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This morning the sky is grey and the temperature hovers around zero degrees in Porte de Saint-Ouen. A short distance from the Paris ring road, surrounded by buildings near a football stadium, volunteers in bright hi-vis jackets are handing out coffee and breakfast to dozens of exhausted looking people. Many of them have been living on the street for years, some have fallen into poverty since the crisis, and others are migrants who have no access to emergency shelter. But, all are the ‘un-locked down’ of the Covid-19 pandemic.
Homelessness, hunger, loneliness, unremitting hardship and the cold contribute to weakening people’s physical, and sometimes mental, health. But rough sleepers, and more generally people pushed into precarity, often put off or stop seeking medical treatment altogether.
Médecins Sans Frontières runs mobile clinics five days a week to reach out to rough sleepers. The choice of location is carefully thought out. “Being near soup kitchens allows us to meet people suffering the worst hardship. They come here to eat and then they see us, right by them,” says project coordinator Jean-François Véran.
Social worker Nicolas goes to talk to people sitting on benches while they eat. He listens, advises and directs them to shelters for women, to an association that supports drug users, and another that assists asylum seekers with their applications. And for anyone who needs to see a doctor, the mobile clinic is just a few steps away.
Prospective patients wait in line for Mathieu and Akram to register their names, ask them why they’ve come and offer them more coffee. Some days an interpreter is on hand to facilitate the team’s consultations. Medical care is available to everyone free of charge, and health insurance is not required. And for people who prefer to remain anonymous, neither are identity documents. Covid-19 has swelled and reshaped what was already a diverse population of rough sleepers. Many have recently lost their jobs and have never been to a soup kitchen before, and others haven’t been able or don’t know how to renew their right to health insurance. Almost everyone is disoriented because the health facilities they’re used to attending and associations that support them are either shut or have restricted their opening hours. The lack of information is evident, often leaving people not knowing where to turn.
Wearing a pink padded jacket and mask, Christine* is sharing a bench with 31-year old Afghan asylum seeker Bilal*. Rather confused, Christine says she has escaped from a clinic that wanted to send her to a home for dependent seniors, and Bilal explains he was evicted first from a camp in Saint-Denis, and then another on Place de la République. He’s squatting “in parks in Saint-Denis, La Chapelle and Porte de la Villette. Anywhere, but nowhere with a roof over my head.”
Around 400 migrants are in a similar situation. Dispersed across Paris and the suburbs, they are the victims of a policy of dismantling and harassment that prevents them setting up camp elsewhere—even if there are no offers of alternative shelter. They do what they can to stay out of sight. Jean-François Véran continues, “The repercussions of these methods, that go back many years and have escalated in recent months, are all the more acute in a time of pandemic. People who need support and medical care are increasingly invisible and frightened, and we’re losing access to them. Lots arrive at our clinic exhausted and sleep deprived.”
One by one, Christine* and Bilal* are seen by MSF nurses Sandrine and Sinan in small tents equipped with electric heaters powered by a noisy generator. Their hats on, the nurses check their patients’ vital signs (blood pressure, pulse and temperature) and provide treatment—dressings, dispensing drugs without a prescription, antigen tests for people with Covid-19 symptoms etc.—, that does not require the intervention of a doctor.
Some people’s visits to the clinic end in a truck converted into a consultation room. This is where Alix, the MSF doctor, receives patients who need a prescription or a more in-depth medical examination. Bilal is one of them, because he has had stomach problems for 10 years. Speaking hesitant but precise French after just three months in France, he repeats his visit several times over during the morning interpreting to help his fellow citizens.
Most of the disorders the medical teams see are the result of living on the street—aches and pains, dermatological and digestive problems, severe sores and infections—, and some of their patients have mental health issues and an acute sense of abandonment and isolation. A vicious circle, there’s no doubt that sleeping rough increases the risk of these types of conditions.
Médecins Sans Frontières’ mobile clinics help to ensure these particularly vulnerable people continue to have access to medical services, for Covid-19 or otherwise. They also enable us to maintain close contact and monitor the physical and mental health of rough sleepers so that we can adapt and deliver an appropriate response to their needs.
On 20 November, Médecins Sans Frontières started running mobile clinics near soup kitchens to assist people living on the streets in Paris. Open five days a week, the clinic’s doctor, two nurses, logistician and social worker offer primary health care, information and Covid-19 tests. Launched as a weekly operation in 2017, this was increased to five days from March to June during the first wave of the pandemic to respond to these people’s urgent needs.
At the end of the first three weeks, 250 patients have had medical examinations in the mobile clinic and 50 have been referred to various facilities by the social workers.
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