The Cox’s Bazar district on Bangladesh's southeast coast has hosted Rohingya refugees fleeing targeted violence in neighbouring Myanmar's Rakhine state since 1978. The latest campaign of violence, which began on 25 August 2017, has provoked an unprecedented exodus.
This recent influx of refugees comes on top of 75,000 Rohingya who arrived after another spike in violence against them in October 2016.
We first established a mission in Bangladesh in 1985 and have had a continuous presence in the country since 1992. Before August 2017, we had one project in Kutupalong, Cox’s Bazar; we now run multiple hospitals, primary health centres, and health posts in and around camps on the peninsula.
Our teams have seen streams of people arriving, destitute and traumatised. Many of them have serious medical needs such as violence-related injuries, severely infected wounds and advanced obstetric complications.
Most of the refugees are living in makeshift settlements, UNHCR-registered camps or among the host community. Those in the settlements have little access to shelter, food, clean water or latrines.
On hilly terrain, prone to flooding and landslides, the poor hygiene in the densely populated camps makes them breeding grounds for disease outbreaks.
We are treating patients for respiratory tract infections and diarrhoeal diseases, which are directly linked to their living conditions. We have also seen a number of infants with malnutrition.
Most of the refugees arrive in Bangladesh with no vaccination coverage. In 2017, increasing numbers of people with suspected measles prompted the government to step up its immunisation efforts in the camps and makeshift shelters. MSF has supported a number of vaccination campaigns run by the government of Bangladesh to prevent the spread of diphtheria, measles and cholera. Despite several rounds of vaccinations, gaps remain. By the end of June 2019, MSF had treated over 5,000 patients for suspected measles.
On 10 November 2017, we reported the first suspected case of diphtheria. Between then and the end of the outbreak, we had treated 6,547 cases of the disease, with most cases being children aged between five and 14 years old.
The emergency response to the issues of shelter, water and sanitation needs to be urgently scaled up. If the Rohingya's living conditions aren't massively improved, the risk of infectious diseases will remain.
Follow-up for non-communicable diseases (NCDs) and surgical capacity are additional areas of concern, as facilities within the camps are limited and we fear they may be reduced over time.
The violence the Rohingya experienced and witnessed in Myanmar has left its mark. Many suffer from post-traumatic stress disorder or acute depression. This is compounded by their current situation, the daily difficulties of living in a refugee camp, and uncertainty about their future.
Despite the obvious needs, only a small proportion of the Rohingya living in Bangladesh currently has access to specialised mental healthcare services.
As settlements continue to expand, access to them needs to be improved and more support provided to scale up the full range of healthcare required.
We also work in Kamrangirchar, one of the biggest slum areas in the Bangladeshi capital, Dhaka. Our staff provide vital healthcare and mental health services to women living in this densely populated community.
The vast majority of patients who seek counselling have been abused by a family member they are still living or in close contact with.
While there are often few options for women to change their living situations, our counselling team carries out vital work in helping them develop resilience and hope.
We also provide reproductive healthcare for adolescent girls, family planning services, and an occupational health programme for factory workers.
Bangladesh is prone to cyclones and floods. Over the years, our work in the country has involved several emergency responses.