self-isolation.
In addition to this, supplies need to be shared across borders according to where the needs are the greatest. This needs to start with states in Europe sharing their supplies with Italy. It will soon need to extend to other regions that will be hit by this pandemic and whose ability to cope is already compromised.
As MSF, we will also need to manage the gaps we will face in staffing our other ongoing emergency projects. Our medical response to measles in DRC needs to continue. So too does our response to the emergency needs of the war-affected communities of Cameroon or the Central African Republic. These are just some of the communities we cannot afford to let down. For them, COVID-19 is yet another assault on their survival.
This pandemic is exposing our collective vulnerability. The powerlessness felt by many of us today, the cracks in our feeling of safety, the doubts about the future. These are all the fears and concerns felt by so many in society who have been excluded, neglected or even targeted by those in positions of power.
I hope COVID-19 not only teaches us to wash our hands, but makes governments understand that healthcare must be for all.
16 Mar. 2020
Challenges in supporting COVID-19 response
The COVID-19 pandemic has already spread to more than 100 countries around the world. These include countries whose health systems are fragile and where MSF teams have a long-standing presence, as well as regions such as Europe, where the capacities are more robust but where the epidemic is particularly virulent. Travel restrictions generated by the outbreak also directly affect MSF''s work around the world.
What questions does MSF face in this context? Clair Mills, MSF’s medical director, explains the challenges.
Are we right to be afraid of COVID-19?
Several factors make this virus particularly worrying. Being a new virus, there is no acquired immunity; as many as 35 candidate vaccines are currently in the study phase, but experts agree that no widely usable vaccine will be available for at least 12 to 18 months.
The case-fatality rate, which by definition is calculated only on the basis of identified patients and is therefore currently difficult to estimate accurately, appears to be around one per cent.
It is known that at least some of those people infected can transmit the disease before developing symptoms - or even in the absence of any symptoms. In addition, a very high proportion - around 80 per cent - of people develop very mild forms of the disease, which makes it difficult to identify and isolate cases quickly.
Confirmation of the diagnosis requires laboratory and/or medical imaging capabilities that are only available in reference structures, like teaching hospitals. It’s therefore not surprising that it’s proved impossible to contain the spread of the virus, which is now present in more than 100 countries around the world.
This epidemic then is very different from those - such as measles, cholera, or Ebola - in which Médecins Sans Frontières has developed our expertise over the last few decades.
Furthermore, it is estimated today that approximately 15-20 per cent of patients with COVID-19 require hospitalisation and six per cent require intensive care for a duration of between 3 and 6 weeks.
This can quickly saturate the healthcare system - this was the case in China at the beginning of the pandemic and is now the case in Italy. There are currently more than 1,100 patients in intensive care units in Italy and the hospital system in the country’s north, although well developed, has been overwhelmed by the rapid increase in the number of patients.
As is often the case during this type of pandemic, medical staff members themselves are particularly exposed to infection. Between mid-January and mid-February in China more than 2,000 health care workers were infected with the coronavirus (representing 3.7% of all patients).
This pandemic is likely to lead to the disruption of basic medical services and emergency facilities, the de-prioritisation of treatment for other life-threatening diseases, conditions and for other chronic infectious diseases everywhere but especially in some developing countries, where the health system is already fragile.
Some feel that the response to this epidemic is an overreaction, and that the remedies - border closures, quarantine, etc - are likely to be worse than the disease. Is this justified?
Even though they cannot prevent the outbreak from spreading, the measures currently being taken by many countries can slow it down by reducing the increase in cases and limiting the number of severe patients that health systems have to manage at the same time.
The aim is not only to reduce the number of cases but also to spread them over time, avoiding congestion in emergency and intensive care units.
What are MSF''s priorities in this context, and its main concerns?
Priorities for intervention vary from one context to another. In some areas that seem to be spared today, such as Central African Republic, South Sudan and Yemen, where fragile or war-torn health systems are already struggling to meet the health needs of people, protecting healthcare personnel and limiting the risks of spreading the disease as much as possible are needed.
This is done by implementing prevention programmes - identifying areas or populations at risk; running health awareness and information activities; distributing soap and protective equipment for healthcare personnel; and reinforcing hygiene measures in medical structures - to prevent our hospitals and clinics from becoming places where the disease is transmitted.
In countries where MSF has a longstanding presence we want to contribute to these efforts against COVID-19 while ensuring continuity of care against malaria, measles, respiratory infections, and other illnesses.
This continuity is now weakened by the restrictions (a ban on entering the country, preventive isolation for 14 days, etc.) imposed by governments on staff from certain countries, such as Italy, France and Japan, where some of our international staff come from, as well as the closure of borders and the suspension of certain air links.
Despite these constraints, our strength lies in the fact that we can rely on locally recruited staff in our countries of intervention. They represent 90 per cent of our employees in the field.
In countries where health systems are more robust but where the epidemic is particularly active, such as in Italy or Iran, the main challenge is to avoid overloading hospital care capacities. In these contexts, we can contribute to the efforts of national medical teams by making MSF staff available to support or relieve them when needed.
We can also help by sharing our experiences in triage and control procedures for infections acquired during epidemics.
We have provided teams to support four hospitals in northern Italy and have also offered support to the Iranian authorities to support them in caring for severe patients.
Depending on the evolution of the epidemic in France, we will make our experience, logistics and the know-how of our staff available to the response, if they can be useful.
One of the keys in the fight against COVID-19 is the availability of protective equipment, in particular masks and gloves used for medical examinations. The anticipation of shortages leads to requisitions by many countries, which can in turn become a reflex on the part of countries to monopolise these precious resources.
Right now, such equipment should rather be considered as a common good, to be used rationally and appropriately, and to be allocated as a priority to health workers exposed to the virus, wherever they are in the world.
Generally speaking, this pandemic requires solidarity not only between countries but at all levels, based on mutual aid, cooperation, transparency, the sharing of resources, and, in the affected areas, towards the most vulnerable populations and towards caregivers.

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Action plan seeks to reach 48 million women and girls in humanitarian crises
by United Nations Population Fund (UNFPA)
Feb. 2020
When Yemen’s unrelenting conflict arrived in Taizz City late last year, Ashwaq saw her neighbourhood fall to pieces. Amid the bombardments, her house caught fire. She, her husband and their four children – including a son who is paralyzed – fled for their lives.
When they arrived in Sana’a, Yemen’s capital, Ashwaq found that the influx of displaced people had caused rents to skyrocket. She was unable to afford even the most basic accommodations.
Her family found temporary shelter with a relative. “There was not enough room for the six of us,” Ashwaq remembered. “We were all squeezed into a single bed. Within two weeks we searched again for a house. We were lucky to find a room and a bathroom in exchange for taking care of a larger house. However, we soon realized we were running out of money to buy daily essentials and medicines for our paralyzed son.”
Tragically, Ashwaq is only one of more than 168 million people in need of humanitarian assistance around the world.
“In 2020, lamentably, the world will face an unprecedented moment: 1 out of every 45 people will be affected by humanitarian crises. The stakes of inaction have never been so dire,” said UNFPA’s Executive Director, Dr. Natalia Kanem, in the organization’s Humanitarian Action Overview, released today.
Tens of millions of women and girls in crises
There are tens of millions of women and adolescent girls living through humanitarian crises today. Yet their reproductive health needs – including family planning information and care, maternal health care, access to menstrual hygiene supplies, as well as protection from, and treatment for, sexual and gender-based violence – are often overlooked.
And when these needs are neglected, the consequences are simply unbearable.
More than half of all the world’s maternal deaths take place in countries affected by crises and fragile conditions. Vulnerability to gender-based violence spikes in crisis settings, with risks ranging from domestic violence to rape as a weapon of war.
UNFPA works with partners around the world to address these needs. In 2020, UNFPA plans to reach an estimated 48 million women, girls and young people, including 4 million pregnant women, in 57 countries. The cost for this will be an estimated $683 million.
Yemen tops the list of countries with the greatest financial requirements for humanitarian assistance, with $100.5 million needed to meet the needs of women and girls.
The crisis in Yemen has continued for years without respite, leaving 80 per cent of the population in need of humanitarian support. As recently as last week, hostilities saw an escalation in Marib, Sana’a and Al Jawf, resulting in more than 9,400 new displacements. UNFPA responded with reproductive health clinics, able to support both natural and Caesarean deliveries, as well as deployment of medical teams and reproductive health supplies.
But underfunding of UNFPA’s humanitarian response in Yemen has threatened the agency’s ability to provide such life-saving support in recent years.
Ashwaq and her family were able to receive emergency support after a neighbour directed them to a local relief centre. There, supplies were being distributed through the Rapid Response Mechanism, a collaboration with UNICEF and the World Food Programme, led by UNFPA.
The mechanism distributes critical emergency supplies, such as food and hygiene items, to crisis-affected communities within 72 hours of displacement.
The Rapid Response Mechanism, funded by donors including the European Commission’s Humanitarian and Civil Protection department and the Yemen Humanitarian Pooled Fund, operates in 330 of Yemen’s 333 districts.
“We are able to sustain ourselves with the food and essential items available in this relief package,” Ashwaq said. “My only wish now is to find treatment for my son.”
But longer-term solutions are still needed to secure the health, welfare and dignity of displaced persons in Yemen – and in all crises around the world.
“We had to leave everything behind,” Zahrah Mohammed Hassan, 18, told UNFPA. “I wish to have beautiful days like before and to return to our homes. I wish to live in peace with my child and no more wars.”

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