Category: News & Stories

Its very unfortunate that in the 21^st century there are still huge gaps in the healthcare systems in low-to-middle income countries. Medical gaps ranging from non-existing healthcare services to low ratio of healthcare workers to population. The Covid-19 pandemic exacerbated those gaps even more.

However, with adapting Digital technology there is a huge potential to improve countries’ responses to infectious-disease threats and to strengthen primary healthcare, such as Diabetic care.

It is currently estimated that 80 per cent of annual mortality related to non-communicable diseases (NCDs) occur in low- and middle-income countries, according to the WHO. The prevalence of diabetes is high across the Middle East and North African (MENA) region, constituting an increasing public health problem. Lebanon is one of the countries in the region that has experienced a sharp rise in the burden of NCDs, including diabetes, over the last decade. In Lebanon, the estimated prevalence of diabetes in 2021 for people aged 20-79 years is 396 per 1000 people, and it is predicted to increase to 469 per 1000 by 2030, according to data from the International Diabetes Federation. 

The triple threat of climate change, conflict, and health emergencies: A deadly mix for the most vulnerable in fragile settings.

Geneva (MSF/ICRC) – Climate change is not a distant threat. It is already dramatically affecting vulnerable people across the globe. In particular, the changing climate is having devastating consequences for people living in conflict situations and those who don’t have access to basic health care.

Médecins Sans Frontières/Doctors Without Borders (MSF), the International Committee of the Red Cross (ICRC), and the Red Cross and Red Crescent Movement are working closely with communities in countries where the convergence of climate change, armed conflict and health emergencies is a grim reality. Of the 25 countries most vulnerable to climate change and least ready to adapt, the majority are also experiencing armed conflict. In many of these locations, people lack access to basic healthcare. When climate shocks occur in countries with limited food, water and economic resources, people’s lives, health, and livelihoods are threatened.

Somalia has suffered through an erratic cycle of droughts and floods in recent years, exacerbating an already dire humanitarian situation further complicated by three decades of armed conflict. People have limited time to adapt because the shocks are so frequent and severe.
Humanitarian organisations have also been responding to flooding in South Sudan and across the Sahel; devastating cyclones in Madagascar and Mozambique; and severe drought in the Horn of Africa. The climate crisis worsens health and humanitarian crises.

As humanitarians, we are alarmed by the current reality and projections for the future. We see droughts, floods, insect plagues and changing rainfall patterns which can all jeopardise food production and people’s means of survival. We see more extreme and more powerful weather events such as cyclones which destroy essential health infrastructure. We see changing patterns of deadly diseases such as malaria, dengue and cholera. Conflict and violence increase the need for emergency health assistance while also limiting the capacity of health facilities.

All these situations are occurring in a world that has warmed 1.2 degrees above pre-industrial levels, as we witness how the world’s most vulnerable pay the deadly price of a problem overwhelmingly caused by the world’s richest nations. Additional warming will lead to disastrous consequences unless urgent and ambitious mitigation measures are taken and adequate support is mobilised for the most affected people and countries so they can adapt to growing climate risks.

“Today, needs are already outstripping the response. This is a crisis of solidarity and it is now giving way to a crisis of morality. The world cannot leave those suffering the most tragic consequences without support,” said Stephen Cornish, Director General of MSF Switzerland.

Financial and technical support must reach people who need it the most which are not happening at the scale it should. The Paris Agreement’s commitment to increase support for the least developed countries fails to acknowledge that a significant number of them are also affected by conflict and should be prioritized. To date, promises have not been met to reduce carbon emissions and support countries experiencing the biggest impacts.

“We’re seeing the severe compounding effects of growing climate risks and armed conflict from Afghanistan to Somalia, Mali to Yemen. Our work in these places helps people cope with the climate crisis. But humanitarian actors cannot respond alone to the multitude of challenges. Without decisive financial and political support to the most fragile countries, the suffering will only worsen,” said Robert Mardini, the ICRC’s director-general.

We are calling on world leaders to live up to their commitments under the Paris Agreement and Agenda 2030 and ensure that vulnerable and conflict-affected people are adequately supported to adapt to a changing climate. We must collectively find solutions and ensure access to adequate climate finance in challenging environments. Leaving people behind is not an option.

As part of its continuous and ongoing efforts to fight the cholera outbreak in Lebanon, Médecins Sans Frontières (MSF) has adapted its hospital in Bar Elias, in the Bekaa valley, to receive and treat cholera patients with an initial capacity of 10 beds, which can be expanded according to the needs. With the adaptations done, the hospital will continue to function for urgent surgical procedures.

Since the declaration of the outbreak in Lebanon on the 6^th of October, MSF has increased its efforts in various regions of the country, including Tripoli, Akkar, Bekaa and Beirut, to support the communities and the Lebanese Ministry of Public Health in the curbing of the cholera spread. 

MSF teams are simultaneously carrying out needs assessment for supporting the setting up of other cholera treatment facilities in the most affected areas. The teams are also sharing their expertise in the management of cholera outbreaks with other local and international actors in the country through trainings and sharing of experiences according to the international protocols. This is due to MSF’s longstanding 50 years of experience in emergency settings throughout the world, and years of experience with cholera prevention and treatment.

This cholera outbreak is happening at a time when Lebanon is faced with an economic crisis with dire consequences on the medical response, the proper maintenance of the waste management and water networks, as well as its impact on people’s access to safe and clean water. “Local and international actors in Lebanon are needed at this time to put forth and prioritize the necessary measures for ensuring safe access to clean drinking water, and safe water and sanitation supplies for everyone”, says Julien Raickman, MSF Head of Mission in Lebanon. 

In addition to the hospitalisation capacities in Bar Elias, other MSF clinics in Akkar, Northern Bekaa, and South Beirut are getting equipped with oral rehydration points, “and we are also supporting designated health care facilities to manage patients seeking medical attention for acute watery diarrhoea.” Adds Reickman.

 It is worth noting that most of the cholera infected patients do not report severe symptoms. However, it remains vital not to delay seeking medical care in case of acute watery diarrhoea as starting rehydration treatment early is key to prevent deterioration and risk of death. Since the beginning of the outbreak, the international medical organisation is also mobilising its teams to raise awareness on cholera among the different communities.

On Thursday 20 October 2022, an emergency team from the international medical organisation Médecins sans Frontières (MSF) received an official alert about a group of people, newly arrived on the Greek island of Lesvos, in need of urgent medical care. When an MSF team arrived on site, they found three people tightly handcuffed and four injured, reportedly from beatings.

“That day, we were called for an emergency intervention”, says Teo di Piazza, MSF project coordinator in Lesvos. “As we were approaching the location, on a mountain, we started hearing people screaming, a lot of screaming. We were worried and started running in their direction. When we arrived, we found 22 people. Everybody was crying, women, children and men. Three people were handcuffed very tightly with plastic bundles. Four others were injured. Based on their reports, the injuries were due to violence from a group of people who had left when we approached.”

Everyone in the group was in shock. “We could see people were in a critical state”, says Teo di Piazza. “We had to call one of our psychologists to provide emergency psychological first aid to the group”. The four injured people were referred to the hospital for an assessment of their condition and medical care.

“According to testimonies, shortly before we arrived, seven or eight people were approaching the group, saying they were doctors and they had food”, Di Piazza continues. “They reportedly started to beat them and handcuff them as soon as they found them. And when they heard us, the group told us those other people immediately ran away.”

MSF teams have heard similar testimonies of violence occurring when people arrive on Lesvos and Samos islands to seek safety after a traumatic journey. MSF finds these reports extremely concerning and urges the appropriate state authorities to take all necessary measures to prevent and stop such incidents from happening, and ensure people have access to safe reception, protection and asylum procedures.

The MSF team informed the police authorities of the incident and supported the referral of injured people to the hospital. They also provided follow-up care to the group the next day.

On Lesvos and Samos, MSF teams coordinate with other humanitarian as well as protection organisations, such as UNHCR, and also local state authorities to receive official alerts and provide emergency medical assistance to people arriving on the two islands. MSF provides them with medical and psychological first aid, distributes food, water and dry clothes and coordinates with local public health services for referrals to hospital if needed. Local police then transfer people to the camp, for registration processes after five days of quarantine. Since August 2021, MSF teams on Lesvos and Samos have provided emergency medical assistance to 2,225 people.

• What is the main role of an IPC specialist?

Infection prevention and control (IPC) focal points or specialists are trained professionals from diverse backgrounds, including nursing, midwifery, medicine, public health, pharmacy and allied health fields. IPCs work on the frontlines to prevent and manage infections in healthcare facilities and support community-based interventions, by promoting a culture of safety and impact the health of patients, staff and families.

• What are some of the most important things you do to maintain a safe environment for patients and yourself?

Patient safety, which is the cornerstone of quality patient care, includes preventing errors and the harm they bring to patients. Providing safe patient care is a necessary component of providing high-quality healthcare. To protect both patients and medical staff, it is crucial to prevent infection and cross-infection. Infection-causing organisms, such as viruses and bacteria, are relatively simple to spread from one site to another and, eventually, from one person to another. It is crucial in daily life, but it is much more crucial in the healthcare setting where patients can have compromised immune systems or open wounds that leave them exposed to infection.

In our daily life, each individual can definitely avoid spreading and contracting diseases by taking precautions and by acting responsibly; such as maintaining good hand hygiene, following good food hygiene practices, getting vaccinated when required, only using antibiotics if your doctor decides that you need them, and by keeping an eye out for infections and their side effects.

• What did we learn after the Covid-19 pandemic regarding IPC? And are those lessons carried out nowadays?

The world has changed significantly since 2020, and we have discovered considerable infection prevention and control (IPC) gaps, particularly among health care professionals who are more at risk and require more protection and training. Additionally, this pandemic demonstrated to us that individuals have short memories and that things that are not always around fade quickly. Therefore, I would say that we need to keep the Covid-19 pandemic experience in our minds and invest in infection prevention at the community level and in healthcare settings; Individuals should maintain a responsible behaviour and attitude to prepare for any possible risks by adhering to appropriate and credentialed recommendations to prevent infections and diseases.

• Do you see a need for IPC awareness in the middle east? Among patients or healthcare workers?

The need for more education and awareness among patients, their families and healthcare workers should always be initiated regardless of the type of healthcare facility—a hospital or a clinic. Unfortunately, noncompliance with IPC procedures has a considerable negative impact on the environment of care, patient protection, and healthcare worker safety; and continuous efforts are being made to overcome this barrier both in the Middle East and across the world.

• Where do you see the main problem in achieving full awareness? And how it can be achieved?

Any healthcare facility in the world can access guidance documents and recommendations, but the implementation will vary widely depending on the context. For instance, there are clearly difficulties in the development of successful IPC programmes in low-resource settings – healthcare facilities are frequently affected by poor IPC leadership, including inadequate financing for IPC activities and specialized, dedicated workers, a lack of IPC policies and procedures and insufficient resources due to budgetary constraints. Many hospitals still lack basic infrastructure, including measures and treatments for unclean water, sanitation, and hygiene, lack of IPC training for staff, poor compliance to IPC procedures like hand hygiene, environmental cleaning and disinfection, and reprocessing of reusable medical equipment, as well as inadequate infection surveillance systems. All these are critical barriers to effective IPC in low resource settings.

In conflict-affected settings, the access to healthcare, water, and sanitation, as well as the need for emergency surgical and medical care, are all significant local constraints and barriers that prevent effective IPC. These constraints and barriers also have a significant impact on the rise in healthcare-associated infections, particularly surgical site infections and antimicrobial resistance.

A plan, leadership toward one goal—patient and staff safety—as well as administrative commitment are all necessary for the establishment of effective infection prevention and control measures. Minimal resources may be employed to accomplish this. It is as possible to implement appropriate IPC procedures in low-resource contexts as it is in high-resource ones.