Author: Prof. Karl Blanchet, Director of CERAH & Co-director of InZone
It is obvious that responding to the COVID-19 pandemic is the key priority for all governments in the world. This week, more than 5,880 cases have been confirmed in Africa but we all think, as well as Dr Tedros, General Director at the World Health Organisation, that this figure does not represent the reality on the ground due to the fact that the number of cases will be under reported because there is no systematic testing of suspected cases.
While the pandemic is progressing in the world, we have concerns that countries with weaker health systems will have difficulty to put in place the right procedures and services. According to UNHCR, amongst the 100 countries affected today by the virus, 30 of them have a refugee population exceeding 20,000. The recent information received from two refugee camps, one in Kenya and the second one in Jordan, reports that the camps are closed and any movement in or out is restricted. Access to safe drinking water has been reduced due to the decrease of water tanks entering the camp. Refugee populations have not received proper information from authorities on the measures to put in place to reduce transmission. This situation really demonstrates the slow preparation currently in place in potential high-risk places, where populations are overcrowded, hygiene and living conditions are challenging and access to water and soap have become difficult.
In a way, countries such as the ones in Africa have had time to put in place the right measures in place to prevent the transmission, detect cases and manage confirmed cases. Following the progress of the pandemic from China to Europe, we would think that the other countries in the world would be ready to respond. It does not seem to be the case in every country for every group of populations. It is high time that displaced and refugee populations inside or outside camps receive proper evidence-based information on prevention measures and the support services in case of suspected cases.
Humanitarian organisation can play a key role in supporting national authorities. Like every pandemic, time is of the essence. This is exactly the added value of humanitarian responses. The capacity to deploy the right resources and expertise to the right places. One of the key effective strategies used in China and European countries has been the creation of field hospitals for the triage cases. Humanitarian organisations have a lot of experience in this field and could constructing these in vulnerable countries to get ahead of the curve.
A lot of questions related to current humanitarian activities is about what to prioritise. There is no doubt that it cannot be business as usual. Humanitarian organisations as well as governments need to redistribute their health staff and postpone some of the health interventions that are not essential. It is crucial that activities do not continue as usual. Governments and humanitarian organisations need to rapidly conduct a priority exercise to postpone some of the activities to be able to reallocate staff to the detection and management of cases and ensure that essential health services are delivered. For example, chronic care patients such diabetes or HIV patients should receive 30 days of medication and then self-isolate at stay home.
Protect healthcare staff
It is also a priority for government and humanitarian organisations to protect healthcare staff by providing personal protective equipment caring for patients with confirmed or possible COVID-19 infection. This means ordering in mass the right equipment. For the African countries, being in the ‘third wave’ of the virus presents the advantage of having more time to prepare for the pandemic. But it also means that all global orders (specifically respirators and facemasks) are firstly directed to the countries affected first. Personal Protective Equipment (PPE) kits have been prepositioned by WHO to support case management of the first 100 cases in priority countries. Having access to a large number of PPE will become very challenging. It is important to be very transparent with health care workers on the potential risk they endure in case of a shortage of PPE. It is important that the private sector contributes to the collective effort by urgently increasing their production.
Prevent, detect and manage are the three pillars of the public health strategy to tackle the pandemic. We know that social distancing is very effective at avoiding the spread of the virus. This means avoiding any mass gathering activity and respecting a two-metre distance between individuals. As of today, no information has been provided to refugees living in camps and rumours are not managed at all. While all the camps have been closed the existing populations inside have been left with no proper prevention information. As we now know handwashing is a very effective intervention for controlling the transmission of the virus, however in many refugee camps, slums and remote villages, running water and soap are not available. It is urgent to install water stations with soap in all overcrowded places. Evidence-based information about prevention measures need to be clearly explained to all using community workers, local NGOs and local medias.
Detect and manage cases
A key priority for managing cases is testing. However this requires having access to tests, which currently are allocated by priority to the most affected countries. Putting in place a testing campaign requires clear protocols, laboratory capacities and triage in place. Many countries such as China, France and Switzerland have created triage field hospitals outside main hospitals to separate confirmed cases with suspected cases. The large humanitarian organisations have stocks of field hospitals that can be rapidly deployed to sites. The management of severe cases in intensive care units (ICUs) requires, in particular, the use of ventilators, which is in a dramatic shortage at the moment. We also expect that governments will give priority to their own populations before offering services to refugee populations. This is a real human rights issue, which need to be prevented by lobbying politicians and supporting the action of ministries of health in including refugee populations in their coverage plans.
Time for international collaboration not for selfish nationalism
Travel bans and closure of borders are a concern for humanitarian operations to continue in the most acute crises such as Yemen and Syria. We witness around us a lot of solidarity between neighbours and citizens with a wide recognition of the importance of healthcare workers in our society. Rising nationalism and protectionism is however a concern at a time when we need international cooperation to make sure everyone can cope. Meaning Bangladesh can cope with an outbreak in Cox’s Bazaar, Kenya being able to offer running water to refugee populations in Kakuma refugee camp, and refugee populations in Jordan living outside camps being able to access to the right evidence-based prevention information. Humanitarian crises do not stop in times of a pandemic. Many countries will suffer a double burden and international solidarity will be the only way affected populations will survive.