COVID-19: caring for the ignored on the Anglo-French border

  • Stéphanie Lavaud, Medscape.com

  • UK Medical News
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In the midst of the COVID-19 crisis, Médecins du Monde (MdM: Doctors of the World), alongside other NGOs and associations, have appealed to the authorities over the 'disgraceful conditions' endured by hundreds of migrants in Calais and Grande-Synthe, on the Anglo-French border.

Medscape French Edition reports that the response has been poor, notably in Grande-Synthe, where, in full lockdown, more than 500 migrants had to share a single source of drinking water, while the NGOs had to stop or slow down operations in order to respect the protective measures.

The camp at Grande-Synthe is around 7.5 miles from Dunkirk and is now one of the oldest refugee camps for people, just like those in Calais, hoping to go to the UK but stranded on the Anglo-French border.

Their situation is desperate: "Six hundred people, including 50 families with children, pregnant women, living in disgraceful conditions with a lack of showers and toilets and limited access to drinking water, and all this for several months," MdM said in a press release on April 4th.

The majority live in close proximity in disused buildings in Linière, the site of an old linen factory, while others have found refuge in the woods of the Puythouck leisure facility.

For the past 10 years, MdM and other associations and stakeholders in the voluntary sector intervened regularly with a mobile clinic, providing care and offering to accompany visits to the closest hospital, in Dunkirk.
 
Humanitarian Activities Stopped

However, with the appearance of COVID-19, the NGO had to halt or revise its aid activities to refugees on the ground.

"At the beginning, there were a lot of unknowns on the strength of the virus, the contagious risk, and the definition of persons at risk," Franck Esnée, MdM’s regional coordinator for the Hauts-de-France region, told Medscape French Edition. "Many volunteers are retirees, and we asked them to step back as a precaution."

The NGO also did not have the capacity at the time to disinfect its vehicles and therefore was initially unable to maintain its mobile clinic, he added.

In fact, during the early days of the crisis and lockdown, there was no longer a guaranteed medical presence in the camp.

One Drinking Water Tank With Four Taps and Soap

In association with the Red Cross, MdM rapidly made a proposal to the prefectures of the Nord and Pas-de-Calais départements for a coordinated health response in Calais and Grande-Synthe.

"For Calais, we set up a health operation fairly quickly, with doctors, nurses, mediators and translators for the refugees, to explain about COVID and ensure ongoing care outside of that," said Franck Esnée.

"In Grande-Synthe, we were excluded from any coordinated response by the sub-prefecture of Dunkirk, which chose to install a device that it considered sufficient, namely a drinking water tank with four taps and soap, knowing that people in Grande-Synthe had neither showers nor toilets, and until then had only a water tap on a fire hydrant.

"The second response from the sub-prefecture was to assign two Civil Protection first-aid workers to take people’s temperatures."

The offer, in the midst of the coronavirus epidemic, of neither nurses nor doctors for Linière was deemed insufficient by MdM and denounced publicly.

A 'Failed, Dangerous and Ineffective Policy'

The only response of the Nord prefecture, as of April, has been to enforce the eviction of migrants.

Consequently, "the buildings at Linière were emptied in favour of accommodation centres, while the refugees, estimated at 450 individuals, fled, hid and dispersed in six different places in Grande-Synthe," reported Franck Esnée.

For the humanitarian coordinator, this strategy, which aims to keep people away and not respond to their needs, hugely complicates their work. He doesn’t mince his words, referring to the Government’s "failed, dangerous and ineffective policy".

For him, "each eviction not accompanied by accommodation or permanent lodgings makes the individuals a little more precarious and causes loss of confidence in state systems", a situation denounced by human rights activists in France and by the United Nations.

Gradual and Coordinated Recovery

One thing is certain in this situation, which is increasingly bogged down: "no health group is able to act alone, hence the need to coordinate with others," said Franck Esnée.

This is why, "fairly quickly, the Red Cross decided to put in place a nurse and a doctor in a small mobile clinic, which we came to support. The Red Cross looked after the care itself, and we took care of mediation and information, with the possibility of detecting potential signs of COVID by taking temperatures and directing individuals to the Red Cross in case of medical problems."

Have there been cases of COVID-19 among the refugees? It is difficult to know.

Franck Esnée reports several cases in Calais, but admits to being unaware if others have been confirmed in Grande-Synthe.

"The refugee population is not the one at risk, even if being a migrant multiplies vulnerabilities. On the other hand, the policy, implemented without barrier measures and with a ham-fisted confinement, considerably increases the risk of transmission and contagion," he underlined.

Now, MdM organises two services per week, as does the Red Cross, which has its mobile clinic.

"It allows for the detection [of COVID-19] but is not enough to offer accompaniment to the hospital if necessary and care of people on the spot who need it. But we too will resume the mobile clinic very quickly," he added.

In the meantime, the migrants keep trying to realise their "life plan" to smuggle their way into England, which some achieve.

A Belgian GP Helps the Migrants

Before COVID, Stéphanie, a Belgian family doctor, went to Grande–Synthe once a month with clothes and sanitary ware, "but without offering medical help because there is already Médicins du Monde and the Red Cross," she told Medscape French Edition.

During the lockdown, she learned that the NGOs were no longer going and she thought it "absurd, living 25 km (15.5 miles) from Dunkirk, to not to be able to go and help".

Initially alone, then with doctor and nurse friends, she collected supplies and crossed "easily" the Franco-Belgian border to go to the camps every week.

"Easter Monday, there were 10 of us, with lots of basic medical supplies. Well protected, we set up a table, saying we were doctors and asked if there were any problems. There was one Belgian woman in particular who now lives in the camp and acts as a relay for the migrants. On site, we provide a lot of care for wounds and injuries."

"Linière is an old factory and the migrants regularly get nails in their feet. There are also a lot of kidney problems, scabies, infections and superinfections of all kinds, headaches, diabetes, depression, and psychiatric disorders" Stéphanie said.

"In terms of COVID, I know of one person from the camp who went to Dunkirk hospital with a respiratory problem. He came back after 2 weeks, with a letter that said "unknown aetiology". It is difficult to know more because he speaks only Kurdish, but I am not aware of any deaths due to COVID.

"I have not noticed any suspicious symptoms but it’s complicated because, if the kids have a little flu, they don’t say because they don’t want to be put into quarantine and miss an opportunity to cross to England.

"What we do in Grande-Synthe is the basics. If we see a problem, we try to send the person to a doctor we know at Dunkirk hospital.

"I learned that Médicins du Monde will return to the camp, the idea being to work together, as solidarity has no borders."

Translated and adapted from Medscape's French Edition.