MSF Focus on India

OUR COVID-19 RESPONSE IN INDIA

In India, coronavirus cases continue to surge across the country—as of 31 July, more than 1.66 million COVID-19 cases have been confirmed, with close to 36,000 deaths.

The increase of COVID-19 cases in Bihar is a particularly worrying development, as this Indian state has a fragile healthcare system that will likely be rapidly overwhelmed. Bihar is one of the poorest states in India and, with around 100 million inhabitants, one of the most populated. More than 45,900 cases of COVID-19 have been confirmed in Bihar alone, which also has the lowest testing rate per capita in the country.

To address the crisis in Bihar, MSF is focused on ensuring everyone has access to treatment, particularly those from marginalised backgrounds. MSF staff are supporting the Nalanda Medical College Hospital by running a temporary hospital in a converted sports hall for patients with mild to moderate COVID-19 symptoms. This facility is also equipped to treat patients with severe symptoms when needed. Our teams are providing mental health support, as well as doing community engagement in order to counter stigma and misinformation about the virus.

With the rapid spread of COVID-19 in Mumbai, MSF has increased training of healthcare staff and prioritised infection prevention and control measures, screening and triage. In our existing drug-resistant tuberculosis and HIV programs, we are screening patients for COVID-19 in a private, independent clinic and outpatient department. We are continuing our health promotion activities and are distributing masks and soap in COVID-19 hotspots.

In Kashmir, outpatient departments at all hospitals—including MSF mental health clinics—are currently closed to prevent the spread of COVID-19. MSF teams are continuing to provide psychological support via mobile phone consultations.

MSF has launched a 24-hour hotline in India to provide mental health support by phone in both English and Hindi. Starting with five counsellors recruited and trained by MSF, the project will be scaled up based on needs.   

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Our teams are also gearing up to confront potential outbreaks in the hundreds of areas we were already working before the pandemic struck. We are deploying medical staff, sending supplies and applying nearly 50 years of experience fighting epidemics to protect the most vulnerable and save lives.

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India is the world's largest democracy with over 1.3 billion people. It is a rising economic powerhouse and a nuclear-armed state, but also has considerable social, economic and environmental problems.

Médecins Sans Frontières first worked in India in 1999, responding to natural disasters, conflict, and endemic disease.

Teams operate a wide range of programs for people unable to access healthcare, including mental health support, treatment for infectious diseases, malnutrition, and sexual violence.

According to joint estimates by UNICEF, World Health Organization (WHO) and the World Bank Group, India is home to one-third of the world’s severely acutely malnourished children.

Infectious Disease

MSF runs a number of long-standing projects in conjunction with the state authorities, addressing existing healthcare needs and emerging public health concerns. We run mobile clinics in remote areas of the country, where even preventable, and treatable, conditions such as malaria can quickly become life-threatening on a large scale.

We provide medical and psychosocial care for people living with HIV, drug-resistant tuberculosis (DR-TB), hepatitis C, and kala azar in and around major cities such as Mumbai, Manipur and Bihar, and provide specialised care for co-infection cases.

MSF opened a clinic providing care for hepatitis C in Meerut city in Uttar Pradesh, northern India. Uttar Pradesh is one of India’s largest states, with an estimated population of more than 200 million. Within weeks of opening, staff were overwhelmed by the huge number of people in need of testing and treatment.

The latest generation of hepatitis C drugs - direct-acting antivirals - are manufactured in India and available at a much lower cost compared with other parts of the world, but they are, nevertheless, still unaffordable for millions of patients.

At the clinic, run in collaboration with state health authorities, the team has pioneered a simplified model of care to enhance adherence to treatment. This means that patient visits have been reduced to only one visit a month.

Many of the patients seeking care are thought to have been infected through poor medical practices such as unsafe blood transfusions and the use of unsterilised equipment by unqualified medical practitioners or traditional healers. Therefore, health promotion and community education plays a vital role in MSF's infection prevention initiatives.

Treating kala azar-HIV co-infection in Bihar, India

Many patients must navigate the social stigma that is associated with diseases such as HIV and/or kala azar. Individuals often face isolation and ostracism from relatives and village communities. © Singh / MSF

MSF continued to provide medical and psycho-social care for patients with HIV and drug-resistant tuberculosis (DR-TB) at four projects around Mumbai, aiming to reduce the number of infections, as well as disease mortality.

MSF’s teams treat some of the sickest patients, who require the most advanced combination medications which are not available in the public sector. They are also developing patient-centred, individualised models of care, and trying to influence the country’s treatment guidelines.

In Mumbai, a city of 22 million people, around 50,000 people have TB, and 4,000 are infected with drug-resistant strains of the disease.

Transmitted through the bite of an infected sandfly, kala azar (visceral leishmaniasis) is an endemic disease that thrives in agricultural settings and is prevalent in Bihar, which accounts for 80% of national cases. MSF focuses on addressing kala azar–HIV co-infection, an emerging public health concern, which carries a greater risk of death as the diseases reinforce each other and weaken the immune system.

Domestic and Sexual Violence

Sexual and gender-based violence is a medical emergency. Survivors of sexual and gender-based violence are often reluctant to come forward due to stigma and a lack of confidentiality. Some victims have even been shamed in news headlines.

In the nation’s capital, Delhi, we provide medical and psychological care to victims of domestic and sexual violence and raise awareness about the importance of seeking timely medical and psychological care.

Health educators work tirelessly in the Jahangirpuri community: walking around looking for groups of men, women and children to educate them about sexual and domestic violence, devising new and innovative methods to spread awareness, and raising awareness of the services Umeed Ki Kiran Clinic provides. The priorities are encouraging victims of domestic and sexual violence to seek medical care, and trying to dismantle the community's perception of shame and taboo associated with sexual violenc, instead teaching them to care for their physical and mental health. © Nanda / MSF

The Umeed Ki Kiran (“Ray of Hope” in Hindi) clinic in Jahangirpuri, in the city’s north end, has been providing support to survivors of sexual assault and domestic violence since November 2015, and has become a safe space for the vulnerable.

We work with community-based organisations, police, government protection agencies and the health ministry to highlight the clinic’s services and create an efficient referral system. We also engage the community in discussions on domestic violence, sexual assault and child abuse.

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