Doctors Without Borders/Médecins Sans Frontières (MSF) teams in Tanzania are concerned about the threat posed by the spread of the new coronavirus disease, known as COVID-19. Hundreds of thousands of people living in refugee camps here are highly vulnerable to infectious diseases and have limited access to health care services. MSF teams are doing everything we can to prepare for a potential outbreak in Nduta refugee camp, where we are the primary health care provider for 73,000 Burundian refugees, however much greater support is needed to bolster the COVID-19 response in the area. In this open letter, Pete Clausen, MSF head of mission in Tanzania, urges the international community to act before it is too late. “To put it simply, if a COVID-19 outbreak happens here, the spread could be impossible to stop,” writes Clausen. As of April 10, the World Health Organization has reported 25 confirmed cases of COVID-19 and one death in Tanzania.

I am the country representative for MSF in Tanzania, where our teams run a 150-bed hospital and four health centers in Nduta refugee camp, near the border with Burundi. Nduta is home to over 73,000 Burundian refugees who fled their homes due to violence and unrest in 2015.

In Nduta camp, our team of 800 staff and volunteers work around the clock, treating thousands of refugees and the host community every day for malaria, acute respiratory infections, and diarrhea, as well as those with underlying non-communicable diseases and other significant health conditions.

As the sole health care provider in Nduta, MSF’s main concern for the past month has been how vulnerable these people are to a COVID-19 outbreak, how rapidly it would spread in the camp, and how fatal it could be to our patients with co-morbidities, such as HIV, sickle cell disease, and tuberculosis.

If not controlled quickly, the spread of COVID-19 in Nduta could grow exponentially in a matter of weeks and lead to an excessive number of deaths. This is partly due to the living conditions, where people stay in basic shelters, with limited access to services that most of us consider standard, such as water and sanitation.

The luxury of self-isolation and physical distancing adopted by some societies is simply not possible in Nduta, where more than five family members can share one small room. Cramped conditions make adhering to critical hygiene advice almost impossible. Already in January of this year, our medical teams recorded high increases in patients with watery diarrhea and respiratory infections, and we currently have four overflow tents at full capacity.

A COVID-19 outbreak in this setting could lead to a high number of patients with severe infection, putting extreme pressure on MSF’s hospital and the overall health system in the camp. With limited inpatient care in the region, few isolation facilities, and a global shortage of personal protective equipment, an outbreak in Nduta will make an effective response exceptionally difficult.

Burundian refugees in Tanzania are among the most underfunded refugee groups in the world, according to the UN Refugee Agency. Kigoma region, where Nduta is located, is one of the poorest regions in Tanzania. Consequently, both refugees and the host community are especially vulnerable to an outbreak. To put it simply, if a COVID-19 outbreak happens here, the spread could be impossible to stop.

MSF teams in Nduta have been implementing preparedness measures for various scenarios, but with shortages of supplies and staff, there is only so much we can do. We are calling on the international community to ensure support in the COVID-19 response here in Tanzania, in order to protect vulnerable refugees and the host community. There is an urgent need to increase isolation and treatment capacity as well as reinforce testing across Kigoma. This neglected group of people, who have been all but forgotten by the world, need our help now, before it is too late.