COVID-19 in the Middle East and North Africa: On-the-ground perspectives

CHAD

Dr Thierry Kimato, Medical Director and Dr Frederic Vuillemin, Medical Director, Medical Services

25 April 2020

Current lockdown status: The first COVID-19 case was declared on 19 March and imported via a passenger on a flight from Cameroon - a neighbouring country. On the same day, the Government announced a lockdown, suspending all international commercial flights for an undetermined period and only maintaining humanitarian and cargo planes. Land borders were closed the following day. 

All schools, colleges and universities, as well as restaurants and bars, were shut down from 20 March. Non-food retailers were closed from the 23 March, including access to places of worship. Additional protective measures were set up on 2 April, a curfew initially from 19:00 to 6:00 and then changed on 16 April from 20:00 to 5:00. 

Five weeks later, there has been an announcement of 46 confirmed COVID-19 cases and more than 300 contacts tracked and monitored, with more than 1,500 people quarantined. 

A dedicated referral hospital for confirmed COVID-19 patients was set up by the authorities at Farcha, which is located on the outskirt of N’Djamena, the capital. The medical operational set up of this facility is limited and accommodation conditions are harsh.

On 25 April, the country president decreed a National Health Emergency in response to recent developments and actualisation of the outbreak.

 

Impact on the community: It is recommended to wear masks but a challenge to get a hold of them. There are no particular restrictions of movements during the day while curfew at night time only allows movements for urgent medical reasons. Additionally, only markets, supermarkets and pharmacies are open, and hand hygiene is mandatory before entering those. Social distancing could not be realistically implemented in certain popular areas of N’Djamena where population density is pretty high. 

People have so far demonstrated impressive resilience while facing the outbreak and have globally respected restrictive measures. As of 30 April 2020, there have been two fatalities related to COVID-19. The disease is currently perceived by the population from the same perspective as any other severe infectious disease, some of them being common and endemic in Chad which the community is used to.

Chad received support from various international stakeholders, such as the World Health Organization (WHO), which provided additional epidemiologists. The support is through private funding and donations, while essential ICU medical equipment will be acquired. An initiative of free water for six months and free electricity for three months is announced, including temporary tax-free importation for medicines and medical equipment.

On a mid-term perspective, there are areas of concerns as the country income depends on Oil & Gas revenue whose prices have been severely impacted by the global pandemic. The global shortage of essential PPE and consumables is a significant public health issue. The outbreak will represent additional stress on an already challenged healthcare system that has been striving for years to maintain its bottom line.

What is International SOS doing on the ground? Our clients face multiple challenges concerning their employees’ health. We have been the regular healthcare reference point for many organisations. We provide our clients continuously with tailored medical support and advice in line with their needs and concerns. Our credibility, respectability and medical leadership have been acknowledged by the Ministry of Health. 

Some of our clients have had to downsize their operations swiftly and we have been closely working with them to understand their business challenges, brainstorm relevant solutions to accompany them throughout the pandemic. 

As part of conforming to the culture in Chad, we have optimised the flow of our clinic patients as the local culture is to accompany sick people to hospitals by many dependents. This habit generates an influx of hundreds of people daily that we had to reduce with a new facility access policy. This has been well received by patients. 

Our clinic in N’Djamena was jointly examined by the Ministry of Health and WHO, impressed by our level of preparedness and attention to protecting our staff from potentially infected patients.

 

On 3 April, we conducted the ground transfer of a patient with COVID-19, to evacuate back to Europe.

 

IRAQ

Dr Ehab Chalabie, Medical Director

17 April 2020

 

Current lockdown status: Iraq imposed a restricted lockdown from mid-March until the end of April, pausing commercial flights and closed border entry points.

 

Impact on the community: The government is in the process of allowing the return of the international assignee workforce of international organisations, especially in the oil and gas industry to keep oil production viable.

What is International SOS doing on the ground? We continue to support by liaising with the local health system and establishing a line of communication with all local health authorities in the cities that International SOS operates in. Additionally, our Iraqi team, with assistance from our regional team, has launched a process of updating all MedSites and clinics with site-specific infectious disease management plans and procedures. 
 
International SOS has also been granted permission from the local authorities to MedEvac international assignees from Iraq and isolate personnel on-site, which has been very well received by our clients. We have also been working alongside the local health system to collect samples for testing for any suspected cases. Additionally, we have started to medically supervise returning expatriates for the legally applied 14-day isolation at the sites after being audited and approved by the local health system. Our team is also regularly updating clients about the COVID-19 pandemic status, including statistical monitoring.
 
We have also mobilised additional medical staff members to assist our clients with screening procedures on their operational sites.

 

 

 

KINGDOM OF SAUDI ARABIA

Dr Rudolph De Wet, SMA KSA

03 May 2020

 

Current lockdown status: In KSA, as of 21 April 2020, a revised lockdown was announced. This was a total lockdown with no travel allowed without a valid and relevant permit. There were three levels of permits that were available to essential services personnel only:

• Travel within a city and area.
  - This permit is currently available through a dedicated government electronic portal and could be applied for, and received online.
  - This permit is limited to identified essential services personnel to travel between work and home (you have to provide the information for both).

• The other two special permits are for travelling between cities or between provinces.
  - This permit needs to be applied for personally and needs to be granted and stamped.

 

There was an update to the above arrangement with the start of Ramadan on 24 April 2020. From 24 April provisionally until 13 May there will be a slight relaxation of the travel restrictions. Essential travel for groceries and for seeking medical services are permitted from 09:00 – 17:00 within your own immediate area without a permit. Travel between cities and provinces are still prohibited unless you have the permits from the MOI.

All public transport including international and domestic flights are still suspended unless special permission is granted by the government for some essential services and their employees. Some flights arranged by the various countries to repatriate their citizens, especially those in KSA on business, tourist, and visiting visas, are being allowed from Riyadh and Jeddah International airports.

Currently, all new visa applications have been suspended and people already in the Kingdom can apply for an extension of their current visas online, excluding the tourist visas.

 

Impact on the community: All public gatherings such as schools, sporting events, religious gatherings, etc. are still prohibited. 

Since the start of Ramadan, limited amounts of shops in malls have started opening slowly with strict admission criteria, including the number of patrons allowed to enter at one time, maintaining social distancing, and the wearing of masks. It appears that the relative relaxation of the restrictions will be reviewed on 13 May to see what the effect of the measures have been on the number of new cases.

The situation remains fluid in KSA and there are various levels of restrictions imposed in different areas. Qatif, the first city that went under lockdown and had been under complete lockdown (no one in or out) for 8 weeks, has been re-opened this week with individuals living in Qatif being allowed to move outside of Qatif with the necessary permissions. Dammam Industrial city, on the other hand, was placed under a complete lockdown overnight from today, just as the lockdown on Qatif was lifted.
 
KSA has a system whereby locals can apply for government support for 60% of their salaries for three months, which is limited to local Saudi nationals. Saudi Arabia’s government continues to be pro-active and have instituted several community initiatives to support, particularly Saudi nationals, but also all who reside within its borders during this time. There are new COVID-19 hospitals being planned for Riyadh and Jeddah currently and the MOH has also started identifying and running isolation facilities for suspected cases or confirmed stable cases. Treatment and testing are free for both Saudi Nationals as well as expatriates.

 

What is International SOS doing on the ground? We continue to communicate and work closely with the MOH, strengthening and building on our current relationships. This provides us with immediate access to the latest updates and developments in all COVID-19 related matters. We further continue to monitor the official websites, MOH, MOI, etc. daily for the latest updates due to the fluidity of the situation. A daily update is sent out to our clinic and MedSite staff as far as possible for updates on any new circulars or regulations.

We continue to keep our clients up to date as well as offering a range of COVID-19 related services and consulting options. The Burj Al Shifa (operated by International SOS) has also recently started providing COVID-19 sample collections for clients. Testing for COVID-19, including the use of RDT’s, are still limited to MOH designators, with facilities and private health facilities not being allowed to do the tests unless through a limited special permission and accreditation by the MOH.

We continue to provide screening services; facilitation of, and referral to MOH designated facilities for testing when the appropriate criteria is identified; follow up of results through the electronic HESN system (national laboratory system with special permission received from the MOH); mass-screenings on sites; and assistance with return to work protocols.

We were recently involved in the audit and preparation of an international hotel for the accommodation of frontline health care workers, followed by the second phase where we are now on site as consultants and medics for screening. TeleMedicine will soon be available in the Burj Al Shifa medical complex, which will further enhance our reach throughout KSA.

 

 

 

OMAN

Dr Salim Al Jabri, Lead Emergency Doctor and Dr Ahmed Alhubaishi, Lead Emergency Doctor

22 April 2020

 

Current lockdown status: As COVID-19 cases continue to increase in the country, the government has implemented lockdown restrictions in a step by step process. All gatherings of prayer, conferences and weddings have been instructed to stop as well as the closure of all trade activities with exceptions for grocery stores and petrol stations. Remote learning has also been implemented for all schools and universities, while essential industries and companies continue to work with some restrictions. Simultaneously, the country's capital Muscat is in a complete lockdown with very limited international and domestic flights.

 

The latest updates also include:

• Supreme committee on COVID-19 held a meeting on 28 April 2020 and decided to open some business activities such as workshops, electric shops, car dealerships, printing press Sanad offices and printing press with strict health precautions.
• Extended the closure of Muscat governance until 8 May 2020; necessary travel is allowed through control points with a company authorised letter.

 

Impact on the community: The government has prepared to face the pandemic with more medical facilities for lab investigations, PPE, medicine, and increased the capacity of ICU beds in hospitals. 

During the lockdown, unemployment increased to up to 30% for both government and private sectors. Free treatment for COVID-19 patients has also been announced along with deferring of loan payments.

In general, people are happy with the measures taken to prevent the spread of the virus and the preparedness of the medical services.

What is International SOS doing on the ground? We provided on-the-ground support to our clients through screenings at every bus pick-up point to our clients’ sites. We have started rapid COVID-19 testing as part of the screening process and Rapid Detection Test kits have already been ordered. Additionally, we are also going to start taking nasal swab samples at the point of entry to sites and send these samples for PCR testing to an authorised laboratory.

We have also taken preventive measures such as rearranging our camps to improve social distancing among the crowd, increased our medical staff on-site, provided advice, updated protocols and guidelines about COVID-19 to our clients.

 

 

UNITED ARAB EMIRATES

Dr Nosa Aihie, Regional Medical Director

23 April 2020

 

Current lockdown status: As of 24 April 2020 (coinciding with the start of Ramadan), the Dubai Government partially reduced restrictions on the movement in the Emirates, allowing individuals to leave their homes between 06:00 and 22:00 without a movement permit. Individuals stepping out must follow precautionary measures which include maintaining physical distance from others and wearing a face mask and gloves. Those who do not wear a mask will be subject to a fine of AED 1,000.

Public movement is restricted during the time of sterilisation between 22:00 and 06:00. During this period, the public will be allowed to leave their homes only for medical emergencies. 

Impact on the community: The UAE government has instructed for schools and places of worship to close. Children have been on remote learning since the beginning of the current school term. Generally, people have been following the directives of the authorities by staying at home. Many people have adjusted to the concept of working from home and are trying to remain positive. There has been a noticeable effect on the economy, and several organisations had to cut jobs or asked employees to accept a pay cut. Individuals who have to leave their homes are mandated by the authorities to put on masks and hand gloves.

 

What is International SOS doing on the ground? We remain in a close relationship with our clients through our Assistance Centre in Dubai, and our medical services are fielding various concerns and queries. The Assistance Centre has also helped to repatriate citizens of the UAE back to the country. We have supported our clients by reviewing their Business Continuity Plans and provided tools to help them monitor and plan for the pandemic. Support was also extended to clients through educational webinars.