COVID-19 triggers critical care and ICU capacity building by WHO in Fragile, Conflict and Vulnerable countries – Afghanistan

Jennifer E. Engen

24 February 2022 – Prior to the COVID-19 pandemic, most fragile, conflict-affected and vulnerable countries in the Eastern Mediterranean Region had little or no intensive care unit (ICU) or critical care capacity, despite their dire need to respond to patients dying from gunshot wounds, lack of trauma care, and infectious diseases, among other factors.

With the emergence of COVID-19, the populations in these countries became the most at risk. In addition to their minimal access to critical care, any existing facilities became overwhelmed by COVID-19 waves and many health care workers were immediately shifted to provide care to critical patients in COVID-19 ICUs.

Through the WHO Regional Office for the Eastern Mediterrean’s response to COVID-19 in the early days of the pandemic, countries of the Region began receiving medical ventilators and other biomedical equipment for the treatment of COVID-19 cases. However, avoidable deaths continued to occur and high case-fatality ratios were observed in fragile, conflict-affected and vulnerable countries, with COVID-19 mortality following hospital admission nearing 100% in some instances.

A multi-faceted response

WHO Regional Office Medical Officer and IMST COVID-19 clinical management lead Dr Chiori Kodama says that “When COVID-19 started, resource-limited and fragile, conflict-affected and vulnerable countries had a very small number of ICU doctors and nurses. Thus, many health care workers were repurposed from different fields, so they didn’t know how to manage critical patients in ICUs despite their tireless efforts in saving lives. We had to start from scratch.”

Demand-led trainings were thus developed by WHO regional COVID-19 clinical management team and rolled out through on-site missions and online to frontline health workers in resource-limited and complex emergency countries, as well as middle-income countries in the Region.

On the ground

In Afghanistan, hands-on ICU/critical care training delivered by field missions and WHO consultants benefited 7 834 health care workers. “I am the only woman doctor looking after COVID-19 patients in the Afghan Japan Hospital in Kabul,” says Razia Ghafaari, “The support WHO and the EU have provided to our hospital enabled us to take care of our patients from many provinces in Afghanistan, especially those in the ICU.”

Scores of health care workers were trained in Pakistan and 8 training of trainers workshops were delivered during the field mission to Somalia.

In Iraq, training of trainers workshops for ICU/critical care and ICU assessment enhanced the skills of 87 senior doctors and nurses working in COVID-19 ICU, while the use of biomed equipment and fire safety trainings reinforced the capabilities of many health care workers across the country. Cascading training for ICU/critical care at the national level is planned in due course of time.

In the occupied Palestinian territory of Gaza Strip, 2 field missions offering training in ICU/critical care have advanced the capacity of 985 doctors and nurses. Zaharia Sakallah, a customer service agent, fought an arduous battle with COVID-19 for 58 days at a Gaza hospital. The hospital health care workers, who were not previously trained on ICU/critical care, received the WHO training focused on life-saving skills. “I am slowly but surely going back to full health,” Sakallah says, “The support I received from the medical teams […] is invaluable and I believe is the main reason behind my recovery.”

In particular, Yemen – which had no ICU/critical care capacity in public hospitals prior to the COVID-19 pandemic – greatly benefited from joint efforts with WHO country office and 3 field missions dispatched by the WHO Regional Office, training 1259 health care workers in ICU/critical care, scaling up medical oxygen, and conducting ICU assessments to identify immediate needs in life-saving supplies and fulfil the gap. In practical expression of regional solidarity, Oman is intent on providing technical support in the area of ICU/critical care to strengthen the capacity of health care workers in Yemen, forming a “twinning project” between the 2 countries.

And online

Additionally, virtual trainings were delivered in all above-mentioned countries, as well as in 5 other fragile, conflict-affected and vulnerable and middle-income countries in the Region, benefiting over 10 000 health care workers. Furthermore, a series of webinars was launched in all 22 countries of the Eastern Mediterranean Region, enhancing the skills of over 20 000 health care professionals.

Beyond COVID-19

Dr Kodama emphasized that “Other than the regional introductory critical and ICU care training package for doctors and nurses, we also had to develop an ICU assessment instrument for resource-limited settings because, when COVID-19 started, we didn’t have such a tool to assess current ICU capacity, which was essential for our timely delivery of life-saving items in ICU.”

WHO efforts are currently deployed in the move from the initial surge response in this area to sustainable capacity-building allowing adequate critical patient care beyond COVID-19 in order to enable healthcare workers to respond to more diverse critical conditions. Planned to be introduced to more of the Region’s fragile, conflict-affected and vulnerable countries, the project is currently being piloted in Yemen. For this purpose, the WHO Regional Office dispatched its Emergency Consultant, Dr Gary Greg Kuniyoshi, on 1 February 2022 to Yemen for 3 months, to provide technical support and direct bed-side coaching aiming to more effectively enhance critical care practice among frontline health care workers.

A snowballing effect

A number of ministries of health, as well as a directory of hospitals in FCV settings, have also requested such technical support from the WHO Regional Office to consolidate their frontline health care workers’ life-saving skills, calling for long-term and sustainable national training programs on ICU/critical care.

Thanks to cascade trainings led by WHO country oOffices and to the unrelenting efforts of the Regional Office’s COVID-19 clinical management team, the cumulative number of the Region’s professionals who are now better equipped to respond to the needs of critical care/ICU patients, potentially saving their lives, has come to exceed 40 000 health care workers.


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