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Good afternoon! We have some important updates to share this week.
Afghanistan Attack:

Last week, unknown gunmen opened fire on our maternity ward at the Dasht-e-Barchi Hospital, where pregnant women, mothers and newborns were being cared for. At least 24 were killed and 20 more injured in the attack, a large majority of the patients. MSF, who has been supporting the facility for six years, has been able to confirm that 26 mothers were hospitalized at the time of the attack. Eleven women, including a midwife working for MSF, were killed during the attack.  Two of them were in the delivery room with their unborn babies. Some managed to find shelter in safe rooms along with many health workers.
"I went back the day after the attack and what I saw in the maternity ward demonstrates it was a systematic shooting of the mothers," said Frederic Bonnot, MSF's head of programs in Afghanistan.
Caption: Blood remains smeared on the floor of one of the rooms of the maternity ward in Dasht-e-Barchi hospital
in Kabul, in the wake of the attack. Afghanistan, 13 May 2020. Copyright: MSF
For the time being, medical activities in the maternity ward of the hospital are suspended, but not closed. Currently, people in the region have very few options for maternity care.
"By targeting a maternity hospital, they were targeting a place providing care for the people of Kabul. We will stand by the Afghan people," said Filipe Ribeiro, MSF country representative.

COVID-19 in Rohingya camps:

Last week, some media outlets reported suspected COVID-19 cases in the Rohingya refugee camps in Cox's Bazar. MSF has clarified medical confidentiality must be respected in reporting cases and that personal details of any suspected or confirmed patient must remain confidential. Currently, MSF is treating several patients who are COVID-19 positive, as well as monitoring others with suspected COVID-19, in isolation wards in our facilities. For now, our focus is on treating all our patients and ensuring we give the best possible care for COVID-19 and other medical problems.

COVID-19's impact on the most vulnerable:

The COVID-19 pandemic continues to disproportionately affect the world's most vulnerable. This includes the more than 70 million forcibly displaced people – refugees, asylum seekers, internally displaced people (IDPs) as well as migrant workers, including undocumented migrants.

The majority live in confined, overcrowded settings, formal and informal camps or reception centres, or in detention centres, which lack basic services such as clean water, sanitation and limited access to healthcare. Many others live on the streets or underground in informal housing arrangements.  In many settings, displaced people live in insecurity, facing the risk of arrest, abuse or other stigmatising behaviours.

In our previous newsletter, we shared information on our COVID-19 response in Europe. The virus also poses additional challenges to countries recovering from medical and non-medical crises. In the slums of Mathare in Kenya for example, where MSF provides emergency care and treats victims of SGBV, the impact of COVID-19 leaves highly vulnerable groups in even greater distress.  Access to care has been severely limited as several health facilities have closed or stopped admitting patients with respiratory disease. Additionally, lack of transportation leaves people unable to seek emergency care and living conditions in slums make preventive measures impossible to follow. 

In Brazil, many inhabitants of the country´s cities, including the unemployed and homeless, face daily challenges to secure regular meals and follow physical distancing guidelines. The ones fortunate enough to have a roof over their heads usually share the same room with several people. Others have to continue their activities to try and make ends meet, despite the risk. The most vulnerable ones simply live on the streets, without access to proper sanitation or even water.

In Bangladesh, several communities face a similarly precarious existence in crowded environments, making them particularly vulnerable to COVID-19. Many Bangladeshis live in densely populated urban and slum areas. The refugees in the country are also stuck in cramped, squalid shelters, with up to 10 family members in a room. This makes maintaining physical distance impossible.

"People feel frustrated with the constant advice to wash their hands. If you have only 11 litres per day, how is this enough to wash your hands all the time?" says Richard Galpin, MSF water and sanitation expert. Before COVID-19, around 30% of patients treated by MSF in Bangladesh's refugee camps presented with respiratory tract symptoms, such as shortness of breath. This puts them in a high-risk group for this new disease.

Protecting healthcare workers

In most of these countries, MSF is facing shortages of essential personal protective equipment (PPE), such as masks, gowns, goggles and gloves. Healthcare workers are the group most at risk of contracting COVID-19. While we have witnessed inspiring displays of solidarity with frontline workers across the world, we have also seen fear driving stigmatising behaviour against many workers. In Bangladesh, some of our staff have received verbal abuse or threats by communities fearful of COVID-19 and others are facing eviction by landlords unwilling to house frontline staff.  

Impact of closing borders

Since the outbreak, we have observed a disturbing conflation of COVID-19 outbreak control with migration control measures. At least 57 countries have fully or partially closed their borders with no exception for people seeking asylum. Since late March, the Trump Administration has closed the US border to asylum seekers, creating an additional risk for people fleeing violence who, if deported, will face both the risk of COVID-19 and threats to their own lives.  MSF teams are already witnessing the health impact of continued deportations at the height of the pandemic. 
MSF offers medical, psychological and social work services to migrants and refugees in several shelters in Nuevo Laredo, Mexico. Copyright: Juan Carlos Tomasi/MSF 
MSF has called out the United States government to suspend all deportations to Latin America and the Caribbean, a process that is moving people from the epicentre of the COVID-19 pandemic in the United States to lower transmission countries which would exacerbate the public health crisis in the region.

"Despite the risk of contagion and the implications for people's health, the US has continued to organize flights to deport migrants and asylum seekers to their countries of origin, most with fragile health systems," said Marc Bosch, coordinator of MSF in Latin America.

The public health implications of continued deportations from the United States have been disastrous. The Guatemalan president recently ended deportation flights to the country, after deportees arrived ill. In Haiti, recent deportees from the United States have also tested positive for the virus.  People awaiting deportation by the United States are often held in detention centres for weeks or even months. These and other prison facilities in the United States have become ideal breeding grounds for the enormous spread of this disease.
MSF is adapting its activities in Mexico, Guatemala, Honduras, El Salvador and Haiti, as well as in the United States, to collaborate in the fight against COVID19, in addition to the rest of the countries of the continent where it is present. 

Since the pandemic started, we have also been advocating against patents and profiteering on any tests, treatments, or vaccines used to fight COVID-19. Check out our animated video to know why this is important.

Until next time.
Know someone in your newsroom who would be interested in our stories? Click on the link below or email us at aditi.sonrexa@new-delhi.msf.org