A massive scale-up of humanitarian aid in Bangladesh is needed to avoid a huge public health disaster following the arrival of hundreds of thousands of Rohingya refugees from Myanmar.
After a wave of targeted violence against the Rohingya, more than 500,000 people have fled to Bangladesh from Rakhine State in Myanmar since August 25. The most recent influx of Rohingya refugees has added to the hundreds of thousands of Rohingya who fled across the border during episodes of violence in previous years.
Most of the newly arrived refugees have moved into makeshift settlements without adequate access to shelter, food, clean water, or latrines. Two of the main pre-existing settlements in Kutupalong and Balukhali have effectively merged into one densely populated mega-settlement of nearly 500,000 people, making it one of the largest refugee concentrations in the world.
“These settlements are essentially rural slums that have been built on the side of the only two-lane road that runs through this part of the district,” says Kate White, MSF’s emergency medical coordinator. “There are no roads in or out of the settlement, making aid delivery very difficult. The terrain is hilly and prone to landslides, and there is a complete absence of latrines.”
MSF update, Bangladesh (October 15):
Over 536,000 refugees have arrived in a very short period and the scale of the crisis shows little of abating soon. Their arrival comes on top of hundreds of thousands of other Rohingyas who arrived in previous years and were already living in difficult conditions. MSF teams had already expanded activities in response to the influx of Rohingya last October, but this new influx is pushing all actors to the limit. Camps are severely congested and refugees are in urgent need of food and clean drinking water. If the situation doesn’t improve there is a big chance of a public health emergency.
Humanitarian aid should increase significantly. More actors are required to cope with the big amount of refugees, funding should be made available and the Government of Bangladesh needs to facilitate access for these organisations.
MSF update, Myanmar (October 15):
MSF is extremely concerned that the Rohingya remaining in Central or North Rakhine may soon be forced to flee. Those that remain are currently unable to access medical care, food and other necessary items in Rakhine State, Myanmar.
Independent international humanitarian organizations are still blocked from accessing and operating in northern Rakhine. The Government of Myanmar has decided to work with only a select group of organizations, such as the Myanmar Red Cross, in providing aid. MSF is very concerned that the Myanmar government, who is party to the conflict, would restrict the delivery of humanitarian aid to handpicked organizations only. Not only are the needs higher than the capacity of said organization, but furthermore MSF is urging unfettered access to Rakhine State to ensure the impartial delivery of aid to those in need.
MSF is against the Government of Myanmar establishing camps for internally displaced persons (IDPs) or returnees in northern Rakhine, as this will exacerbate the ongoing segregation between Rakhine and Rohingya communities and will further complicate long term solutions.
MSF medical action for Rohingya refugees in Cox's Bazar, Bangladesh
Number of projects: 7
Number of staff: around 1,000
Number of patients since August 25: more than 30,000
Main morbidities: respiratory infections, skin diseases and diarrheal diseases
Other activities: water trucking, pumps, tube wells, emergency sanitation and mental health support
Matching the influx of people crossing over the border from Myanmar since August 25, MSF has treated more than 30,000 patients in the Cox’s Bazar area, effectively five times the number of people who sought treatment at MSF facilities during the same period last year. The main theme among these patients is respiratory tract infections and diarrheal diseases, which are directly related to the poor hygiene conditions in the informal settlements.
As a result of the massive increase in demand for our medical services, an additional 800 staff have been hired, bringing the total number of staff on the ground in Cox’s Bazar from around 200 people to 1,000. In July, MSF was treating approximately 200 patients a day, now MSF is treating over 2000 patients every day spread out over all clinics.
MSF has rapidly expanded its inpatient capacity at its Kutupalong medical facility from 50 to 70 beds, with new wards and isolation capacity for infectious diseases. The inpatient health facility, which provides basic primary and secondary healthcare services and is MSF’s largest health facility in Cox’s Bazar, has been running since 2009. A second in-patient facility is under construction in Balukhali and is expected to open in mid-October with a focus on mother and child health. Two more in-patient facilities are also planned to open in the region to meet the increased demand for secondary healthcare.
But with a population of more than 521,000 refugees on top of the existing 200,000 who arrived previously, there is still a need to substantially increase the inpatient capacity. The challenge is to find the available space to setup in-patient departments as the area is severely congested.
Due to the huge pressure on our outpatient services, with approximately 2,500 consultations and 1,000 emergency consultations per week at the Kutupalong clinic,quadruple the demand since start of the influx, we are also setting up health posts (Balukhali, Mainnerghona) and additional mobile clinics to meet the needs of the new arrivals.
Water and sanitation
Outside of the medical response, improving water and sanitation is a major part of our attempts to prevent the spread of disease. MSF has built 200 latrines, 25 boreholes and a gravity water supply system while trucking an average of 100m3 water daily to the settlements from the MSF inpatient health facility borehole. Latrine and water point construction is planned in the worst affected areas, in coordination with other actors.
Between now and the end of December we aim to install an additional 100 deep tube wells, 300 shallow tube wells and 1,000 latrines in the Balukhali and Kutupalong Makeshift Settlements. Given the size of the population, we need to have 8,000 latrines built — that is a ratio of one latrine to 50 people for the emergency phase. The longer we delay that, the greater the risk of an outbreak of a waterborne disease. In the other locations MSF is also assessing how to improve water and sanitation.
MSF plans to open additional mobile clinics and Health Posts to serve the people living in Hakimpara Makeshift Settlement. MSF is also supporting the Ministry of Health in its Cholera Vaccination Campaign with technical advice and community mobilization and logistical support. MSF is positioning emergency preparedness stocks and isolation sites (CTUs) in all operational areas in case of an outbreak or other critical health event affecting the population .