Having spent the last five years fighting cholera in South Sudan, battling Ebola in Sierra Leone and responding to a measles outbreak among Rohingya refugees in Bangladesh, the last thing Melanie Villarreal expected was for her next deployment for Medecins Sans Frontieres’ (MSF) to be in London.
The humanitarian worker, who has worked in nine overseas conflict zones and crisis-hit regions during her five years in the job, is now working in a budget hotel in Newham to fight the coronavirus pandemic.
She is one of 10 MSF nurses working in the London Covid Care Centre, a clinic that has been set up in an unprecedented mission to treat and care for homeless people with suspected or confirmed coronavirus, providing rapid testing, accommodation in which to self-isolate and medical care.
It marks the first time MSF – which primarily works in war zones and natural disasters in the developing world – has ever been deployed in Britain. The organisation is operating in the centre through a partnership with University College London Hospital as part of a wider effort by the Greater London Authority to prevent deaths in this vulnerable group among the capital’s homeless population.
“I never imagined I’d work in the UK,” says Melanie, who started working at the care centre on 11 April. “I was completely surprised to be national staff in my own country, but it just highlights the extreme level of the situation. It makes sense,” she adds, explaining that she hadn’t realised the extent to which many homeless people were excluded from mainstream services, including healthcare.
More than 5,400 homeless people across England and Wales are currently residing in hotels, including 1,276 in the capital, as part of an unprecedented emergency operation to get all rough sleepers off the streets during the pandemic. It is from these hotels that most of the Covid Care Centre’s patients are referred, although some are identified on the streets and brought in from there. So far, 43 homeless people have spent time in the facility, each usually spending around two weeks there before being moved back into hotels once they have overcome the illness.
Melanie’s day begins with serving breakfast to residents, before carrying out clinical observations of all patients, which is done four times a day. New admissions can come in at any point, so her team always needs to be prepared for that. Patients are able to go outside individually at set times, and are provided with books and games to keep them occupied.
Between medical checks and observations, Melanie and her colleagues find themselves registering patients with GPs, because often they come in without one, usually because they don’t have a fixed home. “There are a lot of primary healthcare services that could be offered to this population that would potentially save the NHS money in the long run, because people wouldn’t be waiting until they’re at crisis point and going to A&E,” she says.
While there are inevitably considerable differences between responding to crises in developing countries and working in the London clinic, notably not having the added security issues that you get in conflict zones, Melanie says there are also a lot of similarities.
“In other situations, I’m a foreigner, so I haven’t got a clue – and here I also don’t have a clue, because I’m not homeless and I’ve never been homeless,” she says. “So it’s been quite a humbling experience just to understand that there are parts of our society that I have no clue about.
“In a lot of the other contexts we work in people are displaced, so they’re homeless, but there’s still a community together, and it’s the same here. These people are homeless, but they have their own community and their own way of doing things. It surprised me in the beginning because I realised how much of it is similar and it’s on my doorstep.”
Some of those who have been referred to the centre have fallen homeless during the pandemic as a result of the economic pressures caused by the lockdown. “This surprised me,” Melanie says. “This pandemic is really affecting people quite quickly. I don’t think people realise so many people live month to month, they don’t have a bank of savings, and if they haven’t been furloughed or they’re not able to work, that money’s run out now… It could happen to any of us.”
Working alongside MSF at the Covid Care Centre is homelessness charity Thames Reach, which focuses on referring people to the centre and discharging them to safe places once the illness has subsided, as well as the non-medical aspects of the facility such as food, building management, cleaning, laundry, security and finance.
Bill Tidnam, chief executive at the charity, says: “I didn’t think in a million years that we would be working with a humanitarian organisation like MSF. But it’s a very positive thing. It’s been a real pleasure.
“You can tell they’ve worked in conflict zones, they’ve got a tent in the car park which they use for doing initial assessments – it’s a very high-class tent and I’m told it’s all the way from Afghanistan,” he says with a grin, adding: “This is something everyone would have thought was impossible in February. Obviously it’s not the end of the story, but it’s an impressive achievement.”
Bill says the pandemic has highlighted how many people were living in precarious situations across the country, but were not known to the authorities as being homeless: “Lots of people who have been put in hotels were on the fringes. In many cases they had been working, but were not connected to the systems are out there that might support them – healthcare and the benefits system and so on – so it is an opportunity to get people more connected into that.
“The important thing is we now know how to do this. If we wanted to scale it down, we would have the capacity to scale it up again relatively quickly. There should be a good deal of flexibility around it.”
Rosamund Southgate, medical coordinator for the MSF UK response, says the organisation quickly became concerned about the impact the outbreak would have on the most vulnerable communities in the UK as well as the rest of the world, and identified homeless people as being particularly at risk and facing unique challenges in protecting themselves.
We’re all the same, we all get affected, we can all get it
“It is in MSF’s nature to seek to support the most vulnerable in the greatest need. Here in the UK, a group of particular concern were those experiencing homelessness,” she says. “We have watched as some of the most advanced health systems in the world have been overwhelmed by the numbers of extremely sick patients. Our field missions throughout the world remain our priority; we also knew we could contribute our expertise in the UK. ”
The facility is one of a number of hotels that have been categorised by the Greater London Authority (GLA) as for those with different needs and vulnerabilities, and is the only one designed to treat those suffering from the virus.
Deputy mayor for housing, Tom Copley, said it had been a “crucial” part of the GLA’s plan to protect some the city’s most vulnerable, but added that there had been far fewer referrals than initially feared – which he said was a testament to the early action taken to enable rough sleepers to self-isolate and the preventative work done in hostels.
Melanie meanwhile continues her work in the Covid Care Centre with hope that the healthcare she and MSF is providing for homeless individuals will continue beyond the heat of the pandemic.
“This should be seen as an opportunity,” she says. ”We’d need to look at it from all levels and it would take time, but if we were able to do it I think it would revolutionise the way we see things and we treat people here. People have been so polite and so appreciative of the help, even people with a lot of underlying issues themselves.
“When it comes to pandemics, we’re all the same, we all get affected, we can all get it. Whether you’re homeless not homeless, whether you’re from the UK or from Syria. We’re all in the same boat.”