Once there is a single case of measles in refugee settings, an outbreak is declared, and our teams swing into action to prepare a vaccination campaign. To keep vaccines cold for up to a day, often in sweltering temperatures, logistics workers fill coolers with ice packs and load them onto trucks, along with all the supplies necessary for vaccinating thousands of children each day. While community health workers spread the word with local leaders, nurses set up vaccination stations under trees or near schools. Any children already sick will be given treatment and, if necessary, transferred to a hospital. In the past 10 years, MSF has carried out over 30 vaccination campaigns, the majority of them in Democratic Republic of Congo, Central African Republic, Sudan, Niger, Chad, and Nigeria—many of them among populations displaced by conflict.

Starting a campaign before the first case of measles dramatically reduces the chances of an epidemic. Part of MSF’s measles response is therefore to conduct mass vaccination campaigns in areas where coverage is low and chances of an outbreak are high. Alongside countries with chronically low coverage are conflict settings like Syria, where war has destroyed a once well-functioning health systems. This has caused vaccination coverage rates to plummet and triggered several outbreaks, including measles and even diseases like polio that had become almost unknown in Syria. A vaccine coverage survey done by MSF in Kobane (northern Syria) in June 2015 showed that only 17 percent of children were fully vaccinated. For this reason we have supported both routine immunization and vaccination campaigns in Syria since we began working there after war broke out in 2011.

Though children should be fully vaccinated against measles by the time they're 12 months old, this often doesn’t happen in fragile contexts where government vaccination programs don’t reach everyone or have been disrupted. This makes “catch-up” vaccination important in many settings. For example, in refugee camps we often see that even older children get measles. In response, we may expand our vaccination activities to include children up to age 15.

Supporting routine vaccination for children is the most effective way to prevent measles infections and epidemics. MSF has built measles vaccination into most of our programs that provide paediatric care in hospitals, primary care clinics, and malnutrition programs. For example, in camps for people displaced by Boko Haram in Maiduguri, Nigeria—where many of the children suffer from severe malnutrition—we run mobile clinics that provide medical screenings and care, as well as preventive treatments like measles vaccination and seasonal malaria chemoprevention to all the children we see.

MSF is involved in advocating for new measles vaccines that are easier to use in low-resource regions. Developing a heat-stable vaccine that doesn’t need refrigeration, or one which doesn’t require injection, will be essential in expanding immunisation coverage and protecting more children from this deadly infection.

During outbreaks and in our paediatric outpatient clinics and hospitals, our teams deliver medical care to children with measles, especially those who are also malnourished and therefore more likely to become severely ill. Since measles has no cure, the focus is on preventing dehydration, monitoring fever and managing complications, which include eye and ear infections and pneumonia. Children also receive vitamin A supplements, which reduce measles deaths by as much as 50 percent.