Oxygen and COVID-19: UNICEF’s global, rapid and multi-faceted approach

From reaching the last mile in Peru’s Amazon with oxygen concentrators to bringing liquid oxygen to refugees in Bangladesh to refurbishing plants in Sierra Leone, UNICEF scales up efforts to save lives.

Marisela holds her baby in the Neonatal Intensive Care Uni of the Mbeya Regional Referral Hospital, in Tanzania, where the child received oxygen support. November 2018.
UNICEF/UN0270672/van Oorsouw
12 November 2020

This year’s World Pneumonia Day is a critical time to reflect on how to stop children dying from pneumonia. The notorious virus of 2020, COVID-19, when severe, can lead to pneumonia where lungs become inflamed and filled with liquid, making it difficult, if not impossible to breathe. But pneumonia isn’t a new emergency; it takes the lives of 800,000 children each year, almost all of which are preventable.  

With high rates of childhood pneumonia and COVID-19 spreading worldwide, health facilities are faced with the dire risk of not having an adequate supply of oxygen. Every year, 4.2 million children suffering from severe pneumonia in low and middle-income countries urgently need medical oxygen to survive. This life-saving gas helps patients breathe when they cannot do so on their own – whether it be children with pneumonia or hypoxemia, newborns and mothers with birth complications, or patients with severe COVID-19.  

Unfortunately, medical oxygen is seldom available for many people whose lives are at risk. This complex commodity can be challenging to provide, especially in rural settings where electricity, infrastructure and essential health equipment may be in short supply.

The many ways to supply medical oxygen

Graphic displaying four different oxygen sources: Cylinders, oxygen concentrator, oxygen plant and liquid oxygen

A key part of UNICEF COVID-19 response has been delivering oxygen concentrators, devices that take in air from the environment, remove nitrogen, and produce a continuous source of oxygen. As of 11 November 2020, UNICEF delivered 15,188 oxygen concentrators to 93 countries.  

But the response isn’t a one-size-fits-all solution. Some settings may have oxygen plants and cylinder-delivery networks available, others may not. Some may have a reliable source of electricity available to use a concentrator, others may not. And some may have import restrictions for certain health supplies while others face challenges with dwindling health budgets and rising prices from oxygen suppliers.    

UNICEF is working with governments and partners to find the best solutions for each unique country context, which in most cases involves a mix of oxygen sources from cylinders, concentrators, plants and liquid oxygen. 

How UNICEF is supplying oxygen globally

The response has truly been global, rapid, and multi-faceted. UNICEF is supplying medical oxygen to over 90 countries to help fight COVID-19 and keep children and newborns with pneumonia alive.  

In Peru, UNICEF is providing oxygen concentrators to help indigenous communities

Two men inside a warehouse with oxygen concentrators in the background.
In Peru, UNICEF is providing oxygen concentrators to help indigenous communities – some of the hardest hit populations - to cope with the crisis. By plane and by boat, UNICEF, in partnership with the Ministry of Health, delivered 40 oxygen concentrators to local health centres in Amazonas, Loreto and Ucayali regions in the Amazon as well as an additional 15 oxygen concentrators to Huancavelica region in the Andes. Hugo Rázuri, UNICEF Peru’s Health Specialist, explains that the equipment not only provides life-saving oxygen therapy, but also keeps patients closer to home. “Now they’ll be able to treat mild and moderate cases in the same facility without having to transfer them to hospitals. By treating patients on site, we avoid separating them from their families.”

In Bangladesh, UNICEF is expanding oxygen systems to prevent new-born deaths  

A large tank of liquid oxygen in front of a hospital.
In Bangladesh, UNICEF is expanding oxygen systems to prevent newborn deaths which account for approximately 62,000 lives each year. A continuous oxygen supply increases the chances of survival for severely sick newborns, particularly those suffering from pneumonia, sepsis or asphyxia. This year, UNICEF established a liquid medical oxygen plant in Cox’s Bazar Sadar District Hospital to service the Bangladeshi community and Rohingya refugees. The tank provides a continuous 24-7 oxygen supply for the Special Care Newborn Unit. With a large capacity of 9,909 litres, it is also servicing a plethora of medical needs, including COVID-19 patients and other patients in the emergency ward, labour ward, coronary care unit and intensive care unit. “UNICEF has been consciously pursuing the ways and means to make COVID- and non-COVID-related actions complementary to each other so that together they contribute to the overall health system strengthening of the country. This is one example,” said Dr. Ezatulla Majeed, UNICEF Chief of Field Services in Cox’s Bazaar.

In Sierra Leone, UNICEF is investing in refurbishing and installing oxygen plants

Two infants at a hospital receive oxygen via an oxygen concentrator in hospital in Sierra Leone.
UNICEF/Sierra Leone/Davies/2020
When the pandemic first hit Sierra Leone, the country did as others did and quickly ordered oxygen concentrators to prepare for a potential surge of COVID-19 cases. But UNICEF also looked for more sustainable solutions to ramp-up the country’s oxygen supply. In the town of Bo, an oxygen plant was identified, but was not yet installed. UNICEF deployed a biomedical engineer to transfer the equipment to the 34 Military Hospital in Freetown (a COVID 19 treatment hospital) and get it up and running. Via groundwork from UNICEF’s new-born care programme, a long-term approach is key. UNICEF launched an expression of interest for suppliers to install and maintain three Pressure Swing Absorption (PSA) oxygen plants across the country – with plans for completion in March 2021. This approach provides a sustainable supply of oxygen for Sierra Leone, not only as a response to COVID-19, but for essential health needs, such as for new-born care, maternal care, surgeries, and childhood pneumonia

Other examples include:

  • In Chad, oxygen cylinders were delivered to remote areas where access to oxygen is limited.
  • In the Democratic Republic of the Congo, oxygen concentrators were delivered to six health centres treating COVID-19 patients
  • In India, the Government and UNICEF invested in a massive shipment of oxygen concentrators (over 3,000) to support the surge in COVID-19 cases in the country.  
  • In Madagascar, access to oxygen is being provided at 23 hospitals via a supply of oxygen tanks to treat severe COVID-19 cases.
  • In Malawi, UNICEF helped establish an oxygen generating plant at Kamuzu Central Hospital, contributing to building an oxygen ecosystem for the country.  
  • In Ukraine, UNICEF and partners delivered 150 oxygen concentrators to 35 hospitals to support the Government’s COVID-19 response efforts.
  • In Senegal, via the SPRINT Project, UNICEF and the Government are providing oxygen to 64 health facilities in regions with high rates of pneumonia.
  • In Yemen and Venezuela oxygen concentrators were urgently airlifted in since the pandemic has intensified the prolonged emergencies these countries face.  
  • In Zambia, UNICEF helped rehabilitate an oxygen plant to produce 48 cylinders per day for medical use.  

An oxygen response established before the pandemic

Through pneumonia-focused initiatives, UNICEF had the groundwork in place before the pandemic, which has enabled the organization to expand its oxygen response during the pandemic. For example:

Through such initiatives supported by the La Caixa Foundation (ARIDA), Bill & Melinda Gates Foundation (oxygen therapy), and UNICEF internal resources (SPRINT), UNICEF is uniquely positioned to propel an extensive global oxygen response to meet both the imminent need caused by COVID-19, and moreover, to address the 800,000 children’s lives that pneumonia takes every year.  

Continued investments for oxygen

On this World Pneumonia day, UNICEF is asking governments, donors and partners to amplify efforts to bring life to those fighting for breath.  

Oxygen is an answer. The commodity is complex, but solutions are out there - whether it be installing or refurbishing PSA plants, providing liquid oxygen or distributing oxygen concentrators. And the world has started bracing for change. Over the past year, governments, donors, UN agencies and partners have begun to recognize the importance of this essential medicine in helping people recover from pneumonia, whether COVID-19-induced or not.  

Just this year, in addition to the 15,188 oxygen concentrators, UNICEF alone has distributed over 19,600 oxygen accessories (like pulse oximeters, flow splitters, oxygen analyzers and humidifier bottles) and 578,000 consumables (like nasal cannula, face masks and tubing) to 93 countries. In addition, UNICEF country offices have supported many governments to initiate plans to install and/or refurbish PSA plants or provide liquid oxygen to further bolster oxygen scale-up efforts.  

And this is only the beginning.  

The momentum is strong. The time is now. Let’s continue our efforts to invest in oxygen and combat pneumonia.