Bangladesh: Crisis update – October 2017

MSF activities in Cox’s Bazar at a glance

Number of projects: 7
Number of staff: around 1,000
Number of patients since 25 August: more than 30,000
Main morbidities: respiratory infections, skin diseases and diarrhoeal diseases
Other activities: water trucking, pumps, tube wells, emergency sanitation and mental health support

Since 25 August 2017, more than 500,000 Rohingya have fled targeted violence in Rakhine state, Myanmar and crossed the border into neighbouring Bangladesh. Médecins Sans Frontières (MSF), which runs seven projects in the Cox’s Bazar area of Bangladesh, has seen a massive increase in demand for its medical services.

MSF has treated more than 30,000 people at its facilities in Cox’s Bazar since 25 August – five times the number of patients who sought treatment during the same period last year.

Most people are suffering from respiratory tract infections and diarrhoeal diseases, which are directly related to the poor hygiene conditions in the informal and severely congested settlements where the Rohingya are living.

Because of the immense needs for medical services, MSF has hired 800 more people, bringing the total number of staff on the ground in Cox’s Bazar to 1,000. Since July, the number of people teams have treated daily has increased from approximately 200 to 2,000.

Expansion of services

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 inpatient facility is under construction in Balukhali and is expected to open in mid-October with a focus on mother and child health. Two more inpatient 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 had arrived previously, there is still a need to substantially increase the inpatient capacity. The challenge is to find the available space to set up shelter for internally displaced people, as the area is severely congested.

Due to the huge pressure on outpatient services – with around 2,500 outpatient consultations and 1,000 emergency consultations per week at the Kutupalong clinic, quadruple the demand since the influx – MSF is also setting up health posts (Balukhali, Mainnerghona) and additional mobile clinics to meet the needs of the new arrivals. 

Water and sanitation

Improving water and sanitation is a major part of MSF’s attempts to prevent the spread of disease. Teams have built 200 latrines, 25 boreholes and a gravity water supply system. An average of 100m3 of water is trucked daily to the settlements from the inpatient health facility borehole. The construction of latrines and water points is planned in the worst affected areas, in coordination with the Bangladesh Department of Public Health and Environment, and other entities.

Between now and the end of December, MSF aims 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 populations in these settlements, 8,000 latrines need to be built – a ratio of one latrine to 50 people for the emergency phase. The longer this is delayed, the greater the risk of an outbreak of a waterborne disease. In other locations MSF is also assessing how to improve water and sanitation.

Increased humanitarian aid needed in Bangladesh and Myanmar

Humanitarian aid needs to increase significantly in Bangladesh. MSF is also extremely concerned that the Rohingya who remain in central and north Rakhine state in Myanmar may soon be forced to flee as they are unable to access medical care, food and other necessary items.

Independent international humanitarian organisations are still blocked from accessing and operating in northern Rakhine. The government of Myanmar has decided to work with only a select group of aid organisations, such as the Myanmar Red Cross, despite the extent of the needs. MSF is urging unfettered access Rakhine state to ensure the impartial delivery of aid. 


MSF project locations in Cox’s Bazar

Mainnerghona (makeshift settlement)
A health post was set up on 1 October and is now expanded into an outpatient clinic. MSF has a system of ambulances to refer patients needing urgent inpatient care to hospital.

Burma Para (makeshift settlement)
A surveillance network and outpatient department is being set up. The construction started on 12 October and activities should start on 16 October.

Inpatient department health centre
A temporary 30- or 50-bed structure is planned pending the construction of a sustainable inpatient department.

Jamtoli (makeshift settlement)
A health post has been running since late September. MSF plans to expand it into an outpatient department with additional services including a delivery room and examination beds. Two mobile clinics will be set up in the periphery.

Hakimpara (makeshift settlement)
A new mobile clinic at the Hakimpara settlement started running on 8 October.  An outpatient department in the entry of the camp is planned, as well as two mobile clinics in the surrounding area.

Unchiparang (makeshift settlement)
MSF plans to add a delivery room and examination beds to its outpatient department  and run a mobile clinic in the periphery of the settlement.

Hajjakahli reception centre
A mobile clinic started activities on 8 October with nutritional screening, basic primary health care and monitoring at the border point. 

Baggoha and Putibunia (makeshift settlements)
A mobile clinic started in late September and has been since upgraded to a health post. The clinic sees an average of 160 people per day.

Balukhali makeshift settlements
A recently constructed 30 – 50 bed inpatient department will open in the coming weeks. An outpatient department built during the influx of Rohingya in October 2016 has seen triple the number of consultations since 25 August. MSF has also opened a new health post in the part of the settlement where new arrivals have settled. Two more health posts are planned in the coming weeks.

Kutupalong makeshift settlements
This medical facility is MSF’s largest in Cox’s Bazar. Services include outpatient consultations; a 24 hour emergency room; an inpatient department with four wards for neonatal care, children and adults; basic laboratory services; sexual and reproductive healthcare services; and a mental health department. The facility collaborates with local health authorities (who are able to use the MSF laboratory for testing for cholera) and local NGOs providing care for TB patients. Since 25 August, a new health post has been opened nearby and two more are planned in the coming weeks. The outpatient department will be moved down the road to enable further expansion.

Other activities
MSF plans to open additional mobile clinics and health posts to serve people living in Hakimpara makeshift settlement. MSF is also supporting the Ministry of Health in its cholera vaccination campaign with technical advice, community mobilisation and logistical support. MSF is positioning emergency preparedness vaccination stocks and isolation sites (cholera treatment units) in all operational areas in case of an outbreak or any other critical health event affecting the population.