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Responding to COVID-19: Global Accountability Report 4, January to April 2021

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New interventions and continued response efforts: MSF COVID-19 activities in early 2021

The end of the year 2020 marked a turning point in the global pandemic response, as first COVID-19 vaccines became available to priority groups, including elderly people, frontline health workers and high-risk patients. Nonetheless, the pandemic continued to put severe pressure on health systems and led to strict lockdown measures in both low- and high-resource settings around the world. In many countries, sustained new waves of high COVID-19 infection rates again caused large numbers of patients requiring specialized care, while vaccination efforts only advanced slowly due to vaccine scarcity and related supply and distribution challenges.

From late 2020 and into the new year, several new, more infectious variants of the SARS-CoV-2 virus raised concerns over accelerating transmission. In January and February 2021, multiple countries in the Middle East and Northern Africa, South-East Asia, and across the African continent showed increasing trends in case numbers, while alarming rates of new infections and related deaths also continued to be reported from South and Central American countries. March and April saw multiple COVID-19 hotspots resurging around the world, with particularly alarming infection rates in southern Asia.

Over the first months of the new year, the global number of confirmed COVID-19 infections nearly doubled from 82 million at the end of 2020 to more than 150 million by the end of April 2021. More than 1.4 million patients died from COVID-19 related complications during the same period, adding to close to 3.3 million confirmed deaths since the beginning of the pandemic.

In 2021, MSF maintained dedicated COVID-19 activities in some 165 projects in 52 countries, working alongside local health workers and supporting hospitals and treatment facilities to deliver medical care and improve infection prevention and control measures. MSF teams continued to provide protection and care for vulnerable populations in remote communities, people on the move, homeless people, and elderly people living in long-term care facilities. In all its projects around the world, MSF also worked to maintain other essential healthcare services amid lockdown and confinement measures.

While several COVID-19 projects could be closed or reintegrated into regular MSF operations at the end of 2020, the new year saw multiple new or reactivated COVID-19 operations in hard-hit countries on five continents. Compared to the previous four months, the number of MSF projects reporting dedicated COVID-19 activities from January to April only reduced by eight percent. Since the beginning of the pandemic in March 2020, MSF teams responded to the pandemic in more than 330 different projects in 72 countries.

On request from the health authorities in Malawi, MSF started to support the national COVID-19 response in January, offering more than 2,200 suspect COVID-19 medical consultations and supporting admission of nearly 200 confirmed patients to two treatment facilities. As the demand for oxygen for COVID-19 patients far exceeded the national production capacity, cylinders and concentrators had to be imported and remained in short supply. Amid a major second wave of COVID-19 infections in the wider southern Africa region, the Beta variant of the virus spread extremely fast and created a dangerous gap in health provision with high numbers of healthcare staff not able to come work. In February, MSF urged countries and pharmaceutical companies worldwide to ensure that health workers in the southern Africa region are prioritised in the global allocation of vaccines to prevent the local healthcare systems from collapsing. MSF also scaled up its medical response, including severe patient care, community public health activities and decongesting facilities that were getting overwhelmed in Lesotho, South Africa and Zimbabwe.

In March, MSF reactivated part of its pandemic response in Aden and other parts of Yemen, following a dramatic influx of critically-ill COVID-19 patients requiring hospitalisation. Close to 1,000 suspect or confirmed COVID-19 patients were admitted to MSF treatment facilities in Yemen in March and April, nearly half of which required respiratory support and other intensive care. In Palestine, MSF teams witnessed a sharp increase of COVID-19 patients in Hebron and the West Bank in in March and started supporting two hospitals with COVID-19 treatment centres, as well as urging the authorities to step up efforts to curb the spread of the disease, including through vaccination. Major COVID-19 operations also continued in Iraq and Syria over the first four months of 2021.

At the end of March, MSF started to work with the Ministry of Public Health in Lebanon in a COVID-19 vaccination campaign reaching elderly people and medical personnel in nursing homes. MSF teams also supported vaccination activities in Belgium, South Africa and the Unites States with community outreach, health promotion and technical advice.

In Brazil, MSF continued its interventions in several locations across the country amid an extremely severe health situation, supporting intensive care while struggling with oxygen supply shortages. In April, MSF publicly denounced the Brazilian authorities for failing to convene a coordinated response to the pandemic.

In neighbouring Peru, COVID-19 cases similarly led to overcrowded hospitals, a lack of medical personnel, and shortages of oxygen from early in the year. With very low vaccination coverage obtained by late March, MSF launched a new emergency intervention in the Lima region. MSF teams also continued to see and admit high numbers of suspect and confirmed COVID-19 patients in several projects in Venezuela, despite the forced withdrawal from the Ana Francisca Pérez de León II hospital in Caracas at the end of November due to entry and work permit restrictions for international staff.

In late April, MSF restarted its emergency response amid a surging second wave of COVID-19 in the densely populated city of Mumbai in India, following alarming reports of more than 100,000 new daily infections in Maharashtra state. Major COVID-19 operations also continued in the large refugee camp in Cox’s Bazar in Bangladesh and in Afghanistan, and MSF launched a new intervention in Papua New Guinea in late March.

In Europe and Central Asia, MSF scaled-up a COVID-19 intervention in Slovakia in January, strengthening infection prevention and control measures in more than 150 retirement facilities and in settlements. Similar support activities to long-term care facilities, shelters and reception centres for migrants and refugees continued in Belgium, France, Italy, Portugal, and Switzerland. In the Donetsk region of Ukraine, MSF’s mobile clinic offered screening activities and home-based consultations to more than 4,000 suspect COVID-19 patients between January and April.