The first cases of COVID-19 were reported in East African countries in the middle of March and since then numbers have been gradually increasing.
Somalia is the hardest hit, with a total of 928 people who have developed COVID-19, followed by Kenya with 607 people and Tanzania with 480 (updated 8th May 2020).
All countries in the region are now enacting various measures to try to contain the spread of the outbreak, with airport closures, travel bans, curfews and lockdowns.
Across East Africa we are working hard to keep providing essential medical services, taking steps to keep patients and staff safe as well as launching new activities to respond directly to the outbreak.
MSF's concerns on COVID-19 in East Africa
MSF’s global concerns for people in vulnerable groups are particularly relevant in East Africa. We are concerned about the impact on people living in informal settlements like Kibera, refugee camps like Dadaab, or conflict affected areas such as South Sudan, as well as migrants detained, travelling or being deported in congested conditions.
We are deeply concerned about how the outbreak will affect fragile health systems across East Africa, in terms of how they can maintain existing health services and cope with additional pressure from people who need treatment for COVID-19. Although the capacity of health systems across the region varies, in most countries there is very limited ability to treat severe cases.
Across the region, MSF is working with Ministries of Health, the World Health Organisation (WHO), health organisations and community groups to respond to the pandemic. This includes keeping our existing projects running, with some adaptations to keep staff and patients safe and launching some new activities to respond directly to the pandemic.
In our existing projects we are putting in place infection prevention and control measures, triage and screening, as well as isolation facilities or rooms. We are also supporting Ministry of Health structures close to our project locations to do the same, and working to spread health awareness messages.
It is vital that all health workers have access to the Personal Protective Equipment (PPE) that they need. MSF has developed contingency plans across the region to keep essential and lifesaving activities of our regular medical programmes running, yet we fear that worldwide restrictions on stocks and limited supplies of PPE might impact on our emergency response capacity. In some places, such as Kenya, MSF has already had to limit the number of new activities it launches to respond directly to COVID-19, due to the limited supplies of PPE available. We are searching for local solutions, such as producers, within the region to bridge these gaps.
This region has millions of people living in refugee camps, slums and informal settlements. Physical distancing measures are difficult or impossible to implement in some of these places; people often live in overcrowded and flimsy shelters, with many other family members. Basic services such as latrines, food distributions, are often communal – meaning that people have to wait in groups to access basic services. Handwashing and hygiene measures are very difficult to implement, as many people lack adequate access to water or have to walk long distances to access it. This is used for drinking, cooking and washing and isn’t sufficient for additional handwashing.
MSF is extremely concerned about how an outbreak of COVID-19 might affect vulnerable groups such as immunosuppressed patients, people with other diseases like HIV and TB or non-communicable diseases such as hypertension and diabetes - there are a high burden of people affected with these conditions in this region. The limited availability of intensive care capacity to treat severe cases, or hospitals with oxygen supply to care for those who develop serious COVID-19 symptoms, makes the need to protect people who could be more at risk even more pressing.
As the rainy season approaches in different parts of East Africa, we fear that the hunger gap may be exacerbated this year by a poor harvest, the impact of the desert locust invasion and the worsening economic situation in certain countries. We are concerned that emergencies, such as outbreaks of other diseases (malaria, cholera…), may occur in an environment of reduced humanitarian response capacity.
We are concerned about the consequences that lockdowns and restrictions of movement may have on people in this region, given that millions of people in East Africa depend on daily wages to put food on the table.
COVID-19 Activities in East Africa
Kenya
MSF’s hygiene staff disinfecting the halls of Mrima Hospital in Likoni, Mombasa recently. [Paul Odongo/MSF]
New interventions are limited by the constraints with Personal Protective Equipment (PPE), though the teams are looking for local solutions to supply shortages.
MSF is supporting the Kibera South Health Centre in Kibera, the largest slum settlement in Nairobi, which is a health facility built and previously run by the organisation. The team of seven staff is boosting infection prevention control, triage, screening and managing referral of suspect cases to a nearby hospital. They will soon set up water points in the community, and boost the number of people providing health awareness messages.
In Homa Bay, MSF reorganised the support to vulnerable patients (advanced HIV, NCDs) to prioritise remote support and home visits to avoid the exposure patients face at the hospital. At Homa Bay regional hospital, the team have also set up triage, screening and an isolation room to help to prepare for the outbreak. In addition, MSF helped upgrade the setup of the first quarantine site, providing basic equipment and some kits for people in quarantine.
In addition, MSF assisted the county health team to design the facility for managing confirmed cases of Covid-19 in Malela and provided logistic support and training to all the staff on case management and Infection Prevention and Control (IPC).
At the Medication-Assisted Therapy (MAT) clinic in Kiambu, MSF has set up triage system and an isolation room, and is also working at the nearby Karuri Hospital to boost infection prevention and control.
In Mathare, where MSF runs a trauma room, an ambulance has been converted for use in referral of a COVID-19 patient. At MSF’s clinic for survivors of sexual and gender-based violence, teams are providing mental health consultations by phone to continue to give people adequate care throughout the pandemic. They have been increasing health promotion efforts to ensure people know the medical care they provide is still available.
In Eastlands, MSF partnered with local organizations to install and supervise handwashing points. MSF community teams are also running prevention and information campaigns in close collaboration with community and religious leaders.
In Dagahaley camp, in Dadaab, the teams are putting measures in place to ensure adequate infection control, setting up screening and triage, an isolation area and providing health education. Currently there is an isolation unit set up with 10 beds for patients thought to have COVID-19 which has a capacity to expand up to 40 beds if needed. The unit would be transformed into a treatment centre in the event of widespread community transmission or if other possibilities for patient care were not available. Training of health workers to create a pool of frontline responders is ongoing.
In Likoni subcounty, Mombasa, MSF supports the Department of Health to provide comprehensive emergency obstetric and neonatal care in the Mrima health centre. To prepare for COVID-19 they have set up three isolation rooms which will allow women who have COVID-19 to give birth safely.
▸Read how we're adapting to COVID-19 in Kenya
South Sudan
Adrien Mahama, Water and Sanitation coordinator for MSF in South Sudan – illustrates the correct use of masks during an infection prevention and control training for the staff of the Al Sabah hospital in Juba. Gabriele François Casini/MSF
We are working on preparedness for the disease in all of our projects, as well as on preventive measures, in order to be able to isolate and treat suspected patients 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 personal protective equipment (PPE)), identifying and establishing isolation areas for suspected COVID-19 patients and conducting health promotion and awareness sessions with patients and the local community.
MSF has also started conducting training sessions which focus on infection prevention and control, triage and making sure patients can move safely through health facilities (improving patient flow), in close collaboration with the Ministry of Health. At national and sub-national level, we are working with the authorities on preparedness, including the reinforcement of basic isolation capacity and the mapping of health care providers who have the capacity to respond.
Tanzania
Construction of a temporary triage and isolation area in Nduta camp as MSF steps up its preparedness measures
In Tanzania, MSF provides assistance to refugees from Burundi living in Nduta camp. MSF is the sole healthcare provider in Nduta Camp for 75,000 refugees, where our team of 800 staff run a 150-bed hospital, four surrounding health posts and carry out health promotion via a large network of community health workers. Our services, which are also open to host communities from surrounding villages, include mother and child care, nutritional support, treatment for tuberculosis, HIV and non-communicable diseases. We also offer mental healthcare and treat victims of sexual and gender-based violence, among other services.
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 the ability to scale up to 100 if needed.
One hundred and sixteen MSF staff have so far been trained for COVID19 response, with a focus on case definition, triage, screening, infection prevention and control as well as case management. Training is ongoing in our hospital in Nduta refugee camp, Tanzania. 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.
▸Read: Our open letter on conditions for refugees in Nduta Camp
Sudan
Sudanese healthcare professionals try to put on personal protection equipment (PPE) recommended to be used while assisting suspected COVID-19 patients, during a training arranged by MSF in collaboration with the Ministry of Health of Sudan and the World Health Organization. [ Mudawi Hassan / MSF]
MSF continues to carry out regular medical activities in Khartoum, East Darfur, White Nile, Al-Gedaref and South Kordofan states. We run hospitals and health centres and support Ministry of Health facilities, and carry out a wide range of activities to provide primary and secondary healthcare to local communities, internally displaced people and refugees. We are focusing on maintaining our life-saving activities in these locations.
Our activities range from treating children with malnutrition and assisting deliveries to providing care for chronic infectious diseases like TB and HIV and neglected conditions like kala azar.
We are working with the Ministry of Health (MoH), the World Health Organization (WHO) and other health providers to monitor and respond to the changing situation.
MSF is running trainings on infection prevention and control (IPC) and how to improve the flow of patients and staff inside the health facility. Together with the MoH and the WHO, we provided these trainings for healthcare professionals in leadership roles at 90 major hospitals in Khartoum state. MSF also directly provides daily trainings to health workers including bed-side trainings and mentoring, in the health facilities we support.
After the trainings, MSF provided onsite technical support to improve ward and triage circuits and IPC measures in health structures, developing clear action plans for an outbreak of COVID-19. MSF has also trained Ministry of Health staff who are subsequently conducting trainings in nine priority states in Sudan.
At the Omdurman Teaching Hospital, the largest hospital in Sudan, MSF deployed a team of more than 60 staff. MSF is working in the emergency department and closely with the MoH in the management of initiatives established to cope with COVID-19. 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.
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.
We are also supporting the MoH to set up and manage isolation centres in two towns in East Darfur and South Kordofan states (Ed Daein and Dilling). 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.
MSF teams across Sudan are conducting health promotion and awareness sessions with patients and the local community, or at non-MSF primary healthcare centres.
▸More on our support activities in Sudan
Ethiopia
A mother and newborn at the maternity unit in Gambella hospital in Ethiopia [Susanne Doettling/MSF]
In Ethiopia, MSF fills critical gaps in healthcare and responds to emergencies, such as outbreaks of diseases (cholera, measles, etc) and the needs of refugees from neighbouring countries.
Our activities range from supporting the operating theatre and emergency room in the Gambela hospital, to providing primary and secondary healthcare to South Sudanese refugees in the camps, and responses to current emergency outbreaks (cholera and measles) while also running mobile clinics in remote areas of the Somali region. We also treat neglected diseases like kala-azar and snakebites in Amhara, provide medical and mental health support to Ethiopian migrants deported from Saudi Arabia.
MSF is closely monitoring the impact of COVID-19 in Ethiopia, whilst maintaining its regular activities. We are liaising with the Ministry of Health, the Ethiopia Humanitarian Coordination Team (EHCT) led by Humanitarian Coordinator, the World Health Organization and other health and non-health organisations and institutions to follow up the evolution.
It is essential to limit further spread of the disease, and protect people, patients and healthcare workers. It is impossible to predict how the situation will evolve in Ethiopia. MSF will be constrained by the available resources, staff and supplies as in elsewhere in the world. Essential medical supplies such as PPE (masks, gloves, gowns, goggles) must be available to frontline medical providers.
We have been working on preparedness for the disease in our projects by putting in place preventive as well as safety and hygiene measures among our staff, in order to be able to support and isolate suspected patients of COVID-19 who approach our health facilities.
Somalia
MSF staff carry buckets with aid in an area where people displaced by floods in November 2019 took refuge in Beledweyen town, central Somalia.
In Somalia and Somaliland, MSF carries out medical activities in hospitals, with a focus on maternal, paediatric and emergency care, nutrition and diagnosis and treatment of tuberculosis and multi-resistant TB, as well as running mobile clinics for internally displaced people.
For now, the MSF teams are continuing medical activities in Hargeisa and Las Anod (Somaliland), North Galkayo (Puntland state), South Galkayo (Galmudug state) and Baidoa (South-West state). Our in-and-out, short interventions in Jubaland state have been temporarily suspended. We have cancelled new planned activities and have reduced some non-essential activities to focus on most immediate life-saving operations, in case of reduced availability of staff and supplies and our added role in the COVID-19 crisis. However, the disruptions have been small, given that most of our current activities are life-saving.
Over the last weeks, MSF has been coordinating with the health authorities of Somalia and Somaliland at project and national level, with WHO and other health actors. 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 Ministry of Health of Somaliland to make ready 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.