Médecins Sans Frontières - International Review of the Year 2020 (English)

Unique Identifier Code / URN MSB84478

Date taken / Date Recorded 22/06/2021 2:44 PM

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The whole world will certainly remember 2020 as the year of the coronavirus outbreak. It increased pressure on already fragile health systems, and seriously complicated humanitarian response. But the virus did not eradicate conflict, natural disasters, population displacement or epidemics. Consequently, for our teams, 2020 was one of the most demanding years in almost 50 years of activities.

Review of the year: 2020
COVID-19
While COVID-19 didn’t affect all countries equally, it did force all medical teams to adapt to the new health context.
As we do all over the world, at the beginning of the crisis, we worked to fill gaps in the provision of care. Monitoring the evolution of pandemic hotspots, we adopted a variety of intervention models: hospitalisation and isolation of critically ill patients; home care of patients to monitor confirmed cases; and testing. In all our interventions, health promotion activities have been a key component of our response to COVID-19.
In late April, as the number of cases shot up in Yemen, an MSF team renovated a former cancer treatment centre in Aden to open the city’s only COVID-19 unit. In less than a month, 228 patients were admitted, and 99 died.

Roger Gutiérrez – MSF Emergency Coordinator // MSF Head of Emergencies in Aden
The arrival of COVID-19 here has posed yet another challenge to a health system that is devastated by the ongoing conflict. Essential life-saving programmes such as mother-and-child care, nutrition, trauma or routine vaccinations should not be stopped or be de-prioritised because of the response to COVID-19.
COVID-19 restrictions forced us to temporarily suspend several of our missions. Meanwhile, other programmes adapted their protocols so that they could continue to provide HIV, TB and hepatitis C care to our patients. Some of our facilities were repurposed as COVID-19 treatment units, such as the burns centre in Port-au-Prince, Haiti, and the surgical programmes in Iraq and Lebanon.
The severity of the crisis also forced us to work in a number of rich countries that were struggling to manage the pandemic, including in Spain, Belgium, Switzerland, France, and Italy. Our main contribution was to share our experience of fighting large-scale epidemics. Our teams focused on the most vulnerable members of society – older people, the homeless and migrants – who are more susceptible to the virus and are generally less well cared for. The pandemic hit care homes for the elderly particularly hard. 
In the United States, despite the widespread impression that care is easily accessible for everyone, that was far from true in the poorest parts of the country. COVID-19 exacerbated the situation and people were afraid to leave their homes to seek medical treatment. Among other activities, MSF worked with associations in Puerto Rico to set up a system to assist marginalised people.
Yoruba Mitchell (MSF331973) MSF Health Promotion Manager

The network on the island is already so strong because it is a place that is susceptible to things like hurricanes, tsunamis, earthquakes. So what we did was basically come in and support those existing networks with the skills that we were able to contribute with our experience working in outbreaks, and providing trainings and equipment. 
As well as providing medical care, we called for greater solidarity between high and low-income countries regarding access to medicines and personal protective equipment.
ITW Christine Jamet (MSF315313) Director of Operations, MSF Switzerland
We all know that even in Europe there’s a lack of equipment, so how can we expect there to be enough in the countries where we work [...] They already have weak health systems and now they’re also faced with this pandemic, they haven’t got the equipment to protect themselves and they’re much less likely to be able to get it.
MSF’s Access Campaign has also played a key role, urging pharmaceutical companies not to profit from the pandemic, and calling into question the patent system, particularly for vaccines.
MIGRATION
The COVID-19 pandemic has also been used as an excuse to further limit the rights and decent living conditions of refugees and displaced people, whether in South Sudan, Bangladesh or Greece.
On the Greek island of Lesbos, 15,000 refugees are living in cramped conditions in a camp in Moria. Combined with overcrowding, poor hygiene conditions make the camp fertile ground for the rapid spread of COVID-19. MSF teams opened an isolation centre there in May; it was closed by the Greek authorities less than three months later, on the pretext that it violated the island’s town planning regulations.
The authorities imposed a lockdown on camp residents that increased tension in Moria. One night in September, a number of fires broke out and ravaged the camp. Since then, nothing has been done to improve the living conditions of people, who can no longer cope with the situation.
Mother of a 4-year-old child being cared for by MSF: Mother of a 4-year-old child:
My daughter panics a lot when she sees people crowding or talking. For example, when someone is running, or walking very quickly, she gets very worried and asks “what’s going on – why are people running?” She gets very anxious. She grabs me or anyone around and asks “what’s going on?”
Katrin Glatz-Brubakk (MSB49846) MSF Head of Mental Health Activities
Last year, MSF treated 50 children with severe suicidal ideation or even suicide attempts. They keep telling us “I’ve given up. I can’t take this anymore” or “I just want relief from the pain”. And there’s no way they will get it in the conditions in the camp right now.
The pandemic also served as an excuse to suspend rescue operations in the Mediterranean Sea. Boats were held at the docks in Italy for minor technical reasons or refused permission to dock if they had migrants on board. From September, the Sea-Watch 4 search and rescue ship, which our teams had been working on, was prevented from going back to sea. Meanwhile, the shipwrecks continued.
CONFLICT
In 2020, despite the obvious need to fight the COVID-19 pandemic, we continued to respond to other emergencies, particularly in conflict zones.
Throughout the year, the Sahel was the scene of violent clashes. In Burkina Faso, Mali and Niger, this violence prompted massive population displacement. We did our best to meet the growing humanitarian needs in the region. MSF teams continued to provide general healthcare and nutritional support, and transferred critical patients. They also organised distributions of essential supplies and drinking water.
In Mozambique, a largely unreported conflict has been ravaging Cabo Delgado Province in the northeast of the country for four years. To date, it has led to 670,000 people being displaced from their homes. Those fleeing the fighting between armed groups and State forces tell of the horrors they have witnessed.

Auli
Displaced person since August 2020 (MSB73772)

They took me and three other people. In the confusion, I took the chance to escape with my family.
Maria Chavez Project MSF Medical Referent
All of these people here, they have suffered very traumatic experiences coming from armed conflict. They have lost their relatives, their loved ones. Sometimes, they even don’t know if they are still alive, which is even worse because they can’t contact.
MSF teams, at health centres and via mobile clinics, provide general healthcare for adults and children and offer mental health support.
In early November, the Ethiopian Prime Minister ordered military action against the Tigray People’s Liberation Front. The ensuing clashes forced more than 50,000 people to flee to neighbouring Sudan or be displaced within the Tigray Region.

Ken Alew
Displaced person in Adwa (Tigray)

I’m from Edaga Arbi. Our home was destroyed. Our properties were destroyed. After that happened, we went to the village to save our lives. We became displaced. I have four children, but I have nothing now. Our children have nothing.

MSF teams were on hand to provide medical assistance to refugees in camps and at transit points in Sudan. In Ethiopia, we set up mobile clinics and supported health centres and hospitals. Teams were able to travel to the Tigray Region to assess the needs.
Albert Viñas MSF Emergency Coordinator (MSB47968)
We found many houses with 20 or 35 people in them. People were afraid and were locked in their houses. They asked us to call their relatives and pass on a message that they were alive, that they were fine.
Between mid-December 2020 and early March 2021, MSF teams visited 106 health facilities in Tigray. 70 per cent of them had been looted, often by soldiers. 
Humanitarian workers and their medical operations remain exposed in many parts of the world. 2020 was marked by numerous cruel and deliberate attacks, targeting our activities and our teams. The most dramatic took place on 12 May in Kabul, Afghanistan. Over a period of several hours, a number of assailants attacked the maternity ward run by MSF. They killed 16 mothers, one midwife, two children and five other people. A month later, unable to resume our activities without endangering the lives of patients and caregivers, we had to close our maternity ward. 
NATURAL DISASTERS AND EPIDEMICS
In many of the countries where we operate, responding to diseases like malaria and malnutrition remained priorities. MSF continued to respond to epidemics such as measles, chronic diseases, and other infectious diseases. Due to the cancellation of vaccination campaigns and travel restrictions, our teams had to work hard to prevent the situation deteriorating.

Dr Philippe Mpabenda
MSF Intervention Manager
Since the start of the year, Boso Manzi health zone has reported over 900 measles cases and more than 30 measles-related deaths. We will try to break the transmission chain so that measles cases stop and we can avoid more deaths in communities in this health zone.

The Ebola virus continues to spread in the Democratic Republic of Congo. Four successive epidemics have killed more than 2,300 people since May 2018. In mid-2020, as the ongoing epidemic in the north east of the country was being stamped out, other cases were reported in Équateur Province. In November, that outbreak was declared to have ended, but then, in early 2021, new cases were reported in North Kivu province.
Lastly, in 2020, our teams launched several responses following particularly severe weather events. Honduras experienced some of the worst hurricanes in 20 years, while flooding in Niger, Sudan, Somalia and Cameroon caused people to be displaced, outbreaks of cholera, and peaks of malaria and dengue.
Considering the consequences of climate change and environmental degradation, MSF is adapting our activities and reducing our environmental impact to limit the ecological damage of our interventions.
Today, we are still dealing with the pandemic and the emergency on the Sudanese border. Conflicts and crises are ongoing in many parts of the world where we work. More than ever, we remain committed and determined to keep supporting those who most need our assistance.